shoshin

It's a US problem for me! There's been a leadership failure at many levels. I wouldn't spare too many in the executive mansions in DC or at the state level.

The backfilling is understandable but frustrating. In PA, the "total" deaths lately has often been increasing day-to-day often by 20. But the actuals have only been over 20 one (suspicious-looking from a data anomaly perspective) time in the last 7 weeks.

Agreed. The NE lethality had as much to do with our incomplete knowledge of treatments as it did with the likely higher spike in cases. I'll just be happy when it starts falling dramatically. Other regions will spike but I don't think any of the high population areas are left to do so (maybe NorCal?).

If we are following the April pattern and it looks like we are, this or next week would be the week we see deaths drop significantly.

Only NY followed the gated approach from the CDC where you meet several requirements, open a little more, wait, then go to the next gate. None did that through the objective gating and PA 100% did NOT do that. PA Gov. Wolf set a ridiculous standard of cases/100K population to move to the "yellow" phase. Some counties (the smaller ones) met that. Philly took so long to meet it that he eventually waved a magic wand when it was clear Philly was doing fine (hospitalizations were incredibly low, the protests had come and nothing was happening) and Philly got to go to Yellow. Green phase was made based on literally zero objective evidence or rule, but some sort of fiat around "Things look good." Wolf then left it to the counties to open or not, so cities like Philly are still not open for indoor dining because yet another regional power has blocked it. When Pittsburgh spiked up in the last month (PGH never got hit initially and was already at the "green" level), it was not shut down or moved backwards in the progression at all. At no point during PA's reopening--except for the small counties initially--were there objective gating criteria. I will 100% vote against Wolf for his handling of this. He was cautious. He was not cautious. He said he'd be objective. He was not objective. He threw his hands up in the air and ceded authority to county commissioners. A total leadership cluster-F. The problem in PA appeared to be that they didn't want to follow the CDC's guidelines and did things their own way. It was no mixed message that kept PA closed for so long. It was an arrogance that PA DOH knew better. And I'm sure the same thing happened in Florida. It was an utter failure of leadership starting in DC, but at the state level too.

The CDC made a reopening plan that any region could follow. Only NY mostly adopted it. The other governors, no matter their political leanings, did not follow it. Leaving reopening to the governors, who all have their own health departments not versed in world pandemics like the Centers for friggin Disease friggin Control is, was poor leadership from the federal AND state levels. The utter lack of good leadership in this started at the top but it trickled down. Could we have prevented 170K deaths? No. Could we have had fewer deaths and a much more predictable recovery? Yes. That’s the past. Take it up with politicians in November and future Novembers. What we need now is to stem the tidal wave of ancillary fallout from Covid and get back to being open.

I have posted about the suicide/mental health issue on OTW a lot in the last week. There may well be a higher number of deaths due to suicides now, or at some point in the future. When Magox cited that study that purported to show that excess deaths in U45 people was due to suicides, I was interested to see that. It was sadly a bad article and did not back its claim. If you look back through the thread, that's my criticism. It was a crappy paper that might be right, but not based on the data it presented. Regarding waiting for the CDC confirmation, I agree. But here's the problem: The paper in discussion looked at CDC-classified Covid deaths vs non-Covid classified deaths. If you're stuck in the CDC data, you have to rely on the CDC data, and your analysis carries the issues built into CDC data, namely, the slow pace that the CDC takes when classifying deaths. Failure to acknowledge that or build in estimates for how the non-classified deaths could change the conclusions further undermines the paper's credibility. Obliquely and rationally, younger people may be committing suicides at a higher rate. Still haven't seen the data though. I'd love to have that because I keep arguing that the effects of the shutdowns have a terrible effect on mental health--and will for years.

I cited to and quoted the exact same CDC report that you quoted--to make the same point--but I did it several days ago...on this very site. Guess you're in the same box as me. Another mistake for you. Bad week bro: Can happen to anyone but it keeps happening to you because you have a strange obsession with me. People are even writing me about it privately--and not wacky liberals. It's kind of creepy but even more so because we agree on most of this as I've noted many times, not that you'd want to acknowledge it.

I don’t know who Soledad O’Brian is to own a blue check mark but there’s a way to go after whatever doctor she’s referring to without using that poor kid.

The guy who created that is a Q-anon lunatic Tweeter so take it up with him.

Philly restaurants still not open for indoor dining. 2% positives in Philly last two days. PA is worse than NYS for controlling governors. At least in New York, NYC was hit by a Covid-bomb.

Lots of insults and that's exciting but also totally non-responsive to the problem with that article. I said, "The problem with that "article" was that he concluded "Many of these deaths are likely from suicide, despair, alcohol and drug abuse, and violence.“" You responded "NOT A LOT OF PEOPLE UNDER 45 ARE DYING FROM COVID." Your response has nothing to do with the problem with that paper (it avoids the CDC categorization problem too but you can't tackle either problem let alone the bigger one). You've evaded this problem 3 times. That is wise. But strike 3, you're out.

