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Covid 19. Reopening: How to interpret Covid 19 statistics and the effect of age.

There are so many things happening around the country that covid 19 has almost gotten lost in the news.  This is the latest update on the statistics.

The news headlines may be somewhat misleading.  There are many headlines that reporting an increase number of covid 19 cases.  However, the question is, how do we interpret these numbers?  What numbers are indications of trouble to come and what numbers suggest that we are on the road to recovery?

The main headline has been that on Jun 12, 21 states reported an increase in the number of covid 19 cases.  However, a more granular look at the data provides some better insight.

Recall that the main reasons for a lockdown and stay-at-home orders were to minimize deaths and not to overflow hospital capacity.  The purpose was never to simply reduce the number of cases.

A reminder that at the peak of the Covid 19 infections in April, there were no hospitals that were overly full.  In fact, extra hospital beds provided by the USN Comfort in NY, USN Mercy in Los Angeles and thousands of temporary hospital beds in New York, New Orleans and other cities were not utilized.

 Further, in March and April that were predictions that said that we would be short on ventilators and that several thousand more would be needed.  These predictions turned out to be untrue.  There was never a ventilator shortage anywhere.

Not everyone will get infected.

A seldom reported experience is that some people appear to be immune to the covid 19.  This is seen on people who have been isolated on cruise ships and military carriers.  It appears on the cruise ships between 50-70% of the people get infected, the rest do not.  On a French aircraft carrier, 60% of the sailors got infected.  However, there were no deaths and only of the 1074 infected sailors required hospital type care. https://Berenson, Alex. Unreported Truths about COVID-19 and Lockdowns: Part 1: Introduction and Death Counts and Estimates . Kindle Edition.

Who is dying from covid 19?

In a previous blog, it was reported that 42% of all covid 19 deaths occurred in nursing homes.  However, deaths can also be analyzed as function of age.  World wide, median age of people who died  from covid 19 is 81 years old.  That is, half of the people who died who died from covid were 81 years old or older.42% of covid 19 deaths were in nursing homes and assisted living facilities

In New York, as of May 28, almost 40 percent of the 23,700 reported deaths occurred in people over 80. (https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Fatalities?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n)

In Minnesota, the median age of the 1,000 COVID deaths is almost 84. More people over 100 have died than under 50.http://(https://www.health.state.mn.us/diseases/coronavirus/stats/covidweekly22.pdf)

The flip side of the risk to the elderly is that younger adults and especially teenagers and children are at extremely low risk from SARS-COV-2. In Italy, a total of 17 people under 30 have died of the coronavirus. In the United Kingdom, four people under 15 have died. In New York, 14 under 20 and 102 under 30. Worldwide, it is almost certain that more people over the age of 100 than under 30 have died of SARS-COV-2. Many more children die of influenza than coronavirus; in the 2019-20 flu season, the Centers for Disease Control received about 180 reports of pediatric flu deaths. It has received 19 reports of coronavirus deaths in children under 15 so far.

How to interpret increasing number of cases.

There were no patients that were denied access to medical care or ventilators due to overcrowding.

It is difficult to interpret reports simply on the number of covid cases.  This is because each area has a different and changing number of tests being run.  In general, there are more tests being run each day than the day before.  This alone could account for the increase in the number of cases.  For this reason, a better assessment of our ability to cope with covid 19 cases are the hospitalizations (number of people sick enough to need hospital care) and the number of covid 19 caused deaths.

Questions you should ask yourselves when reading about covid 19 statistics, especially number of cases.

  1. Where are the increases in cases occurring? In isolated, bounded areas or are they evenly distributed.  Recall from earlier blogs that 42% of all covid fatalities occurred in nursing homes.  Also, in each state there were just a few counties that accounted for well over half to two thirds of the number of cases is the state.  Am I in area where there are lot of cases?
  2. Who is getting infected? Especially, what age group?  We now know that the vast majority of fatalities were in people over the age of 70 with pre existing conditions.  The fatality rate of people under is not higher than many other diseases and causes of deaths.
  3. It has been over a month since protests involving thousands of people that were not practicing social distancing and/or wear masks. Are any increases in cases due to this?
  4. Are the number of hospitalizations going up so fast that the hospitals can’t handle the number of patients?
  5. Is the fatality rate going up or down?

 CONTINUE TO KEEP SOCIAL DISTANCING WHEN POSSIBLE.WEAR A MASK IF YOU ARE IN A CROWD.STAY HOME IF YOU DON’T FEEL WELL.

The headlines are that on Jun 12, 21 states reported increases in covid 19 deaths, but only 9 of these reported increased hospitalizations.  Further, in general the number of total US deaths is decreasing.  As seen in the chart below:

 

It is also important to note that it has been over 2 weeks since the first protests involving thousands of people who were not social distancing and many were not wearing masks masks.  To date, there has been no increase in hospitalizations or deaths in any areas where these protests took place (Minneapolis, New York, DC etc.)  This is yet another indication that covid infctions are depending on location, age and other factors – stay-at-home and lockdowns effectiveness is being questioned more and more.

I have provided from three states for discussion, California, Texas and Florida.

From the chart below, it appears that the number of cases has increase in past week.

CALIFORNIA

However, the following chart shows that the number of deaths has NOT increased during this same time period and remained more or less unchanged for weeks.  The number of hospitalizations has NOT increased with the increasing number of new cases.

It is also reminded that the cases in Calfirornia are very location dependent.  Of the 150,267 cases reported in Ca, 72,023 have occurred in Los Angeles (48%).  Of the 5062 covid 19 fatalities in Ca, 2890 have occurred in Los Angeles (57%).  The county with the second number of fatalities is Riverside with 383 deaths.  It very much makes a difference where you live.

