It's possible, and it's being done.

https://www.nytimes.com/interactive/2020/04/27/upshot/corona...

> The recent death count reached six times the normal number of deaths for the city at this time of year, a surge in deaths much larger than what could be attributed to normal seasonal variations from influenza, heart disease or other more common causes.

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

> These numbers undermine the notion that many people who have died from the virus may soon have died anyway. In Paris, more than twice the usual number of people have died each day, far more than the peak of a bad flu season. In New York City, the number has spiked to six times the normal amount.

One question I have is how many of these excess deaths is due to coronavirus and how many are due to our response to coronavirus since people are not getting their regular health care. For example, my dad has congestive heart failure and sees his doctor once a month and gets an EKG every time. I've been in appointments and the majority of the discussion centers around changes in his EKGs from the previous months. Right now, he's not getting these regular checkups and appointments. He could have a change in prognosis go undetected and end up with a preventable heart attack.

Is coronavirus the black swan event or is our reaction to coronavirus the black swan event. It's hard to say.

Looking at all cause mortality excess deaths between Sweden and lockdown countries, it's hard to say:

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

One question I'm also curious about is if in the years following the coronavirus, will we see negative excess deaths relative to previous seasonal averages because of the excess deaths right now.

People are huddling inside in fear of Covid-19. How many of these excess deaths are caused by fright and the stress thereof?

"Can You Die from Fear? The Baskerville Effect"

https://www.drmirkin.com/histories-and-mysteries/the-baskerv...

And there's an opposite effect. Way fewer people are dying or being hurt by car crashes. Normally one of the leading causes of death in the "prime of life" age range. And even more weird, deaths and injuries for young people are way down as impulsive risk taking and peacocking are reigned in. So weird all the indirect effects.

> One question I have is how many of these excess deaths is due to coronavirus and how many are due to our response to coronavirus since people are not getting their regular health care.

I wouldn't personally know where to start on getting the data, but you can likely tease this out by evaluating populations with already limited access to healthcare - uninsured, low-income folks with $13k deductibles, etc.

Have you considered getting your dad an Apple Watch, so he can do his EKGs at home and send to a doc? Not as effective as a twelve-lead, but maybe it'd help at least somewhat?

I've been looking at the KardiaMobile but the reviews on Amazon look pretty bad. How well does the Apple Watch perform since it's just on a wrist?

I honestly don't have the information to answer that.

I do know the single-lead EKG has some limitations, but they may not be relevant to your dad's particular scenario. Worth a conversation with the doctor, I suspect.

Yeah the real tricky thing is how well they do. We originally thought he had bradycardia because his heart rate as measured by his heart pressure cuff showed it in the high 30s. However once he got an EKG, it became clear that his heart rate was normal but he was afib and all the irregularity wasn't being picked up properly by the BP cuff monitor. I'm guessing that something like the apple watch is accurate enough to inform someone previously healthy that something is now wrong, but wouldn't be accurate enough to tell someone who is unhealthy if their condition is worsening.

The Apple Watch's EKG is definitely good enough for diagnosing bradycardia - you can see very clear QRS complexes showing up on it.

(I would not necessarily trust the 24/7 LED-based rate monitoring.)

Yeah, but brachycardia wasn't the problem and that's easy to diagnose. What I want to know is if it is good enough to know that it wasn't actually brachycardia but was instead afibrillation with weak parts of the cardiac cycle.

Yeah, its quite amazing how poor our data is. Combine that with how politicized the issue is and I don't think we will ever have reliable numbers.

In the UK about half the excess deaths don't mention COVID at all on the death certificate.

Of those that do, a very high proportion are extremely old, i.e. they died with the disease rather than of it.

If you take that into account the lockdown kills far more healthy people than COVID.

Germany is in lockdown and seeing no excess deaths (covid or otherwise). The whole of Italy is in lockdown, but areas badly affected by covid are seeing much more more unexplained excess death than other less affected areas.

It seems to me that lock-down is very unlikely to be the thing that is killing people.

Germans haven't been told repeatedly they have a patriotic duty to avoid hospitals to save their national treasure.

The British numbers are public and speak for themselves. ER attendance halved. Cardiac patients halved. People stopped going to hospitals when they needed to - luckily Germany avoided socialised healthcare and hospitals are just seen as normal companies.

