Covid And The Rest of Us

[godisney14]

I don't think that the PP said you had equated COVID with influenza. The point (as I understood it) is that IF (big IF) there are fewer deaths from influenza then the non-COVID deaths are lower than normal. Therefore the excess mortality (not sure why you keep putting in quotes), is actually higher than is being calculated.

Completely making up numbers here:

Expected deaths = 100
Actual deaths = 125
Excess mortality = 25

However, the expected deaths assumed 30 deaths from influenza but, this year, there were only 5 deaths from influenza. Therefore (so goes the argument):

"New expected" deaths = 75 (100 - the 25 influenza deaths that didn't happen)
Actual deaths = 125
Excess mortality = 50

I actually don't think that you can/should really do this (and I work with people at EUROMoMo) because the whole point of excess mortality is that you don't try to assign cause-of-death.

It isn't appropriate to think that excess deaths and COVID deaths are synonymous. In many of the countries where I work (mainly low-income or lower-middle-income), maintaining essential health services is a massive struggle. In areas with Ebola outbreaks, deaths due to the lack of EHS far outnumbered Ebola deaths. That's likely to be the case again (though the epidemiology of the two diseases is different). In the broadest sense, one could argue still COVID related (but that wouldn't be given as the cause-of-death). Things are far too entangled to do more than just look at/count the excess deaths.

You’re right in saying that the excess deaths do not necessarily correspond 1:1 with deaths of COVID. But, it does tell you the impact that COVID had from the data.

 

[SirDuff]

You’re right in saying that the excess deaths do not necessarily correspond 1:1 with deaths of COVID. But, it does tell you the impact that COVID had from the data.

Yes definitely to your last sentence. That’s the whole point. I was simply saying that excess deaths does not (necessarily) equal deaths from COVID.

Pretty much the whole point of using excess deaths as a metric is that you can ignore cause-of-death. A few reasons for this:

1) There is still debate about how to define “death from COVID”. Heck, there is debate around a lot of case-of-death coding. ICD-11 is, to many, the “gold standard“ for coding the underlying disease (US is still using ICD-10), but not everywhere uses it (Canada, for example, using ICD-11-CA - we adapt the codes for our use (however, this is done in connection with teams at WHO (who create ICD) and there is a clear and well-understood mapping).

2) Conspiracy theorist who say that there is no COVID (or COVID isn’t a big deal) and people are coding completely unrelated deaths at COVID deaths.

3) In many countries, even if the best of times, few deaths are actually registered and even fewer get any sort of case-of-death recorded (in low- and lower-middle-income countries).

4) Deaths that occur outside of health facilities are even less likely to have cause-of-death accurately coded (and both the number of deaths outside of health facilities and the extent of issues with cause-of-death coding differ widely across countries).

It doesn’t let you (on its own) figure out why things are happening, but it is a pretty good high-level comparative measure.

It also ignores issues below death. Are those issues both non-fatal health issues and also social and economic issues proportional? Probably not, but we don‘t know (estimate of case-fatality rates do not seem to be proportional to case-rates, for example).

 

[PaulaSB12]

Conspiracy theories should have been expected there is one for everything that happens. Now this isn't helped by inaccurate recordings of deaths over in the uk ANY deaths within 28 days of covid positive test is classified as a covid death including
85 year old man in the last stage of terminal cancer
man who died in road crash
and man who broke his neck falling off a ladder.

It turns out in all the deaths in the uk 400 hundred have died who didn't have underlying conditions. that was the figure given out in parliament. As for these lockdowns, cancer deaths are up as people aren't getting tested or treated, suicides are up and mental health is taking a huge hit not to mention domestic violence going up and of course jobs are being lost in their thousand.

 

[ronandannette]

I am lost Annette. You never even came to my head at all.

I wasn't insinuating anything about you. I am very upfront Annette, I would simply debate a point with you directly as usual, if I had a thought to debate. Veiled comments are simply not my forte.

EDIT: Everyone can read SirDuff's succinct Coles' Notes on the issue, instead of my re-rambling.

Was simply jumping off both of your posts, with even more of a discussion - that I find interesting. We are changing the breakdown of deaths by our isolation and mask wearing. And straightforward comparisons are virtually impossible.

