Cont: The One Covid-19 Science and Medicine Thread Part 4

[Dr.Sid]

Nothing what Covid does in Japan makes sense really.

 

[angrysoba]

I was just casting around the numbers and I see Japan is having its highest death toll right now. Their daily death records show an increasing number of deaths in successive waves, which is the opposite of what happened elsewhere.

https://www.worldometers.info/coronavirus/country/japan/

They have a reasonable vaccination rate - maybe one of our residents can try to shed some light on possible reasons?

Yeah, it is odd. I have no idea what the reasons for it are.

I do know that cases have been spiking recently, and the numbers of deaths have hit record levels.

One thing I read recently was...

Amidst another wave of coronavirus infections this winter, the number of daily COVID-19 deaths in Japan has hit new records. That's despite the omicron variant's lower mortality rate. Experts and others claim that it may be due to the existence of "hidden," or unreported infections. Along with seasonal increases in stroke and heart attack patients, the situation in Japan's hospitals is becoming dire.

When the Mainichi Shimbun visited the Trauma, Emergency and Critical Care Center at Fukuoka University Hospital on Jan. 17, an elderly patient was on a respirator in one of the beds for critically ill COVID-19 patients. Nurses wearing personal protective equipment were hurrying around. Hiroyasu Ishikura, the center's 64-year-old chief doctor, said, "Since Christmas last year, we have seen a sudden increase in the number of patients requiring hospitalization."

...In contrast with the seventh wave of COVID-19, which peaked last August, this winter's wave overlaps with a seasonal increase in patients suffering from strokes and heart attacks. "Our emergency resources are already depleted. Over close to 40 years, this is the first time I've seen such a situation," Ishikura said with an agonized expression.

As the medical system is stretched, what stands out is the number of deaths. According to daily numbers released by the health ministry, this winter's wave peaked on Jan. 6 with 246,632 new infections -- lower than the seventh wave's peak of 261,004 on Aug. 19 last year. However, the number of COVID-19 deaths hit 503 on Jan. 14, higher than the 347 reached last year on Sept. 2 at the height of the seventh wave.

Ishikura pointed to "hidden" COVID-19 patients as a reason for the higher proportion of deaths. He believes that many people don't get tested even though they have a fever or other symptoms, or do not register their positive test results with the prefectural authorities. The lower infection numbers, then, are an effect of updated health ministry rules that allowed prefectures to simplify how they tally new COVID-19 infections, which came into effect last September.

Link

Japan has maintained a very high level of masking until recently, has a very high vaccination rate, and generally takes Covid pretty seriously. Until a few months ago, it was still extremely difficult to get into Japan, and they have put restrictions on those coming from China. So it would be a surprise if the small decrease in mitigation strategies have ledo to more deaths.

That said, Japan is planning to downgrade Covid to the same level as flu and to begin dropping the recommendation for mask wearing indoors...

The following is the gist of what will change in Japan when the legal status of the novel coronavirus is downgraded to Class 5, on par with seasonal influenza.

The government will:

-- scrap quarantine period of seven days for patients and five days for close contacts.

-- not pay all medical costs for treating and hospitalizing patients.

-- allow ordinary hospitals to examine COVID-19 patients, rather than current designated medical facilities.

-- not impose control measures, including state of emergency declarations.

-- consider dropping recommendation to wear face masks indoors.

Link

 

[Puppycow]

TA
Good topic. It's pretty strange.

Japan, until 2022 had an exceptionally low covid death total. Under .01%. Now in the last 12.5 months it's .03%.

Like Omicron elsewhere, it's hitting the elderly harder than earlier variants. But this increasing impact is hard to explain. Seems to be creating more and larger clusters in elder community homes.

The health ministry said on January 14 that at least 4,998 people had died after contracting COVID-19 so far this month. That is clearly outpacing the rate of the past few months. Elderly people account for the vast majority of those deaths.

The National Institute of Infectious Diseases says around 60 percent of the deaths were directly caused by the coronavirus. The rest were attributed to heart failure, cancer, pneumonia, old age, aspiration pneumonia, or kidney failure, among other causes.

Here's one discussion:
https://www3.nhk.or.jp/nhkworld/en/news/backstories/2185/

Died "after" but not necessarily due to? It's the perennial question. What exactly counts as a Covid death.

