# Deaths from Covid19 or deaths with Covid19.



## Purple (23 Apr 2020)

Given that the median age for deaths is well into the 80's, about half are in care homes and most have pre-existing conditions, how many of the people who died were dying anyway?
I'm asking because in the next few weeks we'll be having a discussion about lifting the lockdown (that's not a lockdown) and it's important the the discussion is had within the context of good data. It looks like the real infection rate is much higher than was first thought and the fatality rate is much lower. If one in every three hundred people who get the disease dies and the vast majority of people who die are very elderly and have pre-existing conditions then should we be unwinding the lockdown and putting our resources into protecting the at-rick groups?


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## Brendan Burgess (23 Apr 2020)

Hi Purple

A very good question. 

I think that we need to look at how many deaths do we have more than the normal level of deaths. 

For example, I think we have around 30,000 deaths a year in Ireland.  If that rises to 50,000 , then it looks as if 20,000 die as a result of CV. 

But, that really means, that they died earlier than expected.   The number of deaths expected for 2020, 2021 and 2022 will probably not be any different. 

Brendan


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## odyssey06 (23 Apr 2020)

As Brendan notes, 'excess mortality' is the figure that will highlight how many more deaths are occurring.

I think that so many of the deaths are occurring in specific environments may have as much bearing as the age of the people dying.
Keeping offices closed and kids from beaches is a very indirect way to reduce deaths in care home environments.


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## Purple (23 Apr 2020)

Brendan Burgess said:


> Hi Purple
> 
> A very good question.
> 
> ...


How many of those deaths will be a result of people not attending their doctor, not going to A&E etc? The indirect deaths caused by Covid19?


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## pjq (23 Apr 2020)

https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html   The Economist has a similar story


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## Purple (23 Apr 2020)

pjq said:


> https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html   The Economist has a similar story


The fact that many countries are only reporting Covid19 deaths which take place in hospitals (i.e. they are grossly under reporting the total) probably accounts for a large amount of the total difference.


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## Duke of Marmalade (23 Apr 2020)

An interesting thought experiment is "would people be so compliant if exposure to risk was definitively limited to over 80s or indeed to those born between the spring equinox and the next full moon?".  I am not being cynical about the level of community solidarity but I suggest that the main driver of the compliance is fear for self.  I have seen angry looks by people out walking when they deem someone to have come too close.  They are not saying, "you are endangering folk in nursing homes", they are saying "you are endangering me!".
Because there is another grim calculus behind the statistics.  A person of 30 may indeed be at much less risk than a person of 80 but there are 3 reasons for them to be much more concerned about that risk.
1.  In terms of normal mortality the 80 year old was already 100 times more at risk and someone in a nursing home was 500 times more at risk. In other words the proportional increase in risk  brought by Covid could actually be higher for the 30 year old.
2.  A 30 year old would be putting at risk an expectation of 40 years of quality life.
3.  The collateral emotional and economic harm to others is likely to be on a different scale following the death of a 30 year old.


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## Purple (23 Apr 2020)

Duke of Marmalade said:


> An interesting thought experiment is "would people be so compliant if exposure to risk was definitively limited to over 80s or indeed to those born between the spring equinox and the next full moon?".  I am not being cynical about the level of community solidarity but I suggest that the main driver of the compliance is fear for self.  I have seen angry looks by people out walking when they deem someone to have come too close.  They are not saying, "you are endangering folk in nursing homes", they are saying "you are endangering me!".
> Because there is another grim calculus behind the statistics.  A person of 30 may indeed be at much less risk than a person of 80 but there are 3 reasons for them to be much more concerned about that risk.
> 1.  In terms of normal mortality the 80 year old was already 100 times more at risk and someone in a nursing home was 500 times more at risk. In other words the proportional increase in risk  brought by Covid could actually be higher for the 30 year old.
> 2.  A 30 year old would be putting at risk an expectation of 40 years of quality life.
> 3.  The collateral emotional and economic harm to others is likely to be on a different scale following the death of a 30 year old.


So do we wait 12 month plus for a vaccine and suffer the catastrophic economic and social consequences or do we try to keep higher risk groups safe while unwinding the restrictions and build a herd immunity, thereby reducing the economic and social consequences of the lockdown?


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## Duke of Marmalade (23 Apr 2020)

Purple said:


> So do we wait 12 month plus for a vaccine and suffer the catastrophic economic and social consequences or do we try to keep higher risk groups safe while unwinding the restrictions and build a herd immunity, thereby reducing the economic and social consequences of the lockdown?


That's above my pay grade _Purple_.  From the start there has been a reactionary voice arguing that the "cure should not be worse than the disease".  But they used a simple calculus in their argument claiming that economic and social disruption can itself cost lives, seeming to suggest that it was a game of minimising the numbers of deaths. 
But it might  get far more nuanced than that, for example we might have to ask questions like "is an extra few months in dementia worth the loss of livelihood to a young family?"
We have always made trade offs between quantity of life and quality of life.  For example if deaths by road traffic accidents were deemed to be avoidable at all costs we would ban the motor car.


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## odyssey06 (23 Apr 2020)

Duke of Marmalade said:


> But it might  get far more nuanced than that, for example we might have to ask questions like "is an extra few months in dementia worth the loss of livelihood to a young family?"
> We have always made trade offs between quantity of life and quality of life.  For example if deaths by road traffic accidents were deemed to be avoidable at all costs we would ban the motor car.



And people who may already be counting the years left might ask if they'd rather run the risks of the virus than sit out months on end cocooning and not be able to go for walks, meet family, friends etc etc


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## Leper (23 Apr 2020)

Purple raised a good question. With respect let's not over analyse the situation. It's a question for some university educating teenager nearing end of termwhich would fill a paragraph or two of some kind of assessment . The fact is people died of Coronavirus and people died because of Coronavirus. The bottom line is Covid-19 is a dreadful killer virus easily picked up by innocent people.

