Does getting COVID19 shrink your brain?

Does getting COVID19 shrink your brain?  A paper from last Thursday’s Nature says yes.  Not only that, but it slows you mentally. Here’s a link: https://www.nature.com/articles/s41586-022-04569-5.pdf.   and a reference: Nature vol. 604 pp. 697 – 707 ’22.

Here’s what they did.  Take 785 people over 50 from England. Have 401 get infected with the pandemic virus, after obtaining MRI scans, all sorts of data including mental function about them.   Then repeat the MRI and mental tests  4 – 5 months after the infection.  Compare the two groups and there’s your answer.

The moral among you must be wondering how they ever got this past an Institutional review board.  It didn’t.  This was an experiment of nature on participants in the UK Biobank — https://en.wikipedia.org/wiki/UK_Biobank.  Starting in 2006 and ending in 2010 some 100,000 people (ages 40 – 69 on entry) from the United Kingdom (UK) were intensively studied (they donated urine, saliva and blood, filled out questionnaires, and consented to access to their electronic health records).   Planned follow up is 30 years.  All this before we had any idea about the pandemic to hit us in 2020.

Obviously the control group without infection, must be as similar as possible to the infected group and I think the authors tried their hardest.  Even so the control group was a bit older, and the infected group had slightly lower cognitive abilities.

The average time between the two scans was 3 years.  The average time from COVID19 to the second scan was 141 days.  The scans were done before Omicron hit.  Even so only 15/401 had to be hospitalized.  This is consistent with the mildness of the pandemic presently.  On 9 April 22 Shanghai reported some 23,000 positive PCR tests (for Omicron), but only one thousand or so were symptomatic.   Excluding the 15 from analysis didn’t change the result.  I’ve heard from clinicians, that the severely ill are usually obese.  This is partly true for the 15 hospitalized (average Body Mass Index 29.3) vs. the 386 not hospitalized (BMI – 26.6).

So the clickbait is that being infected with the virus shrinks your brain. But does it? It is stated that there was a decrease in thickness of the cerebral cortex (the gray matter on the surface of the brain) concerned with smell and taste.

The decreases were minimal.  Have a look at figure 1a p. 701.  The changes between scans are plotted vs. age, and separately for cases and controls. As we get older the brain shrinks.  This was true for both patients and the controls, but the patients showed more shrinkage (measured by the change between successive MRIs).

What sort of shrinkage in the thickness of he cerebral cortex are we talking about here?  At most 3% and usually under 2%.  But 3% of what?  Most estimates of the thickness of the human cerebral cortex place it around 2 – 3 millimeters (range 1 to 5 millimeters).  So I got out a clear plastic ruler and found that 1 milliMeter is about the thickness of a penny?  Are they really saying that the MRI can measure thickness differences of 2 – 3% of something only 2 – 3 millimeters.

It gets worse.  Most of us have seen MRI pictures by now.  If you look closely, you’ll see that they are slices made of pixels.  These are computed slices of 3 dimensional cubes (voxels).  And what dear reader is the size of an MRI voxel — around 1 x 1 x 1 milliMeters.  So they are measuring cortical thickness with a rather blunt instrument which is 30 – 50% the size of cortical thickness.  Do you think, even with averaging of hundreds of people, that they can pick up a change in cortical thickness of several percent in something so small.

I don’t, and am amazed that the reviewers let them get away with this.

The cognitive changes are on much better ground.  But that’s for the next post.  This post is long enough.

Should you get a second booster of the Pfizer vaccine?

Should you get a second booster of the Pfizer vaccine?  As usual, with medical questions the answer is “it depends”.  Fortunately we now have excellent data on this point for those over 60.  As usual the best data is from Israel, with a mere 623,335 people over 60 getting the fourth shot and 628,976 not getting it.

The short answer is that the booster will give you some protection (compared to not getting the 4th shot)  against getting infected for a few weeks, but essentially no protection from infection at 6 weeks.

The headline news is that for 6 weeks the 2nd booster cuts your chance of  severe COVID19 by a factor of 3.  The protection against severe infection didn’t wane at 6 weeks.

The numbers in a minute, but I’m sure you’re wondering why such a short study?  Because infections with the B.1.1.529 variant of omicron started surging in Israel in December.  So with that in mind  the Israelis began vaccinating people over 60 in January of 2022. You don’t just go and vaccinate over half a million people for fun.   They had to balance the hunger for data about the help a fourth dose would give with the time needed to pass to get a meaningful study.  The longer the study, the better the data, but the longer to remain in the dark.

I’m certain the study will be updated with the passage of time, but likely the number of people with only 3 doses will shrink.  Also almost certainly more people in both groups will get severe COVID19

Now for the numbers: there were 355 severe cases of COVID19 in the 623,335 getting 4 doses and 1,210 cases in the 628,976 getting only 3 doses of the Pfizer vaccine.  So the protection from severe illness by the fourth dose was a decrease in  risk by greater than 2/3.

That’s the headline, but there is more to think about. 1/500 people getting 3 doses had severe COVID vs. 1/1500 people getting 4 doses.  Neither risk is very high.

