Drop in flu deaths?

[Boatswain2PA]

https://www.foxnews.com/health/drop-flu-deaths-indicate-most-at-risk-died-coronavirus

I think it's way to early to know for sure, and I think this is a poorly written article ("NY/NYC has had zero flu deaths, which is also the average of the 5 week average"...what?)

US usually has had 17 flu deaths per week by Oct 17, yet we had none this year. If that early trends keeps up then it is good news.

The UK lost 1132 from flu and pneumonia last month, down from the 1500 average.  Again, if this early trend keeps up then it is good news (although again poorly written article as it lists "flu and pna deaths", and the 1500 average doesn't specify if that is the annual average, or the average for September).

Maybe the masks/social distancing is helping.

Maybe SARS-Cov-19 has culled the herd.

Maybe it's just a statistical anomaly.

[mmiller3]

So many variables. All your points are good. We have not been doing much testing for flu at the Army hospital--all COVID. That may be a factor.

[ohiovolffemtp]

I've started testing for flu - not seen a case yet.  I'm hopeful masking, etc. will help, but don't want to assume anything until we see when flu season really starts in areas where I work.

 

[ventana]

look at what happened to the childhood viral infections with the start of social distancing....  almost dropped to zero....

 

social distancing and masks works....  (I hope) 

[ventana]

look at what happened to the childhood viral infections with the start of social distancing....  almost dropped to zero....

 

social distancing and masks works....  (I hope) 

[Boatswain2PA]

5 minutes ago, ventana said:

look at what happened to the childhood viral infections with the start of social distancing....  almost dropped to zero....

 

social distancing and masks works....  (I hope) 

But childhood viral infections have very low morbidity or mortality.  Not sure it's worth the economic damage to their future.

[ventana]

1 hour ago, Boatswain2PA said:

But childhood viral infections have very low morbidity or mortality.  Not sure it's worth the economic damage to their future.

what is your point??

[Boatswain2PA]

26 minutes ago, ventana said:

what is your point??

IF (and that is a big IF) we are seeing fewer flu deaths because covid has "only" culled the herd of people who were most likely to die soon anyway then the economy-killing efforts have not been worth it.

This would be true evenif these economy-killing covid-prevention efforts have reduced childhood viral infections as that means very little to morbidity and mortality overall.

We will have to see.

[rev ronin]

50 minutes ago, Boatswain2PA said:

IF (and that is a big IF) we are seeing fewer flu deaths because covid has "only" culled the herd of people who were most likely to die soon anyway then the economy-killing efforts have not been worth it.

This would be true evenif these economy-killing covid-prevention efforts have reduced childhood viral infections as that means very little to morbidity and mortality overall.

We will have to see.

"Herd culling" (Ick, BTW) may be responsible for the lower influenza M&M in the elderly, but I would wait until later in the flu season to see.

I expect social distancing, masking, and travel restrictions all play some role, that together provide a reasonable bulwark against seasonal flu transmission--and thus, with lower transmission, and overall unchanged M&M, the net deaths will be lower this year.

You're right that all these NPIs would be overkill if it were ALL for the seasonal flu, in terms of deaths prompted by the NPIs vs. deaths prevented by them, but I look at it as a silver lining in the Covid-19 NPIs, that they actually do have some trickle-down effects on LESS serious disease transmission, to include not just seasonal influenza, but the common cold as well.

[mgriffiths]

3 hours ago, mcclane said:

Please stop posting journalism articles that you come across with your daily web surfing. This is not your personal social media network.

not to hijack the thread, but I thought targeting other users like this was against the policy of this forum...along with the blatant blanket downvotes to Boatswain just for posting.

----------------------------------

While I don't really like the statement "cull the herd" either, this is definitely an interesting, thought provoking topic.  As others have said it's WAY too early to be drawing conclusions, but will be interesting to watch as time marches forward.

To add my own anecdotal experience...I've had zero influenza but have only tested a handful.  On the other hand, in the last three weeks I'm close to 30 positive COVIDs in my rural neck of the woods with at least 3 that I strongly believe were false negatives.

[rev ronin]

1 hour ago, mgriffiths said:

not to hijack the thread, but I thought targeting other users like this was against the policy of this forum...along with the blatant blanket downvotes to Boatswain just for posting.

I mean, I could hide both of their back-and-forth posts, but then we get into the big "you're censoring us" deal.  I rather like the fact that other forum posters are calling out inappropriate behavior, because it means the mod team don't have to be the bad guys.  Social pressure seems preferable to moderation buttons, if you and everyone else would be OK with exercising it a bit...

[Boatswain2PA]

9 hours ago, rev ronin said:

"Herd culling" (Ick, BTW) may be responsible for the lower influenza M&M in the elderly, but I would wait until later in the flu season to see.

