[Cyberyeti]

barmar, on 2021-April-09, 09:51, said:

In general, even if someone is close to death, we consider whatever time they have left to be valuable, and medical professionals and care givers usually try to extend it as much as possible. Other than assisted suicide by request of the suffering patient, anything that cuts short this time is considered tragic (and assisted suicide is also controversial, illegal in many places).

So if someone dies 2 months sooner than they otherwise would have because of COVID, it makes sense to consider this an excess death.

I actually disagree with this having lost relatives who were in so much pain from cancer that the drugs to relieve that robbed them of any mental capacity, and people in late stage Alzheimers who didn't know who their closest relatives were. They were effectively already dead some time before their hearts stopped beating. Dying a few days or weeks early due to Covid might not be such a bad thing in these cases.

[kenberg]

barmar, on 2021-April-09, 09:51, said:

In general, even if someone is close to death, we consider whatever time they have left to be valuable, and medical professionals and care givers usually try to extend it as much as possible. Other than assisted suicide by request of the suffering patient, anything that cuts short this time is considered tragic (and assisted suicide is also controversial, illegal in many places).

So if someone dies 2 months sooner than they otherwise would have because of COVID, it makes sense to consider this an excess death.

Yes, or rather yes but.


I would not like someone saying "Oh, so Ken dies from covid, so what, he is going to die from something soon anyway". I would not like that at all. The "but" is that in emergencies with many people dying sometimes the choices are really tough. To be a bit theatrical, in a burning building if a rescue worker can rescue me or rescue a twenty-year-old but not both of us, I can imagine him choosing the twenty-year-old (especially if she is attractive ). But there could also be thinking from a different perspective. Not long ago, hospitals were overwhelmed. You would hear of ambulances carrying seriously injured people being turned away for lack of bed space. I can imagine planners thinking "Well, these older people are more likely to need hospitalization than the young are so let's give the vaccine to the older ones, it will free up some beds". And then, if you are studying the economic impact of half a million deaths, it probably matters just who is doing the dying.

But definitely, I would not want to be thought of as a "Who cares?".

A note to Cyber: I can well imagine a time when I would say "Hey, it's over. Stop with the pointless attempts to avoid reality". But it's a long way from there to thinking of covid as no big deal or as a welcome solution.

We are hopefully getting the vaccine to many. Nonetheless, there will still be some getting it and some not yet getting it. . We can argue about priorities, but we cannot eliminate priorities, Not yet.
I'm satisfied enough with the way it is being handled.

[Winstonm]

Choosing to die earlier than necessary is an act of courage for those with a fatal disease as it is an abandonment of hope. Hope - tempered by realism - should remain the Provence of the ill person.

[pilowsky]

I think we went through this discussion about a year ago when this all started. I note that opinions are substantially the same.

An important side benefit of the current pandemic is that (anecdotally - from speaking to my local Doctor) the number of all infections in the community has declined dramatically.

When COVID first emerged, I developed a bit of a cold and was tested. It turned out to be a rhinovirus - I've been polishing my horns ever since - and so I quarantined myself so as not to communicate it in Bridge clubs.

As bad as COVID is (really bad), any RTI (respiratory tract infection) is potentially lethal to Bridge players.

Apart from the occasional callow youth, almost all the people that play Bridge are textbook cases of co-morbidity.
Including emphysema, heart transplant, cancer, diabetes, atrial fibrillation, and that's just the healthy people.

All good reasons for playing "behind screens".

Just to repeat myself all over again.

[barmar]

Cyberyeti, on 2021-April-09, 12:53, said:

I actually disagree with this having lost relatives who were in so much pain from cancer that the drugs to relieve that robbed them of any mental capacity, and people in late stage Alzheimers who didn't know who their closest relatives were. They were effectively already dead some time before their hearts stopped beating. Dying a few days or weeks early due to Covid might not be such a bad thing in these cases.

This is why we have living wills, DNRs, etc. -- so you can make your preferences clear before you get to the point that your decisions can't be trusted.

And even with those instructions, it's still sometimes a difficult judgement call as to whether the patient actually meets the criteria they specified for pulling the plug. This is not an easy problem, and if there's any doubt the doctors will usually err on the side of keeping the patient alive (you can't undo the other decision).

[barmar]

kenberg, on 2021-April-09, 19:49, said:

I would not like someone saying "Oh, so Ken dies from covid, so what, he is going to die from something soon anyway". I would not like that at all. The "but" is that in emergencies with many people dying sometimes the choices are really tough. To be a bit theatrical, in a burning building if a rescue worker can rescue me or rescue a twenty-year-old but not both of us, I can imagine him choosing the twenty-year-old (especially if she is attractive ). But there could also be thinking from a different perspective. Not long ago, hospitals were overwhelmed. You would hear of ambulances carrying seriously injured people being turned away for lack of bed space. I can imagine planners thinking "Well, these older people are more likely to need hospitalization than the young are so let's give the vaccine to the older ones, it will free up some beds". And then, if you are studying the economic impact of half a million deaths, it probably matters just who is doing the dying.

