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Do Not Compare COVID-19 (Coronavirus) To Seasonal Influenza

Disasters Article News   (7,922 Views | 36 Replies | 967 Words)

42pines specializes in Occupational Health; Adult ICU.

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Do You Think COVID-19 and Seasonal Influenza Compare?

Increased awareness and preparation in schools about Covid-19 You are reading page 3 of Do Not Compare COVID-19 (Coronavirus) To Seasonal Influenza. If you want to start from the beginning Go to First Page.

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1 hour ago, Susie2310 said:

42pines, it seems that you have significant education/training in statistical methodology and epidemiology.  Your OP says that you specialize in Occupational Health, and I recall your OP also says that you have a degree in Chemistry.  Would you be willing to tell us about the education and courses you have taken, especially your education/training in statistics?  My understanding is that you are also a nurse.  Am I understanding correctly that you are an Occupational Health Nurse (or do you work in Occupational Health in another role) and also work in the ICU as a nurse?  How did you decide to enter the field of Occupational Health?

In regard to your OP and to your other comments on this thread, what is your opinion of the data that has been collected/publicized so far and the analyses of the data, including your reasoning/evidence for your opinions?

Edited by Susie2310

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And people actually believe the numbers coming out from the Chinese government?  My wife has a niece (she is from the Philippines) who is teachih in China.  From what she has told us, the death toll is way, WAY higher than they are letting on.  Think in the upper 5 to 6 figures.  Not 2000+..

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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Not to make the case for socialized medicine but the Netherlands, Germany, Norway and Sweden have around double the cases (confirmed) as in the United States, but haven't recorded a single death between them. What are they doing that our King County health system is failing to accomplish (keeping in mind that most of the deaths here are from older people many of whom are from a single institution)?

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Nurse and Spy has 26 years experience as a BSN and specializes in Disaster Medicine / Public Health / School Health.

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Thanks for this terrific article. And yikes, today I heard Dr. Peter Hotez say they are finding the fatality rate for older adults is 10-15%. He literally called it an "Angel of Death" for older people. 

I also found this quote in an article (https://www.foxnews.com/opinion/Dr-peter-hotez-west-coast-coronavirus-outbreak-highlights-3-vulnerabilities-we-need-to-urgently-address)

He wrote on the topic: "Reports from China in January and February found that the SARS CoV2 disproportionately kills individuals over the age of 60, with those greater than 80 years of age suffering mortality rates as high as 15 percent." 

And this: " We urgently need federal guidance from the CDC on how to best design and implement infection control practices for these facilities and prevent the spread of SARS CoV2 – a tragic and scary “angel of death” among our senior citizens."

His credentials: https://www.bcm.edu/people/view/peter-hotez-m-d-ph-d/b1846a47-ffed-11e2-be68-080027880ca6

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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I believe that the fatality rate is likely much lower than the 3% given by the WHO based on the fact that so few people can even be tested given a lack of covid 19 testing. Stated differently there are probably exponentially more people who are or have been infected with covid 19 than has been officially recognized. 

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On 3/9/2020 at 8:21 AM, myoglobin said:

I believe that the fatality rate is likely much lower than the 3% given by the WHO based on the fact that so few people can even be tested given a lack of covid 19 testing. Stated differently there are probably exponentially more people who are or have been infected with covid 19 than has been officially recognized. 

This has been my line of thinking as well.

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42pines specializes in Occupational Health; Adult ICU.

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From the article: “'Don't believe the numbers you see': Johns Hopkins professor says up to 500,000 Americans have coronavirus” and from the article: 'Don't believe the numbers you see': Johns Hopkins professor says up to 500,000 Americans have coronavirus.” 


“Ohio Department of Health Director Amy Acton said at a press conference alongside Gov. Mike DeWine (R) that given that the virus is spreading in the community in Ohio, she estimates at least 1 percent of the population in the state has the virus.”  “"We have 11.7 million people. So, the math is over 100,000. So that just gives you a sense of how this virus spreads and is spreading quickly."


I’ve never been more disgusted with our government and our public health system.  I wrote to my Senators on January 30th, and never even received an answer.  I’m disgusted that there has been little action, it smacks of utter incompetence.  One of the Boston hospitals wanted to develop their own test and indicated that they could, in fact do this, but FDC said “no.”


The reality is that it does not matter if the eventually CFR turns out to be 3% or Italy’s 7% or 1% or ½% I really don’t think this will turn out to be “just the flu.” 
To all you nurses out there on the front line, (however, there is no front line here, this will touch pretty much all nurses and Practitioners) take care!
 

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On 3/2/2020 at 12:13 PM, Nurse SMS said:

Timely and well outlined. I do wonder, though, at the "known cases" portion of the equation. With the limitations of available testing and the likelihood that many are infected and only get a mild case or even no symptoms, these mortality numbers may be skewed high.

I agree.  Right now, our "known cases" are going to be the most severe because they were allowed to be tested. The mild patients (basically, if you can talk you don't need to be tested, you need to go home) are not being added into the "known cases" count.

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On 3/4/2020 at 10:13 AM, 42pines said:

Correct, but misleading.  Simply stated: A case fatality rate of 3.41% stands only if every single case where the afflicted has not recovered, or died, will recover.

In other words, you are assuming that all remaining cases with unknown outcome will have no fatalities.

Nonetheless, my article's point is simply the "death" rate of the seasonal influenza over eight years is about one death in 750-1000 cases.

Using the 3.41% you have quoted means 34 deaths per 1,000 cases.

That means a death rate of about 34x that of the seasonal influenza.

Thus it is unwise for nurses to say: "oh, it's about the same as the flu."

On the other hand, the seasonal influenza has killed more this year already than has Covid-19 and we can lower that rate by immunization.  Both are important subjects for nurses.

I'm in no way comparing this to influenza, but during flu season, I've seen so many providers prescribe Tamiflu without bothering to lab test the patient first. What about them? They aren't swabbed, so are they officially diagnosed with influenza? Are we counting positive flu swabs only? There are many + flu patients who never went to the doctor.

Edited by 2BS Nurse

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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One of the best lines of evidence for a CFR of one percent or less is from the Diamond Princess Cruise ship as examined in this article  https://www.sciencenews.org/article/coronavirus-outbreak-diamond-princess-cruise-ship-death-rate  . This was a "closed system" where everyone was tested and followed intensely and their were six deaths out of around 700 infections. When the authors adjusted for the "older ages" of the cruise ship members (relative to the general population) they concluded it was likely that the actual infection fatality rate was closer to 0.5 of 1%. Again, if more tests were available we would likely see a case fatality rate that was much lower than WHO figures. 

Edited by myoglobin

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OK, so let's say the death rate is only 1%.  I place a bowl of 100 M&M's in front of you and tell you that one is actually cyanide and will kill you.  Would you take the chance and eat one?  

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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Of course not, but it is important to try and understand real risk levels so that we can make the most informed decisions about trade offs and risk to benefit analysis as we move forward. Thus as a healthy 51 year old I am considering exiting my home based psych tele psych NP position (where I am only getting about four clients per day) and going back to the ICU where I used to work (and can get $50.00 12 hour shifts all month long). For me the benefit of not going more delinquent on my bills may outweigh the risk of disease (which frankly I was probably exposed to six weeks ago in Seattle when many around me were sick with some sort of flu like illness). Of course to do this I would need to get a test to show that I am currently negative so as to not expose patients (potentially).

Edited by myoglobin

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