Good Morning Lisa,
I admit to trying to be over-cautious in clarifying exactly what it is I'm wanting to communicate. What, to me, have been simply interesting talking points, honest questions and factual responses to other posts have gotten me into a pickle more than once. I've been labeled a "self-proclaimed Covid expert", presumably because I think assertions should be backed up by at least some source of fact; a "dangerous Covid denier" because I have legitimate questions about the efficacy of extreme lock-down measures and don't personally know anyone who has contracted Covid, and most hilariously (yet painfully) a "trumploving conspiracy theorist", (I guess) due to my geography. This last one rankles badly as I couldn't give a flying flip about American politics, other than their foreign policy affecting Canada, but I digress...

Hope it is smooth sailing going forward.

It is like Las Vegas for these leaders and their decisons. Here people had us on the short end of the stick, general us - not you Annette - laughing, thinking Trudeau's choices were going to be royally ****ed. But he - and we - lucked out so far.

Couldn't pay me enough to make these decisions.

It will be interesting to see what people decide further down the list.

I have to say I do find it interesting, not sure what word to use, that some that did not deem the virus all that serious are scheduling their vaccine. I am happy that they are, but it is _________. Honestly can't find an appropriate word, maybe the word is headache-inducing Smiling.

Thank you SirDuff. Yes. Hallelujah. Thank God for succinct writers!

It is either Canada or the States where deaths from the flu are down over 90%. I am just too lazy to go look what brand of news I was barely listening to last week.

And yes I was trying to say that there are so many entangled issues, with the numbers released. And then they are often erroneously used to support an argument.

I don't think it's any laughing matter and I am feeling more desperate by the moment to have our vaccination program expanded at a much more accelerated pace. As of Friday, there have only been 42,333 doses administered in Alberta - less than 1,000 for every 100,000 people and we await further supply. A province-wide Ipsos poll last week resulted in over 80% of respondents saying they will take the vaccine as soon as it is available to them.

According to this article, only 548,950 doses (Pfizer and Moderna combined) have been delivered to Canada so far. I don't think this is necessarily a "blame the Federal Government" type of situation, just one that needs every possible resource thrown at it and the way our health care works, only the Feds can do that. (NOTE: Even though the link looks like it's not loading, if you click on it, it takes you right there).
https://www.cbc.ca/news/politics/trudeau-vaccines-scale-up-canada-lags-1.5866552

 

[ronandannette]

Yes definitely to your last sentence. That’s the whole point. I was simply saying that excess deaths does not (necessarily) equal deaths from COVID.

Pretty much the whole point of using excess deaths as a metric is that you can ignore cause-of-death. A few reasons for this:

1) There is still debate about how to define “death from COVID”. Heck, there is debate around a lot of case-of-death coding. ICD-11 is, to many, the “gold standard“ for coding the underlying disease (US is still using ICD-10), but not everywhere uses it (Canada, for example, using ICD-11-CA - we adapt the codes for our use (however, this is done in connection with teams at WHO (who create ICD) and there is a clear and well-understood mapping).

2) Conspiracy theorist who say that there is no COVID (or COVID isn’t a big deal) and people are coding completely unrelated deaths at COVID deaths.

3) In many countries, even if the best of times, few deaths are actually registered and even fewer get any sort of case-of-death recorded (in low- and lower-middle-income countries).

4) Deaths that occur outside of health facilities are even less likely to have cause-of-death accurately coded (and both the number of deaths outside of health facilities and the extent of issues with cause-of-death coding differ widely across countries).

It doesn’t let you (on its own) figure out why things are happening, but it is a pretty good high-level comparative measure.

It also ignores issues below death. Are those issues both non-fatal health issues and also social and economic issues proportional? Probably not, but we don‘t know (estimate of case-fatality rates do not seem to be proportional to case-rates, for example).

That is very interesting; and really who among us was even aware of any of these things prior to Covid? Cause-of-Death statistics weren't something the average person every questioned, in the event we knew about them at all.