Sounds a lot like the Trolley Problem -- you're damned if you do, damned if you don't, and you have to pick one.

[pilowsky]

The solution to the trolley problem is to move the person that is alone on the track to the other track.
That way you can get all of them at the same time.

[Zelandakh]

pilowsky, on 2021-April-12, 16:21, said:

The solution to the trolley problem is to move the person that is alone on the track to the other track.
That way you can get all of them at the same time.

[pilowsky]

Well done Mark! Good to see we are both reading the same philosophical treatise.

[cherdano]

Btw, here is a study just for our dear friend Cyberyeti:

Quote

A new large study of 21 high- & upper-middle-income countries found that suicide numbers "remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period"

https://twitter.com/...150618345844742

[pilowsky]

Yes, suicide and other psychiatric problems increased during the pandemic.There have been a number of publications concerning covid-19 and suicide rates.
it is important to note that these studies investigate both suicidal ideation and suicide attempts.
Hill and colleagues reported last month in the journal Pediatrics that the rates of suicide-related behaviours had increased during the covid-19 pandemic.

Quote

In this study, we evaluated whether rates of youth suicide-related behaviors have been elevated during the COVID-19 pandemic by examining rates of positive results on suicide risk screens administered as routine screening in a pediatric ED. Comparison of the rate of suicide screen results positive for recent suicide ideation revealed significantly increased rates of ideation in March and July 2020 as compared with screening rates in March and July 2019. Similarly, screen results positive for recent suicide attempts were higher in February, March, April, and July 2020 than in those same months in 2019. Of note, the number of ED visits was substantially reduced during the COVID-19 pandemic. Consequently, direct comparison of rates across years should be made with caution.

And

Quote

Across the entire study period, 15.8% (n = 2033) reported past-month suicide ideation, and 4.3% (n = 554) reported a recent suicide attempt (past 3 months).

And

Quote

The chi2 difference tests identified significant differences in the rate of recent suicide ideation in March and July 2020 compared with those same months in 2019. The odds of recent suicide ideation were 1.60 times higher in March 2020 compared with March 2019 and 1.45 times higher in July 2020 compared with July 2019. For recent suicide attempts, chi2 difference tests identified significant differences in the rate of suicide attempts in February, March, April, and July 2020 compared with those same months in 2019. The odds of a recent suicide attempt were 1.58, 2.34, 1.75, and 1.77 times higher in February, March, April, and July 2020 compared with those same months in 2019, respectively. Figure 2 reveals rates of positive screen results by month and year.".
Here are the data from Table 1.
Hill, RA et al., (2021) Suicide Ideation and Attempts in a Pediatric Emergency Department Before and During COVID-19 PEDIATRICS 147:3, March 2021:e2020029280

In a review published in The Lancet this month, Gunnell et al., point out that a similar phenomenon occurred during other pandemics.

Quote

"The mental health effects of the coronavirus disease 2019 (COVID-19) pandemic might be profound and there are suggestions that suicide rates will rise, although this is not inevitable. Suicide is likely to become a more pressing concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups. Preventing suicide therefore needs urgent consideration. The response must capitalise on, but extend beyond, general mental health policies and practices. There is some evidence that deaths by suicide increased in the USA during the 1918–19 influenza pandemic and among older people in Hong Kong during the 2003 severe acute respiratory syndrome
(SARS) epidemic."
Gunnell et al., The Lancet April 2021

Equally interesting is the question is the excess psychiatric morbidity observed during pandemics greater or less than the excess psychiatric morbidity that is known to be observed during other stressful events.
It is not clear to me that this question was addressed in the papers that I have seen so far.

[Cyberyeti]

cherdano, on 2021-April-13, 20:04, said:

Btw, here is a study just for our dear friend Cyberyeti:

https://twitter.com/...150618345844742

In the early months of the pandemic, I would expect some of the main effects to occur longer term, most of my friends who've had issues had them after July, but it is somewhat reassuring. Also as Pilowsky says suicidal thoughts and attempts also matter along with self harming, none of my friends actually killed themselves but 2 attempted suicide and the same 2 self harmed. Another was off working from home for several weeks with his issues and another is suffering now.

Has anybody investigated homicides and domestic violence incidents in the pandemic period ? I would expect more domestic homicides and less outside the home, but don't know how that will net off.

[pilowsky]

Cyberyeti, on 2021-April-14, 07:05, said:

In the early months of the pandemic, I would expect some of the main effects to occur longer term, most of my friends who've had issues had them after July, but it is somewhat reassuring. Also as Pilowsky says suicidal thoughts and attempts also matter along with self harming, none of my friends actually killed themselves but 2 attempted suicide and the same 2 self harmed. Another was off working from home for several weeks with his issues and another is suffering now.

