Who Dies From COVID-19? Do You Really Care?

 

I am a covid veteran
This is a different kind of war
A war some don’t believe in

A war some mock, a “hoax”
The trauma is real
The dying is real
Running down the halls one room after another
“put your mask back on”
“stop pulling on lines”
Mitts
“You have to keep your mask on”
“Your daughter is coming in the morning, don’t you want to see her?”
The goal is to keep that one alive
“long enough”
For his daughter to be here when they turn the oxygen off.
“Let’s just get him to morning.”

There's that name I will never forget
the first in a growing line,
they declined for a time the use of their O2 device
I had to take it
I gave it to another, “more likely to survive”
This one lives
That one dies

They all suffer

The look in their eyes
As they learn the rules of an unfamiliar game
From room air to nasal cannula
NC to oxymask
Non-rebreather
Highflo
Bipap
Max it out
“I can’t breathe!”

I know you can’t breathe

I know
“I know it’s uncomfortable,”
“I know it’s blasting air in your face.”
“I’ll gladly take it off, just do me a favor,
change your code status first.”
“I have a line of people waiting for that machine, if you aren’t going to keep it on”
“I need you to change your code status first”
“What else can be done?”
“Intubation is next”

That look on their face

Excerpt from a poem by Sara McDonald

Sara McDonald takes care of COVID-19 patients at St. Luke's in Boise. She works in the telemetry – or cardiac – unit.

"We have a tendency to take the more difficult, or sicker, patients that have COVID," McDonald said. "They're on more oxygen, their needs are more acute."

Some of that unit is an overflow ICU, so she does tasks for the ICU-trained nurses there. The patients on that floor are intubated.

"They're not aware their bodies are hooked up to machines that are breathing for them," McDonald said.

Other days, she works with patients in the telemetry unit that are not intubated. It can be a higher-anxiety environment. The patients are conscious, McDonald said, but often hooked up to high-flow oxygen machines, which can be uncomfortable for them.

McDonald went home after a particularly taxing night on that floor recently and went to bed. When she woke up, a lump of stress in her throat was still there, so she started typing a poem.

"I just did a free-write, and I just hammered it out, you know, bawling," McDonald said.

She said she needed to share what health care workers are going through.

"We're in a war zone three days a week, and then the other four days of the week, we're expected to just go back to normal social life and attend gatherings and, you know, meet friends at the park and go to barbecues. And it's just not a flip you can switch," she said.

Part of McDonald's poem above shows that “war zone” in detail. Please read her entire poem by clicking here: https://npr.brightspotcdn.com/b7/cc/87930bc54bd1882b1a6e48add5cf/untitled-document-9.pdf.

Dealing With COVID-19

The New York Times and “Our World In Data” report as of December 29, 2021, over 822,000 people in the United States have died from COVID-19. This staggering statistic begs a question: Who is dying from the virus?

It stands to reason that anti-vaxxers and careless individuals who refuse to follow health directives greatly increase the numbers of people who become infected and die from the disease. One stark reality about this carelessness is that ageism reduces human beings’ capacity for caring.

Also people who believe falsehoods about the virus continue to seek out information that confirms their beliefs. They work hard to reject or dismiss any information that opposes those beliefs. And, amazingly, sociologists say trying to fight someone's cognitive dissonance rarely works. People double down on their beliefs when they are challenged, a concept known as the "backfire effect."

Any way you slice or dice the reasons for the lack of empathy leading people to be non-believers in science, people die from this gross disregard. During this pandamic it is evident that some care about themselves and not others who are more likely to suffer from the virus, and … no amount of shaming or exposure to that fact can change their views.

I know this as I write the entry. I will not persuade anyone to change their views about COVID. People strive to make sense out of contradictory ideas and lead lives that are, at least in their own minds, consistent and meaningful. The theory of cognitive dissonance tells us that as people justify each step taken after their original decision, they will find it harder to admit they were wrong at the outset. Especially when the end result proves self-defeating, wrongheaded, or harmful.

I still want to write this entry. Why? We all need to know the truth. We must establish the facts about how this deadly virus spreads and kills so many. Maybe those of us who practice safety precautions and empathy can benefit from understanding who dies. After all, innocent victims fall tragically to the virus every day.

