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22 June 2020

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Terence Gore

Event 201 The pandemic exercise just prior to the pandemic had a discussion about communication, misinformation, and disinformation

https://www.youtube.com/watch?time_continue=2&v=LBuP40H4Tko&feature=emb_logo

JJackson

All
I read Deap's post before there were any comments but there was so much wrong with it I decided to see if anyone would take issue with it. Previously I have tried to engage here on Covid but those of Deap's mind set dominated. I am delighted to see most of the posts have pushed back.
I will add that Kawasaki like syndrome is not gone more cases are being found mainly in the young but fortunately there is a treatment that works, in most cases, and it is fairly rare.
The serology tests results vary enormously and none have been large enough to say anything definitive about the number of people who have gone on to produce detectable antibodies. Some people who have tested PCR positive and been hospitalised do not have detectable antibodies post infection. Again there is not enough data to be definitive but could be 15 to 20%, we also do not know if the antibodies are neutralising (block reinfection preventing disease) and if not what level of protection they will offer. Also unknown is how quickly immunity wanes. Corona viruses do not generally produce very long lasting immunity (6 months to a couple of years) nor do they provide protection against even closely related strains.
I expect one, or more, of the vaccines candidates to work but not provide the same level of protection as a full infection.
Deap holds up S Korea as an example but it is important to remember that after their SARS-1 experience the enacted emergency powers, which COVID triggered, allowing them to track any cases phone and map where they had been and who had been in their vicinity. The can also pull your bank account and find out where you made purchases and who else was there. This makes contact tracing far easier and they pushed test capacity early. These two interventions mean a lot of those potentially exposed are found isolated and tested. We never did any of that here in the UK and it shows.
Excess deaths data for over the course of a wave in an area gives an indication that something is going on. In the UK we have about 50% more dead than usual for New York city that was 300% with 8000 deaths in the worst week when 1000 would be normal. If that is what is happening even with lock-downs and unprecedented physical distancing this disease is not trivial and should not be treated as such.

Eric Newhill

JJackson,
I disagree with your excess death figures. Where did you get them?

Also, excess death assessment will have to wait until the year is over. Many of those who died due to covid were going to die this year due to age and underlying conditions. They may have lost a month or two or three, but that's it.

Also, some proportion of excess deaths are due to people not being able to access healthcare for non-covid acute and chronic conditions + suicides + drug ODs/alcohol (increased stress from being isolated and financial problems from job/business loss).

Deap

How far shall we go to prevent the "40,000 ordinary flu deaths" next year?

BTW: I originally posted this "Swiss Research" on the Open Thread, and not as this separate thread. Creating this separate thread was an editorial decision that was out of my hands and also snas paragraph indentations.

I started my original post with the caveats: "alleged media review", as well as the always appropriate warning "trust, but verify". Which also appear at the head of this thread.

I very much appreciate the vigorous discussion this generated, but hope one is reminded this report was simply thrown out for open thread discussion only in our current Covid milieu of little science, poor data, distorting fiscal incentives, and way too much partisan political exploitation.

Having also been in health care for several decades, the emerging information reported in this thread did not trigger to automatic dismissal; having witnessed other epidemic threats in the past.

Trust but verify - which does mean track the footnotes - is my own watch word too. Problem with anything Covid related today is the dearth of any reliable "science": yet fundamental policy decisions are being issued "in the abundance of caution".

The personal insults directed at me were silly - no offense taken.

However, the ensuing discussion begs the additional question, are we in fact ready for "Medicare or All" blank check, when we still cannot define what "health care" is. Nor defining who exactly will be making these important decisions for us. And then sending us the bill.

Also a very mature-aged observer today, I remain far more intrigued with the underly psychology (better term is perhaps Weltanshaung) that is also in the mix on both the local and global level. A boomer confrontation with mortality; a generational shift passing the torch to a those born into the global internet world; the harvesting of US public K-12 indoctrination in to a new world order?

Cutting my own midlife adult teeth on the Dawn of the Information Age (circa 1990's). We are now witnessing the Dawn of the Disinformation Age. What hath God wrought?

Fred

JJackson,

"Kawasaki like syndrome is not gone"... ....... "it is fairly rare." As in less than 20,000 cases out of a population of 330,000,000. It is a microscopic risk that most people never heard of and need not worry about but will get mentioned numerous times to keep the fear up.