Has anybody investigated homicides and domestic violence incidents in the pandemic period ? I would expect more domestic homicides and less outside the home, but don't know how that will net off.

I don't have data off-hand but have heard it reported that there has been an increase in domestic violence.
This is a problem that is known to increase during times of powerlessness and helplessness (death of a relative/friend, job loss, etc).
The problem is compounded during a pandemic because the ability to flee is dramatically decreased.
News reporting has it that this problem was exacerbated during the pandemic.

You can also expect stocks in gambling-related businesses to increase.

During times of stress, people turn to more primitive coping mechanisms.
They are more easily upset by things that would not usually bother them because their ability to feel in control is weakened.

It even has a name: "Veneer theory"
The quote is from Wikipedia.

Quote

Veneer theory is a term coined by Dutch primatologist Frans de Waal to label the Hobbesian view of human morality that he criticizes throughout his work. Although he criticizes this view in earlier works, the term in this form is introduced in his 2005 book "Our Inner Ape", denoting a concept that he rejects, namely that human morality is "a cultural overlay, a thin veneer hiding an otherwise selfish and brutish nature".^[1]
The idea of the veneer theory goes back to Thomas Henry Huxley and has more recently been advocated by biologists like George C. Williams.

Obviously, there is not complete agreement, but the concept of a thin veneer in civilisation resonates with me when I think back about current events and the past 100 years.

This comes from book chapter:

Quote

Let us begin with the Tanner lecture of the primatologist Frans de Waal,
"Morally Evolved: Primate Social Instincts, Human Morality, and the Rise
and Fall of 'Veneer Theory'." Veneer theory "views morality as a cultural overlay,
a thin veneer hiding an otherwise selfish and brutish nature" (de Waal,
2006a, p. 6). De Waal traces the theory to Thomas Huxley (1894/1989)
who, according to de Waal, saw "human ethics as a victory over an unruly
and nasty evolutionary process" (de Waal, 2006a, p. 7). Of course, we could
trace veneer theory back to the doctrine of original sin. For Huxley, morality
is a choice only we humans may make by detaching ourselves from nature
and natural evolution. This is an extraordinary stance for "Darwin's Bulldog"
to take since it restricts the explanatory power of evolution. It also violates
Darwinian continuity since Huxley says nothing about how humans may
have acquired ethical capacity.

Overcoming veneer theory: Animal sympathy
J. Garrison
ISBN: 9781349575121 , 9781137505255; DOI: 10.1057/9781137505255_11
The Educational Significance of Human and Non-Human Animal Interactions : Blurring the Species Line / , 2016, p.173-190

Editors
Suzanne Rice, A. G. Rud (2016)

[pilowsky]

Here is a paper published in one of the British Medical Journals collection of Journals.http://bit.ly/PhysicalCOVID

I would be interested to know what our statisticians make of it.

The authors seem to be trying to make a case that sedentary people are more likely to die of COVID19.

This strikes me as an obvious non-mechanistic correlation.

Sedentary people are more likely to be older, fatter, and suffer from all the co-morbidities that make COVID19 a bigger problem.

I came across it because it was in a newsfeed.

Quote

Original researchPhysical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients FREEhttp://orcid.org/0000-0001-7633-7345Robert Sallis1, Deborah Rohm Young2, Sara Y Tartof2, James F Sallis3, Jeevan Sall1, Qiaowu Li2, Gary N Smith4, Deborah A Cohen2Correspondence to Dr Robert Sallis, Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA 92335, USA; Robert.E.Sallis@kp.org
Abstract
Objectives To compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines.
Methods We identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient's self-reported physical activity category (consistently inactive=0–10 min/week, some activity=11–149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes.
Results Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; 95% CI 1.10 to 1.32), admission to the ICU (OR 1.10; 95% CI 0.93 to 1.29) and death (OR 1.32; 95% CI 1.09 to 1.60) due to COVID-19 than patients who were doing some physical activity.
Conclusions Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care.
Data availability statementNo data are available.
This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
https://bmj.com/coro...rts-2021-104080

[pescetom]

I'm not a statistician, but it does say they conducted regression for demographics and known risk factors, which I assume means they are comparing apples with apples in terms of age and comorbidities.

[pilowsky]

...and yet, here is what they say under "Demographics"

Quote

The population had a mean age of 47.5 years (SD 17.0), with a median of 47 years (IQR 33.0, 60.0) and included 61.9% females (table 1). 6.4% were consistently meeting PA guidelines and 14.4% were consistently inactive, with the remainder falling in the some activity category. White patients were most likely to consistently meet PA guidelines (9.4%), followed by Asian patients (7.3%), Hispanic patients (5.5%) and African-American patients (4.6%). The mean BMI was 31.2 (SD 7.07). 51.4% of the study cohort had no comorbidities while 17.4% had only one, and 31.3% had two or more. The percentage of those who were consistently meeting PA guidelines was lower among those with chronic diseases (including obesity) and those who smoked.