Although there was no decline in severe COVID19 protection at 6 weeks, some decline at 6 months and a year is likely (if it’s like every other vaccine that’s been studied).  Even more to the point, if the first booster had not declined in protection we wouldn’t need a second.  I don’t see any reason the second booster should act differently. Remember both boosters are to a virus which is no longer circulating.

So should you rush out and get that 4th shot?  Again it depends.  You want maximum protection when cases are surging in your area.  That’s when you get the most bang for your buck.

Here in the USA, statistics are good.   What you are interested in, is people admitted to hospital because of COVID19.  To avoid spreading the virus, everyone admitted gets tested for the virus even if they got run over by a truck..  In this regard Massachusetts’s reporting is quite good — on  14 April ’22 there were 343 COVID19 patients in hospital statewide, but only 113 were hospitalized because of COVID19.   Hopefully, your local statistics are that good.

One of the (few) benefits of the pandemic is the fact that articles about the virus and COVID19 are not behind paywalls, but freely available to all (which is good because we’re all in the same boat, and we need all the brainpower we have to evaluate the latest data).

So here’s a link to the article discussed above — https://www.nejm.org/doi/pdf/10.1056/NEJMoa2201570?articleTools=true

The pandemic of the ‘fully vaccinated’

At the end of 12 January ’22 the state of Massachusetts had 3,180 COVID19 patients in hospital.  484 were in the ICU and 278 were on respirators.  Of those 3,180, some 1,005 were ‘fully vaccinated’.  — https://www.mass.gov/info-details/covid-19-response-reporting#covid-19-interactive-data-dashboard-

Addendum 15 Jan: Thanks to MStriker for picking up the error.  1,005 above should be 1505, giving 49%.

That’s nearly 50% of the hospitalized.  This,  in Massachusetts where we believe in Science.  We’re not talking about the toothless peasantry of West Virginia.  The fully vaccinated are serious and important people; news anchors, members of congress, white house staff, not the unvaccinated riffraff we’ve heard about.  What are the faithful believers in Science of Massachusetts to do? ,

If this sounds like Schadenfreude it is.  I’ve listened and read plenty of it in the press in the past two years, with much gloating over the deaths of the unvaccinated.   .  These people died and snarkery (such as the above) is inappropriate and cruel. So let those who formerly thought they were safe worry a little (including me) and realize that science is never settled.

What can be done to restore the faith?  It would certainly be of interest to know the percentage of the fully vaccinated in the ICU or on respirators.  This might actually be evidence of some protective effect of the vaccines.

This data is certainly known to the department of health.

Also, the definition of fully vaccinated can be found (with some difficulty) on their website.  It is clearly outdated e.g. two shorts of Pfizer or the other vaccine longer than 14 days ago.  There is nothing in the definition about boosters.  The definition goes back to September 2021.

I’m sure that in the charts of all 3,180 hospitalized COVID19 patients, the presence and time of  booster administration is noted.  So the State Department has in hand evidence for the efficacy/nonefficacy of boosters, to prevent hospitalization, and when in hospital to prevent serious complications of COVID19.  This should be released immediately.

Why do some socially isolate and some don’t

The current flare in US cases (and deaths) are likely due to a failure in social isolation, rather than a loosening of restrictions on activity.  Georgia loosened its restrictions back in April.  Following this, new cases dropped for two months, and deaths dropped for nearly 3 months, before rising again to pre-lockdown levels and above.  The number of new ‘cases’ can partially be attributed to more testing, but the number of deaths can not.  For links and the exact numbers see the copy of the previous post after the ***

I think the rise is partially explainable by a failure of social distancing. Have a look at this  https://nypost.com/2020/07/18/video-shows-people-in-queens-flooding-streets-without-masks/.   It may not be a COVID party in name, but it is in fact.

That being the case, wouldn’t it be nice to know why some people social distance and others do not.

Incredibly, a paper just came out looking at exactly that Proc. Natl. Acad. Sci. vol. 117 pp. 17667 – 17674 ’20 (28 July).  It’s likely behind a paywall so let me explain what they did.

The work was conducted in the first two weeks after the 13 March declaration of a national emergency.  Some 850 participants from the USA had their working memory tested using the Mechanical Turk from Amazon — https://en.wikipedia.org/wiki/Amazon_Mechanical_Turk.  Essentially they are volunteers.  I leave it to you to decide how characteristic of the general population at large these people are.   My guess is that they aren’t.

Then the 850 were subsequently asked how much they had complied with social distancing.

But first, a brief discussion of working memory — more is available at https://en.wikipedia.org/wiki/Working_memory

Working memory is tested in a variety of methods, but it basically measures how many objects you can temporarily hold in your head at one time.  One way to test it, is to give you a series of digits, and then ask you to repeat them backwards (after a lag of a second or so).  Here’s what the authors used —

“Participants performed an online visual working memory task, in which they tried to memorize a set of briefly presented color squares for  half a second and after a 1 second delay tried to identify a changed color in the test display by clicking on it using a computer mouse.”

The more you can hold in your head for a short period of time, the more working memory you have.  There is a lot of contention about just what intelligence is and how to measure it, but study after study shows that the greater your working memory, the more intelligent you are.

