Covid19

[Doug Fattic]

My wife the nurse just texted me today another sad story from her work in a health care system. She said: "the husband of our nurse that had COVID just died. 47 years old with no significant health issues. They have one child in college, one in 8th grade. As her supervisor said—anyone that says COVID is not real can ‘kiss my ass’.

Yesterday I saw these statistics in USA Today. Among unvaccinated people who’ve tested positive for COVID-19, about 20% will end up with severe disease, 5% will end up in intensive care and between 1 and 2% will die, according to CDC data.

[ides1056]

When is someone going to put a sock in Tucker Carlson's mouth?

[Too Tall]

When is someone going to put a sock in Tucker Carlson's mouth?

Silly Rabbit.

[beeatnik]

Yesterday I saw these statistics in USA Today. Among unvaccinated people who’ve tested positive for COVID-19, about 20% will end up with severe disease, 5% will end up in intensive care and between 1 and 2% will die, according to CDC data.

Link?

[j44ke]

Link?

Might be referring to the latest CDC mortality data.

[sorry that link was incorrect]

[Doug Fattic]

Sorry I just copied and pasted it directly from an article. I can't find it now. This is the part I quoted "Among unvaccinated people who’ve tested positive for COVID-19, about 20% will end up with severe disease, 5% will end up in intensive care and between 1 and 2% will die, according to CDC data." Of course I haven't the slightest idea if the quote is actually correct.

[gregl]

Sorry I just copied and pasted it directly from an article. I can't find it now. This is the part I quoted "Among unvaccinated people who’ve tested positive for COVID-19, about 20% will end up with severe disease, 5% will end up in intensive care and between 1 and 2% will die, according to CDC data." Of course I haven't the slightest idea if the quote is actually correct.

https://www.usatoday.com/story/news/...id/7139419002/

Greg

[beeatnik]

Sorry I just copied and pasted it directly from an article. I can't find it now. This is the part I quoted "Among unvaccinated people who’ve tested positive for COVID-19, about 20% will end up with severe disease, 5% will end up in intensive care and between 1 and 2% will die, according to CDC data." Of course I haven't the slightest idea if the quote is actually correct.

Here's the reality in LA County which has the worst case and hospitalization figures for a large metropolitan area in the United States.

Confirmed cases: 1,233,060
Deaths: 23890
"Hospitalized (ever):" 83580
For the pandemic about 25% of hospitalized patients have been admitted to ICUs

Case Fatality Rate: 1.94%
Hospitalization Rate: 6.77%
ICU Rate: 1.7%
Deaths/ 1M Pop: 2389

covid.jpg


The numbers above are tragically high and worse than almost every region in the country. If "severe disease" indicates medical contact or intervention that doesn't mean life threatening or worst outcome condition. The reality is that LA County has suffered from this crisis at levels only seen in about 3 other countries worldwide. But, the tragedy of LA is that the situation has been largely ignored by the rest of the country because it didn't happen here first and because it happened to a population that is 80% Latino.

[jimcav]

LA County isn't unique sadly. New Orleans has had a worse case-fatality rate at 2.65% The entire state (Louisiana) has a worse case-fatality rate than LA County. LA the state has about 4.5 million people, and LA the county has just over 10 million. So that enormous, dense county has about 12% of the population confirmed cases, vs the state of LA having about 10% of its population with confirmed positive.

Not an apples to apples, but I'd say as much as things could have been done better, give credit to the healthcare workers for keeping the death rate low.

At least LA county is approaching 2/3 of those older than 65 being vaccinated. San Diego is closer to 50% for those >65. Last month there were 1-2 cases of the P1 variant, now there are nearly 60 in the county (san diego). Things can get out of hand before people realize it, so I really hope everyone takes advantage of vaccination opportunities.

[beeatnik]

Not an apples to apples, but I'd say as much as things could have been done better, give credit to the healthcare workers for keeping the death rate low.