As for Italy, there have been similar problems there with elderly homes in particular and hospitals struggling with staffing sure to lockdowns and isolation.

Ultimately this is the same virus everywhere. It doesn't look like it though. So differences in national performances are telling us a lot of important things about how governments have reacted.

Where are you getting your UK stats from please?

> These numbers undermine the notion that many people who have died from the virus may soon have died anyway.

This is known as mortality displacement or the harvesting effect. We won't actually know whether this was a significant factor until we see future all-cause mortality statistics.

I think by "soon" I think he meant a few days but I don't know that anyone is making that claim.

> These numbers undermine the notion that many people who have died from the virus may soon have died anyway. In Paris, more than twice the usual number of people have died each day, far more than the peak of a bad flu season. In New York City, the number has spiked to six times the normal amount.

I'm betting that in the next few years the death rate will drastically fall because the only people left will be really healthy.

Except that people who survive severe illness with Covid-19 often seem to suffer severe organ damage as a result. Mortality among Covid survivors is therefore likely to be higher than normal in the coming years, so it’s unclear how the numbers will pan out.

If it is killing people a couple of years earlier than they otherwise would have died, it is fair to consider them excess deaths.

Are you counting more than one death per person?

I will take that bet! I'd say that "drastically" means 20% or more. How much would you like to wager?

> I'm betting that in the next few years the death rate will drastically fall because the only people left will be really healthy.

If everybody died this year, then next year's death rate will be zero! That's not a good thing.

If you are old or infirm when you contract a bad case of corona, you die.

If you are relatively young and completely healthy, you spend a month in the hospital; get onto a ventilator for weeks requiring heavy sedation; lose your ability to walk, talk, feed yourself and brush your teeth; have to relearn how to swallow; maybe suffer a collapsed lung and upon release if you're lucky are confined to a wheelchair and physical therapy unable to take care of yourself, your loved ones, and return to your job.

Death is not the only negative outcome of this disease. "Recovery" from corona is sometimes the beginning of a long and slow struggle. I'm looking forward to any analysis on the economic cost of this.

The number of young people that are healthy (no pre-existing conditions like being overweight, diabetes or high blood pressure) that that experience what you describe is extremely rare.

> no pre-existing conditions like being overweight, diabetes or high blood pressure

Well over half the country ticks one of those boxes.

70% of Americans are either obese or overweight.

The coronavirus is going to with us for a long time; we're unlikely to get a miracle cure or effective vaccine anytime soon. On average American adults are about 27lbs (12kg) above their healthy weight. That means if they start losing weight now at a safe, sustainable rate then most people can be down to a healthy weight in a year or so.

Obviously there is a huge amount of individual variation but most people can take steps to improve their individual odds of survival.

If you are relatively young and completely healthy ... you overwhelmingly recover completely fine.

You've selected anecdotes from two very specific places. But that cuts both ways. There are plenty of places where so far they have been equally or less affected than a flu season.

For instance the UK is doing worse than most other countries in Europe but currently there are quite a few years within my life with similar death numbers by this point in the year: http://inproportion2.talkigy.com/

Or look at the graphs for Europe: https://www.euromomo.eu/graphs-and-maps/

There are some countries where it's higher than the flu seasons in the past 4 years. But there are other countries where it's equal or lower.

Overall weekly mortality in the EuroMOMO reporting countries peaked at approx 2x that of 2016, approx 20k deaths per week more. Given the large populations of these countries this is a tiny change. To put that in perspective 20k people is 0.03% of the British population alone, but you'd also need to include all the other countries to get the real percentage.

If you count excess deaths, globally where we have data, official Coronavirus deaths are always about half or 2/3rds the excess death.

In other words, it’s likely we are undercounting deaths caused by COVID by a factor of 1.5 to 2 in places which are actually properly tracking COVID deaths.

You also have this effect where this year diagnosed cases of heart attacks and appendicitis are lower than last year. Can't blame people for not showing up at the hospital because that's where the plague is. This kind of excess death where people with serious conditions avoid hospital because of fear of disease isn't coronavirus but clearly caused by coronavirus.

is it caused by the coronavirus or the excessive measures taken to handle the coronavirus?

shutting down half the hospital when there is no need to for example

The shutdown wouldn't happen if the coronavirus wasn't spreading. It's the indirect cause, remove it and the hospitals aren't shut down.

you are confusing the response with the disease - mandating that people cannot go to go to the beach is not caused by the virus, it is caused by a bureaucrat. There is no evidence whatsoever that going to a beach causes infections. If anything makes your body stronger and more able to cope with a disease.