Years ago I interned to become a funeral director. In this jurisdiction every death has to be certified by an appropriate medical authority prior to disposition and the forms would come in saying all sorts of things; rarely with the exception of an accidental or violent death, were there not a myriad of underlying conditions mentioned. What actually killed the person? Did they die of or with a certain ailment? Hard to say, especially given that only a tiny fraction of deceased persons are ever autopsied and in cases where "death is expected" transport from home directly to the funeral facility without ever being seen or examined by a medical professional is allowed.

 

[NFLDERS]

SO.. Manitoba is going to innoculate 'SOME' Paramedics, Cherry Picking at it's worse!

We are being compared to Toronto now here in Niagara. Our recent numbers are daunting at best... sigh.

 

[SirDuff]

That is very interesting; and really who among us was even aware of any of these things prior to Covid? Cause-of-Death statistics weren't something the average person every questioned, in the event we knew about them at all.

Years ago I interned to become a funeral director. In this jurisdiction every death has to be certified by an appropriate medical authority prior to disposition and the forms would come in saying all sorts of things; rarely with the exception of an accidental or violent death, were there not a myriad of underlying conditions mentioned. What actually killed the person? Did they die of or with a certain ailment? Hard to say, especially given that only a tiny fraction of deceased persons are ever autopsied and in cases where "death is expected" transport from home directly to the funeral facility without ever being seen or examined by a medical professional is allowed.

Not COVID related (and probably not the best thing to share, just something that I know how to quickly find) but I thought you might find interesting:

WHO's World Health Statistics Report (https://apps.who.int/iris/bitstream/handle/10665/311696/WHO-DAD-2019.1-eng.pdf)

Table 4 - Globally, the average percentage of deaths where cause-of-death is reported is 49%. Ranges from 97% in High Income Countries to 3% if Low-Income Countries. If a country is only recording cause-of-death in 3% of deaths (and this is when there isn't a pandemic), do we really think that we are going to accurately know how many people are dying of COVID there?

"An interesting quote from the same report: 11 health-related SDG* indicators require cause-of-death data, yet only around half of countries are able to register more than 80% of adult deaths, and less than one third of countries have high-quality data on cause of death"

*SDGs are Sustainable Development Goals that cover a wide range of topics grouped around 17 high-level goals. SDG 3 is "Good Health and Well-Being" though birth and death registration fall under goal 17.


For some country specific information, you can look here:

https://apps.who.int/gho/data/view.main.HS10v
It shows percent of deaths that have cause-of-death reported (often quite low). Also (if you scroll right), the number of deaths (that get a cause-of-death) were the cause in the report is basically useless because it is ill-defined.

 

[Karin1984]

NL's lockdown probably gets extended by 3 weeks, all measures continue, maybe they will change some group sizes. We will hear it in the next press conference this Tuesday.

 

[ronandannette]

Not COVID related (and probably not the best thing to share, just something that I know how to quickly find) but I thought you might find interesting:

WHO's World Health Statistics Report (https://apps.who.int/iris/bitstream/handle/10665/311696/WHO-DAD-2019.1-eng.pdf)

Table 4 - Globally, the average percentage of deaths where cause-of-death is reported is 49%. Ranges from 97% in High Income Countries to 3% if Low-Income Countries. If a country is only recording cause-of-death in 3% of deaths (and this is when there isn't a pandemic), do we really think that we are going to accurately know how many people are dying of COVID there?

"An interesting quote from the same report: 11 health-related SDG* indicators require cause-of-death data, yet only around half of countries are able to register more than 80% of adult deaths, and less than one third of countries have high-quality data on cause of death"

*SDGs are Sustainable Development Goals that cover a wide range of topics grouped around 17 high-level goals. SDG 3 is "Good Health and Well-Being" though birth and death registration fall under goal 17.


For some country specific information, you can look here:

https://apps.who.int/gho/data/view.main.HS10v
It shows percent of deaths that have cause-of-death reported (often quite low). Also (if you scroll right), the number of deaths (that get a cause-of-death) were the cause in the report is basically useless because it is ill-defined.

Fascinating! I've only gotten through the first bit and I'm already so interested in some of the data, specifically the proportional differences in life expectancy reduction for men v. women related to self-harm (men) and Alzheimer's (women) and the fact that so few females die in childhood/young adulthood compared to males, in high-income countries.

