Underlying conditions, age, and deaths in NYC

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To summarize this table (pointer from Russ Roberts):

Of 1584 Covid deaths, 25 were people with no underlying conditions, 380 were people with “underlying conditions pending,” which I guess means that they are not sure whether or not the person had an underlying condition, and the other 1179 all had underlying conditions.

Of those with “pending underlying conditions,” 234 were aged 75 and over. So another way to look at the data is that of the 1584 deaths, 1413 either were aged 75 and over or had definite underlying conditions. That is 89 percent.

Perhaps those of us under age 75 and healthy ought to be given more freedom to go out in public, provided that we wear face covering. Also, it would help to sort out which “underlying conditions” really matter, to know who should be considered healthy.

30 thoughts on “Underlying conditions, age, and deaths in NYC”

  1. Being in the 89 percent means you disappear in the statistics. The annual statistics come out and it doesn’t make any difference to the numbers whether you were pulling through as late as Christmas.

    The annual statistics don’t discriminate between Christmas and Easter. We care a lot about the difference between Christmas and Easter because we read the news feed all day. But in a history book there’s no spike or uptick or any perceptible difference between this year and the year before or the year after.

    A hundred years from now we look back and nothing stands out about 2020 in terms of the death rate. The unemployment rate, on the other hand, shoots up in 2020. There’s just nothing visible going on with the death rate, because this virus doesn’t target everyone.

    The 89 percent are invisible to history. When you take the long view you see the spike in bankruptcies and the spike in suicides, but the virus itself is invisible.

    • “””A hundred years from now we look back and nothing stands out about 2020 in terms of the death rate”””

      I’ve actually been hunting to see if anyone has been tracking the all-cause death (or hospitalization) rate *now*, and comparing cities/states/countries that locked down at different times.

      But I haven’t seen it.

      Though possibly that rate would be too noisy over a short time window?

      • I believe this should be a top priority for a group within the CDC to what extent we are seeing an increase in death rate and to what extent it’s a shift in category of death.

        In corp America, these folks are analytics groups and they track sales around new initiatives to inform managers to what extent new initiatives drive incremental business and to what extent those initiative shift business from other categories.

        It’s not always perfect, but there are ways to get early contextual guesstimates before the all the data is in, like comparing to historical trends.

        For example, in the US it’s typical for about 230,000 to die in a month, while the U.S. has had about 7,000 deaths with COVID over the last month that we know about. So, if number of deaths have been in-line with historical averages, known COVID deaths make up 3% of the total deaths.

        We can also look at the composition of that 7,000. If NYC’s 89% is representative of US COVID deaths and if people >75 typically make up 89% of all deaths…does this change the way we feel about the numbers?

  2. It would also be worth knowing what % of people in each age group are classified as having an underlying condition as a control; I imagine most people in the oldest group have at least one underlying condition.

    Another really interesting thing about that table: it looks like Manhattan has the fewest cases per capita of any borough by far, despite having far and away the highest population density. Even Staten Island has far more cases per capita. Perhaps population density – at least at the very local level – doesn’t matter as much as one would think.

  3. “Perhaps those of us under age 75 and healthy ought to be given more freedom to go out in public”

    To answer this we’d need to know, % admitted to ICUs by age and prior health problems and the fatality rate by age/health conditional on not receiving ICU care.

  4. Voluntary sequestration and assistance for the elderly. The rest of us run the gauntlet.

    As we have a novel virus and a naive population, and there is no prospect of a vaccine for at least eighteen months, we should take the least-bad option. Go back to normal.

    Wrecking the economy and then proffering debt peonage to corporations and individuals strikes me as a very bad option.

  5. We should totally base decisions on the first data that agrees with our presuppositions/wants. This is totally what the science tells us.

  6. Zero deaths for healthy minors, and only 1 with an underlying condition. Immunosenescence is depressing. From birth onward the thymus gradually atrophies, the production of certain critical immune cells decreases exponentially, and old ones still floating around start to go bad too. Production half-lives tend to range from 10 to 20 years, which isn’t much. It doesn’t take many of those halving periods to have hardly any T cells at all compared to a small kid. Lots of other things get noticeably worse every year, especially when people are really old.