Just in case people have a misunderstanding of what I'm saying - after the Dubs won the succession of All Irelands, just accept they won them as afterwards there is no point in arguing who should have been corner forward or whether the goal-keeper should not be wearing gloves or Nike boots.


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## Purple (23 Apr 2020)

Duke of Marmalade said:


> But it might get far more nuanced than that, for example we might have to ask questions like "is an extra few months in dementia worth the loss of livelihood to a young family?"


Good point and a difficult but very valid question.


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## michaelm (23 Apr 2020)

Purple said:


> So do we wait 12 month plus for a vaccine and suffer the catastrophic economic and social consequences or do we try to keep higher risk groups safe while unwinding the restrictions and build a herd immunity, thereby reducing the economic and social consequences of the lockdown?


Clearly the latter.  Ease restrictions gradually and only reapply if the health system starts to buckle.


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## Purple (24 Apr 2020)

21% of a random selection of New Yorkers who were tested have been shown to have Covid19 antibodies. That strongly supports the contention that the disease is both more contagious and less deadly than we previously thought. In my view that supports the unwinding of the lockdown and an opening up of the economy with more specific restrictions in place for high risk groups.


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## Purple (24 Apr 2020)

From CNN: 
It is worth remembering that the economy is "people" not some abstract concept or the guy with the monocle from Monopoly. 
The Duke put is very well when he asked 


Duke of Marmalade said:


> "is an extra few months in dementia worth the loss of livelihood to a young family?"


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## elacsaplau (24 Apr 2020)

Some very interesting posts.


Duke of Marmalade said:


> But it might  get far more nuanced than that, for example we might have to ask questions like "is an extra few months in dementia worth the loss of livelihood to a young family?"



To what extent has this already happened?

In countries like Italy & Spain, presumably "all human life is sacred but some human life is more sacred than others" decisions have already been made?

What about Ireland? How many people have died in nursing homes? (I can't keep track of what's precisely included - is there a reason for this??!!)
And, how many people have been transferred from NH to hospital and then died in hospital. In other words, if you get Covid-19 in a NH, are you given the same medical support as someone the same age who is not in a NH?

So - is this happening? And, if so, who makes such decisions? Are we accepting of this?


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## Purple (24 Apr 2020)

elacsaplau said:


> And, how many people have been transferred from NH to hospital and then died in hospital


Good point. If someone is transferred to an ICU and then dies are they part of the nursing home numbers or part of the hospital numbers? If they are part of the hospital numbers them the proportion of fatalities from nursing homes is being under reported.


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## Sunny (24 Apr 2020)

Purple said:


> Good point. If someone is transferred to an ICU and then dies are they part of the nursing home numbers or part of the hospital numbers? If they are part of the hospital numbers them the proportion of fatalities from nursing homes is being under reported.



No, the breakdown is available for those who come from residential settings into a hospital environment and pass away.


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## Purple (24 Apr 2020)

Sunny said:


> No, the breakdown is available for those who come from residential settings into a hospital environment and pass away.


That's good. I have been impressed with the honesty and general quality of information from the Minister and Dr Tony Holohan.
It is vastly superior to the bumbling incoherence from their counterparts in the UK.


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## elacsaplau (24 Apr 2020)

Sunny said:


> No, the breakdown is available for those who come from residential settings into a hospital environment and pass away.



That's great, Sunny - can you post the link please?


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## Sunny (24 Apr 2020)

It's in their daily briefing and is also on the Gov website...

Dr Holohan said 433 laboratory confirmed deaths were associated to residential care settings, with 103 occurring in a hospital setting.
He said 361 laboratory confirmed deaths were related to nursing homes and that 87 of those had occurred in hospital.









						Covid-19: 28 more deaths, 936 additional cases
					

The Department of Health has been notified of a further 28 deaths of people who had been diagnosed with Covid-19.




					www.rte.ie
				








__





						Latest updates on COVID-19 (Coronavirus)
					

Latest news and updates on COVID-19 (Coronavirus) from the Department of Health




					www.gov.ie


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## elacsaplau (24 Apr 2020)

Thanks Sunny,

I need help with the math on this link




__





						Latest updates on COVID-19 (Coronavirus)
					

Latest news and updates on COVID-19 (Coronavirus) from the Department of Health




					www.gov.ie
				




1.   Total to 794 deaths

2.   392 (49%) deaths occurred in a hospital setting

3.   433 people have died in community residential settings, 103 of whom died in hospital settings

2 and 3 = 825
If 2 and 3 has a double count of the 103, we get 722 meaning that 72 people have died with Covid outside a community residential setting (i.e. NHs and other centres) and hospitals. Seems a bit odd to me?


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## Sunny (24 Apr 2020)

elacsaplau said:


> Thanks Sunny,
> 
> I need help with the math on this link
> 
> ...



I haven't looked at detail but I presume the difference is because they are talking about laboratory confirmed cases and probable cases. Think there are about 70 probable cases from residential settings.


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## Purple (29 Apr 2020)

So, the median age of the population of Ireland is 36.5 and  with a median age of those shown to be infected by Covid19 (showing symptoms and therefore tested) of 49 and a median age for those who have died of 82 is it reasonable to assume that the younger you are the more likely you are to be asymptomatic?
Some of the smart people on AAM may be able to do the maths but assuming that the disease is as likely to infect you at any age what  is the breakdown of the chances of dying from this by age? In Italy 83% of reported deaths were amongst over 70's. If we have the same rates then should we be looking at more targeted cocooning?


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