 

[ronandannette]

NL's lockdown probably gets extended by 3 weeks, all measures continue, maybe they will change some group sizes. We will hear it in the next press conference this Tuesday.

What are you personally hoping will happen?

 

[lisaviolet]

I don't think it's any laughing matter and I am feeling more desperate by the moment to have our vaccination program expanded at a much more accelerated pace.

I don't think our vaccine rollout is any laughing matter either. Agreed.

Annette, I was not laughing at our vaccine rollout at all, which I agree has been abysmal in many ways. I was laughing about clarifying that I wasn't talking about you again with my Trudeau conversation. With a wink. That's all. A la I don't want to be misunderstood again.

And I was misunderstood again. I was being cheeky with you, smiling. And laughing in the moment a la I think I need to clairfy. Nothing more. And talking about vaccine purchases/choices only.

------------

It is insane that they were not more organized. I researched some job postings last week and forgot to share here.

These were recent postings. Which in itself shows they are not organized.

Before I speak, please know I think that nurses deserve every penny they get for their tireless work.

They were offering these posted positions to RNs, RPNs and PSWs. The same position, vaccine professionals, but offering varying hourly wages.

Offering to PSWs shows that they indeed realize that there is no need to be highly skilled to administer a vaccine (please no one highlight that sentence in isolation because it looks awful on its own and I mean satisfying professional organizations and possible objections). And to clarify I am not downing PSWs, at all.

The wage was between $50 and $60/hour for RNs. And low $20s for PSWs.

We are in a pandemic. We need bodies now. To go around the clock. They knew this was coming. Train people to administer it at an in-between rate to get as many bodies on hand, and hire the nurses to oversee for reactions to the vaccine and management. Hiring PSWs shows that they are not tied to a certain level of care (once again not putting down PSWs, who work tirelessly for low wages).

And before anyone thinks what the heck, we are administering a vaccine here Lisa! Safety! Mere training?! I wouldn't feel safe.

It is not difficult. Train people (weeks/months ago, sigh). I do IM injections, to myself - same needle as vaccine, multiple times a week. And I am not trained. Was never trained and do just fine. And I have had to do it for a loved ones' care as well. It is not rocket science. And if everyone is worried, have nurses be the one to pre-fill the syringe. But once again that part is not rocket science either.

I can't fathom why they were not more organized. It is a provincial matter here in Canada. Hoping that other provinces are well ahead of Ontario.

---------

(And Annette on your other writing this morning, I am truly sorry that you feel judged - and labeled - for your posts about Covid.)

 

[Karin1984]

What are you personally hoping will happen?

I just hope they don't add more measures.

My personal impact is that I am a planner at a callcenter. Last five weeks I have to juggle agents who work from home but cannot be on the phone as there are young children around the house, as the schools are closed. Those agents can handle e-mail or chat, but it's annoying to schedule. I cannot balance e-mail tasks etc. between agents, which is not good for moral.

 

[White Cat]

I can't fathom why they were not more organized. It is a provincial matter here in Canada. Hoping that other provinces are well ahead of Ontario.

(And Annette on your other writing this morning, I am truly sorry that you feel judged - and labeled - for your posts about Covid.)

It’s Ontario. The red tape is exhausting and intrusion from the leaders has strangled progress so much that it’s become normal to the people living there, it’s instilled fear of failure in the people. . It’s evident in some of the posters here from that area. Not you.

 

[ronandannette]

I don't think our vaccine rollout is any laughing matter either. Agreed.

Annette, I was not laughing at our vaccine rollout at all, which I agree has been abysmal in many ways. I was laughing about clarifying that I wasn't talking about you again with my Trudeau conversation. With a wink. That's all. A la I don't want to be misunderstood again.

And I was misunderstood again. I was being cheeky with you, smiling. And laughing in the moment a la I think I need to clairfy. Nothing more. And talking how vaccine purchases/choices only.

It is insane that they were not more organized. I researched some job postings last week and forgot to share here.

These were recent postings. Which in itself shows they are not organized.

Before I speak, please know I think that nurses deserve every penny they get for their tireless work.