    From The Effect of Age on Thymic Function

    After this rapid early decline, involution appears to proceed at a steady rate, with studies examining human thymus suggesting a rate of 3% of thymic tissue is lost per year until middle age, followed by a rate of 1% per year; which perhaps may cease in later life with studies showing TREC levels being barely detectable in individuals over the age of 85 years

  7. I am not particularly a moralizer about smoking. But what fraction of those people expiring from COVID-19 were smokers? Is no one keeping this statistic?

    • Best we can tell, smoking doesn’t hurt, and, because of certain effects of nicotine, may even help. Half of Chinese men smoke, it didn’t make any apparent difference.

      This preliminary analysis does not support the argument that current smoking is a risk factor for hospitalization for COVID-19. Instead, these consistent observations, which are further emphasized by the low prevalence of current smoking among COVID-19 patients in the US (1.3%), raises the hypothesis that nicotine may have beneficial effects on COVID-19. This could be attributed to its immunomodulatory effects and its interaction with the renin-angiotensin system.

      Smoking is indeed pretty bad for people in general, but in a noble (and successful) effort to reduce rates, governments and medical establishments in developed societies engaged in a lot of exaggeration and excessive demonization about it, and many people have become emotionally invested in protecting those errors from even mild correction.

      • Handle:

        Thanks for the info, and I will confess, yes I expected the opposite.

        I assumed the key to survival was youth and lung capacity.

        Smoking aids surviving COVID-19?

        As my great, late Uncle Jerry used to say, “Even if it is true, I still don’t believe it.”

        • Most chemicals have multiple effects on our bodies.

          Consider caffeine. People mostly consume caffeine for the energy boost, but it also boosts gastrointestinal motility and in large doses is a diuretic. It treats lung and breathing issues in premature children, and boosts the relief of some pain medications (e.g., motrin).

          Nicotine is like that too, besides the sensation, it does a lot of other things, to include keeping people slimmer, and some of which may help a few people breath better when they’re sick with c19.

          However, it may not be the nicotine. The other stuff in smoke tends to keep a lot of mucus on the lining of the lungs, and who knows if that thicker mucus layer – usually a liability – might help somehow with the virus.

          So it would be interesting to see what happens to people on average who are have not been smoking for a while, so their lungs are more like normal, but still using nicotine patches or gum.

  8. Knowing p(healthy|died) is interesting. But what I really want is p(died|healthy). Of course, if among those with the virus p(died) << p(healthy) (which is plausible), then that would further strengthen the case.

  10. In NYC, at this point, it doesn’t really matter. The NYC cops are infested with it, as are most government agencies, transit and public meeting venues.

  11. “Perhaps those of us under age 75 and healthy ought to be given more freedom to go out in public, provided that we wear face covering.”
    Arnold, please don’t exaggerate what is being asked of us at this point. As far as I know you can still go outside in the United States. You can drive or walk around. You can visit a friend or relative. You probably can’t go to a restaurant or bar or movie theater for a while – and that sucks a lot. But is it too much to ask for until we know what we are dealing with?

    • For me as an individual, the inconvenience is small. For society as a whole–look at the unemployment numbers, or tell a small business owner that going bankrupt isn’t “too much to ask”

        • Dear Editor, I think you should re-examine what was written by me. Obviously you read it- and that is mostly why I cared to write a comment in the first place.

  12. Deaths are not the only relevant metric. Although hardly any young healthy people die, plenty are still hospitalized or even need intubation before they recover. Even if they don’t, a much larger number will be severely ill for weeks.

  13. [I don’t have to put up with your insults. Deleting all the rest of your comments. Go somewhere else.]

    • That seems extreme. If a comment is stupid and insulting, delete it, and warn the person why. But going back and removing all the previous comments seems like “East Asia has always been at war with Eurasia.” [It was easier to do a mass delete than to be selective]

  14. Perhaps those of us under age 75 and healthy ought to be given more freedom to go out in public, provided that we wear face covering.

    Some evidence against this is that Singapore, South Korea, and Hong Kong are all reporting that significant community transmission is still occurring and, because of that, they’re all moving towards ‘lockdown’ and away from freedom to go out in public.

    What I take from having read you (and Robin Hanson) about this is that we should trade enough testing capacity, against regular use in the healthcare system, to run RCTs.

    I think there’s a real political, and social, constraint against ‘depriving’ the healthcare system of any tests. Maybe a better strategy would be to convince hospitals to allow RCTs to be run with their patients because tests are in short supply. Triage efforts generally should be more random, and more closely monitored – ideally.