You believe a 1.94% CFR is low? And it's been above 3% since the huge spike in Dec.

Cases since Jan 1: 442478
Deaths since Jan 1: 13338
CFR since Jan 1: 3.01%

To (correctly) paraphrase Flash, CA variant (for some people) is a hellavu thing.

[jimcav]

You believe a 1.94% CFR is low? And it's been above 3% since the huge spike in Dec.

Cases since Jan 1: 442478
Deaths since Jan 1: 13338
CFR since Jan 1: 3.01%

To (correctly) paraphrase Flash, CA variant (for some people) is a hellavu thing.

To directly answer, yes, I do mean it is low, but keep in mind the setting: for the density, % infected, and hospital resources. Everything has context.

Once you start talking about CFR, you are in the realm of hospital care/access, you are not in the realm of prevention. IF the USA population and gov't had a different response from the get-go, and even ongoing in many areas, then we'd never even be talking about a CFR over 1%, we'd be like south korea instead. Instead there were all sorts of failings in public health actions (inactions), and correlating disconnects--such as making food supply workers essential without the concomitant focus on their safety

If you look at other examples of surging cases & stressed healthcare, and you will see much higher CFRs than 3

I don't know the data on C-19 variants for LA county, but know that variants are becoming dominant in most areas, which just speaks further to the HCW efforts. Imperial College London reported the UK variant has a 35% higher CFR. In England, they had over 30,000 dead to COVID just in January alone. There are even worse variants spreading than the UK one.

My point was LA has not been the only place, and the HCW up there deserve praise. I'm obviously NOT trying to say LA needs praise for letting the outbreak spread as it has there. LA (and no one) needed to learn such lessons--truly one of the most frustrating things about the USA experience is the ability to somehow ignore the virus will spread here exactly as it has elsewhere. At least LA has responded with higher vaccination rates than my county.

I suppose my response could have been to say the new variants are spreading, they are more infectious and will result in more deaths. Those deaths would be even higher if not for efforts of our HCWs. I wish the LA inspired everyone to get vaccinated, but instead it seems too many areas wait until is is craptastic in their county before they do.

[beeatnik]

Jim, you've always had an universalist approach to the virus. To be fair most epidemiologist still hold those views about suppression and eradication. But let's not confuse mitigation with eradication. The situation in LA County is, in my opinion, more complex than in any other large metropolitan area in the United States. LA locked down early, LA had universal mask use early, LA enacted an eviction moratorium in early March 2020, WFM has been near universal in the knowledge economy. By almost every metric LA County aggressively implemented the same strategies which allowed the Bay Area, Boston and Seattle to limit the rates of community transmission below the national average.

The variable which makes LA an outlier is the size of its Latino population and its unique cultural and socioeconomic position. In LA Co, 80% of children diagnosed with MIS-C are Latino; 80% of Covid-19 positive pregnant women are Latinx. And in January, the County reported 6218 deaths with 3113 believed to be Latinx. Even with the UK variant, the 62/100k deaths in LA Co were higher than the UK's 45/100k.

https://losangeles.cbslocal.com/2021...s-vaccination/
Mortality rates for Black and Latino men are also much higher than their Asian and white counterparts. According to LA County public health officials, Black men die of COVID-19 at a rate of 267 per 100,000. For Latino men, the mortality rate is a whopping 490 deaths per 100,000 people, nearly two and a half times the mortality rate for Asian men and more than three times the rate for white men.

Late Feb
http://www.publichealth.lacounty.gov....cfm?prid=2983
When the surge began in early- November, the average number of Latino/Latinx residents who passed away each day was 3.4 deaths per 100,000 people and then sharply increased to 51 deaths per 100,000 people in mid-January 16. As of February 12, the mortality rate among Latino/Latinx residents has declined to 25 deaths per 100,000 people, yet still remains more than double that of other groups. Since mid-January, the mortality rate among African American/Black residents decreased from nearly 22 deaths per 100,000 people to 9 deaths per 100,000 people. Deaths among Asian residents have declined since the peak, from 19 deaths per 100,000 people to 8 deaths per 100,000 people. The current mortality rate among White residents is also 8 deaths per 100,000 from the peak of about 17 deaths per 100,000.

