It now definitely looks like an uptrend in new COVID-19 cases in the Mountain states. And maybe the Midwest. And maybe the start of an uptick in a couple of other regions. And yet, there’s no uptrend in Canada, or in alpine Europe. And, as of today, the U.S. remains at 13 new COVID-19 cases / 100K / day, same as it was two weeks ago. But with an upward trend now.
Separately, I’m redoing the math to check whether or not I can dismiss the steady 3300 daily new COVID-19 hospitalizations as consisting mainly of people hospitalized with COVID, as opposed to those being hospitalized for COVID. And the answer is no, I can’t. The numbers just don’t work out. Near as I can tell, we’re still seeing 3300 a day hospitalized for COVID, and 350 a day dying from COVID. That means that COVID-19 remains far more serious than seasonal flu.
Data source for this and other graphs of new case counts: Calculated from The New York Times. (2021). Coronavirus (Covid-19) Data in the United States. Retrieved 11/08/2022, from https://github.com/nytimes/covid-19-data.” The NY Times U.S. tracking page may be found at https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
By region:
Hospitalized with COVID versus hospitalized for COVID.
I continue to be amazed by the extent to which seemingly normal people are willing to make stuff up and spread disinformation. And so, despite considerable evidence to the contrary, I continue to read on-line chatter suggesting that the continuing high count of COVID-19 hospitalizations isn’t “real”, ditto for COVID-19 deaths, and that therefore COVID-19 is now no more dangerous than typical seasonal flu.
Near as I can tell, that’s completely wrong.
Deaths.
With regard to COVID-19 deaths, that’s based on death certificate data. The question of dying from COVID versus merely dying with COVID has been analyzed at length by the CDC. While CDC does include death certificates with any mention of COVID-19, they also showed that 94% of deaths with any mention of COVID-19 on the death certificate showed COVID-19 as the underlying cause of death. (For the other 6%, COVID-19 contributed to the death, but was not the underlying cause of death).
So, for the 350 COVID-19 deaths per day, there is zero uncertainty. Within a small margin of error, those people died from COVID. That’s in the opinion of the (typically) physician most familiar with the case, tasked with filling out the death certificate.
By itself, that makes COVID-19 far deadlier, right now, than the worst U.S. flu epidemic in recent memory, which was the 2009-2010 swine flu pandemic. CDC estimates that about 12,500 people died of flu during that pandemic. By contrast, at 350/day, we’re on track to have 125,000 deaths from COVID-19 this year. In round numbers, at the current rate, COVID-19 is equivalent to ten of the worst flu seasons in modern U.S. history, in terms of deaths.
Bear in mind, however, that arguably the majority of deaths are occurring among the still-unvaccinated. If you are fully vaccinated, it’s plausible that you bear no greater death risk from COVID-19 than you do from typical seasonal flu.
Source: CDC.
To sum it up for deaths: Zero ambiguity. Even at the current level of 13 new cases officially diagnosed per 100K population per day, COVID-19 is vastly more dangerous than the worst flu season in the modern era. But that death risk is hugely concentrated among the unvaccinated.
Hospitalizations
I addressed this topic in some long-ago posts (e.g. Post #1351).
The hospitalization numbers that you see for COVID-19 are for persons who are a) admitted to the hospital, and b) test positive for COVID-19. In fact, I believe that if you’ve tested positive any time in the two weeks prior to admission, you get counted.
That count of admissions is a mix of persons who got admitted because of their COVID-19 (principal diagnosis of COVID-19), and people who got admitted to be treated for something else, and just happened to have COVID-19 (secondary diagnosis of COVID-19).
Now, as with death certificates, anyone with direct access to the hospital bills or discharge abstracts could quantify this directly. All they would need to do is count the fraction of those bills where COVID-19 is listed as the principal diagnosis — that is, the diagnosis which, upon reflection, was the reason for the majority of resources consumed during the hospital stay.
Unfortunately, as far as I can tell, nobody has bothered to do that. So we have to look at indirect evidence.
First, the numbers strongly suggest that the fraction of hospital admissions with “incidental” COVID-19 — where the patient was admitted for something else, and just happened to have COVID — should be small. Here’s my version of that calculation, just taking the 13 new cases / 100K / day at face value:
That’s about 5% of the reported daily COVID-19 hospitalizations. Even if the true new-case count were triple the official count, you’d still only get up to about 15% of daily reported admissions. Toss in a factor for a modestly higher COVID-19 new case count among the elderly (who account for most hospitalizations), and maybe you could argue that as much as one-quarter of what is currently being counted as COVID-19 admissions might be admissions where COVID-19 is incidental.
That still means that the vast majority of the current 3300 cases per day are people being hospitalized for COVID-19, not merely those hospitalized with COVID-19 as a secondary (incidental) diagnosis.
You can also look directly at information of Medicare beneficiaries who were hospitalized with any diagnosis of COVID. Per the U.S. DHHS OIG, roughly nine out of ten admitted with COVID were, in fact, treated for acute respiratory problems:
Source: U.S. Department of Health and Human Services, Office of Inspector General, Data Brief, September 2021, OEI-02-20-00410
The upshot is that for Medicare patients admitted with COVID-19 — arguably the majority of all COVID-19 admissions — almost all of them have some sort of acute respiratory problem requiring medical treatment.
Once again, that sure looks like the vast majority of those who were admitted with COVID-19 were, in fact, admitted for COVID-19.
Finally, there has now been at least one academic study of this issue. Their conclusion is that, at the handful of sites studied, about 70% of cases with COVID were cases admitted for COVID (reference).
The point remains the same: The overwhelming majority of cases admitted with some diagnosis of COVID were admitted for treatment of COVID.
As with deaths, the current COVID-19 daily hospitalization rate will result in far more hospitalizations for COVID-19, this year, then occurred for flu, during the worst seasonal flu epidemic in the modern era.