"S Korea as an example but it is important to remember that after their SARS-1 experience the enacted emergency powers"...
State and local governments did that here, commandeering rights in violation of the constitution. They won't be releasing that power and will use it as pleased to keep everyone in line. Masks on people , antifa has a harder time destroying the cultural history of the Republic if they stick out. Meanwhile rejoice, no cancer or heart disease related deaths are reported in the press and after three months of governmental decelerations of screenngs being "non-essential" - like the 40,000,000 jobs lost by government ordered shutdowns, there will be fewer cases reported, unlike for the Wuhan flu, which has plenty of testing ramped up now, which sure accounts for discovering all those cases.

Nothing like 2 flu seasons in one to kill off 100,000 more people than projected, especially when governments order infected patients back to nursing homes. Thanks China, the democratic party, and media in general.

drb

Mike46, I don't see how mercola matters. perhaps I should have posted the original in German? that is all I could find for an english version. Please note the authors of that document are glauner and borscht. and they, too, do not matter either. all that matters is the data in the figure are right, or they are not. At least six papers have been published on vit. D and covid, and you can find at your leisure whether they support the figure in the letter, or not.

Mark

A lot of people seem to have a great deal invested in acceptance that this is some sort of plague that is cutting us down in windrows, reaping us like wheat. I realize the WHO is a largely-discredited organization now, fat as it is with Big-Pharma execs and connections, although you would kind of expect a health organization to have some sort of relationship with the pharmaceutical industry; that notwithstanding, the Assistant Director of the WHO, himself a noted epidemiologist, was in China for much of its experience with the outbreak. He said at the time that outside Wuhan - exempted because of the small dataset and some remaining unknowns at the time - the mortality of the coronavirus was less than 1%. He did caution that that figure should not be broadly extrapolated to the rest of the world, because the Chinese medical care was both excellent and aggressive.

People keep citing the overall death figure as if it means something, that we must believe because it kills this many thousand compared to this many thousand. The mortality figures as reported to the WHO are massively skewed toward a high fatality rate because that suits certain political agendas. We have seen evidence from a variety of sources, including actual written direction from a US government statistical department , to count the cause of death as COVID-19 if it is even suspected. Ditto in the UK, a lot of deaths which were not due to COVID-19, but which was merely present at the time of death. The state of New York admitted to have counted 3,700 deaths as due to COVID when the victims had not even been tested.

Likewise the wave of terror that 'cases are spiking'; does that mean many more people are dying, or does it mean testing is revealing that many more people have it? It is, after all, quite a contagious virus.

I guess in the end, people are going to believe what they want to believe, and there is no doubt there is a social element that is grooving on the virus, on facing the challenge of a lifetime and keeping a stiff upper lip, old chap - banging on the cookware at 7:00 pm and singing paeans to the frontline workers. Those people are never going to accept that it was not really a very dangerous disease at all, one that required sensible precautions, certainly, but never one which required the total cessation of global commerce. Forcing restaurants to pay rental costs by the square foot but limiting them to half the normal clientele for 'social distancing' is idiotic and a death sentence for such businesses; if you feel nervous about being in close proximity to other people, by all means stay home. Have your groceries delivered and left on the doorstep for as long as you like, nobody is ordering you to go to a restaurant. It should surprise nobody that when you let the Health Department make national policy, they will skew the rules toward there being no risk of disease whatsoever, because they have jobs and are probably pulling down some sweet overtime into the bargain.

Eric Newhill

Deap and Mark,
I agree that the psychology is extremely interesting. There indeed seems to be a heavy investment in establishing and maintaining the idea that this virus is of apocalyptic proportions.

That investment mostly - not completely - runs on along party lines from what I can see. Conservatives tend to dismiss the virus and progressives tend to take it very seriously. Maybe that is just the lack of trust in government that conservatives tend to hold and the trust of and seeking of protection via government that characterizes progressives. I sense there is more to it beyond tangible objectives like diminishing the economy and hence Trump's chance at victory (or even mail in ballot fraud). I just can't put my finger on it, yet.

steve

" for labor and delivery. They are tested now upon being admitted. Yes, they are in the hospital and, yes, they tested positive, but they are in the hospital for reasons unrelated to C-19 and are asymptomatic."

Nope. If they test positive they have their elective surgery delayed as there is literature suggesting that Covid positive pts have worse outcomes. Labor floors have either tested all along or stopped as they are the one group where testing wont delay their procedure.

