I wanted to like this a lot more. I wanted to love this.
But there's two reasons why I have to say "thanks, I hate it." Neither of which have to do with the math. Both of which have to do with the implied meaning and assumed interpretation and judgment.
1) all of this assumes all or nothing, death vs not-death. And not even all or nothing generally speaking, but all or nothing in a highly compressed timeframe of acute death. The reality is that "long covid" and ongoing, devastating covid complications is a huge factor that will hugely affect our world for long to come. And that death from covid will continue to happen chronically.
2) all of this is assuming that the healthcare system is even WORKING at anything close to an optimal level. It is, frankly, not. For a multiplicity of factors, if you are in America today you will not get our best efforts or ability or resources in healthcare that you seek, for any medical reason, but especially for covid. To examine mortality rates across varying degrees of healthcare availability and quality is to artificially flatten and equivocate.
This is, in short, mildly interesting but not practically useful and indeed IMO quite possibly practically harmful if it succeeds in comforting the comfortable in their assumptions without necessary caveats and recognition of unaccountable variables that can interfere with the conclusions to be inferred. (Sorry.)
Well, I appreciate the criticism. I don't get enough of it, and, y'know, as criticism goes, this is pretty congenial.
The post really did originate from an attempt to write a more opinionated piece about vaccines. Partway in, I realized I needed to address the "why get a vaccine for a disease with a 99.7% survival rate?" contention, and then I realized I didn't know whether that was actually true, because I didn't have good, America-specific IFR data (at least, none that I trusted enough with sufficiently granular age bands), so then I decided "well I'll just whip that up in 20 minutes and I can do it as a footnote."
Three hours later, I realized it was its own post, and really just needed to be about IFR.
Six hours later, I posted it.
So possibly when I get back to being opinionated, I will be able to satisfy your objections here. Or possibly I will only aggravate them more! We'll find out, if I can finally write that post now!
The only thing in your post I want to specifically push back on is the idea that these IFR estimates assume an optimal American health care system. These IFR estimates assume that the American health care system continues functioning as it has (on average) functioned throughout the pandemic -- which, I think we agree, has not been optimal for some time, and certainly hasn't been during the previous major surges. Now, if the American health care system gets worse in the coming months and *stays* worse into next spring, then you're right, these IFR estimates will end up being too low. And that's a real possibility, because (it seems to me) (opinion time) our entire political system is currently focused on Covid Security Theatre instead of reinforcing the healthcare system, and the healthcare system is cracking under the pressure. But it's hard to take possible changes in the future (even the near future) into account when you're writing an IFR estimate.
All fair enough consideration. As you know I'm in the trenches in healthcare and so I freely admit I have my own biases and rank some unknowns probably higher than I should.
But, to that point - let me offer a single perspective from my own trench right now. It's a tiny 25 bed rural critical access hospital. Normal times and even for much of covid era they have had maybe 14 inpatients with 1-2 being ICU level. They have maybe a couple of deaths a month for inpatients. Maybe one person a month brought in for coroner's autopsy who died at home.
The new normal now is a completely full hospital, all four vents in use with no way to get others from anywhere else, all bipaps etc are in use also. Half of the ER is now plastic cordoned off for a covid ICU (the ER nurses call it Camp Covid) that is also full with patients waiting on beds in the hallway for someone to die or actually get transferred out - not likely, unless they hit the jackpot and call a receiving facility right when they've had someone die there, there's no where to transfer any sick patients in the entire states of MI, WI, or MN right now.... They were trying Chicago for someone recently but the family told them to stop trying and they just accepted this would be goodbye up here. There are now multiple deaths a week and every few days there are a couple deaths in a day. That's a *lot* for this area and tiny hospital. The coroner is here a lot for people who are brought in found dead at home (we do postmortem covid PCR), she's covering two counties (other coroner quit) and she has to drive all over the place every day now, a full time job in itself. This isn't what she signed up for by campaigning to be elected coroner a few years ago. This isn't what any of the staff up here signed up for, and not what any of them want. They don't want to be the hollow eyed and fried people I now see every day, while I'm knowing that my contract ends next week and I get to leave, with a huge sigh of relief, while they have their whole lives here... These patients are their local friends, neighbors, shop owners, mechanics - they know them, all of them, and yet our staff are so burned out that they no longer even know who died on the floor today, they can't care that much anymore. It's no longer shocking to lose patients. Staff were already hard to find, now qualified staff is basically impossible to hire here as they really are limited to local/regional people, people don't relocate for jobs in rural community hospitals (there are a smattering of us travelers, but they can't find any more of us now either). A bunch of people here have quit just in the last two weeks, burned out, and it didn't have anything to do with the vaccine mandate. We did lose a few people to that too, and as much as I sympathize with the mandate it really REALLY has harmed us and the patients in this area to lose even those couple of skilled staff over it...