To cut to the chase — here are their results.

The greater their working memory, the greater the degree of compliance with social distancing.

Here is the author’s explanation –what’s yours?

“We find that working memory capacity contributes unique variance to individual differences in social distancing compliance, which may be partially attributed to the relationship between working memory capacity and one’s ability to evaluate the true merits of the recommended social distancing guidelines. This association remains robust after taking into account individual differences in age, gender, education, socioeconomic status, personality, mood-related conditions, and fluid intelligence.”

Talk about currency and relevance ! !   If failure of social distancing explains the rise in cases, studies like this will help us attack it.

Here is the older post with numbers and links

***

The News is Bad from Georgia

This is an update on a series of post about Georgia and the effect of relaxing restrictions on activity.  If you’ve been following the story, this post is somewhat repetitive, but I’d rather not leave newcomers behind. As of 14 July Georgia seemed to be bucking the trend of increasing deaths (but not of increasing ‘cases’ however defined).  No longer.

 https://dph.georgia.gov/covid-19-daily-status-report.  Page down past the map to the chart with 3 tabs —  cases (which means daily newly diagnosed cases), cumulative cases, and death.  Clicking on the tabs will move you back and forth (or better if your screen is big enough open the link twice and compared cases vs. deaths.

Georgia has changed the way it reports cases, no longer waiting 14 days before result are secure.  I also think they changed some of the older numbers.  I don’t recall seeing over 70 deaths in a day in May and June, yet the current chart shows 4 of them.  There is no way to get the old reports from the Georgia department of health, by clicking on the links in the old posts on the subject.  They all take you to the current one.

The 7 day average of deaths back in 25 April was 35, new cases  740 based on detection of viral genome or antibodies to it — not sick people

Sadly now the 7 day average of death is now 45 and new cases 3700.

The charts allow you to see when both new cases and deaths began to rise.  The number of new cases began to spike 16 June and the number of death began to increase 19 July (eyeball the charts, and you’ll see that these are not precise numbers.  So there was about a 1 month lag between the increases.

So were the doom and gloom sayers correct?  Here they are again to refresh your memory.

From The Atlantic — “Georgia’s Experiment in Human Sacrifice — The state is about to find out how many people need to lose their lives to shore up the economy.” — https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

 From the Washington Post — https://www.washingtonpost.com/opinions/2020/04/21/georgia-leads-race-become-americas-no-1-death-destination/

From MSNBC — https://www.msnbc.com/rachel-maddow-show/georgia-s-kemp-neglected-warn-people-about-his-dangerous-gamble-n1189826

Possibly they were right, but deaths actually decreased for a month or two after 25 April hitting a low of 13 daily deaths on 2 July.   I don’t think any of them predicted a lag of 2 months before the apocalypse.

Most likely it was a change in behavior.  Have a look at this  https://nypost.com/2020/07/18/video-shows-people-in-queens-flooding-streets-without-masks/.   It may not be a COVID party in name, but it is in fact.

At first glance it appears that they are trying for a Darwin award, but on second glance, based purely on a cost benefit analysis (to them only) the chances of a healthy 18 – 20 year old dying from COVID19 are less than 1 in a thousand.  Libido is incredibly intense at that age.   I’m not sure what I would have done in their shoes.  Here are some statistics from Florida with numbers large enough to be significant

Here is some older data from Florida  (from their department of health) — http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/state_reports_latest.pdf

Age  Range     Number of Cases  Number of Hospitalizations Deaths

14 – 24              54,815                                503                                    12

25 – 34             70,030                              1,315                                    34

This is a risk of death if you are a ‘case’ however defined of less than 1/2,000.

This is age range of most of folks in the video. Further more recent examples are lifeguards in NY and on Cape Cod.

Think of all the gay men who knew full well how AIDS was transmitted, still got it and died.  Libido is powerful.  The classic example is Randy Shilts who wrote the magnificent “And the Band Played On” in 1987 about the early days of the epidemic.  He knew everything there was to know about the way the AIDS virus (HIV1) was transmitted yet he himself died of AIDS.

Further examples are lifeguards in NY and on Cape Cod.

 

The News is Bad from Georgia

This is an update on a series of post about Georgia and the effect of relaxing restrictions on activity.  If you’ve been following the story, this post is somewhat repetitive, but I’d rather not leave newcomers behind. As of 14 July Georgia seemed to be bucking the trend of increasing deaths (but not of increasing ‘cases’ however defined).  No longer.

 https://dph.georgia.gov/covid-19-daily-status-report.  Page down past the map to the chart with 3 tabs —  cases (which means daily newly diagnosed cases), cumulative cases, and death.  Clicking on the tabs will move you back and forth (or better if your screen is big enough open the link twice and compared cases vs. deaths.

Georgia has changed the way it reports cases, no longer waiting 14 days before result are secure.  I also think they changed some of the older numbers.  I don’t recall seeing over 70 deaths in a day in May and June, yet the current chart shows 4 of them.  There is no way to get the old reports from the Georgia department of health, by clicking on the links in the old posts on the subject.  They all take you to the current one.

