Covid-19

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cowboyinexile

Have some class
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Their problem began when they starting accepting patients from across the border if I remember correctlyr. They got overwhelmed really quick with that.

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Can't knock them for that though. That's what doctors and hospitals do.

If you want to ask about rural America the problem began when hospital groups started consolidating. The hospital where I live is part of Mayo. It's nice for rural America but for years has been shedding doctors for PA's and limiting nursing staff as a way to cut costs. Currently in the county we have 8 covid patients in the hospital and are at capacity. We have beds for 30 but nurses for 8. If a patient requires ICU care they get shipped to a bigger hospital. We have beds for 5 there but nurses for 0. Technically we have nurses for 5 (or more), but the number is 0.

So serious cases get shipped to Mankato or Rochester. The catch is they can only handle so many and now every county in the area is shipping them there. We do have a nice hospital in Albert Lea that Mayo shuttered 6 months before this thing broke out. Back in February us locals figured that 100+ bed regional facility that had a 7 figure upgrade 10 years ago was a perfect place for covid patients. As of right now it's empty. Plenty of beds but no nurses or doctors to staff it.
 
Feb 11, 2007
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Oklahoma City
I've seen you post this a few times and let it go. This is the wrong way to count CFR. You need to create a lag in the data, even for rough approximations. Deaths do not immediately happen upon diagnosis, which is what your rough analysis suggests. If you want a better approximate CFR, take yesterday's 7 day death average and divide it by the 7 day case average from a month ago (roughly the time from diagnosis to death these days). Pulling numbers from worldometer, you get: 1398/61685 = .023 (2.3%). Even if you only do a two week lag, you're looking at: 1398/102207 = .014 (1.4%),
Assuming the latter current CFR means you also have to assume we're doing a worse job of extending life post infection, which is not accurate either.

Doing it your way will make things look overly rosey when cases are increasing and worse than they actually are when cases decrease.
I am eager to learn and certainly am certainly willing to be corrected. However numbers posted by the Oklahoma Health Dept certainly must have their flaws but they use their own criteria for posting these reports month after month.To use out of State sources with their own errors and to compare it with our own OSHD data just adds in my opinion to the problem. I have never heard or used the term "CFR" and I have never heard of "worldometer". Thank you for your response.
 
Feb 11, 2007
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Oklahoma City
Can't knock them for that though. That's what doctors and hospitals do.

If you want to ask about rural America the problem began when hospital groups started consolidating. The hospital where I live is part of Mayo. It's nice for rural America but for years has been shedding doctors for PA's and limiting nursing staff as a way to cut costs. Currently in the county we have 8 covid patients in the hospital and are at capacity. We have beds for 30 but nurses for 8. If a patient requires ICU care they get shipped to a bigger hospital. We have beds for 5 there but nurses for 0. Technically we have nurses for 5 (or more), but the number is 0.

So serious cases get shipped to Mankato or Rochester. The catch is they can only handle so many and now every county in the area is shipping them there. We do have a nice hospital in Albert Lea that Mayo shuttered 6 months before this thing broke out. Back in February us locals figured that 100+ bed regional facility that had a 7 figure upgrade 10 years ago was a perfect place for covid patients. As of right now it's empty. Plenty of beds but no nurses or doctors to staff it.
Rural hospitals have been having a terrible problems for years without enough income just to try and stay open.You are fortunate to be near Mayo. Its a big problem in Oklahoma as well.
 
May 4, 2011
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Charleston, SC
I am eager to learn and certainly am certainly willing to be corrected. However numbers posted by the Oklahoma Health Dept certainly must have their flaws but they use their own criteria for posting these reports month after month.To use out of State sources with their own errors and to compare it with our own OSHD data just adds in my opinion to the problem. I have never heard or used the term "CFR" and I have never heard of "worldometer". Thank you for your response.
I can't tell if you're serious. CFR is case fatality ratio, a common term in epidemiology. It's what you appear to be trying to calculate as it's the proportion of identified cases that result in death. Early in the pandemic, people were taking the total deaths and dividing by the total identified cases to derive the original CFRs of 5%. You seem to be getting at the CFR for recent cases, but since the vast majority of people are NOT dying before or immediately upon diagnosis, you need the lag.