We should use facts to increase our critical understandings. Consider this information about the immune system and the vast exposure to COVID-19 …

Scientists have long known that viruses and the immune system compete in a sort of arms race, with viruses evolving ways to evade the immune system and even suppress its response. Interferons serve as the body's first line of defense against infection, sounding the alarm and activating an army of virus-fighting genes.

In an international study in Science, 10 percent of nearly 1,000 Covid-19 patients who developed life-threatening pneumonia had antibodies that disable key immune system proteins called interferons. These antibodies – known as autoantibodies, because they attack the body itself – weren't found at all in 663 people with mild or asymptomatic Covid-19 infections. Only four of 1,227 healthy patients had the autoantibodies. The study was led by the Covid Human Genetic Effort, which includes 200 research centers in 40 countries.

(Paul Bastard et al. “Autoantibodies against type I IFNs in patients with life-threatening COVID-19.” Science Vol 370, Issue 6515. September 24, 2020.)

In a second Science study by the same team, the authors found that an additional 3.5 percent of critically ill patients had mutations in genes that control the interferons involved in fighting viruses. Given that the body has 500 to 600 of those genes, it's possible that researchers will find more mutations, said Qian Zhang, lead author of the second study.

(Qian Zhang et al. “Inborn errors of type I IFN immunity in patients with life-threatening COVID-19.” Science Vol 370, Issue 6515. September 24, 2020.)

Who Dies From COVID-19?

Older People

By August 2020 several studies revealed that age is by far the strongest predictor of an infected person’s risk of dying – a metric known as the infection fatality ratio (IFR), which is the proportion of people infected with the virus, including those who didn’t get tested or show symptoms, who will die as a result.

However, recent studies dispute the claim that only the very old are likely victims.

“COVID-19 is not just hazardous for elderly people, it is extremely dangerous for people in their mid-fifties, sixties and seventies,” says Andrew Levin, an economist at Dartmouth College in Hanover, New Hampshire, who has estimated that getting COVID-19 is more than 50 times more likely to be fatal for a 60-year-old than is driving a car.

But “age cannot explain everything,” says Henrik Salje, an infectious-disease epidemiologist at the University of Cambridge, UK. Gender is also a strong risk factor, with men almost twice more likely to die from the coronavirus than women.

(Smriti Mallapaty. “The coronavirus is most deadly if you are older and male — new data reveal the risks.” Nature. August 28, 2020.)

People With Pre-existing Conditions

Early on, in 2020, just months into the pandemic, scientists identified some clear patterns in which people who suffer from Covid-19 are most likely to die. Pre-existing medical conditions are one important factor – especially among lower-income workers who suffer from these conditions.

Data on pre-existing conditions with other evidence shows comorbidities that are supported by at least one meta-analysis or systematic review or by a review method defined in the Scientific Evidence brief.

These conditions include cancer, cerebrovascular disease, chronic kidney disease, chronic lung diseases, chronic liver disease, diabetes mellitus, heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies), mental health disorders, obesity, pregnancy and recent pregnancy, smoking – current and former, and tuberculosis.

(“People with Certain Medical Conditions.” Centers For Disease Control and Prevention. December 14, 2021.)

As of June 3, 2020, roughly nine in ten New Yorkers and Chicagoans who died of Covid-19 suffered from underlying chronic conditions. But those underlying conditions don’t affect everyone equally. They are much more prevalent among lower-income workers, according to researchers at the Centers for Disease Control and Prevention.

Rates of chronic obstructive pulmonary disease, kidney disease and diabetes, for example, among the poorest 10 percent of New Yorkers are estimated to be more that 40 percent higher than the median rate.

In cities across the United States, people with the lowest incomes have considerably higher rates of diabetes, obesity, asthma, high blood pressure, and kidney and pulmonary disease — conditions that put Covid-19 patients at a higher risk of severe illness.

(Yaryna Serkez. “Who Is Most Likely to Die From the Coronavirus?” The New York Times. June 04, 2020.)

The Unvaccinated

Recent research reported by the Texas Department of State Health Services (November 2021) claimed unvaccinated people were 20 times more likely to experience COVID-19-associated death than fully vaccinated people.

The department concluded that vaccination had a strong protective effect on infections and deaths among people of all ages. The protective impact on infections was consistent across adult age groups and even greater in people ages 12 to 17 years. The protective impact on COVID-19 deaths, which was high for all age groups, varied more widely.