NEW YORK.  New  York has received the most attention throughout the covid 19 crisis because it leads the nation as the state with the most cases and the most deaths.  However, the following charts show that there has been a dramatic decreases in both cases and deaths for New York.

 

 

 

 

TEXAS.  Similar to Ca, the number of cases in Texas has increased but the number of deaths has not.  There has been an increase in hospitalizations for Texas, but they are well under their maximum number of beds available.  There were over 2000 covid 19 hospitalizations in the past 2 weeks but there are over 31,000 hospital beds in the states.  There is substantial hospital space in Texas so time will tell if the number of serious cases continues to rise.  It is a very good sign that the number of deaths has not increased during this same time period.

Similarly, Florida reported the highest single day number of new cases, 2500.  However, the number of deaths did not increase correspondingly, More importantly, there was not a signficant increase in hospitalizations.

 

 

 

42% of covid 19 deaths were in nursing homes and assisted living facilities

The United States has reported 102,294 deaths from Covid 19 on 5/29/2020.  Each day that passes, more is learned of the virus and how it exactly impacts our society.

A very surprising fact became apparent this week, that was not previously noticed or highlighted..

42% of covid 19 patients were in nursing home or assisted living facilities.  This is an incredible statistic, as the number of patients in these places only account for 0.6% of the total US population.

Nursing homes are residential facilities for those needing 24/7 on-site medical supervision; assisted living facilities are for those not needing 24/7 medical supervision.  An estimated 2.1 million people live in nursing homes and the vast majority (>90%) are over the age of 65.

This finding has many important implications.  First although it has been known for some time that the most at risk group was over 65 with some pre existing conditions, it turns out that being in a nursing home is a significant risk factor.  This means the fatality risk of not being in a nursing home is lower.  Less than 1% of the population accounts for 42% of all covid 19 deaths.

Because nursing homes are remain ‘hot spots’ for covid deaths and cases, it may be difficult for some states or area to achieve mandates such as no covid deaths for a number of days.  The deaths may be limited to within specific nursing homes and not a reflection of areas outside the nursing home.

In addition to maintaining social distancing and handwashing, it remains prudent ot wear a mask if you are around others and most important, elderly in nursing homes and restricted spaces should receive extra care and attention to avoid infection.

In the US, two states, New York and New Jersey and nursing homes have contributed to well over 50% of the covid deaths.  This raises the question regarding the overall effectiveness of general  business shutdowns and stay-at-home policies.  Only additional data and study will be able to sort this all out.

There are an estimate 49 million people in the US over the age of 65.  Over 80% of the US covid 19 deaths are from people over the age of 65.  This would correspond to 81,000 deaths.  This corresponds to a fatality of .2%/million people over 65.

However, the fatality rate of being in a nursing home is 6.76% or 30x higher than not being in a nursing home.

The following presents the percentage of deaths that occurred in nursing homes for all 50 states.  The highest fatility rate was in Minnesota where an incredible 81% of covid deaths occurred in nursing homes and the lowest being NY with 20%.  Interestingly, NY has a low percentage of covid 19 deaths in nursing homes because the number of deaths in NY outside of nursing homes is also the highest in the nation.  This will be discussed in further detail below.

Looking at this another way, nn the basis of covid 19 nursing deaths/million people, New Jersey has the highest with 954 deaths/million and Wyoming is the lowest with 7.  This can be seen in the map below.

Some comments on some key individual states.

Florida

Nursing home and assisted living covid 19 deaths account for almost 40% of the 2400 of the states covid deaths.  There are an estimated 155,000 people living in Florida nursing homes.  This is .07% of the population of Florida accounting for 40% of the deaths.

https://www.clickorlando.com/news/florida/2020/05/09/florida-reports-650-coronavirus-deaths-at-nursing-homes/

California

49% of all Covid 19 deaths in California occurred in nursing homes or assisted living facilities.  387 nursing homes have reported deaths with many of them clustered around Los Angeles.

The highest nursing home death toll in the state remains at Redwood Springs Healthcare Center in Tulare County, where 28 residents have died.

https://www.latimes.com/california/story/2020-05-08/california-coronavirus-deaths-nearly-half-linked-to-elder-care-facilities

Minnesota

In Minnesota, 80% of the covid 19 deaths have occurred in nursing homes and assisted living facilities.  The number of residents in these institutions are less than 1% of the population of Minnesota.

 New York

On May 10, there were an estimated 5300 covid 19 deaths in New York nursing homes and assisted living facilities.  This is almost 3x more than the deaths in the entire state of Florida.  However, so many have died outside of nursing homes (highest in the country), that the percentage of covid 19 in NY nursing homes is one of the lowest in the country.

https://abc7ny.com/nursing-home-deaths-cuomo-criticized-in-new-york/6168676/

The U.S. is not an outlier in terms of its nursing home-related COVID-19 fatalities. A study by researchers at the International Long Term Care Policy Network of fatalities in Austria, Australia, Belgium, Canada, Denmark, France, Germany, Hong Kong, Hungary, Ireland, Israel, Norway, Portugal, Singapore, South Korea, Spain, Sweden, and the United Kingdom found that 40.8 percent of reported COVID-19 fatalities took place in nursing homes.

Final note:  I am NOT trying to downplay the seriousness of Covid 19.  Each death tragic.  However, these discussions are hoped to provide information about the numbers and comments you receive by other means in some context.  Also, it is hoped that this information will lead to better policies, decisions and improved health of our country.