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Not too many young are dying from COVID-19

When does COVID-19 get more dangerous than the flu? The CDC has some deaths listed for COVID-19. It also has deaths recorded for influenza. These are not perfect records, but, they give us a general comparative sense.

The total count in their data for the column I’ve plotting is about half of or so of the current death total for the USA. With that said, COVID-19 seems to be a really marginal disease in terms of mortality for those 24 years and under. For those 85 years or old COVID-19 is killing order of magnitude more than the flu.

Of course, there is morbidity as well as mortality. COVID-19 seems to have a longer course of progression for the symptomatic, and, there is the worry that it may cause lifetime problems in many people who survive from the severe cases (and even possibly the asymptomatic).

But, the number of people who are under the age of 40 who are dying doesn’t seem that high. And yet when I see headlines and profiles in the media, a huge number of feature focuses seem to be about younger people who die of COVID-19. Why? Obviously, because the deaths of the younger are surprising. But, I also think that part of it is the same rationale for the HIV-AIDS campaign: by pretending as if everyone is vulnerable, you obtain mass social mobilization.

I happen to know lots of people will not look at the raw data to understand what’s happening. But enough will to get annoyed.

50% of the deaths in Europe are in care homes. My family is self-quarantining no because we feel at risk, we’re not. But because there are older people in our family from whom we don’t want to be exiled. Does the media think if we admit and highlight the enormous danger that older people in particular face, we’ll conclude that they’re disposable?

9 thoughts on “Not too many young are dying from COVID-19

  1. Your graph of the CDC data is on a semi-log plot. For a quick visual comparison of relative risks, this can over-estimate the risk faced by a member of a younger cohort. (Clicking on the graph takes the reader right to Table 2 on the relevant CDC page, thanks.)

    For the stated time period of Feb. 1 to April 25, total deaths are interesting:

    674,000 – All causes
    40,000 – Covid-19 and (Covid-19 + Pneumonia)
    57,000 – Pneumonia (ex Covid-19)
    6,000 – Influenza

    Also, almost all Covid-19 deaths are captured from 3/15 to 4/25. Influenza deaths taper off in this later period, while Pneumonia ex Covid-19 about doubles. This “excess death” pattern suggests that some deaths recorded in this category were undiagnosed Covid-19 plus Pneumonia.

  2. Re: above comment — I am making an error in interpreting the CDC tables, so the figures I gave are not entirely correct. In Table 1, Column 8 is not (as I had assumed) simply the sum of Columns 2, 5, 7, and 7.

  3. Pneumonia is the old man’s friend.

    It’s so common that we in most cases we don’t investigate it. a 95 year old dying of Pneumonia is listed as natural causes. Hence why our calculations of the flu include a lot of statistical play.

    So “order of magnitude” isn’t quite correct; the real comparison would be pneumonia deaths veris covid 2 deaths.

    In 85+, that would be 8000 vs 18000.

    We’ll go argue about the excess deaths for a hundred year, but we are also getting some ideas on prevalence. I have no doubt that in the NY area a lot of the pneumonia deaths also had covid. In the rest of the country probably not.

    In fact, the mortality looks very similar to the flu, with the exception of no pediatric deaths.

    The CDC was started because of the Hong Kong flu of 1968. The’ve been scaring us every since. Possibly with good reason — much like 1968 this is what a flu season without a vaccine would look like and why we spend billions every year on flu surveillance and vaccines.

    it does not look like the end the of the world.

    If you want something fun, look at the relationship between receding hairlines and severity of the disease.

    https://www.brown.edu/news/2020-04-07/androgen

    Again the general mortality pattern has been apparent since the Chinese released numbers in late January. The newish discoveries have been that obesity is bad, and that cigarette smoking may be good.

    The calculation that I saw back in March is that it basically doubles everyone’s chances of dying in the next year. Minimal for younger people, very bad for everyone over 75.

  4. Perhaps COVID-19 will drive investment into efforts to reverse aging such as SENS and start-ups like AgeX and Turn.bio. Or does this make too much sense.

  5. In the under 15 year old category, I’d agree that COVID is much less mortality inducing and severe than the flu (perhaps there are stem cells left in your people or more plastic immune system responses that solidify in adolescence?).

    But, when you are looking at the 15-24 category, I think you need to consider the fact that we are looking at a month of COVID deaths (and heavily biased toward the end of the period) for a condition that does not look likely to disappear in the summer months v. what looks like a full year of seasonal flu deaths.

    Lots of people are sick with COVID and won’t recover, but haven’t died yet. Lots of people who aren’t infected with COVID yet, will get sick, and a small but significant share of them will die. Basically, all the blue bars in the chart should really be increased by a factor of five to ten to make a fair comparison of the likely end game.

    Another way of conceptualizing the data, and I don’t know how much this has been formally analyzed, is that the true relationship could be between select pre-existing conditions and morbidity and morality risk, with age serving as proxy for the likelihood of having one or more of the risk enhancing pre-existing conditions.

    In this frame, it makes a lot more sense that the young, who are normally viewed as having weaker overall immune systems than those in the prime of life, are so little affected. It also is a good fit when you dig down to who in particular among the young dies or suffers serious impairment.