As for CFR, I haven't found another example of the CFR increasing at higher rate than in LA County after December. The obvious reason is that no other region experienced such a catastrophic surge. As you're likely aware, the increase was in people under 70 as most of the nursing home and LTC fatalities in Southern California occurred before August 2020. Interestingly enough last week, CA had the lowest case rate in the nation at 6/100k (now 5) but the highest CFR at near 3%; a higher CFR than Michigan with 49/100k cases. The latest 14 day numbers from the NYT show CA with 3.8% of the Nation's cases (daily avg) but 8.4% of deaths (daily avg).

The high levels of vaccination are likely the result of a more direct experience with the worst of the plague. No other region suffered as much in late 2020/early 2021 and the vaccines are embraced as the only hope.

To directly answer, yes, I do mean it is low, but keep in mind the setting: for the density, % infected, and hospital resources. Everything has context.

Once you start talking about CFR, you are in the realm of hospital care/access, you are not in the realm of prevention. IF the USA population and gov't had a different response from the get-go, and even ongoing in many areas, then we'd never even be talking about a CFR over 1%, we'd be like south korea instead. Instead there were all sorts of failings in public health actions (inactions), and correlating disconnects--such as making food supply workers essential without the concomitant focus on their safety

If you look at other examples of surging cases & stressed healthcare, and you will see much higher CFRs than 3

I don't know the data on C-19 variants for LA county, but know that variants are becoming dominant in most areas, which just speaks further to the HCW efforts. Imperial College London reported the UK variant has a 35% higher CFR. In England, they had over 30,000 dead to COVID just in January alone. There are even worse variants spreading than the UK one.

My point was LA has not been the only place, and the HCW up there deserve praise. I'm obviously NOT trying to say LA needs praise for letting the outbreak spread as it has there. LA (and no one) needed to learn such lessons--truly one of the most frustrating things about the USA experience is the ability to somehow ignore the virus will spread here exactly as it has elsewhere. At least LA has responded with higher vaccination rates than my county.

I suppose my response could have been to say the new variants are spreading, they are more infectious and will result in more deaths. Those deaths would be even higher if not for efforts of our HCWs. I wish the LA inspired everyone to get vaccinated, but instead it seems too many areas wait until is is craptastic in their county before they do.

[jimcav]

Perhaps I should have said right off that I share your concern, but I also think it reflects more variant cases than they realize, and worry other areas may follow suit. I agree with what you posted above almost 100%, maybe it is 100%, as I think LA didn't do enough outside the "knowledge" economy, and your phrasing it that way makes me think we agree that there wasn't enough done for the lower income "essential" workers who are exactly the people most impacted. I saw a special last year on PBS about SoCal Hispanic workers and it was simply awful in terms of safety/prevention for that population. Granted the focus of the show was agriculture, and how any exposures were made much worse due to the multi-generational and often multi-family housing situations; but I 've seen other similar articles that talked about how other areas did a terrible job in similar work settings.

Yes, to clarify the higher CFRs were for surges in European Countries, some into low double digits. I haven't searched CDC data for USA CFRs. Some of the new variants have the potential to offset much of what US HCW have achieved in terms of success of care. Hopefully vaccination will keep pace ahead of surges in variant cases. I keep trying to find out what percent of C-19 tests are being genetically analyzed for variant analysis, but my google searching hasn't really answered it. I have assumed LA has the UK variant as dominant now, but it doesn't seem that they test enough to know.