In the September time frame, unvaccinated people in their 40s were 55 times more likely to die from COVID-19 compared with fully vaccinated people of the same age. Unvaccinated people aged 75 years and older were 12 times more likely to die than their vaccinated counterparts.

Overall, regardless of vaccination status, people in Texas were four to five times more likely to become infected with COVID-19 or suffer a COVID-19-associated death while the Delta variant was prevalent in Texas (August 2021) compared with a period before the Delta variant became prevalent (April 2021).

The protective effect of vaccination is most noticeable among younger groups. During September, the risk of COVID-19 death was 23 times higher in unvaccinated people in their 30s and 55 times higher for unvaccinated people in their 40s.

In addition, there were fewer than 10 COVID-19 deaths in September among fully vaccinated people between ages 18-29, as compared with 339 deaths among unvaccinated people in the same age group.

Then, looking at a longer time period -- from Jan. 15 to Oct. 1 -- the researchers found that unvaccinated people were 45 times more likely to contract COVID-19 than fully vaccinated people. The protective effect of vaccination against infection was strong across all adult age groups but greatest among ages 12-17.

 (“COVID-19 Cases And Deaths by Vaccination Status.” Texas Department of State Health Services. November 8, 2021.)

And something we always suspected but now is supported. Recent polling shows that partisanship is now this single strongest identifying predictor of whether someone is vaccinated.

People in counties that voted for Donald Trump are nearly three times more likely to die from Covid-19 than those who live in counties that voted for Joe Biden, according to a new study by National Public Radio.

The study found that areas that voted for Trump by at least 60% in November 2020 had death rates 2.7 times higher than counties that voted heavily for Biden.

(Daniel Wood and Geoff Brumfiel. “Pro-Trump counties now have far higher COVID death rates. Misinformation is to blame.” NPR. December 5, 2021.)

Obese Individuals

Dozens of studies since the pandemic began have reported that many of the sickest COVID-19 patients have been people with obesity. In recent weeks, that link has come into sharper focus as large new population studies have cemented the association and demonstrated that even people who are merely overweight are at higher risk.

For example, in the first metaanalysis of its kind, published on 26 August in Obesity Reviews, an international team of researchers pooled data from scores of peer-reviewed papers capturing 399,000 patients. They found that people with obesity who contracted SARS-CoV-2 were 113% more likely than people of healthy weight to land in the hospital, 74% more likely to be admitted to an ICU, and 48% more likely to die.

((Barry M. Popkin, Shufa Du, William D. Green, Melinda A. Beck, et al. “Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships.” Obesity Reviews. Volume 21, Issue 11. August 26, 2020.)

Minorities and Those With Mood Disorders

U.S. studies in JAMA Network Open today detail disparities in COVID-19 deaths in 2020, showing higher mortality rates among racial minorities. Mortality risk is 1.9-fold higher for Black individuals and 2.3-fold higher for Hispanic/Latino individuals compared with White non-Hispanic individuals.

(Justin M. Feldman, ScD; Mary T. Bassett, MD, MPH, et al. “Variation in COVID-19 Mortality in the US by Race and Ethnicity and Educational Attainment” JAMA Netw Open. November 23, 2021.)

Site of care is associated with the higher mortality rate in Black patients. This should not be interpreted as evidence that there was no differential treatment of Black and White patients within individual hospitals. However, it does suggest that although disparities are usually due to a combination of who you are (individual characteristics) and where you go for care (structural factors), for outcomes after COVID-19 hospitalization, the latter plays the larger role and must be addressed if we are to eliminate disparities.

(David W. Baker, MD, MPH. “Breaking Links in the Chain of Racial Disparities for COVID-19. JAMA Netw Open. June 17, 2021.)

And, The Pandemic's “Perfect Victims”

Nearly 18,000 more dialysis patients died in 2020 than would have been expected based on previous years – they were COVID-19’s perfect victims. That staggering toll represents an increase of nearly 20% from 2019, when more than 96,000 patients on dialysis died, according to federal data released this month by the United States Renal Data System 2021 Annual Data Report (ADR).