Worldometer is a data aggregating site and I applied the CFR to the entire US. Given your preference for using OSDH data (I'm assuming that's what you meant), they say there was an average of 13.9 deaths on a seven day rolling average on November 9 (the last date for which they put out that average). Lagging it a month, there was a 7 day rolling average of 1076 new daily cases on October 9. So, with roughly an average of a month between diagnosis and death, you would estimate about 1.3% of those diagnosed around October 9 have died. In other words, a rough estimate of the current CFR for Oklahoma is 1.3%.

I'm just using their COVID dashboard to calculate that if you want to check my sources or math. https://experience.arcgis.com/experience/0e8ccb659c804924b72ddc862ec0eadf
 

wrenhal

Federal Marshal
Aug 11, 2011
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Their problem began when they starting accepting patients from across the border if I remember correctlyr. They got overwhelmed really quick with that.

Sent from my Moto Z (2) using Tapatalk
Can't knock them for that though. That's what doctors and hospitals do.

If you want to ask about rural America the problem began when hospital groups started consolidating. The hospital where I live is part of Mayo. It's nice for rural America but for years has been shedding doctors for PA's and limiting nursing staff as a way to cut costs. Currently in the county we have 8 covid patients in the hospital and are at capacity. We have beds for 30 but nurses for 8. If a patient requires ICU care they get shipped to a bigger hospital. We have beds for 5 there but nurses for 0. Technically we have nurses for 5 (or more), but the number is 0.

So serious cases get shipped to Mankato or Rochester. The catch is they can only handle so many and now every county in the area is shipping them there. We do have a nice hospital in Albert Lea that Mayo shuttered 6 months before this thing broke out. Back in February us locals figured that 100+ bed regional facility that had a 7 figure upgrade 10 years ago was a perfect place for covid patients. As of right now it's empty. Plenty of beds but no nurses or doctors to staff it.
Sounds like everywhere lost a bunch of nurses when they started laying off due to surgeries getting cancelled.

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steross

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Mar 31, 2004
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Today (Nov. 20,2020) the Oklahoma State Health Dept. reported that of 167, 261 "cases" (persons testing positive), the number of deaths determined to be from Covid-19 was 1603. Thus 0.095% of those tested positive died. Again 95% of those who died were 50 years or over and 80% were 65 years or older. Others have reported that deaths co-morbilities (hight blood pressure obesity, heart diease, diabetes, lung disease etc) are associated with higher death rates. This makes it difficult and sometimes impossible at times to determine the primary reason for the death.
Have you been involved in the care of a critically ill COVID patient?
It is medically extremely easy to see the cause of death for the vast majority of them.
What makes you think that the people caring for them cannot differentiate a viral illness that fills the lungs full of fluid from obesity, heart disease, diabetes, or other lung diseases?

If an obese patient had a large stroke then died in the hospital, do you think it would be difficult for the medical team to figure out it was a stroke and not just obesity?
 
Feb 11, 2007
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Oklahoma City
Have you been involved in the care of a critically ill COVID patient?
It is medically extremely easy to see the cause of death for the vast majority of them.
What makes you think that the people caring for them cannot differentiate a viral illness that fills the lungs full of fluid from obesity, heart disease, diabetes, or other lung diseases?

If an obese patient had a large stroke then died in the hospital, do you think it would be difficult for the medical team to figure out it was a stroke and not just obesity?
Steross...as a person trained in internal medicine, having a fellowship in immunopathology, board certified in
Clinical and Anatomic Pathology and now as a practicing pathologist determining the primary (not associated cases of death) from contributing causes is often difficult if not impossible to untangle. I sent my previous post to a practicing pathologist friend in Texas whose only answer was "a-man". But let me add I salute you and other physicians who willingly go into harms way to care for the sick
 
Feb 11, 2007
4,638
2,031
1,743
Oklahoma City
I can't tell if you're serious. CFR is case fatality ratio, a common term in epidemiology. It's what you appear to be trying to calculate as it's the proportion of identified cases that result in death. Early in the pandemic, people were taking the total deaths and dividing by the total identified cases to derive the original CFRs of 5%. You seem to be getting at the CFR for recent cases, but since the vast majority of people are NOT dying before or immediately upon diagnosis, you need the lag.

Worldometer is a data aggregating site and I applied the CFR to the entire US. Given your preference for using OSDH data (I'm assuming that's what you meant), they say there was an average of 13.9 deaths on a seven day rolling average on November 9 (the last date for which they put out that average). Lagging it a month, there was a 7 day rolling average of 1076 new daily cases on October 9. So, with roughly an average of a month between diagnosis and death, you would estimate about 1.3% of those diagnosed around October 9 have died. In other words, a rough estimate of the current CFR for Oklahoma is 1.3%.