As an example, here is the LA county release from 3/24:
"Public Health continues to track variant cases in Los Angeles County. Among 73 specimens analyzed at the Public Health Laboratory this past week, 25 cases, or 34% of the specimens analyzed, were the California variant of concern, identified as B.1.427 or 429, and 21 cases, or 29% of the specimens analyzed, were the U.K. variant of concern, B.1.1.7. This means 63% of the variants sequenced this past week are variants of concern with the probability of increased transmissibility and more severe disease. Los Angeles County has yet to identify cases of the South African variant or the Brazilian variant of concern, the P.1 variant. Other variants of interest that were detected included 8 cases of the New York variant and 1 case of the Brazilian variant of interest P.2. While these variants are still considered only variants of interest (and not variants of concern), their presence indicates transmission of mutated viruses from across the globe"

I can't fathom how they think analyzing 73 tests a week gives any adequate representation of what is going on in the county. By 3/24, San Diego County had already confirmed 58 cases of P1 variant (brazil), and to think we have it, but somehow LA doesn't, is beyond stupid.

[beeatnik]

I wonder how Latinos with low SES would have handled or responded to messaging that said something like "2 months to flatten the curve." I think in a few years we'll know what worked and what didn't. Early on I noticed that one the first impacted neighborhoods, Westlake (top 3 for population density), began to lower case rates to suburban levels. The photo in the guardian article below may provide some evidence (everyone fully masked and some wearing gloves). It's also possible that residents of 300sq ft studios spent less time indoors.

https://www.theguardian.com/us-news/...-increase-1000

westlake.jpeg


As for variants, the CA variant mutation is found in India's double mutant variant and their case curve is very similar to CA's in the winter surge.

Perhaps I should have said right off that I share your concern, but I also think it reflects more variant cases than they realize, and worry other areas may follow suit. I agree with what you posted above almost 100%, maybe it is 100%, as I think LA didn't do enough outside the "knowledge" economy, and your phrasing it that way makes me think we agree that there wasn't enough done for the lower income "essential" workers who are exactly the people most impacted. I saw a special last year on PBS about SoCal Hispanic workers and it was simply awful in terms of safety/prevention for that population. Granted the focus of the show was agriculture, and how any exposures were made much worse due to the multi-generational and often multi-family housing situations; but I 've seen other similar articles that talked about how other areas did a terrible job in similar work settings.

Yes, to clarify the higher CFRs were for surges in European Countries, some into low double digits. I haven't searched CDC data for USA CFRs. Some of the new variants have the potential to offset much of what US HCW have achieved in terms of success of care. Hopefully vaccination will keep pace ahead of surges in variant cases. I keep trying to find out what percent of C-19 tests are being genetically analyzed for variant analysis, but my google searching hasn't really answered it. I have assumed LA has the UK variant as dominant now, but it doesn't seem that they test enough to know.

As an example, here is the LA county release from 3/24:
"Public Health continues to track variant cases in Los Angeles County. Among 73 specimens analyzed at the Public Health Laboratory this past week, 25 cases, or 34% of the specimens analyzed, were the California variant of concern, identified as B.1.427 or 429, and 21 cases, or 29% of the specimens analyzed, were the U.K. variant of concern, B.1.1.7. This means 63% of the variants sequenced this past week are variants of concern with the probability of increased transmissibility and more severe disease. Los Angeles County has yet to identify cases of the South African variant or the Brazilian variant of concern, the P.1 variant. Other variants of interest that were detected included 8 cases of the New York variant and 1 case of the Brazilian variant of interest P.2. While these variants are still considered only variants of interest (and not variants of concern), their presence indicates transmission of mutated viruses from across the globe"

I can't fathom how they think analyzing 73 tests a week gives any adequate representation of what is going on in the county. By 3/24, San Diego County had already confirmed 58 cases of P1 variant (brazil), and to think we have it, but somehow LA doesn't, is beyond stupid.

[ides1056]

This was avoidable and predictable. It kills me. India, Brazil, Venezuela. I find imagining an outcome that doesn't look like long Covid for all just plain fiction.