The 7 day average of deaths back in 25 April was 35, new cases  740 based on detection of viral genome or antibodies to it — not sick people

Sadly now the 7 day average of death is now 45 and new cases 3700.

The charts allow you to see when both new cases and deaths began to rise.  The number of new cases began to spike 16 June and the number of death began to increase 19 July (eyeball the charts, and you’ll see that these are not precise numbers.  So there was about a 1 month lag between the increases.

So were the doom and gloom sayers correct?  Here they are again to refresh your memory.

From The Atlantic — “Georgia’s Experiment in Human Sacrifice — The state is about to find out how many people need to lose their lives to shore up the economy.” — https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

 From the Washington Post — https://www.washingtonpost.com/opinions/2020/04/21/georgia-leads-race-become-americas-no-1-death-destination/

From MSNBC — https://www.msnbc.com/rachel-maddow-show/georgia-s-kemp-neglected-warn-people-about-his-dangerous-gamble-n1189826

Possibly they were right, but deaths actually decreased for a month or two after 25 April hitting a low of 13 daily deaths on 2 July.   I don’t think any of them predicted a lag of 2 months before the apocalypse.

Most likely it was a change in behavior.  Have a look at this  https://nypost.com/2020/07/18/video-shows-people-in-queens-flooding-streets-without-masks/.   It may not be a COVID party in name, but it is in fact.

At first glance it appears that they are trying for a Darwin award, but on second glance, based purely on a cost benefit analysis (to them only) the chances of a healthy 18 – 20 year old dying from COVID19 are less than 1 in a thousand.  Libido is incredibly intense at that age.   I’m not sure what I would have done in their shoes.  Here are some statistics from Florida with numbers large enough to be significant

Here is some older data from Florida  (from their department of health) — http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/state_reports_latest.pdf

Age  Range     Number of Cases  Number of Hospitalizations Deaths

14 – 24              54,815                                503                                    12

25 – 34             70,030                              1,315                                    34

This is a risk of death if you are a ‘case’ however defined of less than 1/2,000.

This is age range of most of folks in the video. Further more recent examples are lifeguards in NY and on Cape Cod.

Think of all the gay men who knew full well how AIDS was transmitted, still got it and died.  Libido is powerful.  The classic example is Randy Shilts who wrote the magnificent “And the Band Played On” in 1987 about the early days of the epidemic.  He knew everything there was to know about the way the AIDS virus (HIV1) was transmitted yet he himself died of AIDS.

Further examples are lifeguards in NY and on Cape Cod.

COVID19 will be with us for a long time

Feast your eyes on this video of hundreds of maskless  people partying in the streets of Queens NYC 18 July.  It has to be seen to be believed.  Unfortunately, you’ll have to sit through some ads, but it’s worth the wait.

https://nypost.com/2020/07/18/video-shows-people-in-queens-flooding-streets-without-masks/.   Reports of COVID19 parties have been critized as being urban legends, with no specifics as to time or place or people being given.  Here’s Queens NYC one night — It may not be a COVID19 party in name, but it is in fact.

Much has been made of the spread of the pandemic in the South, notably Florida and Texas.  It has been laid to premature lifting of restrictions with Trump leading the charge.

Well New York City hasn’t, and the people shown partying are unlikely to take the President’s words as holy writ.   Two questions arise

l. Are these people insane or rational?

2. Is what they are doing likely to cause a similar surge in cases?

It’s time to deal with the world as it is, rather than the world as we’d like to be (enter the world of docs confronting any new disease — think Everett Koop and the early days of AIDS).

Forgetting the second question for a time, viewed from their perspective, their behavior is rational — which is not to say I condone it.

Here is data from Florida through yesterday (from their department of health) — http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/state_reports_latest.pdf

Age  Range     Number of Cases  Number of Hospitalizations Deaths

14 – 24              54,815                                503                                    12

25 – 34             70,030                              1,315                                    34

This is age range of most of folks in the video

So the risk of death for 14 – 24 is .02% or under 1/1,000 — ditto for the 25 – 34 age group.   And that’s if the revelers actually acquire the virus.  So from a selfish perspective, their behavior is rational.

Is their behavior harmful to society at large?  You’d think so.

Well maybe not.  Here’s some work from 3 months ago.

https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html–https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html.

The State randomly tested 3,000 people at grocery stores and shopping locations across 19 counties in 40 localities to see if they had the antibodies to fight the coronavirus, indicating they have had the virus and recovered from it. With more than 19.4 million people residents, according to U.S. Census data, the preliminary results imply that at least 2.7 million New Yorkers have been infected with Covid-19.

With more than 19.4 million residents, according to U.S. Census data, the preliminary results indicate that at least 2.7 million New Yorkers have been infected with Covid-19.  They weren’t all hospitalized.

Here’s some work this month from Queens — https://www.nytimes.com/2020/07/09/nyregion/nyc-coronavirus-antibodies.html

At a clinic in Corona, a working-class neighborhood in Queens, more than 68 percent of people tested positive for antibodies to the new coronavirus. At another clinic in Jackson Heights, Queens, that number was 56 percent. But at a clinic in Cobble Hill, a mostly white and wealthy neighborhood in Brooklyn, only 13 percent of people tested positive for antibodies.

