[BostonCard]

https://jamanetwork.com/journals/jamaint...le/2770542

I can't find the thread where it was asked, but I know someone (Teejers?) has been wondering what the risk of COVID-19 is to young people without identifiable risk factors.  The answer is that it is very low, but not zero.



The study was conducted in hospitalized adults aged 18 to 34.  Of course a small minority of adults that age are hospitalized.  However, among those who were, the risk of having to go on a ventilator, for those who didn't have any risk factors (obesity, diabetes, or hypertension) was about 7%, and the risk of death was between 1 and 2%.  You can see the dashed lines in the figure above to see the corresponding values in middle aged adults (35 - 64).

So, bottom line is that it is fair to characterize those people as low risk.  But it is not "no risk".

BC

[BostonCard]

https://jamanetwork.com/journals/jamaint...le/2770542

I can't find the thread where it was asked, but I know someone (Teejers?) has been wondering what the risk of COVID-19 is to young people without identifiable risk factors.  The answer is that it is very low, but not zero.



The study was conducted in hospitalized adults aged 18 to 34.  Of course a small minority of adults that age are hospitalized.  However, among those who were, the risk of having to go on a ventilator, for those who didn't have any risk factors (obesity, diabetes, or hypertension) was about 7%, and the risk of death was between 1 and 2%.  You can see the dashed lines in the figure above to see the corresponding values in middle aged adults (35 - 64).

So, bottom line is that it is fair to characterize those people as low risk.  But it is not "no risk".

BC

[teejers1]

https://jamanetwork.com/journals/jamaint...le/2770542

I can't find the thread where it was asked, but I know someone (Teejers?) has been wondering what the risk of COVID-19 is to young people without identifiable risk factors.  The answer is that it is very low, but not zero.



The study was conducted in hospitalized adults aged 18 to 34.  Of course a small minority of adults that age are hospitalized.  However, among those who were, the risk of having to go on a ventilator, for those who didn't have any risk factors (obesity, diabetes, or hypertension) was about 7%, and the risk of death was between 1 and 2%.  You can see the dashed lines in the figure above to see the corresponding values in middle aged adults (35 - 64).

So, bottom line is that it is fair to characterize those people as low risk.  But it is not "no risk".

BC

Hmm.  Something doesn't quite seem right about that.  Maybe it's the limitation of 3 comorbidities (is that the universe?).  Maybe it's the way "Covid deaths" are attributed - an example:  kid ODs on drugs; hospital finds out he has Covid; dies.  I'm just spit-balling here, but even though it's limited to hospitalizations, I find that number high for otherwise healthy young people.  But maybe . . . 

P.S.  It was I who was wondering, so thanks for sharing.

[teejers1]

https://jamanetwork.com/journals/jamaint...le/2770542

I can't find the thread where it was asked, but I know someone (Teejers?) has been wondering what the risk of COVID-19 is to young people without identifiable risk factors.  The answer is that it is very low, but not zero.



The study was conducted in hospitalized adults aged 18 to 34.  Of course a small minority of adults that age are hospitalized.  However, among those who were, the risk of having to go on a ventilator, for those who didn't have any risk factors (obesity, diabetes, or hypertension) was about 7%, and the risk of death was between 1 and 2%.  You can see the dashed lines in the figure above to see the corresponding values in middle aged adults (35 - 64).

So, bottom line is that it is fair to characterize those people as low risk.  But it is not "no risk".

BC

Hmm.  Something doesn't quite seem right about that.  Maybe it's the limitation of 3 comorbidities (is that the universe?).  Maybe it's the way "Covid deaths" are attributed - an example:  kid ODs on drugs; hospital finds out he has Covid; dies.  I'm just spit-balling here, but even though it's limited to hospitalizations, I find that number high for otherwise healthy young people.  But maybe . . . 

P.S.  It was I who was wondering, so thanks for sharing.

[BostonCard]

Really? I actually think it's pretty low.  Keep in mind that most people (especially young people) with COVID-19 are never even hospitalized.  So, if you take the universe of people who have been diagnosed with COVID-19, and figure maybe at most 10% are hospitalized (probably lower if you also throw in completely asymptomatic individuals), then you are left with a death rate of ~1/1000 or less.  That's about what the comparable rate is for influenza.

