Tuesday, June 30, 2020

From the CDC: Age Distribution of U.S. Covid-19 and Influenza/Pneumonia Deaths

Centers for Disease Control data shows that, as with influenza/pneumonia, age is the most important factor in Covid-19 deaths. 

Two weeks ago, I published charts illustrating U.S. influenza and pneumonia deaths over the last decade, and I suggested that the age distribution of these deaths might be a template for age distribution for the current Covid-19 epidemic. 

CDC data (here) indicate the age distribution of 108,000 U.S. Covid-19 deaths from February 1 through June 20.  The chart at left shows that the distribution mostly reflects that of flu/pneumonia, with some exceptions.  The biggest difference involves the most elderly population, 85+ years.  Surprisingly, that cohort represents only one-third of Covid-19 deaths, compared with 46% of those attributable to flu/pneumonia.  The lower percentage among the oldest population is partially made up by the 65-74 group, which comprise 21% of Covid-19 deaths versus 13% for flu/pneumonia.  Overall, the 65+ year population accounts for 81% of Covid-19 deaths, just under the 84% percentage for flu/pneumonia.  Note that the Covid-19 percentage is also higher than flu/pneumonia in the 55-64 year age group, 12% versus 8%. 

The news is somewhat better for younger age groups, as seen in the second chart below.  Those under 35 years of age are not contributing deaths from Covid-19, compared with flu/pneumonia.

The U.S. is now experiencing a near-nationwide surge in Covid-19 cases, and health officials predict that it is only a matter of time until deaths surge as well.  These charts can guide readers in establishing their risk and risk tolerance.

Friday, June 12, 2020

Influenza/Pneumonia Experience Offers Lessons for Covid-19

In only a few months, U.S. covid-19-related deaths surged past 100,000.

To put that in perspective one can examine the nation’s annual mortality rate for the similar diseases, influenza and pneumonia.  Together, these diseases are coded in the 10th revision of the International Classification of Diseases as J09-J18, and, according to the CDC, the category is the 8th most common cause of death in the U.S.  I downloaded the most recent ten years of data (2007 to 2016) from the CDC mortality website.  On average, influenza/pneumonia was responsible for 53,800 American deaths per year.  The exact number varied, from just over 50,000 in 2010 and 2012, to 57,000 in 2015. 

Covid-19 has been widely reported to pose an elevated risk for older adults.  In this regard it mimics the distribution of influenza/pneumonia.  In the chart above, note that 46% of influenza/pneumonia deaths were in the age group 85+ years, 26% were in 75-84-year-olds, and 13% in 65-74-year-olds.  In other words, a full 85% of deaths from influenza/pneumonia are in the retirement-age population.  These individuals frequently have underlying health conditions that make them more susceptible, or immune systems that are less robust than those of younger people.

However, no age group has complete immunity from influenza/pneumonia.  There are deaths at all ages, even though the numbers get very low.  The second chart below provides a closer look at ages from birth to 44 years.  Note that about as many children under 5 die from influenza/pneumonia as the entire group from 5 to 24 years. 


It will be a couple years before the covid-19 deaths and their distribution are understood in detail.  On March 24, the CDC assigned a new code for these deaths, assuring more accurate tracking.

Covid-19 is an entirely new infection, and the dynamics will not mirror influenza/pneumonia, for which many in our population are at least partly vaccinated.  However, policymakers should recognize that the most susceptible population is 65+ years old.  A question that should be debated: Is it possible to quarantine and protect the elderly while not shutting down the economy, the consequences of which are devastating, most severely for people with marginal incomes and resources?  Intelligent policymaking will require robust data and comprehensive analysis.

Monday, June 1, 2020

Tobacco Prohibitionists Not Letting This Pandemic Go to Waste

Anti-tobacco forces are callously abusing COVID-19-driven anxiety, pain and suffering as they spew their unique brand of science-free propaganda.  A good example is a video interview, titled “The Dangers Of Vaping and Smoking During Coronavirus,” with Matt Myers, head of the Campaign For Tobacco-Free Kids (here).  Following are selected Myers quotes, with my observations (in bold). 

The interview opens with a question on new research suggesting that nicotine might protect smokers from developing COVID-19 illness:

“It is completely false….it is pure and simple bad science.  Last week the World Health Organization convened 29 of the world’s leading scientists, and what they found was two things: First, in fact smoking increases your risk of serious diseases – of serious effects of this disease.  And B, there is no credible evidence that smoking provides any protective effect.  All of the science points that smoking, and potentially vaping, increases your risk of the most serious consequences.”

Myers, a lawyer, is making dogmatic statements on science that legitimate scientists are unwilling to make at this time.  Certainly, a debate about the effects of nicotine and smoking on COVID-19 infection prevalence and illness severity is warranted; here are some articles, pro (here, here, here) and con (here, here).    

“Even if vaping was significantly less hazardous, and we don’t know that for sure, it is still a dangerous product.” 

Even if…?  Extremists are incapable of acknowledging the most incontrovertible facts.  Despite their denials, inhaling vapor has been proven vastly safer than inhaling toxic smoke.  Myers’s denial was a set-up for his major theme – the so-called teen vaping epidemic.

“…in the United States we have over 5 million kids who have become addicted to e-cigarettes.  Many of them would have never smoked in their life…We have a youth e-cigarette epidemic that we need to address…In the last 3 to 4 years we have seen more kids become addicted to e-cigarettes…addicted in a way that’s even more powerful than we’ve seen with cigarettes.”

Myers’ “5 million” is a complete fabrication.  The 2019 National Youth Tobacco Survey, from which the highest estimates are drawn by the CDC, indicates that, at most, 172,000 underage teens might have been addicted to e-cigarettes (evidence here).  There is nothing to suggest that any of these youths have an e-cigarette addiction that is more powerful than cigarettes.

The interviewer asked a leading question about H.R. 2339, a bill approved by the U.S. House of Representatives but languishing in the Senate, that is meant to reverse the youth tobacco epidemic.  “This is one of the most important pieces of legislation Congress could pass.  It would prohibit the sale of all flavored e-cigarettes…it would ban the sale of menthol cigarettes…the tobacco industry has marketed menthol cigarettes to African-American youth and adults with devastating consequences…Eighty-five percent of African-Americans use menthol cigarettes…because the tobacco industry has targeted them.”

Myers wants to ban menthol cigarettes.  Despite a flood of research articles, the FDA has never developed a scientific rationale for such a ban (here and here).   Myers makes a common mistake in claiming menthol is all about race, as a full 68 percent of menthol smokers are not African-American (here).

Tobacco prohibitionists, armed with unfactual talking points, aren’t letting this pandemic go to waste.