So the disease has already to spread to half the population in some neighborhoods in Queens. If even 10% of them were sick that would have been 140,000 hospitalizations.  It didn’t happen.

So some parts of Queens may be close to herd immunity.

 

Here are the deaths. A tale of two states

On 29 June I wrote a post asking “Where are the Deaths” because, although the number of new cases of COVID19 were increasing, deaths were not (https://luysii.wordpress.com/2020/06/29/where-are-the-deaths/).   I said I’d check back in 2 weeks.

Florida has shown a surge in new cases and a surge in deaths since then — have a look at — https://tallahasseereports.com/2020/07/08/two-charts-show-positive-trends-for-florida-in-coronavirus-battle/.  The top chart shows the 7 day average of new cases, and the one below shows the 7 day average in deaths.   Both charts show the need for averaging, as daily deaths or new cases in any 7 day period you care to study vary by a factor of at least 2.  The 7 day average of new cases appears to be about 1,000 on 1 June.  Now (13 July) it’s ten times that.  The 7 day average of daily deaths was about 40 on 1 June,  now it’s twice that at 80.

Georgia (which I chose to follow because it was one of the first states to loosen the lockdown) shows nothing of the kind.  Have a look at https://dph.georgia.gov/covid-19-daily-status-report.  Page down past the map to the chart with 3 tabs —  cases (which means daily newly diagnosed cases), cumulative cases, and death.  Clicking on the tabs will move you back and forth (or better is your screen is big enough open the link twice and compared cases vs. deaths.

Daily new cases on 1 June in Georgia (7 day moving average) 769, on 30 June the 7 day moving average had exploded to 3916

What happened to deaths?  They dropped ! ! !   7 day moving average of daily deaths on 1 June 22,  On the 30th of June it had dropped to 18.

Why is Florida report results for mid July while Georgia is back at the end of June?  Because Georgia is conservative (who knew?) and doesn’t regard results as solid until 14 days have passed, and all the data has had a chance to filter in.

I have no explanation for why  two adjacent Southern states should be so different.

On a far more disquieting note, young people are now having COVID parties where they actually try to get infected — https://www.independent.com/2020/07/10/isla-vistans-deny-holding-a-covid-party/, https://www.msn.com/en-us/news/us/tulane-dean-students-who-throw-large-parties-during-covid-19-pandemic-could-face-suspension-expulsion/ar-BB16s4n0.  The links show it’s nationwide.

Addendum 18 July — these links have been criticized as being urban legends with no explicit names and places.So look at this — https://nypost.com/2020/07/18/video-shows-people-in-queens-flooding-streets-without-masks/.   It may not be a COVID party in name, but it is in fact.

At first glance it appears that they are trying for a Darwin award, but on second glance, based purely on a cost benefit analysis (to them only) the chances of a healthy 18 – 20 year old dying from COVID19 are maybe 1 in a thousand.  Libido is incredibly intense at that age.   I’m not sure what I would have done in their shoes.

Think of all the gay men who knew full well how AIDS was transmitted, still got it and died.  Libido is powerful.  The classic example is Randy Shilts who wrote the magnificent “And the Band Played On” in 1987 about the early days of the epidemic.  He knew everything there was to know about the way the AIDS virus (HIV1) was transmitted yet he himself died of AIDS.

I’ve found it impossible to actually talk to a living human being at any State Department of Health.  I’d love to know what has happened to the 425 or so people in Massachusetts who tested positive for the virus after attending the Black Lives Matter protests. Most appeared to be under 30.    Videos show some protecting wearing masks, but many didn’t who were vocally active. Have any been hospitalized?  Have any died?  If the Department of Health has done followup on the 425 (which they should have done) we could know.   But if nothing happened to 425 I doubt that they’d want it out as it would destroy the narrative that everyone should socially isolate.  But data is data and always useful regardless of its implications.

 

What is a case of COVID19?

If you tell me you’ve had a case of the flu, I know exactly what you mean; you were sick for a time and are now over it.  That is not at all what State Departments of Health or the press mean by ‘cases’ of COVID19.

They mean one of two things

l. Presence of the virus genetic material on a sample you give

2. Presence of antibodies to the virus in your blood.

Neither means that you’ve had any clinical illness whatsoever.   In the case of the Bronx where 20 – 50% of various areas had a positive antibody test, none were hospitalized — these were people walking about.

So the scare headlines about cases of COVID19 explode are just that.  Americans love sports.  Consider the players on the active rosters of the NFL, Major Leagues and NBA last year.  If any of them had died of COVID19 you would certainly have heard about it.

On June 29th I wrote a post ”Where are the Deaths?” making the point that if ‘cases’ surged, deaths should as well. Here’s a link — https://luysii.wordpress.com/2020/06/29/where-are-the-deaths/.   It hadn’t happened then, and hasn’t happened now.

Granted there should be a lag between diagnosis and death.  Amazingly, it’s hard to find figures on just what the lag is.  An early report from Italy said 8 days, but these were mostly very old people.

