Monday, November 30, 2020

Covid-19 Deaths in the United States: It’s Not the Flu

In the past I have been critical of how the Centers for Disease Control Office on Smoking and Health has exaggerated and distorted smoking-attributable deaths, teen vaping and smoke-free tobacco risks.  But there is another branch at CDC that does a sterling job year after year: the National Center for Health Statistics (NCHS).  That center counts deaths in the United States.  The numbers it produces are invaluable, because they are the final arbiters of the quality of Americans’ lives…and how they die.  And for anyone out there who still thinks that Covid-19 is a trivial illness no worse than the flu, take a look at the following table.  It compares deaths from influenza and pneumonia, the eighth leading cause of death in the U.S., with deaths from Covid-19 so far this year.

Comparison of Influenza/Pneumonia Deaths in 2016 with Covid Deaths in 2020 (through November 25)
Age (yrs) Flu/Pneumonia Deaths 2016 v Covid Deaths 2020Ratio

Less than 15356 v 874 : 1
15-24189 v 4281 : 2
25-34452 v 1,8121 : 4
35-44894 v 4,6631 : 5
45-542,133 v 12,3711 : 6
55-645,034 v 29,8881 : 6
65-748,169 v 51,6671 : 6
75-8412,596 v 64,5751 : 5
85+21,714 v 74,7221 : 3

I’ve purposefully compared Covid deaths to influenza and pneumonia.  Not only is the latter combination a standard category, its numbers are much higher than for influenza alone.  From ages 25 to 84 years, Covid deaths are four to six times the numbers for flu/pneumonia, and we still have over one month to go.  The flu/pneumonia numbers are for the whole year 2016, but the Covid-19 numbers are only from the end of January until November 25.  So expect Covid-19 deaths and the ratios to increase substantially, especially with the pandemic exploding now in virtually all states.

There’s another reason that the Covid-19 deaths are conservative.  First, the CDC reports only estimates that there have been only about 12 million cases to date (here).  A recent study in JAMA reported that only about 10% of the U.S. population has been exposed to the virus. 

Overwhelming hospitals and health care systems will also have consequences for millions of Americans with serious heart diseases, cancer, emphysema and stroke.  Mortality rates for all of these diseases have been on a substantial decline for decades.  However, when Covid-19 overloads health care resources, Americans with these diseases will be shortchanged and may die, resulting in higher mortality rates for those illnesses.

In fact, physicians in maximum-capacity hospitals are already talking about nightmare scenarios.  They will have to make triage choices about the patients who will receive resources and care, and those who will not.  “‘I don’t see how we avoid becoming overwhelmed,’ says Dan Johnson, a [Nebraska] critical-care doctor. ‘People need to know that the assumption we will always have a hospital bed for them is a false one.’” (here) 

These scenarios are on the cusp of occurring across the country, and they are being driven by some Americans’ refusal to wear masks and to not meet with friends and relatives in bars, restaurants and elsewhere, all because they believe these measures infringe on their freedom.  I wonder how many of these refuseniks would extend their freedom to volunteer not to be treated if they develop a serious illness.      



Friday, November 13, 2020

Another Groundless Gateway, Courtesy of Children’s National Hospital


Pediatrics, the flagship journal of the American Academy of Pediatrics, published an article two and a half years ago asserting that e-cigarettes are a “gateway” to smoking.  After extensively analyzing the data from the FDA’s Population Assessment of Tobacco and Health, or PATH, on which the claim was based, I concluded that the study was so flawed that it deserved retraction.  I discussed this in several blog posts (here, here, here and here).

Now it’s déjà vu all over again.  Pediatrics has published another article by researchers at Children’s National Hospital and other institutions that is being touted by a CNH press release: “E-cigarettes can be a ‘gateway’ to conventional cigarette smoking for teens who had no prior intention to smoke.”

The hyperbolic release has generated headlines like these:

“E-cigarettes Can Be A ‘Gateway’ To Smoking For Teens!!!

“Vaping Lures Teens to Smoking: Study”

“Study: Teens Who Vape Are 4 Times More Likely to Smoke Cigarettes”

 It doesn’t require extensive analysis to recognize this as nonsense.  Here’s what the authors actually determined:

Ever e-cigarette use, even one or two times, is associated with ever cigarette smoking, even one or two puffs, 12 months later, for teens who had no prior intention to smoke.

You read that correctly.  The press release and subsequent news articles magically transformed that into VAPING CAUSES SMOKING.

If you’re wondering how the authors defined “intention to smoke,” they used a definition that I discussed in a blog six years ago, which has renewed value today.