Steve

blum

I sense there is more to it beyond tangible objectives like diminishing the economy and hence Trump's chance at victory (or even mail in ballot fraud). I just can't put my finger on it, yet.
Posted by: Eric Newhill | 23 June 2020 at 06:44 PM

To what extent did the 'psychology' or bad economy leave traces in your business: health care insurance? You've got access to up to date numbers? Increases in health care insurances or decreases based on jobs lost? Higher demand in premiums?

Any numbers available on customers that may have or in fact died, as you suggest, not of covid, premium customers too, since the hospitals sent them home in heavily life-endangering states due to the corona panic. I find that hard to believe. But may no better, maybe even have access to numbers.

********

concerning intangibles: A conspiracy of the larger Resistance with China?

What exactly? ...

JJackson

Eric
Excess death data from Financial Times
https://www.ft.com/content/6b4c784e-c259-4ca4-9a82-648ffde71bf0
Also BBC had the same data.

Eric we do not know how many cases of Kawasaki like syndrome there are or will be. As you point out people are not keen to take their children into hospital so with out the publicity they did not associate the symptoms with COVID. The same is true for clotting complications. This is not a severe pandemic it is moderate but more severe than anything since 1918. It is a good dry run to test our resilience, or lack thereof.
How has humanity done - 3 out of 10?

Mark

Here's the information from which I believe the figures are sourced. Studies are quoted where applicable, looks like mostly good data to me. Particularly effective is the graph displaying the Imperial College predictions for Sweden, without a lockdown, and the actual cases and deaths. Not even close.

https://swprs.org/studies-on-covid-19-lethality/

guidoamm

Looking at infection and mortality rates on ships should be instructive.

If we take the most biased source that is Wikipedia, out of around 40601 passengers and crew, so, far, by end June 2020 we have 22975 infections and 76 dead.

This, after we allowed the authorities to count people that died weeks and months after the fact and whose death has been attributed to Covid19 merely by virtue of the fact that they had been on one of the ships in question.

76 / 40601 gives us an overall mortality rate of 0.0037%

76 / 22975 gives us an IFR of 0.33%

Let's double that so we have a margin of safety.

On a cruise ship, where passengers and crew live at close quarters, where all cabins share the same ventilation system, where people shake hands, dance and eat together, speak loudly at close proximity to one another, where they share sunbeds, chairs and common spaces.

Cruise ships where the average age of passengers is exactly the cohort that is most susceptible to succumb to this bug.

Cruise ships that, at the best of time, are a petri dish of viruses and bacteria.

If we take Wikipedia data at face value and if we double the mortality rate reported so as to have a margin of safety.

Overall mortality: 0.008%

Infection Mortality rate would be: 0.66%

https://en.wikipedia.org/wiki/COVID-19_pandemic_on_cruise_ships

g

guidoamm

Let us also remember the "saga" of The Zaandam.

Here is the hit piece that was peddled by The Guardian complete with an emotional music score and a theatrically sensational narrative designed to instil fear and dread into the reader. For good measure, they even start the piece with BOJO's hospitalisation, just to point out that nobody is safe; not even political leaders.

At time stamp 3':00 they even mention the "terrible" situation that was the Diamond Princess.

This virus is scaaaaary.... and nasty! This virus is the new Black Death.

https://www.theguardian.com/news/audio/2020/apr/07/zaandam-onboard-the-coronavirus-hit-cruise-ship

The narrative, tells us:

March 7th, 1200 passengers board the Zaandam

March 14th, the Zaandam docks in Chile but no one is allowed to disembark

March 22nd, flu-like symptoms are reported amongst passengers and crew.

Here is the problem.

Between boarding on March 7th and the influenza-like symptoms becoming manifest on March 22nd, we have an interval of 14 days.

This tells us that whomever carried the virus onboard the Zaandam, had a leisurely 14 days to spread it around and spread it good! So, for 14 days, passengers and crew mingled, cooked, ate, drank, danced, spoke to each other, drooled and sprayed over each other, touched surfaces, touched food, used bathrooms, rolled around laundry, walked around, swam in the pool, shared sun beds and dripped sweat on all manner of surfaces for other passengers to smear themselves in.

Those 14 days should have been the infectionpalooza of the whole sorry Covid19 boondoggle culminating into a mortality fest of biblical proportions.