I’ve been focusing on Georgia for several reasons.  First, they were the first to loosen their restrictions of activity. Second they are very conservative in the way they report data, not regarding any number as solid until 14 days have passed and all the information has had a chance to flow in. Third, Georgia uses moving averages of cases and death for the past seven days.  This smooths out the spikes (which are largely due to how the data flows in).  For an example of going off the deep end about a one day spike in cases — see https://luysii.wordpress.com/2020/05/28/data-cherry-picking-101/ — a copy of which will be found below the ****

So now hie yourself to the following website — https://dph.georgia.gov/covid-19-daily-status-report

If you scroll down to COVID-19 testing, you will see that they’ve tested a 1.17 million people (nearly 10% of the populaton).  94,000 had the virus present and 9,000 had a positive antibody test (so asymptomatic people account for nearly 10% of the ‘cases’ of COVID19

Now keep scrolling down the site, past the map of Georgia and you get to COVID-19 cases over time.  There are 3 tabs you can click: Cases, Cumulative Cases and Death.

Each is plotted vs. the date.

There is a movable cursor allowing you to see the data from any given day.  On the day restrictions were loosened (25 April) the 7 day moving average of new cases was 736, and the 7 day moving average of daily deaths was 41.

Now click on cases and look at 24 June (using the cursor), and the 7 day moving average of daily new cases has exploded to 2,100

Click on deaths and the 7 day moving average of daily deaths on 24 June is 17.

When did the explosion in daily new cases begin?   To my eye, it happened around the first of June (when the daily death rate was 24).  So during the explosion of new cases death rates continued to drop.

Very similar data is available from Florida; look at the two graphs — side by side– of new cases and daily deaths on the following link — https://www.miamiherald.com/news/coronavirus/article242270081.html

For those of you old enough to remember, the number of new cases is as useful as the body count was during the Vietnam war.  It was something which could be precisely determined, but what was irrelevant for what was really needed to be known.

The two pieces of data we need to determine whether we’re winning or losing in the pandemic are (1) the daily death rate from COVID19 (2) the number of people currently hospitalized with COVID19.

If the marked increases in new cases is meaningful and scary, we had better see a rise in the death rates soon; but it’s already been 3 weeks for Georgia (solid numbers) and about 5 weeks for Florida, and we still haven’t seen a rise in death rates comparable to the rise in the number of ‘cases’ since 1 June.  In fact we’ve seen no rise at all.

Follow the links, look at the data and draw your own conclusions.

****

Here’s the old post warning you to beware of ‘daily spikes’ of anything.

 

Data Cherry Picking 101

A friend sent me the following link — https://www.voanews.com/covid-19-pandemic/wisconsin-reports-its-highest-daily-increase-covid-19-cases.

It starts off like this — dates in parentheses added by me.

“Health officials in the midwestern U.S. state of Wisconsin reported a record number of new COVID-19 cases Thursday, (28 May) two weeks after the state Supreme Court struck down a state-wide stay-at-home order issued by the governor and enacted by the state health department.

The Wisconsin Department of Health Services reported 599 new known COVID-19 cases Wednesday, (27 May) with 22 known deaths, the highest recorded daily rise since the pandemic began. The department reports the state had more than 16,460 known cases and 539 known deaths as of Wednesday.”

Well that proves it, doesn’t it?   Removing restrictions has clearly  been a disaster.

No it doesn’t.  This is data cherry picking par excellence — one day’s cases — after a long holiday (Memorial Day)  weekend means nothing.  The ‘spike’ is an artifact of how cases are reported.

Here are the daily new COVID-19 cases from Massachusetts (which has relaxed nothing so far)

24 May 382

25 May 281

26 May 197

27 May 688 

 

QED

Where are the deaths?

Our current model of the pandemic is that if the number of people testing positive for the viral genome increases, deaths will increase.   Could the model be wrong?  We’re about to find out.  The number of cases diagnosed daily has markedly increased recently in Georgia and Florida.

The number of hospitalizations for illness due to the virus (e.g. the old meaning of Covid19)  in Miami Dade county rose from 607 on 15 June to 1,062 on 28 June. https://www.miamiherald.com/news/coronavirus/article243854907.html Certainly deaths are sure to show a similar increase.  Aren’t they?

Well so far deaths are falling as diagnosed cases are rising. https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429.  has data through 28 June (a Sunday, where reporting is likely to be slow).

If anyone knows how to get these graphics into a WordPress post, please let me know (just write a comment).  Every time I try my post collapses and nothing shows up.  The WordPress Gods must be angry with me.  The links will get you there however, but even then you’ll have to root around to find what I’m talking about.  Apologies.

There is a new WordPress editor out, and I’ll try it to see if it helps.

Florida is particularly good to study because every Friday they tally the number of cases with a positive antibody test for the virus for the past week.  These are people who have recovered, and who likely have never been very sick.  There would be little reason to test someone hospitalized with COVID19 for antibodies.  Here’s a link — http://ww11.doh.state.fl.us/comm/_partners/action/report_archive/serology/serology_latest.pdf.

It boils down to the fact that about 35% of 51,982 newly diagnosed cases of infection in the two weeks ending 26 June are really positive antibody tests.