You are right that the universe of possible co-morbidities is very large, but other than asthma (which doesn't seem to increase the risk of bad outcomes for COVID-19), there aren't a ton of other diseases likely to affect young people.  Fewer than 1% are going to have heart disease or cancer, and while you do see more of some types of autoimmune diseases in young people, we are still not talking about enough to really increase the death rate.  The great thing about being young is (generally) health.

 BC

[BostonCard]

Really? I actually think it's pretty low.  Keep in mind that most people (especially young people) with COVID-19 are never even hospitalized.  So, if you take the universe of people who have been diagnosed with COVID-19, and figure maybe at most 10% are hospitalized (probably lower if you also throw in completely asymptomatic individuals), then you are left with a death rate of ~1/1000 or less.  That's about what the comparable rate is for influenza.

You are right that the universe of possible co-morbidities is very large, but other than asthma (which doesn't seem to increase the risk of bad outcomes for COVID-19), there aren't a ton of other diseases likely to affect young people.  Fewer than 1% are going to have heart disease or cancer, and while you do see more of some types of autoimmune diseases in young people, we are still not talking about enough to really increase the death rate.  The great thing about being young is (generally) health.

 BC

[M T]

If you want to see the breakdown by age and comorbidities, look at (I used the 9/9 weekly report)
  https://www.cdc.gov/nchs/nvss/vsrr/covid...orbidities
The data file has the numbers by state (and I think is available by week).

There are clearly different comorbidities that are more relevant to the younger crowd.  For instance there are more COVID-related deaths in the 25-34yo age group than in the 85yo group where obesity was a contributing factor.  Not just a higher percentage, but the raw number is higher.

I found nothing surprising when looking at a measure of the TOTAL number of contributing factors mentioned in an age group divided by the total deaths in the age group. (Total respiratory & total circulatory conditions had multiple conditions, potentially resulting in a TOTAL measure > 100%)
Total respiratory conditions were pretty much the same over all the age groups  with a slight, broad peak in the 55-64yo age group.
Total circulatory conditions increased monotonically with age (37% 0-24; 75% 85+   NOTE this does not mean that 37% of 0-24 had circulatory problems.  There were 7 circulatory conditions that  contributed to this measure.). 
Hypertension conditions climbed to 65-74 and flattened out.
Ischemic heart disease, Cardiac arrhythmia, Heart failure climbed with age. 
Cardiac arrest was flat from 0-24 to 55-64 and it tailed off a little beyond that.
Other diseases of the circulatory system were more prevalent in the younger age groups and then flattened out.
Sepsis had a broad peak at 45-54.
Diabetes had a broad peak at 45-64.
Obesity declined with age.
Alzheimers and vascular & unspecified dementia kicks in about 65 and climbed with age.
Renal failure had a broad peak from 45-74.
Intentional & unintentional injuries, poisoning & other adverse events was most important for the youngest age group and fell with age, except for 85+ which increased some.

[M T]

If you want to see the breakdown by age and comorbidities, look at (I used the 9/9 weekly report)
  https://www.cdc.gov/nchs/nvss/vsrr/covid...orbidities
The data file has the numbers by state (and I think is available by week).

There are clearly different comorbidities that are more relevant to the younger crowd.  For instance there are more COVID-related deaths in the 25-34yo age group than in the 85yo group where obesity was a contributing factor.  Not just a higher percentage, but the raw number is higher.

I found nothing surprising when looking at a measure of the TOTAL number of contributing factors mentioned in an age group divided by the total deaths in the age group. (Total respiratory & total circulatory conditions had multiple conditions, potentially resulting in a TOTAL measure > 100%)
Total respiratory conditions were pretty much the same over all the age groups  with a slight, broad peak in the 55-64yo age group.
Total circulatory conditions increased monotonically with age (37% 0-24; 75% 85+   NOTE this does not mean that 37% of 0-24 had circulatory problems.  There were 7 circulatory conditions that  contributed to this measure.). 
Hypertension conditions climbed to 65-74 and flattened out.
Ischemic heart disease, Cardiac arrhythmia, Heart failure climbed with age. 
Cardiac arrest was flat from 0-24 to 55-64 and it tailed off a little beyond that.
Other diseases of the circulatory system were more prevalent in the younger age groups and then flattened out.
Sepsis had a broad peak at 45-54.
Diabetes had a broad peak at 45-64.
Obesity declined with age.
Alzheimers and vascular & unspecified dementia kicks in about 65 and climbed with age.
Renal failure had a broad peak from 45-74.
Intentional & unintentional injuries, poisoning & other adverse events was most important for the youngest age group and fell with age, except for 85+ which increased some.