People who don't need to die are dying. Not just of covid, not just the unvaccinated, but people simply dying of things that we should be able to care for, and that we could still care for until about a month ago. The standard of care, the quality of care, *is not there*. God forbid you get sick or in a car wreck in these days.
This is just my experience in this one corner of the country over these past 3 months. But even if covid drops off drastically and we get over it in the community, the effects of losing so many staff and the drain on resources for long term care of these extant covid patients is going to be with this community long into the spring, best case scenario. And I am confident that this impact will be across the country, with excess death rates due to many causes being markedly higher than pre-covid, pre-delta.
I noted this morning a letter to the editor in today's NYT, from an ER doctor also in Michigan and every single sentence he wrote resonated. He understands. The second epidemic is worse than the first - it is the onslaught of non-covid people we could have, should have, saved, but for the first pandemic. Now we can't. It's draining and despair inducing. We signed up to help save lives. Instead we have this. How long do we keep at this? How long can we?
Anyway. I'm kind of raw and rambling right now, I'm sitting in the hospital parking lot writing this on my phone after another exhausting shift. This is my life for another week, then as a traveler I get the privilege to choose to not take another contract for a month or so. I will have some time to rest, off the front lines, and then hopefully be ready to face another contract. For most people they don't get this kind of option, it's either keep going or quit. My daily prayers will be with these people up here in the UP I am leaving behind in the trench. Please, please, pray for them too.
Well that's a comment that's getting heavily excerpted in a future post. I can see from the numbers that hospitals are under unreasonable strain, but that's no substitute for the vivid details you wrote right there.
I would be interested in what these numbers would be if broken down by other health factors, which I assume could be derived from national statistics. I have had COVID now at 40 and it was incredibly mild. I am 40 but also am physically fit and have pretty good nutrition habits.
One thing I have been advocating for (since the pandemic started) is focusing on at risk groups more than the general population. That way general freedoms, as a well as privileges, can continue while still being reasonable. Maybe it is too hard, but I have never had anyone explain to me why it is or if it really is.
I would be interested in a break down of why the hospital systems are being over run as well, because I believe that COVID is a factor but I also believe there are contributing factors that aren't being talked about such as low recruitment (this had been talked about for years prior to pandemic) and retention. I have a lot of nurses and NAs in my family and all of them have been railing about the situations in their respective institutions for as long as I can remember. This is circumstantial, I admit, and I am open to being wrong, which in this case would mean the things I mention are negligible factors.
I also would love to know more about treatment of COVID and how it has evolved.
Lots of your comment touches on opinion stuff that I may (hopefully) address in a future post (my fling with anti-monopoly politics makes me inclined to look at the hospital system through a very particular lens these days), so suffice to say I see where you're going with that hospital system thought and I'll leave that be.
"I would be interested in what these numbers would be if broken down by other health factors, which I assume could be derived from national statistics. I have had COVID now at 40 and it was incredibly mild. I am 40 but also am physically fit and have pretty good nutrition habits."
At first I thought this data didn't exist, but, now that I'm thinking about it, I suspect I could use an odds ratio to derive this for one (but only one!) health factor per age group.
I'm thinking obesity, which I understand is the most common and biggest covid risk factor other than age. Might be quite interesting. But woof I gotta recharge my batteries before I look at this spreadsheet again! :)
Another interesting thing will be if COVID is actually good for the healthcare system long term. If the increase in salaries and positions bring about a better pipeline of recruits. Much like war is good for certain aspects of society (emphasis on certain of course).
I wanted to like this a lot more. I wanted to love this.