The loss led to an unprecedented outcome: The nation’s dialysis population shrank, the first decline since the U.S. began keeping detailed numbers nearly a half century ago. Many are old and poor. They also are disproportionately Black. A 2017 study called end-stage renal disease “one of the starkest examples of racial/ethnic disparities in health.”

Those inequities carried through to the pandemic. Dialysis patients who were Black or Latino, according to federal data, suffered higher rates of COVID-19 by every metric: infection, hospitalization, death. Their deaths went largely unnoticed.

Consider that to get their treatments, the majority of dialysis patients in the U.S. must leave the relative safety of their homes and travel to a facility, often with strangers on public or medical transportation. Once at the dialysis center, they typically gather together in a large room for three to four hours.

The fear of contracting the virus was enough to keep many from venturing out for medical care, including those already on dialysis and those set to get the treatment for the first time. Exactly how long patients can go without dialysis depends on a number of factors, but doctors generally begin to worry if they miss two of their thrice-weekly sessions.

(Duaa Eldeib. “They Were the Pandemic’s Perfect Victims.” ProPublica. December 28, 2021.)

 

Conclusion

Who is dying from the virus? I'm sure many of you knew the answer to the question before reading this blog entry. However, I hope now you better understand the dire need to protect the most vulnerable. Do we with empathy pick up the slack for those who simply don't care? I've always heard “Let your conscience be your guide.” Face a very sad truth: No one can exercise the right of conscience for someone else. All we can do is act for the sake of people's life and health.

Why so many people have given up on taking the vaccine, masking, social distancing, and adhering to other simple precautions to protect those most prone to suffer and die is an indication of the prevalence of selfishness in 21^st century American human nature.

More than 90% of U.S. counties have now climbed back into "substantial" or "high" transmission of the disease, the levels at which the CDC has urged all Americans to wear masks in public while indoors.

"I need to be very clear, vaccines alone will not get any country out of this crisis. Countries can and must prevent the spread of Omicron with measures that work today," said Dr. Tedros Adhanom Ghebreyesus, the World Health Organization's director-general.

Despite resistance to taking necessary precautions and refusing to practice a greater awareness that COVID carelessness contributes to infection to a significant segment of the population, people continue to refuse to adhere to simple health directives.

Jacob Sutherland of The San Diego Union-Tribune writes …

“Empathy is often regarded as incompatible with “American individualism.” As Kennedy noted, however, empathy in and of itself is an American principle with which we as individuals can and must use our constitutionally derived freedoms to pursue unabated.

“Mask wearing, social distancing and hand washing have been weaponized by some within the political sphere as partisan issues, but the nature of these public health measures are rooted in the decolonial, and American, standard of empathy which seeks to right the wrongs of the past, whether those wrongs be committed by colonizers or covidizers.”

(Jacob Sutherland. “Commentary: Americans’ selfish behavior during COVID-19 is rooted in colonialism.” The San Diego Union-Tribune. December 15, 2020.)

That core principle of individualism in American culture is causing significant health consequences across the country. Listen and you will hear resistance grounded in statements like “The government can’t tell me what to do” or “I’m young and not afraid of contracting the virus” or even one of the conspiracies like “The pandemic is being manipulated by the ‘deep state.’”

Have you ever heard one of these individuals say “Infect me with the virus. I want to risk dying for my proud independence.” I haven't. If you have, please instruct that “brave” individual to read this blog entry before contracting the disease. It just may save his or her life.

Selfishness

Find if you can one victory
That little minds have ever won.
There is no record there to read
Of men who fought for self alone,
No instance of a single deed
Splendor they may proudly own.

Through all life's story you will find
The miser-with his hoarded gold-
A hermit, dreary and unkind,
An outcast from the human fold.
Men hold him up to view with scorn,
A creature by his wealth enslaved,
A spirit craven and forlorn,
Doomed by the money he has saved.

No man was ever truly great
Who sought to serve himself alone,
Who put himself above the state,
Above the friends about him thrown.
No man was ever truly glad
Who risked his joy on hoarded pelf,
And gave of nothing that he had
Through fear of needing it himself.

For selfishness is wintry cold,
And bitter are its joys at last,
The very charms it tries to hold,
With woes are quickly overcast.
And only he shall gladly live,
And bravely die when God shall call,
Who gathers but that he may give,
And with his fellows shares his all.

Edgar Albert Guest