Worth noting that the mean BMI was 31.2.

A BMI >29.9 is "obese".
So, the overwhelming majority of people in this group are either overweight or obese.

The people in the group come from a Kaiser-Permanente "managed-care" health care system.
It has a major emphasis on prevention yet the population is still mostly overweight or (on average) obese.

When you look at their data you find that the odds ratio for active vs inactive is 1.2. (link to their Table https://bjsm.bmj.com...80/F2.large.jpg)
It is one of the smallest effects found in this retrospective study.

[Cyberyeti]

A really interesting article that explains the problem with relying on lateral flow tests as Covid gets rarer:

https://www.theguard...-yyD3mawbEEPCsk

and to Pilowsky - using BMI to define obesity is at best a very blunt instrument.

Back when I was younger and fitter, my BMI would have been over 30 with a body fat percentage of zero, I just carried that much lean bodyweight.

[pilowsky]

Cyberyeti, on 2021-April-18, 04:20, said:

A really interesting article that explains the problem with relying on lateral flow tests as Covid gets rarer:

https://www.theguard...-yyD3mawbEEPCsk

and to Pilowsky - using BMI to define obesity is at best a very blunt instrument.

Back when I was younger and fitter, my BMI would have been over 30 with a body fat percentage of zero, I just carried that much lean bodyweight.

It isn't as blunt as you think. You may have been a Dean Lukin https://www.mensheal...t-of-a-lifetime when you were younger - but when he lost weight, his BMI returned to something sensible.

Quote

In a bid to get healthier during the late 1980s, Lukin went on a diet and lost a lot of the weight that made him one of the top Super Heavyweight weightlifters in the world, claiming that his waist was now the size that his upper thighs were during the 1984 Olympic Games.

My first publication used Bayes theorem. I learned it in High school then applied it a couple of years later.
I suspect it is only "obscure" to the people that write in the Guardian. On the other hand, most of my friends from High School became lawyers/politicians and probably never heard of it.
Just because you don't know something doesn't make it obscure; you just don't know it.
Embarrassingly, I think I got it wrong last year and was corrected (with varying levels of kindness) on this Forum.

I noticed that the Brits have something called SAGE (https://www.gov.uk/g...ergencies/about).

When I said elsewhere that 1/100 year events happen every year, SAGE was exactly the kind of body I fantasised would exist worldwide to help us keep safe.
The Americans seem to have this in a very fragmented way (e.g. NTSB) or the Pandemic Playbook - but it is not taken (as) seriously by the government.

Someone told me when I was a teenager that there are many things that can't be worked out from first principles; you just have to know them. Guessing doesn't work.

[Cyberyeti]

pilowsky, on 2021-April-18, 15:17, said:

It isn't as blunt as you think. You may have been a Dean Lukin https://www.mensheal...t-of-a-lifetime when you were younger - but when he lost weight, his BMI returned to something sensible.

Possibly if I actually did anything in particular to build muscle, I didn't, that was my natural state. I played a fair amount of sport of many types, but never pushed weights, the only times I went to a gym was for aerobic type exercises.

Quote

My first publication used Bayes theorem. I learned it in High school then applied it a couple of years later.
I suspect it is only "obscure" to the people that write in the Guardian. On the other hand, most of my friends from High School became lawyers/politicians and probably never heard of it.
Just because you don't know something doesn't make it obscure; you just don't know it.
Embarrassingly, I think I got it wrong last year and was corrected (with varying levels of kindness) on this Forum.

I noticed that the Brits have something called SAGE (https://www.gov.uk/g...ergencies/about).

When I said elsewhere that 1/100 year events happen every year, SAGE was exactly the kind of body I fantasised would exist worldwide to help us keep safe.
The Americans seem to have this in a very fragmented way (e.g. NTSB) or the Pandemic Playbook - but it is not taken (as) seriously by the government.

Someone told me when I was a teenager that there are many things that can't be worked out from first principles; you just have to know them. Guessing doesn't work.

I did a statistics degree so studied Bayesian statistics, but I suspect most people haven't.

SAGE has taken a lot of abuse here because they screwed up in the early days of the pandemic in the eyes of many and didn't recommend a lockdown fast enough. There is another body called independent SAGE consisting of scientists who didn't get invited to the real one which has proposed more radical measures. I don't know which one is right.

[cherdano]

Our friend Nick Triggle from the BBC is still at it, minimizing the acceptance of 30,000-100,000 additional deaths after most have been vaccinated.
https://www.bbc.co.uk/news/uk-56830398