I wonder if there is a push to start getting accurate data -
For Example the with verus From stats - such as:
Who died with - Who died from
Who is hospitalized with - Who is hospitalized from
The CDC released the 18 & under stats... that are vague again because it has deaths involving COVID -
Its hard enough to get accuracy with a vague denominator (so many with COVID are never tested and do not hit the books) but now we have a vague numerator.
I understand Katelyn's use of "With" vs "For" as a transmission surrogate, but when I start thinking clinically, it really doesn't matter in-hospital if you came in for respiratory failure due to COVID-19, or were found to have COVID-19 when admitted for your heart attack or ischemic bowel. SARS-CoV-2 is known to affect a large number of organs, and someone who's positive has to go into aerosol precautions, so it doesn't really matter.
Similarly, the question of cause of death doesn't really matter when you consider the excess deaths numbers we're seeing both for the US and worldwide.
Well -I agree with you if that is the CAUSE of death or the CAUSE of hospitalization.
Where do you find the excess death numbers? That is interesting. Have 1m more Americans died in the past 2 years? This website shows an increase in the increase death rate of Americans since 2012.
Are you suggesting that a child with a broken legs be listed as in ER with COVID if the test was positive?
Same with deaths - Do you think a motorcycle accident should be a COVID death if they test positive?
As for a heart attack being classified as a COVID hospitalization should depend on the patient not the broad stroke of a brush called COVID. Some cardiac patients actually died before COVID. That actually seems irresponsible if you are using that broad stroke.
Why would you want to do that vs find the real cause of death from the treating physician?
In general terms, we have seen a marked increase in both the US and world death rate beyond expected numbers. Some of these can be directly attributable to COVID-19 and the direct disease processes. OTHERS, however, are a result of delaying care and medical/surgical procedures because of the epidemic. Overall, however, the excess death toll is almost certainly a result of the pandemic and how various medical systems in different countries handled things.
COVID deaths have been handled and reported differently around the world as you'll see in the cited articles. Some countries require autopsy findings associated directly with COVID-19 (e.g., Russia) before the cause of death can be attributed to COVID. I am personally aware of states and counties that would not allocate testing to coroners' offices but then required positive test results to attribute the cause of death to COVID.
Something you're missing is that an incidental finding of COVID immediately changes the procedural management of a patient presenting for another reason. Your child with a broken limb and a positive COVID test would have to be placed in isolation and appropriate precautions taken. On the other hand, a multitrauma patient, e.g., motorcycle patient with incidental COVID would almost certainly not be tested unless they'd survived long enough to be transferred to ICU, where an incoming test would dictate which room they could go into, and how they've got to be cared for, for the safety of other patients and staff.
Heart attacks and strokes are a completely different kettle of fish, because disseminated COVID has significant effect on clotting and directly on blood vessels. As for being irresponsible for painting with a broad brush, I'd say my research in cardiovascular medicine and surgery, if somewhat dated, allows me to have an opinion. Colleagues with whom I've spoken to, as well as published research, have started concluding that SARS-CoV-2 has a great affinity for vascular tissue. As mentioned above, the predisposition of patients with moderate or severe COVID symptoms toward increased clotting in the microvasculature and larger vessels, including otherwise unexpected clotting the cerebral vasculature was the reason d-dimer assays were common early; the reduction in their use now is simply because ALL COVID patients with moderate to severe disease have markedly elevated d-dimer levels; most hospitalized patients are anticoagulated based on general protocol. To reduce the risk of cardiovascular events.
In general, a death certificate has a list of precipitating causes. Think of this as a differential diagnosis of the cause of death, and often it's a lot like the prototypical differential diagnosis we work with when we first see the patient, although your differential is often fluid in the course of care of a really complicated ICU patient as new issues arise. It's not a case of not wanting to know what killed the patient, but a list of what the most likely causes were. If the patient is sent for autopsy, that "differential" can be modified and the pathologist is responsible for the cause of death.
Great info yet again.