Let's try this again. The problem with that "article" was that he concluded "Many of these deaths are likely from suicide, despair, alcohol and drug abuse, and violence.“ The cause of death is not a conclusion backed by his data, and that's why it's shiffy. And there's also the issue that the CDC is about 20,000 deaths behind in matching Covid deaths so some of those deaths in the "non-Covid" pile that you're pointing to are actually Covid deaths. How many, I don't know. But that article makes no effort to account for this pretty big and known problem in the data set. So you repeated his data, said I'm wrong, and ignored the gaping chasm of a hole in his conclusion. I credit you with being smart enough to avoid the actual problems with your article. That's wise.

Your link is from a month ago. The data I pasted--and the article Magox linked--is from yesterday. Just a mistake on your part.

I don't know if it's right that "The parts of Spain and France that weren't hit hard are now beginning to get hit..." I only looked at Spain but the highest number of cases in Spain were in Madrid and Catalan before the lockdown. Post the June reopening, Madrid and Catalan are also leading the rise of new cases. It could be more likely that what's happening is that the draconian lockdowns stopped the spread, but once they reopened, the spread continued. To be clear, I do think this thing burns out to some level and we see that in the US. I don't think this is the dreaded second wave, but instead the end of the first wave that never finished. And I bet this is not as bad as the first wave if they allow it to hit (which they won't).

No, but here's the thing: The studies provide the data to back up your gut feel. Suicides are up seems like a reasonable hypothesis. But until you know how much higher suicides are in 2020 than 2019, you can't say it definitively. The problem with that article thing Magox cited is that it purports to show an increase in non-Covid deaths, and then concludes that the "deaths are likely from suicide, despair, alcohol and drug abuse, and violence“ with ZERO causal linkage. Could those deaths be due to people not getting medical care because they fear going to the hospital? Could they be from accidental deaths resulting from staying home? Could they be due to complications arising from an increase in sedentary behavior? Could they be from Covid and the CDC has yet to categorize them as such? Who knows and certainly not that author. It's a bad article. Magox knows it and that's why he's not defending it on the merits.

It was not a good situation for sure. But we are on the downside of that slope in most areas and the point is that we managed it. That's what we needed to do. Given all the mental health crisis statistics shared upstream from the CDC, it's time to focus on the future and getting out of this dark pit, not prolonging our time here. My point, and I believe you understand it is this: We need to try to protect those people that are most vulnerable to Covid, while at the same time, reopening because everyone is suffering from non-Covid complications. We simply have become a country mired in non-Covid sickness and it's no way to "live." The mental health issues, the other medical complications (my wife is a hospice social worker who works entirely with an at risk population who are largely refusing to go to doctors--anecdotal but also born out by evidence widely reported), suicide, homicide, economic fallout. I could link to many sources for each of these but one sure way out of them all is to pave a sure path to reopning, starting with schools. You'll note that the long-praised countries of Europe are starting to see cases rise again. Where? In places that just lifted their strict lockdowns in June. So what did the lockdowns accomplish? A temporary pause in the cases and deaths. What can they celebrate today? Bearing down and getting through it now that their hospitals are ready? No. They celebrate more lockdowns. The virus spreads, and after it hits hard, it settles in at a painful but manageable level. It's a clear trend--the trend being: It isn't going away until it does due to a true herd immunity (assuming we get the vaccine compliance necessary, I like Gates's prediction of mid 2021 for the US). As a country, we managed our response to this poorly and we lack leadership. But part of overcoming that lack of leadership is joining together in forging a clear path forward and out of this. Some things: - mask up, sure - schools outdoors, why the heck not? - school in shifts, who's even talking about this? - work with businesses to try for shift work where possible to minimize contact, ok - restaurant seating capacity limits, at least let's have the discussion - sports, let's discuss - nursing homes criteria, let's make these very rigid eh? - rapid tests, deploy them to the places where they are needed the most, not just to the highest bidders The list goes on. There are ways to move forward and out. But what we have now is finger pointing and a vague "We have to get better" and "too many people are dying" mantra that is not a path forward but a fear-driven refrain that does not advance us out of the problems noted above vs. "Let's full bore open up wide and let 'er rip" that ignores the seriousness of the virus. As long as these two sides won't acknowledge the others' merit or humanity, we do not move meaningful discussions forward, and we need to desperately. Especially for schools, and especially before winter sets in.

Every time I hit you on any numbers, you resort to this trope. It's weak. I'm not sure why you run from the numbers. It's a certainty that a mental health crisis is leading to more deaths. Nothing in that paper shows that, however, despite its "conclusion." It's a paper that alleges to show a death spike but doesn't account for the CDC's lag in confirming Covid deaths, and then concludes the spike is due to mental health-related violence, without any causal link. You are drawn to papers that back your conclusion without questioning the sources and that's a bad source. I was hoping for a really good source on the subject, actually, as I've been trying to make the same point (mental health issues are spiking) on OTW and with others. There's a CDC report on this from last week by the way if you want to check it out. It doesn't have suicide and homicide data--but does have other mental health stats that show likely effects of Covid when you compare 2020 to 2019 (see footnotes 1 and 2). The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders.* Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April–June of 2020, compared with the same period in 2019 (1,2). To assess mental health, substance use, and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years across the United States during June 24–30, 2020. Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic† (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18–24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults§ (30.7%), and essential workers¶ (21.7%). Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic.