Exposure to the virus is how you get the virus. If there are other people at the beach, some of them might be infected, and you're being exposed by being in proximity. Maybe if you're Far Enough Away you can limit the exposure, but are people really Social Distancing on beaches and in restaurants? Evidence so far suggests the answer is no.

Incidentally there is also a lot of data out there suggesting that the virus can travel through the air a pretty reasonable distance, and it's likely to be breezy on the beach.

In any case, why would a bureaucrat want to go out of their way to close hospitals if there wasn't a good reason? Who benefits from that? Literally no one. It's only a reasonable idea because of the outbreak. The only people you see closing hospitals on purpose are vulture capitalists.

What evidence would that be? Do you have any reliable data on the number of people infected at beaches? So far the results of real world contact tracing aren't consistent with computerized models of virion distribution in open air.

you just exhibited the fallacy of equating a restaurant to a beach (or being outside). You are also using "exposure" in the most generic sense of "presence" within a distance. That's really not how it works.

Like I said there is absolutely no evidence that you could get infected while in an open environment, moreover plenty of evidence that being outside is greatly beneficial to health and well being.

Now I am asking you the same question you asked me: "why would a bureaucrat want to go out of their way to close a beach if there wasn't a good reason?"

The answer is simple as unpleasant, they don't understand what they are doing.

> In any case, why would a bureaucrat want to go out of their way to close hospitals if there wasn't a good reason? Who benefits from that?

Politicians benefit from that. The current situation is no different than "No one ever got fired for hiring IBM". In this case "hiring IBM" is a surrogate for doing whatever your voting base believes in. In blue states, the majority believes in shutting things down aggressively, so politicians do. In red states, the majority thinks we should keep things open, so politicians do.

Politicians by and large in this crisis aren't responding to what experts say, they are responding to their own self interest. This is super easy to spot by seeing what experts are saying or what evidence is raised that they summarily dismiss because it contradicts what their constituency desires.

Why are we talking about closed beaches? We were talking about people with symptoms of appendicitis who choose to stay away from the hospital that is very much open for such cases.

Closing the beaches is frankly idiotic, but postponing elective surgery isn't. It's not wise to go in for a breast enlargement when an epidemic is on the move. With an appendicitis, on the other hand, you don't have a choice.

If a surgery isn't needed to prevent serious permanent injury in the next few days, it's considered elective. Tumor removals, for example, are elective surgery and have generally not been allowed.

Maybe, but the article is doing the exact same thing with the flu, except probably even worse because we're not systematically testing people for the flu in the same way that we are Covid-19.

You don't need to systematically test people in order to assign their death as a flu death.

We have many different ways of counting deaths. We either count the people who had a test; or we count death certificates; or we do surveillance to see what respiratory illnesses are circulating and how many people are searching google for flu-like symptoms and how many people are attending primary care and ED for flu-like symptoms.

(and which ever method we pick, if we pick the same method for covid-19 we see many more deaths)

The whole point of the article is to argue that those flu deaths are "wildly inflated statistical estimates" and not real flu deaths in the same way that Covid-19 deaths - where we are systematically testing increasingly wide-ranging groups of people who are hospitalized or even just in care homes - are real Covid-19 deaths. That the only apples-to-apples comparison is not to statistically compensate for the lack of flu testing at all and only compare tested, confirmed cases.

It's obvious just from comparing the numbers in the article to the ones in the comment I'm replying to that lack of testing has a much, much bigger effect on confirmed flu numbers than confirmed Covid-19 ones - confirmed Covid-19 deaths are at 2/3 to 1/2 of excess deaths, whereas confirmed flu is at 1/4 to 1/8th of estimated flu deaths, and the flu estimate does more work to exclude unrelated deaths than just counting raw excess deaths would. The supposedly apples-to-apples comparisons in the article looks to be even less directly comparable than the apples-to-oranges one it's rejecting.

But note that this is not true at a regional level - many US states, for example, have official coronavirus deaths higher than the excess death.

>Mortality statistics show 122,000 deaths in excess of normal levels across 14 countries analysed by the FT

https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac8...