They were offering these positions posted to RNs, RPNs and PSWs. The same position, vaccine professionals, but offering varying hourly wages.

Offering to PSWs shows that they indeed realize that it is no need to be highly skilled to administer a vaccine (please no one highlight that sentence in isolation because it looks awful on its own and I mean satisfying professional organizations and possible objections). And to clarify I am not downing PSWs, at all.

The wage was between $50 and $60/hour for RNs. And low $20s for PSWs.

We are in a pandemic. We need bodies now. To go around the clock. They knew this was coming. Train people to administer it at an in-between rate to get as many bodies on hand, and hire the nurses to oversee for reactions to the vaccine and management. Hiring PSWs shows that they are not tied to a certain level of care (once again not putting down PSWs, who work tirelessly for low wages).

And before anyone thinks what the heck, we are administering a vaccine here Lisa! Safety! Mere training?! I wouldn't feel safe.

It is not difficult. Train people (weeks/months ago, sigh). I do IM injections, to myself - same needle as vaccine, multiple times a week. And I am not trained. Was never trained and do just fine. And I have had to do it for a loved ones' care as well. It is not rocket science. And if everyone is worried, have nurses be the one to pre-fill the syringe. But once again that part is not rocket science either.

I can't fathom why they were not more organized. It is a provincial matter here in Canada. Hoping that other provinces are well ahead of Ontario.

Oh my Dear, that is funny! We are both tripping all over each other in typical Canadian fashion trying so hard not to offend and to declare we are not offended or intending to be offensive. Let's just proverbially hug it out and virtually sing Kumbaya once and for all!

While in different times I would love nothing better than to wax eloquent on the foibles of "good hair guy" on non-Covid related matters, I must say I am so, so glad that we have had almost no dissent amongst our federal leaders on the Covid response. It has saved us a world of hurt and has allowed focus to be on the things that really matter. Decisions have been made and everyone has done their best to execute plans in the most efficient fashion. As you said - hard, hard decisions and really, only time will tell the story and hindsight determine what, if anything, should have been done differently.

As for the issue of administering vaccine, well, if we don't count the complications of the Pfizer product, I hope we quickly move to the distribution model like is used for flu vaccine. Appointments made and shots given at pharmacies. There are tens of thousands of pharmacies nation-wide and every pharmacist in them is "qualified" to give an injection. (I just had one for shingles vaccine on Friday and the pharmacist did a fine job.) Since this model has worked so effectively for decades, let's use it and see what it avails.

 

[lisaviolet]

or the issue of administering vaccine, well, if we don't count the complications of the Pfizer product, I hope we quickly move to the distribution model like is used for flu vaccine. Appointments made and shots given at pharmacies. There are tens of thousands of pharmacies nation-wide and every pharmacist in them is "qualified" to give an injection. (I just had one for shingles vaccine on Friday and the pharmacist did a fine job.) Since this model has worked so effectively for decades, let's use it and see what it avails.

Agreed.

And beyond that, I seriously don't get not thinking outside the box, like Israel.

What is the argument or block to not go to a 24 hour system? If they are worried about more bodies in our drug stores, why the heck can't they vaccinate off hours. Seniors could come in early mornings and tons of people, including some seniors I am sure, would not hesitate to do a middle of the night booking.

Write a damn contract with our pharmacies. The MRI machines at hospitals have gone on a 24 hour booking system before, so it is not like we are not pushing it full throttle on screenings. And have a model already in place.

 

[lisaviolet]

Oh my Dear, that is funny! We are both tripping all over each other in typical Canadian fashion trying so hard not to offend and to declare we are not offended or intending to be offensive. Let's just proverbially hug it out and virtually sing Kumbaya once and for all!

In typical Canadian fashion.

 

[lisaviolet]

It’s Ontario. The red tape is exhausting and intrusion from the leaders has strangled progress so much that it’s become normal to the people living there, it’s instilled fear of failure in the people. . It’s evident in some of the posters here from that area. Not you.

Are you moving soon?

See the wink, see the wink! And see the smile.

And did you really just go all Canadian and make sure I knew you weren't talking about me. Happy New Year!