[BostonCard]

The term "co-morbidities" is being used differently by the CDC than by the JAMA article.  The JAMA article (and, I'm guessing what Teejers is interested in) really discusses risk factors (chronic diseases present before the infection with COVID-19 that predisposes for a worse COVID-19 outcome).  The CDC really is looking through the discharge diagnosing and listing all concomitant conditions.  For example, sepsis is an acute event that would occur after developing COVID-19, not as a predisposing factor for COVID-19.  Although it is not directly caused by COVID, once someone is very sick, the body is susceptible to infection (made worse by being in a hospital and having all sorts of interventions like indwelling urinary catheters, IV lines, and endotracheal [breathing] tubes).  So, a patient who comes into the hospital with severe COVID-19 pneumonia, might develop a secondary infection which leads to sepsis, and can contribute to the patient's death.  Cardiac arrest is basically the final common pathway to death, almost regardless of cause (save for brain death).  At some point, the body's heart just can't support pumping blood through the body and either fails to generate a blood pressure (pulseless electrical activity, or PEA) or goes into a disorganized rhythm (ventricular tachycardia or ventricular fibrillation).  But "cardiac arrest" is obviously not a risk factor for COVID-19 pneumonia.

BC

[BostonCard]

The term "co-morbidities" is being used differently by the CDC than by the JAMA article.  The JAMA article (and, I'm guessing what Teejers is interested in) really discusses risk factors (chronic diseases present before the infection with COVID-19 that predisposes for a worse COVID-19 outcome).  The CDC really is looking through the discharge diagnosing and listing all concomitant conditions.  For example, sepsis is an acute event that would occur after developing COVID-19, not as a predisposing factor for COVID-19.  Although it is not directly caused by COVID, once someone is very sick, the body is susceptible to infection (made worse by being in a hospital and having all sorts of interventions like indwelling urinary catheters, IV lines, and endotracheal [breathing] tubes).  So, a patient who comes into the hospital with severe COVID-19 pneumonia, might develop a secondary infection which leads to sepsis, and can contribute to the patient's death.  Cardiac arrest is basically the final common pathway to death, almost regardless of cause (save for brain death).  At some point, the body's heart just can't support pumping blood through the body and either fails to generate a blood pressure (pulseless electrical activity, or PEA) or goes into a disorganized rhythm (ventricular tachycardia or ventricular fibrillation).  But "cardiac arrest" is obviously not a risk factor for COVID-19 pneumonia.

BC

[fullmetal]

teejers, don't forget that there are severe legal, professional, and financial sanctions placed on any medical professional who falsifies information relating to a cause of death.  This is something no doctor would risk -- in addition, whatever so-called incentives to boost covid mortality numbers would accrue to the hospital corporation and not the doctor, so there is zero incentive for staff to falsify information.

No doctor would take an overdose patient and claim that covid caused the overdose.  I doubt the deceased would even be tested for covid if they were brought in by ambulance and expired in the ER (covid PPE precautions would be taken though).

[fullmetal]

teejers, don't forget that there are severe legal, professional, and financial sanctions placed on any medical professional who falsifies information relating to a cause of death.  This is something no doctor would risk -- in addition, whatever so-called incentives to boost covid mortality numbers would accrue to the hospital corporation and not the doctor, so there is zero incentive for staff to falsify information.

No doctor would take an overdose patient and claim that covid caused the overdose.  I doubt the deceased would even be tested for covid if they were brought in by ambulance and expired in the ER (covid PPE precautions would be taken though).

[teejers1]

teejers, don't forget that there are severe legal, professional, and financial sanctions placed on any medical professional who falsifies information relating to a cause of death.  This is something no doctor would risk -- in addition, whatever so-called incentives to boost covid mortality numbers would accrue to the hospital corporation and not the doctor, so there is zero incentive for staff to falsify information.