Differs on a country by country basis, but generally it's pretty bad in Western Europe anyway. See https://euromomo.eu/graphs-and-maps/ for excess mortality data.

By the way, most countries' local COVID peak is either in April or still to come; it's not really winter deaths.

One caveat; in many countries, death reporting is pretty slow and data from the last couple of weeks shouldn't be considered particularly reliable.

This was posted here recently: https://www.euromomo.eu/graphs-and-maps

It only covers Europe but effects of Covid-19 are easy to see. For example during the peak, about 85,000 Europeans were dying per week as opposed to the normal range of 50-55K.

I don't know of a source for non-European countries unfortunately.

Until there is an international cooperation to standardize how Covid19 deaths are counted, these type of numbers are all we have for international and historic comparison.

Here's the 2 numbers that matter:

- Covid w/o a shutdown

- Overall deaths from lockdown w/o Covid

Neither number can ever do more than guess at and fight at which statistical model lies less.

Here's the charts for a number of states in the US. It's pretty dramatic. https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...

It's pretty dramatic because they excluded all of the states where it is not dramatic.

Dear god those charts are useless. Different scales all lined up next to each other, no clue as to the value of the bottom of the y axis, no clue as to what the baseline or the peak numbers are, no ability to actually inspect the data... Who are they hiring to do this nonsense at NYT?

They're not intended for comparing chart to chart, there's a table with key numbers below, and links at the bottom to country-by-country, state-by-state, and "look up your city" options.

It's a "look at the spikes" illustration in the spot in an article a big photo would typically go.

Going to be charitable and hope the bottom of y axis is zero.

in the most affected countries in Europe, it is significantly higher (2, 3 times) than the worst flu seasons in recent times.

That being said, we have developed a combination of vaccines and ICU treatments to drastically reduce the mortality of the flu. This is not your '70 flu anymore.

The question I have yet to see posed is "How would society be experiencing the common flu if it had never existed before and this is the first time it jumps to humans?"

The first year you see an airborne transmissible disease is likely to be the worst regardless of the disease. The big problem I see is that we're comparing the common flu in its herd immunity steady state to the coronavirus in its first year.

Once coronavirus settles into its steady state, we will be able to compare it to the flu, apples to apples.

That being said, assuming the flu and coronavirus at steady state is approximately comparable, would it justified to react to the flu in its first year the same way we're reacting to the coronavirus in its first year? If we know there will be a modest spike in the first year that mostly claims the infirm and becoming endemic is unavoidable, is it worth doing the damage we're doing to the economy.

That this is going to become endemic and likely reach steady state in a year or two (possibly longer depending on how long we retard reaching that point with lockdowns varying from geography to geography) is at this point a foregone conclusion because not every country has the natural borders of New Zealand and can completely kill this off. It will bounce back and forth between the northern and southern hemisphere indefinitely at this point until herd immunity.

A case of deadly flu with little population resistance would like the Spanish flu pandemic. Yes, I would say that the an extraordinary reaction would be entirely appropriate.

At this point, the disease becoming endemic is all but guaranteed, so we're just delaying the inevitable at great economic cost. The best case scenario is to ride the healthcare system capacity threshold while getting the economy moving again so there aren't excess deaths beyond those that would have been claimed sooner or later.

The people arguing for waiting for a vaccine simply don't understand how long that likely to take. It's an unreasonable expectation to keep the world shut down until a vaccine is available as it will cause far more damage than the virus is liable to cause.

One problem with comparing excess deaths is that automotive traffic deaths are down, and automotive traffic deaths are a very large slice of the pie in many countries (including the USA).

There were about 2.8 million total deaths in the United States in 2019 compared to about 40 thousand motor vehicle deaths.

Going further, in 2017 all accidents combined were 6% of deaths in the US (https://www.cdc.gov/nchs/fastats/deaths.htm). Nearly half (1,246,565) of the 2,813,503 deaths in the US in 2017 were from heart disease and cancer. Deaths from heart disease per day are almost as bad as covid-19 right now, so since there is a lot one can do proactively to reduce the chances of heart disease, I'm taking it way more seriously than I did before: don't smoke, hour+ of exercise every day, heart-healthy diet, sleep enough, and less stress.

“That's what people are interested in”. I very much disagree. 9/11 didn’t exactly register in all cause mortality. There’s a lot more people are interested in, for good reasons.