I wonder if there is a push to start getting accurate data -
For Example the with verus From stats - such as:
Who died with - Who died from
Who is hospitalized with - Who is hospitalized from
The CDC released the 18 & under stats... that are vague again because it has deaths involving COVID -
Its hard enough to get accuracy with a vague denominator (so many with COVID are never tested and do not hit the books) but now we have a vague numerator.
I understand Katelyn's use of "With" vs "For" as a transmission surrogate, but when I start thinking clinically, it really doesn't matter in-hospital if you came in for respiratory failure due to COVID-19, or were found to have COVID-19 when admitted for your heart attack or ischemic bowel. SARS-CoV-2 is known to affect a large number of organs, and someone who's positive has to go into aerosol precautions, so it doesn't really matter.
Similarly, the question of cause of death doesn't really matter when you consider the excess deaths numbers we're seeing both for the US and worldwide.
Well -I agree with you if that is the CAUSE of death or the CAUSE of hospitalization.
Where do you find the excess death numbers? That is interesting. Have 1m more Americans died in the past 2 years? This website shows an increase in the increase death rate of Americans since 2012.
Are you suggesting that a child with a broken legs be listed as in ER with COVID if the test was positive?
Same with deaths - Do you think a motorcycle accident should be a COVID death if they test positive?
As for a heart attack being classified as a COVID hospitalization should depend on the patient not the broad stroke of a brush called COVID. Some cardiac patients actually died before COVID. That actually seems irresponsible if you are using that broad stroke.
Why would you want to do that vs find the real cause of death from the treating physician?
https://www.macrotrends.net/countries/USA/united-states/death-rate
Excess mortality stats:
https://journals.sagepub.com/doi/full/10.1177/0141076820956802
https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
https://www.nature.com/articles/d41586-022-00104-8
In general terms, we have seen a marked increase in both the US and world death rate beyond expected numbers. Some of these can be directly attributable to COVID-19 and the direct disease processes. OTHERS, however, are a result of delaying care and medical/surgical procedures because of the epidemic. Overall, however, the excess death toll is almost certainly a result of the pandemic and how various medical systems in different countries handled things.
COVID deaths have been handled and reported differently around the world as you'll see in the cited articles. Some countries require autopsy findings associated directly with COVID-19 (e.g., Russia) before the cause of death can be attributed to COVID. I am personally aware of states and counties that would not allocate testing to coroners' offices but then required positive test results to attribute the cause of death to COVID.
Something you're missing is that an incidental finding of COVID immediately changes the procedural management of a patient presenting for another reason. Your child with a broken limb and a positive COVID test would have to be placed in isolation and appropriate precautions taken. On the other hand, a multitrauma patient, e.g., motorcycle patient with incidental COVID would almost certainly not be tested unless they'd survived long enough to be transferred to ICU, where an incoming test would dictate which room they could go into, and how they've got to be cared for, for the safety of other patients and staff.
Heart attacks and strokes are a completely different kettle of fish, because disseminated COVID has significant effect on clotting and directly on blood vessels. As for being irresponsible for painting with a broad brush, I'd say my research in cardiovascular medicine and surgery, if somewhat dated, allows me to have an opinion. Colleagues with whom I've spoken to, as well as published research, have started concluding that SARS-CoV-2 has a great affinity for vascular tissue. As mentioned above, the predisposition of patients with moderate or severe COVID symptoms toward increased clotting in the microvasculature and larger vessels, including otherwise unexpected clotting the cerebral vasculature was the reason d-dimer assays were common early; the reduction in their use now is simply because ALL COVID patients with moderate to severe disease have markedly elevated d-dimer levels; most hospitalized patients are anticoagulated based on general protocol. To reduce the risk of cardiovascular events.
In general, a death certificate has a list of precipitating causes. Think of this as a differential diagnosis of the cause of death, and often it's a lot like the prototypical differential diagnosis we work with when we first see the patient, although your differential is often fluid in the course of care of a really complicated ICU patient as new issues arise. It's not a case of not wanting to know what killed the patient, but a list of what the most likely causes were. If the patient is sent for autopsy, that "differential" can be modified and the pathologist is responsible for the cause of death.