A Lesson in Mortality

Clearly the coronavirus outbreak has aroused the fear of dying that is always just beneath the surface of awareness. Most of us are closer to being snowflakes than warriors, and thus secure in our artificial physical and cyberspaces. With only virtual threats serving as entertainment, the notion that we could actually die from an unseen virus is terrifying.

Meanwhile, mass media is following the global warming/climate change game plan: Hose the public with a tsunami of large numbers, guaranteed to cow them into fearful submission. That approach backfired with climate claims since anyone who bothered to check could verify that nothing out of the ordinary has yet happened. But the viral emergency is different: It is happening and people are dying from Kung Flu! Or are we again being besieged with numbers out of context in order to feed on our fear of mortality?

It occurred to me that unless you are a public health professional or an actuary, you pay little or no attention to morbidity statistics, and thus have no basis to judge how serious is this crisis. For example, every day In every province, elected officials along with health officials are messaging us that things are dire, even “unprecedented”, and all we can do is put our lives on hold in order to save them. I am following the restrictions but can’t help wondering about the level of exaggeration.

For example, here are some mortality facts in Canada, where I live. Source: Deaths and age-specific mortality rates, by selected grouped causes, Statistics Canada.

ln the last reported statistical year (2018) the top twelve causes resulted in 209,290 deaths, or 574 people dying every day. When we add in the less lethal killers, in 2018 in Canada, 283,706 people died, or 777 every day. This is not abnormal, but is the ongoing reality of our society where lives end for all kinds of reasons to make room for infants to be born and take their place among us. Below are the tables for the last five years to show how this level of mortality is our ordinary state.

Canada Leading Causes of Death

Causes of Death 2014 2015 2016 2017 2018
Cancers 77,059 77,054 79,084 79,844 79,536
Heart Disease 51,014 51,534 51,396 53,029 53,134
Arteries 13,573 13,795 13,551 13,893 13,480
Accidents 11,724 11,833 12,524 13,894 13,290
Chronic Lung Disease 11,876 12,573 12,293 12,847 12,998
Flu and Pneumonia 6,597 7,630 6,235 7,396 8,511
Diabetes 7,071 7,172 6,838 6,882 6,794
Alzheimer’s 6,410 6,587 6,521 6,675 6,429
Other infections 4,881 4,964 4,168 4,272 4,578
Suicides 4,254 4,405 3,978 4,157 3,811
Kidneys 3,098 3,129 3,054 3,270 3,615
Liver 3,126 3,176 3,385 3,425 3,514
Total Top 12 Causes 200,683 203,852 203,027 209,584 209,690
Total All causes 258,821 264,333 267,213 276,689 283,706
Population 35,437,435 35,702,908 36,109,487 36,543,321 37,057,765

There are many things to note here. The diseases of cancers, heart and arteries dominate in the aged cohorts of our society, and show that the bulk of the population is not threatened by diseases that wreak havoc in many parts of the world. Note how far down is the batch of other infections, including such as malaria, cholera, HIV. The overall death rate in Canada is about 0.75% of the population each year.

With the Wuhan virus raging, our attention is drawn to the middle portion of the figure: deaths caused by lung failure. Chronic lung disease kills more, but close behind is flu and bacterial infections leading to pneumonia. This is important because Kung Flu in its severe manifestation is essentially viral pneumonia.

All of the deaths in the tables above are identified according to the International Classifications for Diseases.  On March 24, 2020 a new ICD code was established to designate deaths caused by Covid 19.

The notice included these instructions:
The WHO has provided a second code, U07.2, for clinical or epidemiological diagnosis of COVID-19 where a laboratory confirmation is inconclusive or not available. Because laboratory test results are not typically reported on death certificates in the U.S., NCHS is not planning to implement U07.2 for mortality statistics.

Will COVID-19 be the underlying cause? The underlying cause depends upon what and where conditions are reported on the death certificate. However, the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.