But there's two reasons why I have to say "thanks, I hate it." Neither of which have to do with the math. Both of which have to do with the implied meaning and assumed interpretation and judgment.
1) all of this assumes all or nothing, death vs not-death. And not even all or nothing generally speaking, but all or nothing in a highly compressed timeframe of acute death. The reality is that "long covid" and ongoing, devastating covid complications is a huge factor that will hugely affect our world for long to come. And that death from covid will continue to happen chronically.
2) all of this is assuming that the healthcare system is even WORKING at anything close to an optimal level. It is, frankly, not. For a multiplicity of factors, if you are in America today you will not get our best efforts or ability or resources in healthcare that you seek, for any medical reason, but especially for covid. To examine mortality rates across varying degrees of healthcare availability and quality is to artificially flatten and equivocate.
This is, in short, mildly interesting but not practically useful and indeed IMO quite possibly practically harmful if it succeeds in comforting the comfortable in their assumptions without necessary caveats and recognition of unaccountable variables that can interfere with the conclusions to be inferred. (Sorry.)
Well, I appreciate the criticism. I don't get enough of it, and, y'know, as criticism goes, this is pretty congenial.
The post really did originate from an attempt to write a more opinionated piece about vaccines. Partway in, I realized I needed to address the "why get a vaccine for a disease with a 99.7% survival rate?" contention, and then I realized I didn't know whether that was actually true, because I didn't have good, America-specific IFR data (at least, none that I trusted enough with sufficiently granular age bands), so then I decided "well I'll just whip that up in 20 minutes and I can do it as a footnote."
Three hours later, I realized it was its own post, and really just needed to be about IFR.
Six hours later, I posted it.
So possibly when I get back to being opinionated, I will be able to satisfy your objections here. Or possibly I will only aggravate them more! We'll find out, if I can finally write that post now!
The only thing in your post I want to specifically push back on is the idea that these IFR estimates assume an optimal American health care system. These IFR estimates assume that the American health care system continues functioning as it has (on average) functioned throughout the pandemic -- which, I think we agree, has not been optimal for some time, and certainly hasn't been during the previous major surges. Now, if the American health care system gets worse in the coming months and *stays* worse into next spring, then you're right, these IFR estimates will end up being too low. And that's a real possibility, because (it seems to me) (opinion time) our entire political system is currently focused on Covid Security Theatre instead of reinforcing the healthcare system, and the healthcare system is cracking under the pressure. But it's hard to take possible changes in the future (even the near future) into account when you're writing an IFR estimate.
Thanks again! Cheers.
All fair enough consideration. As you know I'm in the trenches in healthcare and so I freely admit I have my own biases and rank some unknowns probably higher than I should.
But, to that point - let me offer a single perspective from my own trench right now. It's a tiny 25 bed rural critical access hospital. Normal times and even for much of covid era they have had maybe 14 inpatients with 1-2 being ICU level. They have maybe a couple of deaths a month for inpatients. Maybe one person a month brought in for coroner's autopsy who died at home.
The new normal now is a completely full hospital, all four vents in use with no way to get others from anywhere else, all bipaps etc are in use also. Half of the ER is now plastic cordoned off for a covid ICU (the ER nurses call it Camp Covid) that is also full with patients waiting on beds in the hallway for someone to die or actually get transferred out - not likely, unless they hit the jackpot and call a receiving facility right when they've had someone die there, there's no where to transfer any sick patients in the entire states of MI, WI, or MN right now.... They were trying Chicago for someone recently but the family told them to stop trying and they just accepted this would be goodbye up here. There are now multiple deaths a week and every few days there are a couple deaths in a day. That's a *lot* for this area and tiny hospital. The coroner is here a lot for people who are brought in found dead at home (we do postmortem covid PCR), she's covering two counties (other coroner quit) and she has to drive all over the place every day now, a full time job in itself. This isn't what she signed up for by campaigning to be elected coroner a few years ago. This isn't what any of the staff up here signed up for, and not what any of them want. They don't want to be the hollow eyed and fried people I now see every day, while I'm knowing that my contract ends next week and I get to leave, with a huge sigh of relief, while they have their whole lives here... These patients are their local friends, neighbors, shop owners, mechanics - they know them, all of them, and yet our staff are so burned out that they no longer even know who died on the floor today, they can't care that much anymore. It's no longer shocking to lose patients. Staff were already hard to find, now qualified staff is basically impossible to hire here as they really are limited to local/regional people, people don't relocate for jobs in rural community hospitals (there are a smattering of us travelers, but they can't find any more of us now either). A bunch of people here have quit just in the last two weeks, burned out, and it didn't have anything to do with the vaccine mandate. We did lose a few people to that too, and as much as I sympathize with the mandate it really REALLY has harmed us and the patients in this area to lose even those couple of skilled staff over it...
