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ET – First, your hypothetical death. No, that’s not where I’m coming from. I am speaking only of causes of death on death certificates.
‘Is all the data that states that so many people died from car accidents or ovarian cancer or alcoholism or knife crime or whatever else wrong?’
Not at all. If a death certificate states that death occurred as a result of heart failure (direct cause) due to internal bleeding, as a result of being hit by that damn bus again, then the bottom of line 1 will show one of the numerous ICD codes relating to accidental death, specifically the one relating to buses. We may safely add this death to the number of people ‘killed by buses’ or ‘killed in road accidents’ because it is the UNDERLYING cause. We can also use the other information on the certificate to produce other stats which may be useful, such as ‘in all deaths by bus, x percent involved internal bleeding’ or ‘heart failure is the result of internal bleeding in x percent of cases’ or even use the line 2 info to say ‘x percent of people suffering from diabetes are killed by buses’. What we cannot do is simply add up all the occurrences of ‘internal bleeding’ from all death certificates and announce ‘Internal bleeding caused x number of deaths’. Because it would be a rubbish statistic and totally unreliable as a basis for decision making.
I did look at the WHO guidance for death certification and recording. According to this Covid-19 must be at the bottom of line 1, i.e it must be the underlying cause of death, to be counted. They give a number of useful examples where there are co-morbidities. For instance, a death certificate which has 1a Acute respiratory distress syndrome due to 1b covid-19 due to 1c HIV, would be a certification error, as HIV should be on line 2. Another example has 1a heart failure due to 1b myocardial infarction, with covid-19 listed on line 2 i.e. in the ‘other significant factor contributing to death’. In big red letters it states This is NOT a covid-19 death.
The guidance also notes‘Deaths due to COVID-19 are different from COVID-19-related (or COVID-19–associated) deaths. These may be deaths due to accidental or incidental causes, or natural causes when COVID-19 is not identified as the underlying cause of death according to ICD coding guidance (see Section 4.2)’
On the other hand, the ONS states ‘For overall counts such as in the weekly deaths release, the Office for National Statistics (ONS) uses the concept of “deaths involving COVID-19”, which means any mention of U071 or U072 anywhere on the certificate.
The start of this exceeding tortuous discussion was initiated by Duck’s suggestion that perhaps the lower death rates in Asia might be accounted for by differing methods of recording. Perhaps he was right.
ET (and SA, for I saw your comment before it was lost), you’re making a mistake. Steph has literally called me all sorts of names (I listed them earlier) because, it seems, Steph interprets criticism as insult – which is very common these days, and explains much of what is wrong in our deteriorating world; criticism has become taboo, and all “views” have to be accorded equal “respect” – I personally have even heard child sacrifice defended on the grounds of “respecting” other cultures. As best as I remember I have not called Steph any names; the closest I have come was months ago when I called her opinions “ill informed”.
What I have done, which you have apparently misinterpreted as “attacking the person”, is that I’ve pointed out what appears to me to be a manipulative emotional dynamic of praising the personal qualities of public spokespeople who play down the severity of the pandemic, and maligning me. I did so precisely because of its potential to manipulate, both those of us commenting, and other readers – “Ooh, nice people say the virus is no problem, whereas nasty people say it is – and I want to be thought of as nice, not nasty”.
Such tactics both act, and are deployed, subconsciously; to Steph I presumably seem like a nasty person, precisely because I stress the severity of the pandemic, and indeed Steph accused me of not caring about human rights; an accusation she has never retracted. My defence, both of myself and of objectivity about the pandemic, is to bring the matter to consciousness
– – – – – – –Further, Steph has scoffed at me for dismissing conspiracy theory as conspiracy theory. I have therefore asked Steph to discuss conspiracy theory with me, but she acts as if she hasn’t read my request. I have asked why she won’t discuss it, and she acted like she hadn’t read that either. This should be a warning sign; there is some reason why Steph wishes to avoid the subject, and Steph hides that reason. From our experience of “commercial confidentiality”, “national security” etc., we should have learned that secrecy is all about maintaining some sort of advantage, nearly always an unfair one. Whether it’s the sources of claims of WMD in Iraq, or vioxx causing heart attacks, secrecy kills.
ET and SA, you don’t get insulted by Steph, but then you’re permitting her to set the agenda. You’re discussing the minutiae of death certification, but that entire field has already been settled by the data. You’re permitting yourselves to be drawn into generating reams of “controversy” where none should exist – covid-19 has killed tens of thousands of people in the UK – the various graphs place that beyond reasonable doubt, but the longer you play by Steph’s rules on Steph’s playing field, the more unreasonable doubt you will help create. And that appears to be precisely what Steph wishes to achieve.