I'm just using their COVID dashboard to calculate that if you want to check my sources or math. https://experience.arcgis.com/experience/0e8ccb659c804924b72ddc862ec0eadf
Help me with these questions: 1. What is the definition of a "case" here in Oklahoma vs other reporting places in the US and around the world? 2. What is the definition of Oklahoma Covid-19 deaths? Is it anyone testing positive for the virus who dies in Oklahoma. Do all other places use Oklahoma's definition of Covid-19 deaths.
3. In Oklahoma a wide variety of tests for Covid-19 are used with various levels of sensitivity and specificity
making case definition difficult. What variety of tests are used in other reporting places?
 

steross

he/him
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Mar 31, 2004
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Steross...as a person trained in internal medicine, having a fellowship in immunopathology, board certified in
Clinical and Anatomic Pathology and now as a practicing pathologist determining the primary (not associated cases of death) from contributing causes is often difficult if not impossible to untangle. I sent my previous post to a practicing pathologist friend in Texas whose only answer was "a-man". But let me add I salute you and other physicians who willingly go into harms way to care for the sick
Thanks for telling me your credentials again but that wasn’t my question. You made a very specific claim. You claimed that it is difficult to impossible to tell the cause of death. I strongly disagree the vast majority of the time. These patients come in with a distinct pattern and hypoxic respiratory failure. They have a positive test. They has specific lab abnormalities. What is the issue calling it death by Covid when they die with that?

I don’t know what “a-man” means. But, I know none of the people dying of Covid made me think, gee, I wonder if this horrific virus that they have filling their lungs full of fluid so they can’t get oxygen is their problem or is it their diabetes? Not once.

If you want to salute me, do not make misleading statements about what I do. I am seeing lots of Covid. It is not hard to diagnose at all and we aren’t misdiagnosing it as you claim. That is a political talking point for uneducated people trying to downplay the pandemic. It is not the reality that I am living.
 
Mar 11, 2006
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This is fairly balanced article. Title is “1 America, 1 Pandemic, 2 Realities”

Article compares South Dakota, which it describes as “having the fewest restrictions of any state” to New Mexico which the article describes as having “some of the toughest restrictions in the country”.

Couple of interesting nuggets:
* Unemployment:
* South Dakota is tied for third for the lowest unemployment rate in the country at 3.6%. SD is only 30 bps above pre-COVID.
* New Mexico has the 7th highest unemployment rate (only CA, NY, HI, NV, NJ, LA are higher). NM unemployment rate is up 330 bps from pre-COVID.

* Deaths per capita
* South Dakota: 88 per 1M residents
* New Mexico: 63 per 1M residents

* Cases
Article points out the SD has a lot of current cases, but then states,
“Although reports of new infections have started to level off in South Dakota, daily case numbers have more than doubled over the past two weeks in New Mexico.”

https://news.yahoo.com/1-america-1-pandemic-2-164142659.html
 

steross

he/him
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Mar 31, 2004
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This is fairly balanced article. Title is “1 America, 1 Pandemic, 2 Realities”

Article compares South Dakota, which it describes as “having the fewest restrictions of any state” to New Mexico which the article describes as having “some of the toughest restrictions in the country”.

Couple of interesting nuggets:
* Unemployment:
* South Dakota is tied for third for the lowest unemployment rate in the country at 3.6%. SD is only 30 bps above pre-COVID.
* New Mexico has the 7th highest unemployment rate (only CA, NY, HI, NV, NJ, LA are higher). NM unemployment rate is up 330 bps from pre-COVID.

* Deaths per capita
* South Dakota: 88 per 1M residents
* New Mexico: 63 per 1M residents

* Cases
Article points out the SD has a lot of current cases, but then states,
“Although reports of new infections have started to level off in South Dakota, daily case numbers have more than doubled over the past two weeks in New Mexico.”

https://news.yahoo.com/1-america-1-pandemic-2-164142659.html
Long term SD vs NM unemployment long term. Looks like the period just prior to COVID is the best NM does.
Screen Shot 2020-11-21 at 8.27.06 PM.png
Screen Shot 2020-11-21 at 8.27.17 PM.png
 
Mar 11, 2006
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Prediction for this week: Social media will see a lot of virtue signaling tweets and Facebook posts about Thanksgiving. Color me not surprised that Chris Hayes already is leading the way.
https://twitter.com/chrislhayes/status/1330360722300293124?s=21