    For example, among the young who have died in Colorado are premature infants already in ICU, the child with severe epilepsy only responsive to CBD after whom the strain of marijuana known as Charlotte’s Web is named, a girl a couple of years behind my son in high school who was in a wheel chair and had respiratory issues, etc.

    Anecdotal and small sample studies seem to show that mortality is heavily concentrated among those with a short list of pre-existing conditions (ca. 70%-90%+), and it isn’t unreasonable to suspect that many or most of those who die without any of the pre-existing conditions on the short list also have pre-existing conditions that are less common in the general population (and hence don’t make up a huge share of the total) or are undiagnosed or not recognized as relevant.

    Those conditions are most rare in the 5-14 age group, which has none of the congenital conditions that kill within the first five years of life (especially the first year or two), but before anything else crops up, in an age group that faced strong continuing selection from infectious diseases prior to vaccination and antibiotics, even in non-epidemic periods. Those who died in that age range overwhelmingly die without reproducing first, unlike those who die in their 30s or later, so genetic conditions that increase mortality in that age range are subject to strong selective pressure.

    It is also worth noting that deaths among the elderly, despite age itself being statistically a huge risk factor, are heavily concentrated among those in nursing homes and assisted living facilities, i.e. among those who almost by definition have some impairments or serious pre-existing conditions already. Admittedly, some of the risk is from high density institutional living in what are predominantly pretty non-medically and sloppily run facilities that do not enough to prevent infections from spreading. But, the percentage of the dead in these institutions seems to be running at 35%-70% (in Colorado where I live it is 63%), but they are a much smaller share of the total elderly population, about 5%. It is’t just the elderly who are dying, it is the elderly who have pre-existing conditions, often serious ones.

    There are cases of seemingly healthy people dying of COVID with no apparent pre-existing conditions, but the other common thread there in many of those cases seems to be extremely high levels of exposure, for example, ER doctors and COVID ward nurses, and public transit workers in areas with very high infection rates.

  6. Maybe everyone here is reading this chart incorrectly. You can’t compare Flu to Covid this way because Flu has infected so many more people. Each year 15%-20% get the flu, outside of NY probably 1% or less has Covid. This covers less than half the flu season so figure we are looking at Covid numbers that are at a minimum 7-10x too low. This is not the flu.

  7. Funny thing, Razib: the West somehow forgot everything they taught the Chinese more than a century ago:

    At the beginning there was general disbelief in the necessity or usefulness of preventive measures. It was an absolute novelty to the Chinese mind to attempt to check the spread of any infection, and apathy naturally accompanied their fatalism. “This is the scourge of Heaven” said many. “All will die whose time has come, and no others. Then why take people away to isolation stations? Why burn good clothes and bedding?”

    Interference with personal liberty was strongly resented, and still more the disturbance of trade and business. When a shop was forcibly closed and disinfected, and twenty-nine persons removed from it to an isolation station because of the death of a thirtieth, the merchants were highly incensed. The co-operation of the general public could thus hardly be expected. When the house-to-house visitation began it caused much fear. It was said that every sick person was to be removed, and those who had been ill for weeks struggled to rise and present a cheerful front to the unwelcome intruders. As days went on and no terrible results followed from the police inspection, it came to be welcomed by many as a kind of official certificate of health and protection from Plague.

    https://www.google.com/books/edition/Thirty_Years_in_Moukden_1883_1913/wW5CAAAAIAAJ?hl=en&gbpv=1&dq=&pg=PA234&printsec=frontcover

    You should post on this.

  8. Related to topic, Razib, saw that you mentioned on your Twitter timeline an analysis suggesting that on average a decade of life lost per Covid19 fatality, adjusting for age and morbidity.

    That roughly is consistent with what I’ve done simply looking at the life expectancy at age data, and the age distribution of deaths (without considering conditions).

    That seems to imply that we will see true medium term excess death from this, and not just an earlier “harvesting” of people who would soon die anyway.

    But! (Having covered the case sympathetic to that analysis above, the caveat follows). Such an analysis would be (as far as I know) exactly as true for flu mortality. And yet in the case of flu mortality there absolutely is generally such a “harvesting” effect seen after periods of excess mortality. See David Speigelhalter on this.

    So how do we resolve this? My guess is that it resolves because we’re simply just actually pretty crap at predicting mortality on an individual level, or even a small random subset level, even controlled for age and underlying conditions, which are at best noisy, limited indicators. But this isn’t mostly because death is random, inherently unpredictable and no one is “marked for death” but just because, in general, we just don’t observe the right indicators and don’t have the right models…

    The implication here is that, although we might think that we are saving lots of years of life, still, we’ll only really know when we look at age stratified excess deaths at least after a year or two. Looking at these sort of age adjusted and conditioned adjusted life expectancies provides a first approximation but it’s may be a bit of wiseacre overconfidence on us if we’re thinking the story ends there and we can already know we’re not going to see early harvesting. If there is “early harvesting” then the years of life saved will be less than we even think, even on current estimate of what seem to me to be current best guess fairly low (sub 1%, more than 0.1%) IFRs and age adjusted life expectancies. We’re inevitably flying blind, and will only really know in the longer term, even in the optimistic case on our knowledge.

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