Yet, on:

March 22nd, when confinement was ordered, only 13 guests and 29 crew exhibited flu-like symptoms.

March 27th, 138 passengers and crew are affected by flu-like symptoms and 4 are dead

April 3rd, "There have been nine confirmed cases of COVID-19 among the 1,243 passengers and 586 crew members onboard the ship and RTÉ reports that up to ten Irish passengers are among the passengers. However, there are nearly 200 sick passengers and crew members who have yet to be tested for the virus. "

At time stamp 19:10 of the hit piece, The Guardian informs us that 1100 passengers left the ship in Florida to travel home.

In summary

Zaandam cruise ship
1200 passengers
850 crew
March 7th to April 3rd
Total of 24 days stranded at sea without setting foot on land

In this confined space that is a cruise ship where the median age of passengers is well above 60 years of age (the most susceptible cohort to respiratory diseases), where isolation is impossible, where passengers and crew live at very close quarters...

In 24 days, this terribly contagious and lethal virus infected AT MOST 209 passengers and crew.

Of the 4 fatalities reported, only 2 tested positive for Covid19.

Eric Newhill

Steve,
I see admissions for orthopedic surgery with a secondary diagnosis of covid. maybe those are joints/bones damaged in accidents - or maybe there are exceptions for severe cases. Pregnant women in labor/delivery are also having secondary diagnoses of covid. There are various ways that could happen. maybe your hospital is different policies. maybe the women asked to be tested.

Eric Newhill

Blum,
Mostly I can't talk about the answers to your questions. It's company info.

I can tell you that since medical claims volume was so low Feb - current, that our medical loss ratios have fallen below 80% and due to restrictions set by Obama, we would be penalized as a result. So we are paying claims for members who incurred claims after their benefits were cancelled due to lack of payment on premiums and we are delaying disenrollment of members for failure to pay premium in some products.

This should not impact premiums for next year as we realize that Q1 & Q2 2020 were a one off situation.

I don't work on Medicare Advantage and the impact on covid hospitalizations on the <65 membership was very minimal. So no hits to us from expensive ICU/Vent utilization. Like it just wasn't there.

ACA impacts are yet to be determined. Enrollment up or down due to covid related economic issues is hard to tell so far. A lot of confounds. However, same medical loss ratios as commercial and same extremely minimal impact due to covid ICU/Vents. Just not there either. We were watching for it and studying it, but it never materialized. Covid is a potential problem for the 65+ group only.

All of that said, we are very concerned about members who were unable to receive treatment for non-covid conditions due to restrictions and are watching to see if the is an uptick in preventable hospitalizations for conditions ranging from diabetes to cardiovascular issues. There had been significant drops in hospitalizations for a wide variety of chronic and acute conditions as well as meaningful decreases in screenings, imaging (MRIs, CAT, PET scans, mammograms, skin cancer, etc).

How it all shakes out is TBD

Account Deleted

guiodoman:

It is instructive. It shows that isolation and testing works.

Deap

In defense of cruise ships and their misrepresentation as "floating petri dishes", there is a very high awareness of noro-virus ( G-I, tourista) prevention on all cruise ship. And has been for years. This means there already is a high degree of onboard sanitation protocol on board and awareness among long time cruise passengers.

Good habits are drummed into cruise passengers almost daily - washing hands reminders, in every language. Using knuckles on elevator buttons, covering coughs and sneezes, not shaking hands, never touching mouth, nose or eyes with anything other than immediately cleaned fingertips, hand sanitizers stationed around the ships and at every food service and embarkation point, and constant disinfection of common high touch areas and equipment, including the cabin TV remote.

Additionally if noro infection is a guide, cruise ships require very strict isolation in one's cabins if a patient becomes symptomatic. This can be monitored by electronic key cards. The picture of cruise ships being high contact party centrals applies to a few lines, but certainly not ships like the Zaandam - lots of quiet spaces, nice cabins and excellent sanitation protocol to the best of anyone's ability.

I should know, I was on this ship in February this year. I did get a negative covid anti-body test (Quest Labs) after following the lurid media saga of its very unfortunate reprise one month later as the Flying Dutchman ghost ship, wandering the seas endlessly and forever.

One is far more concerned they might pick something up on the plane flight to get to the cruise ship embarkation port, rather than from the cruise ship itself. Hence the introduction of unwanted infections on the ships themselves.