People who don't need to die are dying. Not just of covid, not just the unvaccinated, but people simply dying of things that we should be able to care for, and that we could still care for until about a month ago. The standard of care, the quality of care, *is not there*. God forbid you get sick or in a car wreck in these days.
This is just my experience in this one corner of the country over these past 3 months. But even if covid drops off drastically and we get over it in the community, the effects of losing so many staff and the drain on resources for long term care of these extant covid patients is going to be with this community long into the spring, best case scenario. And I am confident that this impact will be across the country, with excess death rates due to many causes being markedly higher than pre-covid, pre-delta.
I noted this morning a letter to the editor in today's NYT, from an ER doctor also in Michigan and every single sentence he wrote resonated. He understands. The second epidemic is worse than the first - it is the onslaught of non-covid people we could have, should have, saved, but for the first pandemic. Now we can't. It's draining and despair inducing. We signed up to help save lives. Instead we have this. How long do we keep at this? How long can we?
Anyway. I'm kind of raw and rambling right now, I'm sitting in the hospital parking lot writing this on my phone after another exhausting shift. This is my life for another week, then as a traveler I get the privilege to choose to not take another contract for a month or so. I will have some time to rest, off the front lines, and then hopefully be ready to face another contract. For most people they don't get this kind of option, it's either keep going or quit. My daily prayers will be with these people up here in the UP I am leaving behind in the trench. Please, please, pray for them too.
Well that's a comment that's getting heavily excerpted in a future post. I can see from the numbers that hospitals are under unreasonable strain, but that's no substitute for the vivid details you wrote right there.
Just swinging through here to say I really like the phrase “comforting the comfortable”… I hope you did a jig after writing it
I would be interested in what these numbers would be if broken down by other health factors, which I assume could be derived from national statistics. I have had COVID now at 40 and it was incredibly mild. I am 40 but also am physically fit and have pretty good nutrition habits.
One thing I have been advocating for (since the pandemic started) is focusing on at risk groups more than the general population. That way general freedoms, as a well as privileges, can continue while still being reasonable. Maybe it is too hard, but I have never had anyone explain to me why it is or if it really is.
I would be interested in a break down of why the hospital systems are being over run as well, because I believe that COVID is a factor but I also believe there are contributing factors that aren't being talked about such as low recruitment (this had been talked about for years prior to pandemic) and retention. I have a lot of nurses and NAs in my family and all of them have been railing about the situations in their respective institutions for as long as I can remember. This is circumstantial, I admit, and I am open to being wrong, which in this case would mean the things I mention are negligible factors.
I also would love to know more about treatment of COVID and how it has evolved.
Lot of research to do.
Lots of your comment touches on opinion stuff that I may (hopefully) address in a future post (my fling with anti-monopoly politics makes me inclined to look at the hospital system through a very particular lens these days), so suffice to say I see where you're going with that hospital system thought and I'll leave that be.
"I would be interested in what these numbers would be if broken down by other health factors, which I assume could be derived from national statistics. I have had COVID now at 40 and it was incredibly mild. I am 40 but also am physically fit and have pretty good nutrition habits."
At first I thought this data didn't exist, but, now that I'm thinking about it, I suspect I could use an odds ratio to derive this for one (but only one!) health factor per age group.
I'm thinking obesity, which I understand is the most common and biggest covid risk factor other than age. Might be quite interesting. But woof I gotta recharge my batteries before I look at this spreadsheet again! :)
Another interesting thing will be if COVID is actually good for the healthcare system long term. If the increase in salaries and positions bring about a better pipeline of recruits. Much like war is good for certain aspects of society (emphasis on certain of course).