And while I was composing my comment, Steph scored again:
– “The start of this exceeding tortuous discussion was initiated by Duck’s suggestion that perhaps the lower death rates in Asia might be accounted for by differing methods of recording. Perhaps he was right.”
Duck was pushing the conspiracy theory that there is no pandemic; it is merely a fiction produced by a vast international conspiracy of governments, scientists, doctors and statisticians, to rob the general population of their liberty. “Perhaps he was right”.
I already described a conclusive test for this; examine the various graphs for those Asian countries – general mortality against time, infection numbers against time, and covid-19 mortality against time.
– “Doubt is our product,” Michaels quotes a cigarette executive as saying, “since it is the best means of competing with the ‘body of fact’ that exists in the minds of the general public. It is also the means of establishing a controversy.” Michaels argues that, for decades, cigarette manufacturers knew that their product was hazardous to people’s health, but hired mercenary scientists who “manufactured uncertainty by questioning every study, dissecting every method, and disputing every conclusion”. In doing so the tobacco industry waged a campaign that “successfully delayed regulation and victim compensation for decades”
Doubt is Their Product – Wikipedia
So, Steph, how could misclassification of cause of death cause huge peaks in the general mortality graph? And why do those peaks track the covid-19 mortality graph, and track the covid-19 infection test results after a delay of around two weeks?
Clark – Just so you are aware. Apologies. Rude though it undoubtedly is, I henceforth refuse to engage with you at all.
Just answer the question Steph:
How could misclassification of cause of death cause huge peaks in the general mortality graph? And why do those peaks track the covid-19 mortality graph, and track the covid-19 infection test results after a delay of around two weeks?
Others, if Steph indeed refuses to answer when I ask this, I think you should ask it as well. This is the question that cleaves the death certification “controversy” at the joints. Do not permit yourselves to be dragged down into irrelevant detail again.
‘Autoantibodies’ may be driving severe Covid cases – Guardian
– “Researchers at Yale University found that Covid-19 patients had large numbers of misguided antibodies in their blood that targeted the organs, tissues and the immune system itself, rather than fighting off the invading virus.
– The scientists compared immune responses in patients and uninfected people and discovered scores of aberrant antibodies in the former. These blocked antiviral defences, wiped out helpful immune cells, and attacked the body on multiple fronts, from the brain, blood vessels and liver to connective tissue and the gastrointestinal tract.
[…]
– Ring said that if Covid-19 autoantibodies endure in the body they might play a part in long Covid. “Post-Covid syndromes could plausibly be caused by long-lived autoantibodies that persist well after the virus is cleared from the body,” he said. “If this is the case, there are immunosuppressive treatments, such as those used for rheumatological diseases, that could be effective.” Long Covid is thought to affect about 10% of 18- to 49-year-olds, rising to one in five among the over-70s.”– – – – – – –
This is another reason I think wrong to concentrate only upon mortality rates – the denialists and trivialisers mention nothing but the mortality rate, doing everything they can to minimise it and cast doubt upon the statistics, and of course repeatedly reminding us that covid mostly kills the old, as if that makes it OK.
Conversely, the denialists and trivialisers never mention long term effects upon people in the prime of life, and never mention the mortal suffering that would ensue from healthcare systems becoming overloaded – except to pretend that it wouldn’t happen, of course.
https://www.medrxiv.org/content/10.1101/2020.12.10.20247205v3.full.pdf
I read that also today. Above is a link to a .pdf of the paper.
E.T. and Clark
Thanks for this. There are in fact some references to this phenomenon of multiple autoantibodies in Covid-19 patients and of course the cytokine storm is very well described in severe cases. However the detection of autoantibodies does not necessarily translate to autoimmune disease but may just be related to a very potent polyclonal activation of the immune system. The effects of these autoantibodies on cytokines (the messenger proteins that produce the immune and inflammatory response) is not always consistent and may even enhance the effects of the cytokines. On balance the immune system is turbocharged in these patients, hence the cytokine storm and to me therefore the description of these auto-antibodies, their lack of specificity and consistency in effect amounts at present to an observation and a result of this immune activation but the effects on the long and short term immunity is yet to be defined. At present the main worry in fact is hyperactivity of the immune response rather than suppression of immunity.As to focus on mortality referred to above by Clark, these are some considerations:
1. The overall infection mortality rate has been estimated as between 0.2% and 1% in large series. In fact the mortality groups is much higher, at almost 10% in those above the age of 70. In fact the existence of co-morbidities, another risk factor is also very prevalent in that age group. Take GB for example, there are about 3.1 million above the age of 80 years and 4.5 millions between 70 and 79 years of age. Then there are about 5 million diabetics and also about 15-20 % of the populations are obese. These figures mean that the at risk groups are approaching a third of the population and all these risk groups have a mortality in excess of 1% and in some cases perhaps several percent points.