You know I agree that red tape is beyond frustrating in Canada. It is the one thing we agree on. And the States definitely has a better system, in my opinion, with a smaller amount of regulations. Off topic, but I used to go bat **** crazy to travel to NYC and see developments fly up in record time. While here in Toronto they announce planning and the next generation will see it actually happen.

But you also know how incredibly fortunate I feel to live in this country, for a myriad of reasons. Including the one Annette mentioned - leaders came together to focus on the job at hand.

 

[lisaviolet]

Not COVID related (and probably not the best thing to share, just something that I know how to quickly find) but I thought you might find interesting:

WHO's World Health Statistics Report (https://apps.who.int/iris/bitstream/handle/10665/311696/WHO-DAD-2019.1-eng.pdf)

Table 4 - Globally, the average percentage of deaths where cause-of-death is reported is 49%. Ranges from 97% in High Income Countries to 3% if Low-Income Countries. If a country is only recording cause-of-death in 3% of deaths (and this is when there isn't a pandemic), do we really think that we are going to accurately know how many people are dying of COVID there?

"An interesting quote from the same report: 11 health-related SDG* indicators require cause-of-death data, yet only around half of countries are able to register more than 80% of adult deaths, and less than one third of countries have high-quality data on cause of death"

*SDGs are Sustainable Development Goals that cover a wide range of topics grouped around 17 high-level goals. SDG 3 is "Good Health and Well-Being" though birth and death registration fall under goal 17.


For some country specific information, you can look here:

https://apps.who.int/gho/data/view.main.HS10v
It shows percent of deaths that have cause-of-death reported (often quite low). Also (if you scroll right), the number of deaths (that get a cause-of-death) were the cause in the report is basically useless because it is ill-defined.

Thank you for posting. So fascinating to take in.

 

[ronandannette]

Agreed.

And beyond that, I seriously don't get not thinking outside the box, like Israel.

What is the argument or block to not go to a 24 hour system? If they are worried about more bodies in our drug stores, why the heck can't they vaccinate off hours. Seniors could come in early mornings and tons of people, including some seniors I am sure, would not hesitate to do a middle of the night booking.

Write a damn contract with our pharmacies. The MRI machines at hospitals have gone on a 24 hour booking system before, so it is not like we are not pushing it full throttle on screenings. And have a model already in place.

So far, the limited availability of product hasn't necessitated a 24 hour program; Godspeed we will soon have enough that we could be pumping it in 'round-the-clock. As for the bolded, there are strict occupancy limits in our retail outlets - most have staff or security personnel counting people in and out. If shots were given by appointment only and people wait in their cars until their appointed time (like we must to see a doctor or dentist), I don't see how it would be a problem at all.

...But you also know how incredibly fortunate I feel to live in this country, for a myriad of reasons. Including the one Annette mentioned - leaders came together to focus on the job at hand.

I don't know quite enough about the levels of bureaucracy in either Ontario or the States to comment on that part, but in this sentiment ^^ I am with you 100%!

 

[NFLDERS]

Oh my Dear, that is funny! We are both tripping all over each other in typical Canadian fashion trying so hard not to offend and to declare we are not offended or intending to be offensive. Let's just proverbially hug it out and virtually sing Kumbaya once and for all!

While in different times I would love nothing better than to wax eloquent on the foibles of "good hair guy" on non-Covid related matters, I must say I am so, so glad that we have had almost no descent amongst our federal leaders on the Covid response. It has saved us a world of hurt and has allowed focus to be on the things that really matter. Decisions have been made and everyone has done their best to execute plans in the most efficient fashion. As you said - hard, hard decisions and really, only time will tell the story and hindsight determine what, if anything, should have been done differently.

As for the issue of administering vaccine, well, if we don't count the complications of the Pfizer product, I hope we quickly move to the distribution model like is used for flu vaccine. Appointments made and shots given at pharmacies. There are tens of thousands of pharmacies nation-wide and every pharmacist in them is "qualified" to give an injection. (I just had one for shingles vaccine on Friday and the pharmacist did a fine job.) Since this model has worked so effectively for decades, let's use it and see what it avails.

A post I can finally Kumbaya to. Also expanding further would have me risk becoming political here, and I have not the Covid19 energy.