And yes, often one gets "cruise crud", transient but mild upper respiratory infections probably due again to airline exposures and in and out of A/C and less than compliant fellow passengers. But this has been the case long before covid. Were these the "flu like symptoms" that got classified as "covid"?

But no one ignores sanitation within the cruise ship industry - for noro, if not now for covid. For more information visit the CDC "Vessel Sanitation Program" (VSP) - routine and spot checks are a 24/7 awareness for the staff and crew - and published ratings mean no one wants to be branded with low scores. In fact, many of the "fun events" like crowded outdoor buffets had to be eliminated because of insufficient access to hand washing stations for the food handlers.

CDC's VSP puts everything under a sanitation microscope these days, for the benefit of the passengers, as well as the industry. Bad publicity on one ship damages them all.

One point cruise lines do need to consider is the ADA demands they accommodate high degrees of passenger disabilities which can concentrate high numbers of co-morbid factors within this industry; including C-PAP users, the morbidly obese who do love shipboard buffets, as well as very advanced age and often very compromised mobilities to the point of even accommodating a very occasional wheeled gurney in the dining room.

So when all other more routine travel is no longer possible for these severely medically compromised persons, it did fall of cruise ships to offer required ADA accommodations that concentrated their numbers in this particular travel industry. I am very sorry to see what happened to this industry, because by its nature it has been responsive to a unique passenger demographic for ever.

A ship's Hotel Director once candidly observed, look around this room - 50% of the passengers should not even be on a cruise ship. Yet ADA demands said accommodate them.

Three people died in the first week on my very first global cruise in 1977 - elderly and had made arrangements ahead of time leaving notes for a "burial at sea" if the time came while on board. In the 1970's - well before covid. I personally thought at the time, that is how I want to go too. Doing what I love.

Eric Newhill

JJackson,
I think you should take a look at the CDC data in this link
https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

You can refresh the graph to show different cuts of the data. Hit the button for "Total number above average by cause" - this is the number of deaths above average for the period Q1 - Q2 2020 (during the covid scare).

You don't have to believe me about what was killing people. Look at the cause of excess deaths. It ain't covid or covid like symptoms. And it sure looks to me like it implies that covid was basically just this year's flu. I'm busy right now and maybe I didn't read what I'm looking at closely enough, but you tell me what you see.

Jack

How to interpret this hospitalization chart?

https://twitter.com/klendathucap/status/1275902770395205638?s=21

LJ

Chris Martinson addresses many points in this post, at a fairly technical level. His most alarming point is the virus has become far more virulent.

https://www.youtube.com/watch?v=8B-rk5VUcLo

guidoamm

English outsider,

Confinement is an arithmetically doomed strategy that, at best, can buy you a handful of days of respite.

Confinement is not meant to eradicate the virus. Confinement is merely meant to slow down the progression of the infection; to "flatten" the curve.

Once you have an infection rate of, say, 2.5 and you know it takes 2 days for an infected individual to infect others, you can work out a progression that gives you 83 million infected in 31 days.

If we assume that we have ordered the population to confine the day we realised we had 1000 individuals infected with a new virus, this means that we sheltered in place around day 12 of the spread of the infection.

Let us now assume that confinement reduces the infection rate from 2.5 to 1.4.

So now, we order the population to shelter in place around day 12 of the spread of the infection. By day 31 therefore, in terms of infections, we will find ourselves where we would have been on day 26 if we did not order the population to confine.

The rationale for confinement was to mitigate the potential medical surge this virus could occasion. As you know, other than in Bergamo, hospital capacity was never strained anywhere in the West. Even in New York where the governor was clamoring for more ventilators and where a military field hospital and a hospital ship were sent to boost bed capacity, the effort went wasted. Ventilators were eventually shipped to other states and the field and ship hospitals were withdrawn.

The fact that surge capacity went unused however, cannot be attributed to confinement.

There are a number of empirical and scientific data that show that confinement was not useful in slowing the contagion.

In a first instance.

As a virus, Covid19 would have been spreading in the population months before anyone noticed we had a new virus on our hands. Thus, the idea that we were able to confine the population on day 12 of the spread is highly improbable.

In a second instance.