If I were to hazard a guess, I would say that Japan like everywhere else has pandemic fatigue (although mask wearing is still quite ubiquitous here, but the restaurants are full again and people have to take them off to eat). Maybe fewer people are bothering to get tested?

Right now I don't have enough information to say why, I can only guess. Maybe it is finally reaching older, more vulnerable people. Official statistics show 32 million Covid cases since the beginning of the pandemic. That's only about a quarter of Japan's population of 125 million. I assume that actual infections are much higher, but I don't know the true number. I've never been a "case" nor has anyone in my immediate family nor any of my in-laws that I'm aware of. Only a tiny handful have been reported at the company where I work. I could guess that some people don't want to see a doctor if they can avoid it, so maybe they wait until their case is very bad, and this gives a poorer prognosis than if they had sought early treatment.

 

[The Atheist]

Thinking about it a bit more, the overall death rates are still well within keeping of other countries, so it almost looks like it's a catch-up. The oldies didn't die earlier in the pandemic due to Japan stamping it out hard, and now people have relaxed it's ploughing through them.

 

[Puppycow]

Thinking about it a bit more, the overall death rates are still well within keeping of other countries, so it almost looks like it's a catch-up. The oldies didn't die earlier in the pandemic due to Japan stamping it out hard, and now people have relaxed it's ploughing through them.

The rates were surprisingly low here for a long time, considering how old Japan's population is. I do think there's some catching up now finally.

 

[The Atheist]

Between that and what's still happening in China, it pretty well proves the point you can't hide from it forever.

Sooner or later, it's gonna get ya.

As time goes on and fewer people wear masks, the chances of not being infected are getting very close to zero.

 

[Dr.Sid]

Between that and what's still happening in China, it pretty well proves the point you can't hide from it forever.

Sooner or later, it's gonna get ya.

As time goes on and fewer people wear masks, the chances of not being infected are getting very close to zero.

Indeed. Still later seems to be like a way better option. Weaker variants, vaccines, cures .. not to mention the simple fact that if you die one year later, you live one year longer.

 

[The Atheist]

No doubt about that, and waiting until antivirals were available is a winning ploy. As far as I can tell, Paxlovid is still highly effective at stopping covid in its tracks.

I don't understand the almost 50/50 split of people taking it and who refuse to do so.

 

[Chris_Halkides]

on paxlovid refusal

At The Atlantic Rachel Gutman-Wei wrote, "Drug interactions are another source of worry for the anti-Paxxers. Official COVID-treatment guidelines warn that the antiviral may have ill effects when combined with any of more than 100 other medications. Geriatric patients in particular might need to tweak their daily regimens of pills while under treatment with Paxlovid, Kalender-Rich told me. That’s hardly ever a problem medically, she said, but some people are still reluctant to make the change, especially if a previous doctor told them to never, ever skip a dose."

Paxlovid hesitancy does not seem particularly political from what I can gather.

 

[Dr.Sid]

What about price ? I mean it's free where I live, but I guess it might not be everywhere.

 

[Puppycow]

The US Government paid $530 a course for Paxlovid.

Apparently Japan is about to stop paying extra for covid treatments (angrysoba posted a link above)

https://english.kyodonews.net/news/...-covid-19-downgraded-to-class-5-in-japan.html

I guess the logic is that the government wants to save money now, and will treat Covid like it treats any other disease. Normal health insurance will still apply, but that means co-pays and whatnot. Part of the cost to be borne by the patient. (Typically 30% is the norm I believe)


So if it costs the same here as in the US (I don't know if it does), 30% would be like $190, which is not cheap.

 

[The Atheist]

"Drug interactions are another source of worry for the anti-Paxxers. Official COVID-treatment guidelines warn that the antiviral may have ill effects when combined with any of more than 100 other medications.

Viagra and Cialis are two of the drugs. That probably accounts for half the blokes who wouldn't take it. The doctor went through an extensive list with me, but I don't take any other legal drugs, so it wasn't a problem.

I understand from what he told me, that you only need to stop taking whatever the interactive drug is for the course of Paxlovid, which was 5 days.

What about price ? I mean it's free where I live, but I guess it might not be everywhere.

Free in NZ as well, and our uptake rate is 50/50.

 

[marting]

This is weird. New study on covid-19 child mortality.

