Mar 23 2020
Q: If Covid-19 is not necessarily more contagious than the flu, as some very prominent medical experts have been claiming, why do we have such an influx of patients that are flooding the hospitals? Italy is a great example of that… What is causing this - the fact that it’s a new virus, our lack of immunity to it, the panic, or…? Is it that people are heading to the hospital in bigger numbers because they are reacting with a more paranoid response than they customarily do to the flu? In other words, were we as a society previously underestimating the effects of the flu on some of the more vulnerable people and letting them die at home? Meaning, did it not use to occur to loved ones to take their old grandfather to the hospital when he got the flu – until it was too late? Is that why we usually have thousands of more vulnerable people die every year from the flu?
A: The answer is YES on all of your assumptions. The excess mortality during “influenza seasons” is well documented. For instance, the article published in the International Journal of Infectious Diseases in November of 2019 is titled “Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14-2016/17 seasons)” https://www.ncbi.nlm.nih.gov/pubmed/31401203
The results of this investigation are very telling:
The estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 were attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16 and 2016/17, respectively;
The average annual mortality excess rate per 100,000 ranged from 11.6 to 41.2 with most of the influenza-associated deaths per year registered among the elderly.
in conclusion, the authors state that:
Over 68,000 deaths were attributable to influenza epidemics in the study period;
The observed excess of deaths is not completely unexpected, given the high number of fragile very old subjects living in Italy;
the unpredictability of the influenza virus continues to present a major challenge to health professionals and policy makers.
Further, the article in the Clinical Microbiology and Infection Journal titled “European all-cause excess and influenza-attributable mortality in the 2017/18 season: should the burden of influenza B be reconsidered?”https://www.ncbi.nlm.nih.gov/pubmed/30790685 published in October 2019 concludes:
Excess mortality was mainly attributable to influenza activity from December 2017 to April 2018, but also due to exceptionally low temperatures in February-March 2018;
The pattern and extent of mortality excess was similar to the previous A(H3N2) dominated seasons, 2014/15 and 2016/17;
The 2017/18 overall all-cause influenza-attributable mortality was estimated to be 25.4 (95%CI 25.0-25.8) per 100,000 population; 118.2 (116.4-119.9) for persons aged 65;
Extending to the European population this translates into over-all 152,000 deaths;
The high mortality among elderly was unexpected in an influenza B dominated season, which commonly are considered to cause mild illness, mainly among children;
Even though Influenza A (H3N2) also circulated in the 2017/18 season and may have contributed to the excess mortality among the elderly, the common perception of influenza B only having a modest impact on excess mortality in the older population may need to be reconsidered.
Referring to my resent blog post https://www.doctorwhy.blog/blog/ventilators, in 2017 the average daily number of deaths in Italy amongst 65+ was 935 (almost 1/2 of the entire number of deaths). At the same time, the number of people dying from influenza in 2016/2017 season was 137 per day. This represents 15% of the daily mortality, or 1 out of 6 people dying during flu season die from influenza.
The main questions are:
are hundreds of Italian coronavirus deaths reported daily in addition to 137 dying from influenza, or influenza deaths are mixed into the total?
are these deaths over and above of average of 935 deaths per day for 65+ and over and above of 1,744 per day across all ages?
If so, does this mean that the likely number of deaths last Sunday in Italy was 793 (from coronavirus) + 1,744 from other causes = 2,537, or 793 are mixed into 1,744 total?
Q: If Covid-19 is not more deadly than the flu, why are most experts in the US claiming it’s 5 to 10 times more deadly than the flu? Some experts I’ve heard are also saying that it may have the same mortality rate or even a lower mortality rate than the flu. Since we don’t have a real handle on the number of cases (the real denominator), some experts have sited the Princess Diamond cruise in Japan as a potentially good sample to consider when assessing the mortality rate of Covid-19.
A: I agree, The Princess Diamond is the worst case scenario: several thousand people were trapped in the enclosed space - many, actually 1/2 - which is a crew to passengers ratio - without windows at lower decks sharing rooms with 2-3 other crew members, and having to deliver food and supplies, clean passenger rooms, assist in providing medical care, etc. Did they have enough personal protective equipment, sanitizers, etc? How about medications, or facilities to deliver state of the art care? It is with one, may be two doctors on board? The approximate ratio of infected people was 19% (700 out of 3,700) and mortality rate was 0.18% ( 7 out of 3,700). In my opinion, unless I am missing something, these “experts” are either incompetent or malicious (intentionally or unintentionally).
Q: Why are some experts (plus some governors/mayors…) claiming this will last all the way through May and possibly beyond, while others are saying this is 60-day cycle, which is consistent with epidemics…
A: As I mentioned above, unless I am missing something, the “experts” are either incompetent or malicious (intentionally or unintentionally). The POTUS, governors, mayors, etc. rely on such experts, hence “garbage in - garbage out”. Also, everyone is hedging bets: if epidemic continues longer than usual, their position will be “I told you so”, if not, they will claim success and get a credit for beating terrible epidemic sooner than anticipated. It is a “win-win” proposition for them, while for us it is a “lose - lose”!