Might not be just for influenza.  If the vast majority of deaths are obese or panmorbid, then we may see a drop in all (non-accidental) M&M in the next months/year or so.

9 hours ago, rev ronin said:

You're right that all these NPIs would be overkill if it were ALL for the seasonal flu,

Not sure what NPI stands for, but assume it means all of the measures we are taking to combat covid spread (masks, distancing, etc).

What happened to "flattening the curve" that was pushed six months ago?  NYC hospitals were overwhelmed, so we asked America to mask up and avoid Gramps so we can flatten the curve to ensure we had enough ICU beds/vents for grandma.  The area under the flat curve is the same as under the steep curve, yet spread out so we could have enough beds/vents.

Seems we have moved the goalposts.  It's okay to change goals (goalposts), but I don't think we have articulated why we have done that, and we certainly haven't articulated what the new goal is.

Are we trying to now flatten the curve until we get a vaccine?  Okay, that would make sense to me, but that's not what is being articulated, and it presumes we will have a safe/effective vaccine (unlike the Swine flu vaccine).

Are we now just combating the disease by masks and social distancing that is destroying the economy?  

I don't know.  Nobody seems to know.

[Boatswain2PA]

9 hours ago, mgriffiths said:

not to hijack the thread, but I thought targeting other users like this was against the policy of this forum...along with the blatant blanket downvotes to Boatswain just for posting.

Don't worry about it, just a couple of gnats.  Slightly bothersome, but insignificant.

[MediMike]

3 minutes ago, Boatswain2PA said:

Might not be just for influenza.  If the vast majority of deaths are obese or panmorbid, then we may see a drop in all (non-accidental) M&M in the next months/year or so.

Not sure what NPI stands for, but assume it means all of the measures we are taking to combat covid spread (masks, distancing, etc).

What happened to "flattening the curve" that was pushed six months ago?  NYC hospitals were overwhelmed, so we asked America to mask up and avoid Gramps so we can flatten the curve to ensure we had enough ICU beds/vents for grandma.  The area under the flat curve is the same as under the steep curve, yet spread out so we could have enough beds/vents.

Seems we have moved the goalposts.  It's okay to change goals (goalposts), but I don't think we have articulated why we have done that, and we certainly haven't articulated what the new goal is.

Are we trying to now flatten the curve until we get a vaccine?  Okay, that would make sense to me, but that's not what is being articulated, and it presumes we will have a safe/effective vaccine (unlike the Swine flu vaccine).

Are we now just combating the disease by masks and social distancing that is destroying the economy?  

I don't know.  Nobody seems to know.

I think the argument that the AUC is the same regardless is factually incorrect. Take a look at what we have learned regarding the management of this disease.

No longer am I seeing a COVID patient struggling and immediately intubating. No longer are we pushing unproven medicines. No longer are L we avoiding NIPPV and HFNC.

We have trials demonstrating impressive benefit with the good 'ol standby of steroids, trials with significant improvement in mortality.

It's not just grandma man. I cover four community hospitals and we've got intubated/proned patients from 46-84yo. 

[Boatswain2PA]

31 minutes ago, MediMike said:

I think the argument that the AUC is the same regardless is factually incorrect.

What have we done to change the AUC?  You think masks/distancing are changing the AUC?
 

34 minutes ago, MediMike said:

Take a look at what we have learned regarding the management of this disease.

ENORMOUS amounts, especially in the critically ill (which is unusual compared to other diseases).  But I don't see how that changes the AUC (which generally represents the # of infected, which is mostly about changing the R0 value).
 

35 minutes ago, MediMike said:

No longer am I seeing a COVID patient struggling and immediately intubating. No longer are we pushing unproven medicines.

Nothing is EVER proven in science my friend.  Meanwhile lots of us are "pushing" unproven meds to the non-critically ill.

 

37 minutes ago, MediMike said:

It's not just grandma man. I cover four community hospitals and we've got intubated/proned patients from 46-84yo. 

And almost all of the non-geriatric are pan-morbid/obese, right?  That is certainly what the risk factors are....

[MediMike]

2 hours ago, Boatswain2PA said:

What have we done to change the AUC?  You think masks/distancing are changing the AUC?
 

ENORMOUS amounts, especially in the critically ill (which is unusual compared to other diseases).  But I don't see how that changes the AUC (which generally represents the # of infected, which is mostly about changing the R0 value).
 

Nothing is EVER proven in science my friend.  Meanwhile lots of us are "pushing" unproven meds to the non-critically ill.

 

And almost all of the non-geriatric are pan-morbid/obese, right?  That is certainly what the risk factors are....