Unfortunately Florida doesn’t have available a statewide number for the total hospitalized cases of COVID19 — like Massachusetts– https://www.mass.gov/doc/covid-19-dashboard-june-29-2020/download  — but with a population more (6.9 million) than  Miami Dade metropolitan area (5.5 million), there were only 760 cases statewide.

Now on to Georgia, which I’ve been following because they were one of the first states to lift restrictions.  As of 3PM today 29 June,  the 7 day moving average of daily deaths was 15 (this number is for 16 June, because Georgia doesn’t regard its numbers as solid until two weeks have passed).  On 25 April, the day the lockdown was partially lifted, the 7 day moving average of daily deaths was 41.

The number of cases in Georgia diagnosed (using both antibodies to the virus and the genome) has risen markedly in the past 2 weeks. Unfortunately I’ve been unable to find what percentage of the positive tests in Georgia are due to antibodies to the virus.

Both Florida and Georgia are so typical for what docs face all the time.  The data you have is never quite the data you’d like to have.

Now the time from hospitalization with COVID19 to death is unknown, but it’s unlikely to be greater than a month. However, for both states, given the rise in diagnosed cases, we had better see a rise in deaths, or something is seriously wrong with our model.

Has this ever happened before?  You bet.  The nationwide rise in obesity over the past several decades was predicted to have awful effects on mortality.  Yet life expectancy continued increasing.  For details see a copy of an old post after the ****

So I’ll revisit these states in two weeks or so to see if deaths have risen.  This post is long enough, but it’s worthwhile inserting two pieces of data from family and friends.  Family spies tell me that yuppies in Brooklyn are partying in the street without any protection.  Similarly, a friend from Baltimore notes  “Not many people are wearing masks in Baltimore or Washington, particularly individuals at high risk.”

Although Trump’s medical pronouncements are rightly ridiculed, I find it improbable that the bunch described above take what he says as holy writ and that he’s responsible for their behavior.

We are currently witnessing a massive social and medical experiment which would never get past an institutional review board.

****

https://luysii.wordpress.com/2011/03/20/something-is-still-wrong-with-the-model/

Something is still wrong with the model

We’re getting fatter and fatter as a nation and with fatness comes diabetes, hypertension, elevated lipids, strokes, heart attacks and death.  That’s the model.  There’s something wrong with it however, as people in the USA are living longer and longer, and deaths are dropping. The following is one of the first posts I wrote on the blog and it got a lot of play.

https://luysii.wordpress.com/2009/08/20/something-is-wrong-with-the-model/ (I’ll reproduce it here at the end of this post)

What’s happened since?  The following year the Center for Disease Control (CDC) reported a one month dip in expectancy to 77 years and 11 months.  Last week the CDC announced that because of a computer programming error the dip didn’t happen.   They also announced new data for the most ‘recent’ year available (2009 not 2010) and life expectancy continues to increase (now 78 years and two months for a child born today).  This is probably not a statistical fluke.  The data is based on death certificates. Why in the world we don’t have data for 2010 yet and why it took 14+ months for the CDC to collate the data for 2009 I leave to your imagination.

The absolute number of deaths  dropped by 36,000.  Now docs misdiagnose a lot of things but death isn’t one of them.  So my guess is that life expectancy is even higher, because the CDC is probably using the numbers the census counts rather than the numbers of people who are actually here (e.g. undocumented immigrants etc. etc.).

As noted earlier, one self serving explanation is that medical care is just getting better and better, and certainly it is, but it is very unevenly distributed, which was one of the points in passing ObamaCare.  More likely, in my opinion, is that obesity just isn’t as bad as its cracked up to be.  This goes against years and years of experience as a practicing physician.  Next time you visit a friend in the hospital, look at what’s lying in the beds — you will find the percentage of really heavy people much higher than the people walking the streets.  How many times have I seen an obese diabetic hypertensive, hyperlipidemic patient improve all 3 (and presumably their risk of premature death) by losing weight.   Yet facts must be faced — we’re not dropping like flies even though we’re getting fatter as a nation.  Any thoughts?

 

HERE’s the old post

Back in grad school when a theory came up with a wrong prediction, we all clapped hands because it showed us exactly where a new theory was needed, and just how it failed. No casting about for something to work on. A program that crashes intermittently is very hard to fix. Once you’ve found input that consistently makes it crash the job becomes much easier.

The Center for Disease Control released new data for 2007 (based on 90% of all USA death certificiates) showing that mortality rates dropped again (by over 2%) to 760/100,000 population. It’s been dropping for the past 8 years, and viewed longer term is half of what it was 60 years ago. Interestingly death rates from heart disease dropped a staggering 5% and even cancer dropped 2%.

But the populace is fat and getting fatter. This has been going on for 30 years. You can Google NHANES for the gory details, but the following should be enough. [ Science vol. 299 pp. 853 – 855, 856 – 858 ’03 ] The data from a recent NHANES (’99 – ’00) shows that the percentage of obese (as opposed just overweight) increased from 23% in the surveys from ’88 to ’94 to 31%. This is based on the body mass index (BMI). Someone 6′ 1″ would have to weigh 225 pounds to be obese.