What happens if the terms reported on the death certificate indicate uncertainty? If the death certificate reports terms such as “probable COVID-19” or “likely COVID-19,” these terms would be assigned the new ICD code. It Is not likely that NCHS will follow up on these cases. If “pending COVID-19 testing” is reported on the death certificate, this would be considered a pending record. In this scenario, NCHS would expect to receive an updated record, since the code will likely result in R99. In this case, NCHS will ask the states to follow up to verify if test results confirmed that the decedent had COVID19.

The impact of this coding policy is seen in Canada’s record of Covid deaths.  From the first identified case on January 31, 2020, there were a total of 27 deaths reported as caused by Covid 19 over the 35 days up to March 24, 0.8 deaths per day.  In the last 13 days since the ICD was issued, 296 Covid 19 deaths have been added, an average of 23 per day. For context, note that in 2018 Flu and Pneumonia deaths averaged 23 a day, obviously much higher than that during winter months.

Comparing last year’s flu season to this one shows the last five weeks a sharp uptick in tests but with a sharp drop in positives . Could it be Covid19 making the difference? Note also the scale of testing is much higher this year, begiinning in January.  (Red line is Flu A, blue line is Flu B positives)

Worldometer showed on March 24, 2020, almost 19,000 Covid 19 deaths had been reported globally going back to January 23, an average of 305 per day over 62 days. After the code was announced, 50,533 Covid 19 deaths were reported in just 12 days, a daily average of 4211.

There are epidemic numbers being generated, and no doubt some places have seen hospitals overwhelmed (Lombardy, NYC, Tehran, etc.).  But is it really a pandemic (everywhere)?  And how many deaths from pneumonia and other causes are classified differently in this feverish environment?

The guidance will result in attributing deaths to Covid 19 in all cases where the virus was probably or certainly present. However, the experience so far shows that the large majority of severe cases include multiple serious conditions. Because the Mortality results are compiled more slowly (2019 is forthcoming), we have no way of knowing how many 2020 flu and pneumonia deaths have been counted as Kung Flu deaths instead of using the previous codes.

Indur M. Goklany commented on this issue: How to analyze and not analyze #COVID-19 deaths

Don’t look just at deaths from coronavirus, look at cumulative deaths from comorbidities. Since most people dying from coronavirus also exhibit comorbidities,[1] and it is unclear how deaths are assigned to the former rather than one of the co-morbidities and whether there is a uniform accepted methodology from one doctor to another (or one hospital to another or one country to another) in the assignments, it is not clear how much credence can be given to coronavirus death estimates at this time.

This also means that we shouldn’t attempt cross-country and cross-jurisdictional comparisons because they could mislead. It is best to look at (and compare) aggregate excess deaths from all co-morbidities rather than just one or another co-morbidity. I would suggest looking at excess deaths against an average over the last 5-10 years for both all-cause deaths and deaths from all coronavirus-plus- comorbidities to get an idea about how devastating coronavirus has been versus an average year.

I wouldn’t be surprised if at the end of the current period with most populated areas currently shut in by individual choice or government decree, once all the data are in, excess deaths for all causes are not negative relative to the 5- or 10-year average, since physical distancing should also reduce transmission of the flu (influenza and pneumonia kill about 50,000+ Americans annually)[2]. At least, I would hope that would be the case, so we can look back and see that some good came of our flattening our economy. At least one can hope.

Footnote: Meanwhile at least one doctor working with Covid 19 patients is questioning the medical paradigm identifying the disease as a viral pneumonia. 

Listen this short video:  Dr. Cameron Kyle-Sidell, a doctor treating COVID-19 patients in New York City’s Maimonides Medical Center, warns that the medical community may be wrong about the nature of the coronavirus and how it is said to cause acute respiratory distress syndrome (ARDS).

There’s no cooler way to get around Mazatlan, Mexico, than riding in an open air pulmonia. And yes, the name means Pneumonia in english. When these vehicles first became available and popular, traditional taxi owners started a rumor you could catch the disease from riding in them.

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