I believe the economic shut down, social distancing and masking have definitely had an effect on the AUC and subsequently bought us time to learn how to manage the disease. I also think the premise that the only reason to flatten to curve was to reduce hospital bed usage is a little silly, the idea is to reduce mortality, and while one benefit of the flattening is a reduction in beds it's like saying the only reason you eat is because something tastes good while ignoring the fact that you need nutrition.

And speaking of eating (clearly I'm hitting my 0300 snack phase), the non-geriatric aren't all that obese to be honest with you, at least not more than the average American...for whatever that's worth.

 

 

[Boatswain2PA]

4 hours ago, MediMike said:

I believe the economic shut down, social distancing and masking have definitely had an effect on the AUC and subsequently bought us time to learn how to manage the disease.

Agree 100%.  We flattened the curve while we learned how to get more people to survive it, and that will lead to a reduced mortality.
 

4 hours ago, MediMike said:

I also think the premise that the only reason to flatten to curve was to reduce hospital bed usage is a little silly, the idea is to reduce mortality,

I think that is what we sold the public on though.

But other than improved therapeutics or a vaccine, I think the AUC is going to remain mostly inevitable, and it's going to be very large.  It's been obvious to me that it's an airborne disease, and the R0 value is very high.  This site says it's somewhere between 4.7 and 6.6 https://sarahwestall.com/covid-19-has-much-higher-r0-value-than-originally-reported/).  

Our distancing/masking efforts can reduce the R0, but we have obviously lost containment of the virus and with an R0 value like that I think it's safe to say that "we are all going to get it eventually!" (and by "all", I mean until we reach effective herd immunity).
 

[Boatswain2PA]

4 hours ago, MediMike said:

the non-geriatric aren't all that obese to be honest with you, at least not more than the average American...for whatever that's worth.

So you have a lot of young, not-obese people on vents?  That's news to me.  We are full, and all regional tertiary centers are full, with covid on vents, but almost all are obese/polymorbid.  I haven't admitted a non-obese with no comorbids to the ICU yet.  

[EMEDPA]

1 hour ago, Boatswain2PA said:

 I haven't admitted a non-obese with no comorbids to the ICU yet.  

I have. Just one, but sick as crap. Legit room air sat of 25% with a good waveform. He was part of a random screening at a fish processing plant the week before. sent home for being +, despite no sx. One week later couldn't breathe at home and 911 called. 

[LT_Oneal_PAC]

4 minutes ago, EMEDPA said:

I have. Just one, but sick as crap. Legit room air sat of 25% with a good waveform. He was part of a random screening at a fish processing plant the week before. sent home for being +, despite no sx. One week later couldn't breathe at home and 911 called. 

 I also have, just 2 weeks ago. 
 

but even if it was only co-morbid baby boomers or obese, would it matter?

FYI, this comedy sketch was made long before Covid.

[Boatswain2PA]

1 hour ago, LT_Oneal_PAC said:

I also have, just 2 weeks ago. 
 

but even if it was only co-morbid baby boomers or obese, would it matter?

I'm sure they (the non-obese previously no comorbidities critically ill with covid) are out there, but they are extremely rare.  

Would what matter?  I wasn't trying to get into the ethical dilemma of whose life is more valuable.  As in most things in ethics, there are multiple correct ways to view them.  However if the R0 is such that we will not be able to contain it until we reach herd immunity or have a vaccine, then these folks are going to get critically ill no matter what.  It's just a matter of how many at a time.

[rev ronin]

BTW, NPI = non-pharmacological interventions.  Masking, distance, gathering size restrictions, travel restrictions, etc.

[MediMike]

7 hours ago, Boatswain2PA said:

So you have a lot of young, not-obese people on vents?  That's news to me.  We are full, and all regional tertiary centers are full, with covid on vents, but almost all are obese/polymorbid.  I haven't admitted a non-obese with no comorbids to the ICU yet.  

I agree that a non-obese with no comorbids is a unicorn, but yes, I have multiple folks in their 40s who are what I'd consider average American on the vent.

Do you have the opportunity to follow the hospital course of your patients once admitted? I have way more people decompensate after being in-house for a couple days than those who show up at the front door sick as snot.

[CAAdmission]

14 hours ago, MediMike said:

I have way more people decompensate after being in-house for a couple days than those who show up at the front door sick as snot.

Makes you wonder if we are doing something iatrogenic to cause it. What's the "typical" course of treatment you are using?

[Boatswain2PA]

1 hour ago, CJAdmission said:

Makes you wonder if we are doing something iatrogenic to cause it. What's the "typical" course of treatment you are using?

I dont think so.  I think it is the natural course of the disease.  I see the same thing in the ED with people presenting mild/moderately I'll, send them home and they get better, then decompensate a week or so later.