We are told to be prepared for an epidemic of diabetes, high blood pressure, elevated blood lipids because of this. Every doc has seen blood sugar drop, blood pressure lowered, lipids come down in people with any/all of the above when they are able to lose a significant amount of weight. These diseases are significant only if they kill people, which they certainly seem to do in my experience. The next time you’re visiting a friend in the hospital, look at what’s lying in the beds. Very likely, many more than 31% of them are obese.

So why are death rates dropping and people living longer? Something must be wrong with the model — it’s pretty hard to quarrel with the data as being inadequate. Certainly the increased incidence of obesity should have produced something by this time (it started 30 years ago).

Well, the self serving answer for the drug developers is that their drugs are better. MDs would like to think it’s due to better care. Possibly. Here’s some detail.

#1: More people are exercising than they used to. How many joggers and walkers did you see on the streets 20, 30 years ago?

#2: Fewer people are smoking. Forget lung cancer (if you can). The big risk for smokers is premature vascular disease. Normally we all have carbon monoxide in our blood (it comes from the breakdown of hemoglobin). [ Brit. Med. J. vol. 296 pp. 78 – 79 ’88 ] Natural carbon monoxide production would lead to a carboxyhemoglobin level of .4 – .7%, but normal levels in nonsmokers in urban areas are 1 – 2%. Cigarette smoke contains 4% carbon monoxide, so smokers have levels of 5 – 6%. This can’t be good for their blood vessels.

#3: Doctors know more than they did. My brother is a very competent internist. He took over the practice of a similarly competent internist after his very untimely many death years ago. Naturally he got all the medical records on the patients. He found letters (now over 25 years old) from the late MD to his patients informing them of their lab results, and assuring them that their cholesterol was just fine at 250 mg%.

#4: The drugs are better. In addition they may be working in ways that we have yet to fathom. Consider the statins — their effect on vascular disease is far greater than their effect on blood lipids (cholesterol, triglyerides) — particularly when compared to other agents that lower blood lipids to the same extent.

Any further thoughts?

Death rates from coronavirus drop in half 2 months after Georgia loosens lockdown restrictions

There were apocalyptic predictions of doom when Georgia loosened its lockdown restrictions against the pandemic coronavirus SARS-CoV-2 on 25 April.  Here they are

From The Atlantic — “Georgia’s Experiment in Human Sacrifice — The state is about to find out how many people need to lose their lives to shore up the economy.” — https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

 From the Washington Post — https://www.washingtonpost.com/opinions/2020/04/21/georgia-leads-race-become-americas-no-1-death-destination/

From MSNBC — https://www.msnbc.com/rachel-maddow-show/georgia-s-kemp-neglected-warn-people-about-his-dangerous-gamble-n1189826

A month later (25 May) not much had happened —

7 day moving average of new cases of COVID19 ending 25 April — 740

7 day moving average of new cases of COVID19 ending 13 May — 525 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 539)

7 day moving averages of deaths from COVID19 ending 25 April — 35

7 day moving average of deaths from COVID19 ending 13 May — 24 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 27).

Back on 25 May I wrote “People who assumed (on purely correlative evidence) that lockdowns prevented new cases, and that lifting them would cause a marked increase in new cases and deaths, are clearly wrong.  It’s possible that cases will spike in the future proving them right, but pretty unlikely.  It’s only fair to give the doomsayers a sporting chance and followup is planned in a month.”

So here’s the followup.   The 7 day moving average of daily deaths had dropped to 17 as of 11 June.  Remember Georgia waits 14 days as data filters in to regard the numbers as definitive.  Here’s the link — https://dph.georgia.gov/covid-19-daily-status-report

So the death rate from COVID-19 dropped in half 2 months after Georgia loosened some of the lockdown restrictions.

There are only two useful statistics in all of this.  The moving average of the daily death rate and the number of COVID19 cases in the hospital.  I no longer follow the number of new cases, because they include people with a positive antibody test (all of whom have recovered).  We know that most cases are asymptomatic.  It’s very hard to get the second number of people sick in the hospital with COVID19 (I’ve tried with no luck).  COVID19 used to mean that you were sick — no longer, it now counts positive antibody tests, rendering the number relatively useless.  By choosing who to test, numbers can be easily inflated — https://luysii.wordpress.com/2020/06/22/new-york-city-covid-19-cases-spiked-today-stock-market-futures-tank/

Daily death rates are great for cherry picking scare headlines — it’s worth looking at this article from Tampa — https://www.wtsp.com/article/news/health/coronavirus/florida-coronavirus-cases-hospitalizations-deaths/67-4bbd0c35-6742-4f51-a59a-ea1d101f54ea

It contains a great figure with the number of deaths each day from March onward on which is superimposed the moving average — the range is from 10 to 100.  Even more impressive is the fall on weekends and the rise during the week.

Fortunately, every Friday  Florida releases the weekly results for antibody testing, so we’ll be able to see how many of these new cases of COVID19 are people who have recovered from it.

Here’s another link — well worth looking at — with the number of new cases in Florida in one graph (with the marked increase in the past week) and the number of death from the disease just below.  The deaths in the past week are the lowest they’ve been in a month — https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429