No doctor would take an overdose patient and claim that covid caused the overdose.  I doubt the deceased would even be tested for covid if they were brought in by ambulance and expired in the ER (covid PPE precautions would be taken though).

I believe you; however, the SCC Dashboard (which as I noted previously, is really the only data set I follow) data set uses the term "number of deaths with Covid" - not "deaths caused by Covid."  Moreover, I have a pretty distinct memory that someone here (BC, I believe) posted that if a decedent had tested positive then that would be recorded as a Covid death, regardless of other conditions (including ones that may reasonable be deemed superseding ones).  So, maybe you're right all around in all info being provided; or maybe SCC (and perhaps other counties?) report Covid deaths differently.

I don't know - but I guess I hope your belief applies to SCC info (even if it means the virus is more deadly).  Accurate and readily understandable information is important.

[teejers1]

teejers, don't forget that there are severe legal, professional, and financial sanctions placed on any medical professional who falsifies information relating to a cause of death.  This is something no doctor would risk -- in addition, whatever so-called incentives to boost covid mortality numbers would accrue to the hospital corporation and not the doctor, so there is zero incentive for staff to falsify information.

No doctor would take an overdose patient and claim that covid caused the overdose.  I doubt the deceased would even be tested for covid if they were brought in by ambulance and expired in the ER (covid PPE precautions would be taken though).

I believe you; however, the SCC Dashboard (which as I noted previously, is really the only data set I follow) data set uses the term "number of deaths with Covid" - not "deaths caused by Covid."  Moreover, I have a pretty distinct memory that someone here (BC, I believe) posted that if a decedent had tested positive then that would be recorded as a Covid death, regardless of other conditions (including ones that may reasonable be deemed superseding ones).  So, maybe you're right all around in all info being provided; or maybe SCC (and perhaps other counties?) report Covid deaths differently.

I don't know - but I guess I hope your belief applies to SCC info (even if it means the virus is more deadly).  Accurate and readily understandable information is important.

[BostonCard]

teejers, don't forget that there are severe legal, professional, and financial sanctions placed on any medical professional who falsifies information relating to a cause of death.  This is something no doctor would risk -- in addition, whatever so-called incentives to boost covid mortality numbers would accrue to the hospital corporation and not the doctor, so there is zero incentive for staff to falsify information.

No doctor would take an overdose patient and claim that covid caused the overdose.  I doubt the deceased would even be tested for covid if they were brought in by ambulance and expired in the ER (covid PPE precautions would be taken though).

I believe you; however, the SCC Dashboard (which as I noted previously, is really the only data set I follow) data set uses the term "number of deaths with Covid" - not "deaths caused by Covid."  Moreover, I have a pretty distinct memory that someone here (BC, I believe) posted that if a decedent had tested positive then that would be recorded as a Covid death, regardless of other conditions (including ones that may reasonable be deemed superseding ones).  So, maybe you're right all around in all info being provided; or maybe SCC (and perhaps other counties?) report Covid deaths differently.

I don't know - but I guess I hope your belief applies to SCC info (even if it means the virus is more deadly).  Accurate and readily understandable information is important.

Wasn't me.  I've filled out death certificates, and there isn't even a place to put any condition that doesn't contribute to death.  You can see a blank one here:

https://www.cdc.gov/nchs/data/dvs/DEATH1...al-acc.pdf

If you look, box 32 (Part I) has the cause of death.  So, for a COVID-19 related death, you might see something like:
a. Respiratory failure (due to)
b. Acute Respiratory Distress Syndrome (due to)
c. COVID-19 pneumonia

And then in Part II, one might write all the co-morbidities that contributed, like:
Diabetes, morbid obesity, hypertension

For a death that was due to something else, you might see COVID-19 pneumonia in the other contributing factors (for example, for a patient with COVID-19 pneumonia who goes on to develop a secondary bacterial pneumonia:
Part I
a. Septic schock (due to)
b. Klebsiella pneumonia
Part II
COVID-19 pneumonia