There is no evidence presented for the conclusion, “Many of these deaths are likely from suicide, despair, alcohol and drug abuse, and violence.“ There may be something to that—and I’m sure there is actually— but it’s a clumsy conclusion not backed by the data presented. Further, the article notes that the cdc data on Covid categorization lags but does no analysis on how that affects the paper’s data. For example, the CDC was 30,000+ deaths behind just a few weeks ago. So the excess deaths may be largely attributed to Covid deaths not yet categorized as such. In all, it’s an incomplete article posing as an academic paper on the Twitter-net. I hope he does more work to backfill this data in 2 months, through this same date. Then he can identify the gap in excess deaths if there is one, but maybe not yet the causes. Bad source.

The inability of people to engage in civil discourse is one of society’s real challenges Right now. I’ve done nothing to insult you. You have insulted me. I’ve tried to engage you on this side issue about your hypothetical and personalizing public policy. You refuse to talk about it. As it is, you say you didn’t read my post, which is highly unlikely. But if you did, you’d see that I answered your hypothetical even though it has no place in a public policy discussion. I did that just to see if you’d keep talking about the public policy issue we are discussing since you say you care about it. I am happy to keep discussing issues with you. You can keep being insulting and call me names. I won’t reciprocate. But you should keep working to stay engaged. Taking your ball and going home is what too many people do.

I am combatting an "n of 1" argument, as I believe you know. That's not where public policy is ever made. And no, I am not comparing Covid-19 to a peanut allergy. Hospitals shift their cases and have successfully kept ICU beds available using various strategies. So there has been flow, but not overflow of people in tents, parking garages, and the like. The hospital system has not failed except maybe in NYC in April, which was unique for a lot of reasons. With Florida, Georgia, and Texas never closing and past their peak, there was no "overflow" of hospitals resulting in the quality of care death spike that I feared would happen back in April (and yes, I posted about it back then). It just didn't happen. With cases and hospitalizations falling in those places--which again NEVER CLOSED--there's no reason to think we are going to see another hospital spike much worse than what just happened. Most of the polio shutdowns were for the summer and focused on children's activities (but not every summer for 19 years). Other non-essential businesses largely proceeded apace. When summer ended, most kids went back to school, though there were periodic shutdowns. There's no modern comparison to what we've done to America, shutting down so much to protect the average age of 79 with 2 comorbidities. Think about that again: We let almost everything stay open for a disease that affected our kids--except the kid things--but are shutting down everything to protect the elderly.

Also from that same CDC report: "A quarter of young adults reported that they had thought about suicide in June, compared with nearly 11% of respondents overall reporting they were seriously considering suicide in the 30 days before completing the survey, doubling pre-COVID-19 rates. Black and Latino people, caregivers, and essential workers were particularly vulnerable to such thoughts." There's more at stake here than that Covid-19 is dangerous.

No, your question has no place in public policy determinations. You don't get that but you do understand the jungle gym argument and how it shows your argument doesn't work. If my daughter died because she went back to school, I don't think I'd have room in my mind for covid discussion. But of course I would regret anything I ever did to contribute to her death. I assume this answer makes you feel like you scored a point in our argument. It should not. Public policy is not made on the basis of the single person harmed. It's made for the whole. If you want to discuss rationally what is better for society, let's do that. There's a debate to be had between "open all the stadiums for football" and "don't open even schools until there's no more transmission." That's the area we should be discussing as a society. Your personal pain and anxiety informs your view but it doesn't advance the public policy considerations.

Substitute your widespread drug of choice if you want. Some drugs, some foods, some toxins we think of as normal, cause death in small numbers. My point is the same. The argument "what if it's you" is the "n of 1" argument and not a valid one for public policy. But it does explain the human motivations we all have behind our perspectives. That's not how we make public policy decisions. The vaccine people were an example. Could use many others. There are people in my neighborhood who want to tear down all the jungle gyms on playgrounds because a kid got severely hurt. That group makes the n of 1 argument too ("What if it's your kid who falls off the 10 foot plastic castle and has a severe spinal injury?") and the "1" is tragic but that's a risk I accept. “ A report released by the Centers for Disease Control and Prevention (CDC) last week found that among 5,400 respondents, nearly 41% reported at least one mental or behavioral health condition, such as symptoms of anxiety, depression, trauma, or increased use of substances to cope. Anxiety symptoms reported between June 24 and 30 were three times as prevalent as the second quarter of 2019, and depression was four times as high. Young adults in particular were affected — nearly 75% of respondents between the ages of 18 and 24 reported experiencing at least one behavioral or mental health symptom.”

My friend, that's not right. Outdoors is ALWAYS going to be safer. Consider the particles in the total volume and you can see why. The ani-vaccine people who have kids who died from getting vaccines make the same argument. Doesn't make it a good reason not to get vaccines, just makes it come from the heart. It's fine if that's your source, and my heart goes out to them and you, but it's not how we decide matters of public policy.