Isaac Ben Israel, military scientist, general and ex-politician. He currently serves as the chairman of the Israeli Space Agency and the National Council for Research and Development under the auspices of the Ministry of Science, Technology and Space of Israel - Michael Levitt, biophysicist and a professor of structural biology at Stanford University (Nobel) - John Ioannidis, physician-scientist and writer who has made contributions to evidence-based medicine, epidemiology, and clinical research. Ioannidis studies scientific research itself, meta-research primarily in clinical medicine and the social sciences.

These scientists and others, have cast doubt on the purported infectiousness and mortality rates thus on the usefulness of blanket quarantines.

Also, recent studies in France and Norway lead scientists, researchers and politicians to question the benefit of blanket quarantines.

https://www.revuepolitique.fr/covid-19-ce-que-nous-apprennent-les-statistiques-hospitalieres/

https://www.revuepolitique.fr/covid-19-premier-bilan-de-lepidemie/

https://www.spectator.co.uk/article/norway-health-chief-lockdown-was-not-needed-to-tame-covid

Then we have Sweden of course, where fatalities per 10 million population puts it in 4th or 5th place behind a bunch of other developed countries.

In a third instance.

The progression of the infection and the mortality rate aboard the cruise ships and the war ships, buttress the notion that this virus is not as infectious as previously thought.

There are other things to consider. For example. The vast majority of deaths occurred in nursing homes. Incidentally, this would be a much more worthy debate to be had. Specifically:

1 - Knowing what we know of Corona viruses and knowing what we knew from the experience in China, on what grounds did some politicians take the decision to park Covid19 patients in nursing homes?

2 - Why till today, knowing what we know, there are no official guidelines to quarantine nursing homes and the staff working there?

Covid19 is a real virus.

Take the political context out of it however, and the reality is not as dramatic as it is purported to be.

Blanket quarantines were never a rational response, neither at the medical level nor at the economic level.

Just a note about vaccines.

We have been working on Corona virus vaccines for the best part of 30 years. To date, we have nothing to show for it. Not even at the veterinary level.

For some people to claim that they are 18 months away from producing a vaccine should be treated with great suspicion.

Similarly, for someone to claim that life cannot return to normal till a cure or a vaccine is found, should elicit the same degree of scepticism.

JJackson

Eric try looking at "Excess deaths with and without COVID-19" then select NY City and you will see the data. As most of the US has yet to have a serious local wave the country graph does not show a big uptick. The problem lies in the tight geographical and temporal clustering of cases which cause havoc in while area while others have few cases. Once ICU capacity is exceeded the case fatality rate will get a lot higher in that area until cases can returned below that level. If the cases were evenly distributed across the country the numbers would be manageable, sadly there is no way to achieve that so the only option at present is reduce person to person contacts.

JJackson

LJ
I watched about half your link. Most of what he said seems right but he has rather more faith in face masks than I think they merit, they are better than nothing assuming you do not change your behaviour because you are wearing one. On the virology he is obviously out of his depth. S D614G is an ancestral single point mutation that occurred in China right at the start of the outbreak. Neither the D or G form has out performed the other or shown any detectable difference in virulence. The G form happened to spark the European outbreak which then spread to the US east coast. It is our less effective containment strategies that have caused these areas to increase its prevalence. The Scripps data is misinterpreted as it is a cell culture experiment and gives information on viral form, e.g. more Spikes, but lack of Spikes was never likely to be a limiting factor for this virus.

Eric Newhill

JJackson,
Yes, I am aware that NYC is an outlier.

Some points from my perspective. First NYC is not the country, despite what the newsies and govt seem to think. Why should a policy appropriate for NYC be inflicted on the rest of the country? Second, we know that the criminal (IMO) policy of placing C-19 infected people in nursing homes contributed greatly to the number of deaths there. Third, NYC involves some unique situations, like subways and overcrowded living in small apartments, that enhance the spread of the virus and the viral load. Fourth, NYC facilities have been the most liberal in determining cause of death = C-19 (to the extend of being fraudulent, IMO. C-19 increases the reimbursement rate and can result in other financial relief). Fifth, I can already hear 'Steve' howling, but NYC had a lot of incompetent/insufficiently trained people administering vents. They literally killed people (just more of the medical errors that kill 330,000 Americans every year).

So, even though NYC is an outlier, it didn't need to be as nearly as much of an outlier. In fact, had NYC handled the situation properly, I may have been more in line with other big cities.

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