What you probably wouldn't see is something like this, in a case where a patient is involved in an auto accident and has bleeding in his brain, and is noted to have a positive COVID-19 test when admitted to the hospital, as the COVID-19 didn't contribute to the patient's death:
Part I
a. Brain herniation (due to)
b. Intracerebral hemorrhage (due to)
c. Traumatic head injury (due to)
d. Motor vehicle collision

Part II
Positive COVID-19 test

It is worth noting that a number of different publications have been looking at "excess deaths", by comparing the total number of deaths from any cause to the expected deaths (based on the average number the last few years), and comparing that to the number of COVID-19 deaths.  Excess deaths have generally slightly exceeded the number of deaths attributed to COVID-19, which at the very least means that we are not talking about a large number of people who would have died anyways from something else, but whose death was attributed to COVID-19 due to a positive test.  If anything there is likely an undercount (probably people dying without being tested, especially early in the pandemic, and it being called a heart attack or something similar).

https://jamanetwork.com/journals/jamaint...le/2767980

Results  There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, representing 122 300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year. There were 95 235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19–reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths.

Conclusions and Relevance  Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.

BC

[BostonCard]

teejers, don't forget that there are severe legal, professional, and financial sanctions placed on any medical professional who falsifies information relating to a cause of death.  This is something no doctor would risk -- in addition, whatever so-called incentives to boost covid mortality numbers would accrue to the hospital corporation and not the doctor, so there is zero incentive for staff to falsify information.

No doctor would take an overdose patient and claim that covid caused the overdose.  I doubt the deceased would even be tested for covid if they were brought in by ambulance and expired in the ER (covid PPE precautions would be taken though).

I believe you; however, the SCC Dashboard (which as I noted previously, is really the only data set I follow) data set uses the term "number of deaths with Covid" - not "deaths caused by Covid."  Moreover, I have a pretty distinct memory that someone here (BC, I believe) posted that if a decedent had tested positive then that would be recorded as a Covid death, regardless of other conditions (including ones that may reasonable be deemed superseding ones).  So, maybe you're right all around in all info being provided; or maybe SCC (and perhaps other counties?) report Covid deaths differently.

I don't know - but I guess I hope your belief applies to SCC info (even if it means the virus is more deadly).  Accurate and readily understandable information is important.

Wasn't me.  I've filled out death certificates, and there isn't even a place to put any condition that doesn't contribute to death.  You can see a blank one here:

https://www.cdc.gov/nchs/data/dvs/DEATH1...al-acc.pdf

If you look, box 32 (Part I) has the cause of death.  So, for a COVID-19 related death, you might see something like:
a. Respiratory failure (due to)
b. Acute Respiratory Distress Syndrome (due to)
c. COVID-19 pneumonia

And then in Part II, one might write all the co-morbidities that contributed, like:
Diabetes, morbid obesity, hypertension

For a death that was due to something else, you might see COVID-19 pneumonia in the other contributing factors (for example, for a patient with COVID-19 pneumonia who goes on to develop a secondary bacterial pneumonia:
Part I
a. Septic schock (due to)
b. Klebsiella pneumonia
Part II
COVID-19 pneumonia

What you probably wouldn't see is something like this, in a case where a patient is involved in an auto accident and has bleeding in his brain, and is noted to have a positive COVID-19 test when admitted to the hospital, as the COVID-19 didn't contribute to the patient's death:
Part I
a. Brain herniation (due to)
b. Intracerebral hemorrhage (due to)
c. Traumatic head injury (due to)
d. Motor vehicle collision

Part II
Positive COVID-19 test

It is worth noting that a number of different publications have been looking at "excess deaths", by comparing the total number of deaths from any cause to the expected deaths (based on the average number the last few years), and comparing that to the number of COVID-19 deaths.  Excess deaths have generally slightly exceeded the number of deaths attributed to COVID-19, which at the very least means that we are not talking about a large number of people who would have died anyways from something else, but whose death was attributed to COVID-19 due to a positive test.  If anything there is likely an undercount (probably people dying without being tested, especially early in the pandemic, and it being called a heart attack or something similar).

https://jamanetwork.com/journals/jamaint...le/2767980

Results  There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, representing 122 300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year. There were 95 235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19–reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths.

Conclusions and Relevance  Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.

BC