2. As also pointed out morbidity is an extremely important factor. With each wave there is an increase in hospital admissions and admissions to hospital as the denominator which will indicate how saturated NHS capacity is. The Guardian publishes daily figures in a dashboard together with weekly increments of daily number of cases, hospital inpatients, and deaths, but no denominator for hospital beds. The number of general hospital beds in UK is about 106,000 which suggests that about twenty percent of hospital beds are now occupied by patients with Covid 19. There is also a high percentage of bed occupancy which is near capacity often and leads to the usual winter bed crisis. These factors are not much talked about by those who wish to ignore the impact of Covid 19.
3. There also long term effects as mentioned above.
4. The impact of milder cases especially amongst frontline workers would also have an impact on services and the economy.https://www.bbc.co.uk/news/stories-55280321
A story about a contract tracer’s day……………
“For example, when I asked one person to go through the questions with me, the answer was: “Oh I can’t just now – because I’m in Starbucks.” Now, this person has had a positive test and should be isolating. They’ve had a text telling them they are Covid-positive, yet they are still out in Starbucks infecting other people”@SA
It’s a dense article, I’ll have to read through it a few times. I think they are suggesting that the autoantibody response to a plethora of tissue and immune related protiens correlates with severity and variation in clinical effects of covid-19.
I don’t know if you meant this but I don’t think they are relating this to future immunity.What are the rulers playing at, shouting “Everyone get vaccinated!” and “Watch out – there’s a new strain about!” simultaneously?
Is it a case of where there are countermeasures there’s a market for counter-countermeasures?
Or is it just a classic way to induce “learned helplessness”, by telling people one thing and then telling them the opposite, so they very quickly don’t know which way is up?The percentage of the population that knows that the virus that everybody has been talking about for almost a year is a strain of SARS is probably less than 1%.
I clicked to this moronically-titled article – “How a new Covid strain may have spread virus in south of England” – and was about to go postal over its being penned by the Guardian’s so-called “science” editor Ian Sample, but in the body text he doesn’t confuse the virus with a syndrome of symptoms, so that would be his excuse. “The subs did it.” But far more people will read the headline than the main text.
E.T.
Yes it is dense. Yes what you say is true. It is a sort of misdirected exaggerated response which doesn’t translate to effective immunity and can correlate with disease severity.SA, 17:18:
– “The overall infection mortality rate has been estimated as between 0.2% and 1% in large series”
1) As I understand it, the more rigorous estimates are near the top end of that range, and some good figures are higher, eg. New York, estimated from excess deaths and serology random sampling, 1.4%; Diamond Princess, where absolutely everyone was both accounted for and tested, 13 deaths from 712 cases, over 1.8%.
2) Overall infection mortality rate has been falling as doctors learn how best to treat the serious cases.
3) All the figures above are for infection mortality rate with most people who need it receiving hospital treatment; we maybe need to double or even triple those figures if hospital isn’t available – and if we let the hospitals overload, this higher figure is the one that will apply to the vast majority for whom there are no beds left.
Hospitals now overloading in Stockholm.
A report in the Sunday Times over the weekend suggests that the decision not to impose “circuit breaker” restrictions was influenced by a meeting involving the prime minister, the chancellor, and three proponents of a “herd immunity” approach to managing the virus: Prof. Sunetra Gupta and Prof. Carl Henegan, University of Oxford, and Prof. Anders Tegnell, Swedish epidemiologist.
Sunetra Gupta has been given extensive coverage in the corporate media, claiming that far more people have been infected than serology surveys indicate. We wouldn’t be having the current wave if Gupta had been right. Her position contradicts the scientific consensus.
Carl Henegan made an appearance on this thread on Nov 26, for his article in the right-wing Spectator political magazine that contradicts the scientific consensus that use of masks reduces cross-infection through source control.
And Anders Tegnell…
Anders Tegnell designed Sweden’s catastrophic covid control policy, so much praised and promoted by the covid deniers and trivialisers; “Sweden has no lockdown!!!”. As recently as late October he was predicting that Sweden’s second wave would be tiny compared to its first. Now, as current hospital occupancy breaks Sweden’s own record set in April, Tegnell at last admits that he was wrong.
– – – – – – –Cherry picking.
The prime minister cherry picked three “experts”, all three of whose “expert” opinions contradicted the scientific consensus. He included in that meeting the chancellor, whose job, correct me if I’m wrong, is all about money.
How utterly sick I am of opinion. Steph directed many insults at me, but the only one she got right, I do not regard as an insult. Yes, I am angry. Angry with the deniers, trivialisers and conspiracy theorists, and especially the fuckwit politicians who think they can pick and choose “experts” to suit their neoliberal economic agenda.
