Winter Miscellany – December 2020

Alzheimer's, Dengue, Vegan Diets and Osteoporosis... and, yes, a little COVID-19, too.

By Michael Jorrin, "Doc Gumshoe", December 22, 2020

That title is just to remind you that there’s a whole lot more going on in the health/medical area than COVID-19.   But the pandemic has a very large untidy footprint which is making a mark on a great many aspects of health-care in general.

One recent example which could not possibly have escaped my attention, since it was front and center on the front page of the NY Times, is that a great many hospitals throughout the US are stretched to the utmost, and in many cases, stretched well beyond the utmost.   A map showed where the intensive care units were filled to capacity and even beyond.   In twenty such locations, more than 100% of the ICU beds were occupied.   A lot of these were in Florida and Alabama, but some were in other parts of the country.   For example, in Albuquerque, New Mexico (where I used to live), the figure the Times gave for ICU occupancy was 116%.

It’s hard to figure exactly what that means.   I’m guessing that hospitals grab beds from other non-intensive care units and jam them somehow into the ICU.   But obviously there’s a limit to that.   I’m also guessing that some patients who under normal circumstances might have been admitted to the ICU are either admitted to other parts of the hospital or deemed not so seriously ill or injured and sent home.

In any case, it’s a high-stress situation for the hospital staff and for the patient as well.   The hospital is not going to put a patient with COVID-19 in the maternity ward or in the space where patients are recovering from surgery.   It’s a dilemma, and the well-being and health of patients and hospital workers is certain to be affected.

Another way that the pandemic is adversely affecting other health-care areas is that many non-COVID-19 patients are omitting normal care of their health conditions such as diabetes, various cardiac conditions, rheumatoid arthritis and other diseases that need regular attention.   And patients are not keeping up with health maintenance practices such as annual physicals.

One way that COVID-19 has had a major effect beyond those of the infection itself is that the pandemic has led to a large increase in the number of deaths attributed to causes other than COVID-19.   The Centers for Disease Control has released overall mortality figures, and during the eight-month period from March 15 to November 14, the numbers of deaths from several conditions was well above the expected number.   Here are some figures:

Cause Deaths Above 

Normal                                                           

Percent Above

Normal

Diabetes 8,500 15%
Alzheimer’s

Disease

Dementia

21,300 12%
High Blood Pressure   7,600 11%
Pneumonia & Flu   3,000 11%

Other diseases and conditions also saw significant increases in mortality, including coronary heart disease, stroke, and sepsis.   And the increases in mortality in some specific areas soared way above the national average increases as shown above.   For example, New Jersey residents experienced a 37% increase in the numbers of deaths from diabetes; New Mexico saw a 29% increase in the numbers of deaths from Alzheimer’s disease and dementia; and New York City had an increase of 39% in deaths from high blood pressure and a 50% increase of deaths from pneumonia and flu.

It is notoriously difficult to designate a specific cause of death.   It is certainly possible that some of the approximately 40,000 excess deaths attributed to the four conditions named in the chart above were actually COVID-19 deaths.   And, it is certainly also possible that some of the ~ 300,000 deaths currently attributed to COVID-19 were the result of other diseases or conditions.

The argument that at least some of those excess deaths may in reality be due to COVID-19 is supported by the evidence that COVID-19 has a great many comorbidities.   A study in more than 70,000 patients diagnosed with COVID-19 in the early days of the pandemic found that 69 of 1,724 diagnosis codes were strongly associated with COVID-19.   That included 27.6% of patients diagnosed with viral pneumonia, 22.6% of those diagnosed with respiratory failure, 11.8% of those diagnosed with acute kidney failure, and 10.4% of those diagnosed with sepsis.

That does not mean that those patients definitely had COVID-19, but that there is a strong probability that they had that disease.   However, my guess is that many or most of those