    When I think about how these RCTs would be run, I wonder if we even have enough of the required resources – total – right now. One big bottleneck right now apparently is reagents. All of the COVID-19 tests require them, but so do lots of other routine tests, as well as manufacture of other medical supplies. We’re not just constrained treating and testing COVID-19 – we’re constrained in treating or testing almost everything serious. We’re apparently almost certainly going to run out of antibiotics. Most of them recently have been made in China and in Italy, specifically the Lombardy region.

    Here’s a good podcast episode I listened to last night about a lot of this:

    #102 – Michael Osterholm, Ph.D.: COVID-19—Lessons learned, challenges ahead, and reasons for optimism and concern – Peter Attia

    And besides the general supply-chain issues, where we the supplies needed for the researchers come from? Or is there a way nurses and doctors can be recruited to run or participate in these experiments? That seems likely to be very difficult to convince them to do.

  15. 1. For well off basicly hermits to begin with like me, this is no big deal. For normal people, it is a big deal. Anybody arguing that “we” all have to stay home are missing the risk and work of everybody in, for example, the grocery industry, while also missing the pain among the unemployed. In any case, at least some places (reportedly already in Africa) are simply incapable of the “shelter at home” model – and we should fear what may come there.
    (It has been recognized that “shelter at home” has no meaning for homeless people, so government is starting to house them – at tax payer expense.)

    2. I will now bet ($100 to your favorite charity) that it’s not people/sq km, but some more fine grained measure – number of people cohabitating with at least 3 other people in less than 800 sq ft, number of people living in smallish apartments with less than perfect HVAC isolation, etc. Manhatten is mostly pretty rich. The Bronx not so much.

    (The epicenter of the WA pandemic is a nursing home about 2 miles from my house, for some time the majority of deaths in the state occured in that one place. They’ve since been fined. Nursing homes in general are problematic places for infections.

    Likewise, there is a widely reported case of a choir group, meeting well before anybody said not too, all being very careful, none showing any signs of illness – and a huge outbreak and 2 deaths among them. So air-to-air distribution among asymptomatic people is a thing.)

    3. About 2 decades into the HIV/AIDs disaster, it was discovered that some part of the European population has some level of resistence to HIV. It is accepted that this is due to some some historical accident (ancestors survived the black death, ancestors survived smalpox) with strong selection effects.

    We *think* there is *zero* immunity in the population right now (and that could very well be totally true) but we don’t *know* that. We won’t really know for a long time.
    (And the apparently zero death or even serious illness rate in healthy children under 18 suggests a very very strong immune-system-age selection effect.)

    Likewise, we won’t really know for a long time what the interaction between smoking, vaping, marijuana, any of a zillion diseases, and not only viral load but viral rate, do to infection rates or outcomes. (What I mean by “viral rate” – if you get exposed to 1 virus particle per day for 10 days, is that safer than exposure to 10 virus particles on 1 day?)

    4. I *have* seen (but did not save) some discussions of excess mortality in Italy – and (a) there’s clearly serious excess mortality and (b) this is bacically proving that due to reporting limitations they are undercounting covid-19 deaths. (Total excess – known covid -> estimate of unreported covid.)

    Also, we can never know the counterfactual – what if NOT doing “shelter at home” caused the population mortality rate to be 5x higher? Gulp. What if NOT doing “shelter at home” had no effect at all? Uhhh.. We can never be 100% sure – only draw inferences.

    Early on the WHO claimed “no risk”… Yeah sure.

    Likewise, early on, health experts made a pretty good argument that general population didn’t need masks – broad statistical data from various places suggests that’s wrong, as a public health matter. In fact, if everybody had started masking on the 15th of Feb, would the lock-downs have had to go past the “no gatherings of more than 50 people” stage?

    It is the fog of war. Lots will still go wrong.

  16. There was an earlier discussion concerning smoking.

    Similarly, has anyone looked at alcoholism and CoViD-19 death rates? My thinking is that, if alcohol in hand sanitizer kills the virus, does alcohol in the bloodstream do likewise?

    • Or is it that levels in the bloodstream high enough to kill the virus are more than high enough to kill the patient?

  17. Your post sounds like folks six weeks ago who thought that shut in voices or rules are only about reducing individual health risk and not about reducing disease transmission dynamics. I agree that we need to continue questioning assumptions, but to flat out ignore transmission dynamics is clearly wrong.

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