We’ve got over three months until the end of coronavirus season and the weather gets good enough for most activities to occur outdoors, plus all the social mixing of Christmas and the New Year is immanent. Our current UK infection level is rising fast and appears to be equivalent to that in about the first week of April.
Except then, the good weather and the end of coronavirus season were just arriving, whereas now we have months ahead with perfect conditions for infections to soar.
N_ – “What are the rulers playing at, shouting “Everyone get vaccinated!” and “Watch out – there’s a new strain about!” simultaneously?”
They can shout “Everyone get vaccinated!” all they wish but it doesn’t make it so; actually making, delivering and administering over a hundred million of doses of vaccine (two shots per person) that has to be stored at around minus seventy centigrade is a major logistical challenge, and enough doses to make much difference are unlikely to be administered before coronavirus season declines of its own accord in spring.
They have to shout “there’s a new strain about!” because they can’t suppress this news – and because the new strain looks likely to be a big problem. Probably a descendant of the strain that overran the entire Danish mink farming industry – now also in the US mink industry, and the wild US mink population – the new wonder vaccine may be only 25% effective against it, and it can yield false negatives in PCR test.
– “…the virus that everybody has been talking about for almost a year is a strain of SARS…”
Yes, and so we very much hope that SARS-CoV-2 doesn’t mutate to become more like its older cousin SARS-CoV, which has a 10% to 20% fatality rate.
Now Clark you are being alarmist. Where did you get that the new strain is not detected with PCR and that vaccine is only 25% effective?
SA:
Screening of the H69 and V70 deletions in the SARS-CoV-2 spike protein with a RT-PCR diagnosis assay reveals low prevalence in Lyon, France
– “The H69 and V70 deletions in SARS-CoV-2 spike protein have been detected in mink and human infections. We found that these deletions resulted in a false negative result for the spike target of a commercial RT-PCR assay. […] A SARS-CoV-2 variant detected both in minks and humans in Denmark has raised concerns about mutations associated with potential reduced susceptibility to neutralizing antibodies. […] To address the risk of spreading, an easy-to use method enabling a fast large-scale screening is urgently needed.”
The Twitter stream of Dr Emma Hodcroft (@firefoxx66) broke the news of which variant was spreading in south east England; this thread of hers says a lot that I agree with:
https://twitter.com/firefoxx66/status/1338474451944476674
MODS, I left that link raw; if it embeds content into this thread, I’m happy with that.
SA, I regard my attitude as cautious rather than alarmist. This is a very new virus; better to suppress it vigorously now than to discover nasty surprises after it’s too late for millions already infected. With vaccine development proceeding at record pace, and the end of coronavirus season in Spring, a bit of patience with unpleasant restrictions will save lives and could pay off enormously. Very frustrating that we have a bunch of cherry-picking semi-denialist politicians in Westminster who insist upon imposing neoliberal economic conditions that deprive people of choice about when and how to work.
Everyone think for a moment. Twice now in the UK we’ve seen that the number of infections falls very fast when social restrictions are applied. We’ve seen China suppress a massive outbreak and get it almost under control; their lockdown ended months ago, and now they’re on track, trace and quarantine.
If the “more developed” nations had followed the WHO’s warning and China’s example and vigorously suppressed this virus in February, SARS-CoV-2 would have been deprived of hundreds of millions of hosts, and these new variants would have had almost no opportunity to develop, nor to spread.
The longer we leave it, the more we let it spread and the worse it gets! In this sense it is very much like global warming, “a stitch in time saves nine”; even our great grannies knew that. But then they repaired things for themselves instead of forever throwing stuff “away” (wherever that is) and buying new all the time.
Clark
I agree caution is needed and this report from the WHO is interesting to read.Initial observations suggest that the clinical presentation, severity and transmission among those infected are similar to that of other circulating SARS-CoV-2 viruses. However, this variant, referred to as the “cluster 5” variant, had a combination of mutations, or changes that have not been previously observed. The implications of the identified changes in this variant are not yet well understood. Preliminary findings indicate that this particular mink-associated variant identified in both minks and the 12 human cases has moderately decreased sensitivity to neutralizing antibodies. Further scientific and laboratory-based studies are required to verify preliminary findings reported and to understand any potential implications of this finding in terms of diagnostics, therapeutics and vaccines in development. In the meantime, actions are being taken by Danish authorities to limit the further spread of this variant of the virus among mink and human populations.
Later on it states that they do not advocate travel ban to and from Denmark. It also seems that this mink strain has also been found in mink farms in Holland and the states and one of the Baltic countries. A non-human farmed animal or wildlife reserve for the virus is indeed worrying.
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