Assessment of COVID-19 as the Underlying Cause of Death Among Children and Young People Aged 0 to 19 Years in the US

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800816#zoi221514f1

Eric Topol posted a chart from the study showing distribution by age and deaths over time.

https://twitter.com/EricTopol/status/1620090400202715136?cxt=HHwWgMDTgdXo2_ssAAAA

Vaxxes started for 12-17 y/o in May 2021 and 5-11 y/o in Jan 2022. A bit over 50% of the former and 30% of the latter have been vaccinated. There was a surge in the latter half of 2021 but Delta was known to skew somewhat younger. However, the continued levels in 2022 with Omicron which are similar to the pre-vax period seem odd.

Another factor is that a large number of deaths are amongst kids under 5 and these are not vaxxed. Could be distoring the picture.

The study doesn't break down vax status of the children's deaths. Anyone seen a study that does?

 

[rjh01]

This is weird. New study on covid-19 child mortality.

Assessment of COVID-19 as the Underlying Cause of Death Among Children and Young People Aged 0 to 19 Years in the US

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800816#zoi221514f1

Eric Topol posted a chart from the study showing distribution by age and deaths over time.

https://twitter.com/EricTopol/status/1620090400202715136?cxt=HHwWgMDTgdXo2_ssAAAA

Vaxxes started for 12-17 y/o in May 2021 and 5-11 y/o in Jan 2022. A bit over 50% of the former and 30% of the latter have been vaccinated. There was a surge in the latter half of 2021 but Delta was known to skew somewhat younger. However, the continued levels in 2022 with Omicron which are similar to the pre-vax period seem odd.

Another factor is that a large number of deaths are amongst kids under 5 and these are not vaxxed. Could be distoring the picture.

The study doesn't break down vax status of the children's deaths. Anyone seen a study that does?

If a person under 19 years dies, it probably is not from Covid. Only one in 40 of those under 19 die do so from Covid. Remember 99.96% are still alive after a year.

 

[marting]

If a person under 19 years dies, it probably is not from Covid. Only one in 40 of those under 19 die do so from Covid. Remember 99.96% are still alive after a year.

Sure, Covid-19 deaths are pretty unusual for anyone under 50, let alone 20. Deaths for all causes are low for kids >1 and < 19 y/o. Covid-19 deaths are more than an order of magnitude lower yet.

But what really seems strange is that, given kids from 5 to 17 y/o are vaxxed at 30% to 50% and 80% of all kids have shown antibodies from prior infection, why are they still dying at similar rates in 2022 compared to 2020 when there were no vaxxes and much lower prior infection? That's a lot of hybrid immunity. It's as if the virus has become more virulent for that age group. One doesn't see this in the middle ages. Omicron, generally milder, has shown a stronger proclivity to kill people over 65 out of those it kills.

It's just strange.

 

[The Atheist]

This is weird. New study on covid-19 child mortality.

I must be missing something, because I'm not seeing much of an anomaly.

Among children and young people aged 0 to 19 years in the US, COVID-19 ranked eighth among all causes of deaths, fifth in disease-related causes of deaths (excluding unintentional injuries, assault, and suicide), and first in deaths caused by infectious or respiratory diseases. COVID-19 deaths constituted 2% of all causes of death in this age group.

That doesn't look out of the ordinary to me. I'd expect it to be #1 in respiratory disease deaths; it can be dangerous and an extremely high percentage were infected. Less than homicide makes it look not so bad.

 

[dann]

Sure, Covid-19 deaths are pretty unusual for anyone under 50, let alone 20. Deaths for all causes are low for kids >1 and < 19 y/o. Covid-19 deaths are more than an order of magnitude lower yet.

But what really seems strange is that, given kids from 5 to 17 y/o are vaxxed at 30% to 50% and 80% of all kids have shown antibodies from prior infection, why are they still dying at similar rates in 2022 compared to 2020 when there were no vaxxes and much lower prior infection? That's a lot of hybrid immunity. It's as if the virus has become more virulent for that age group. One doesn't see this in the middle ages. Omicron, generally milder, has shown a stronger proclivity to kill people over 65 out of those it kills.

It's just strange.

Or more contagious, and so more children get infected.
Why doesn't the study mention MIS-C? Would MIS-C deaths be considered to have "COVID-19 as the Underlying Cause of Death"?

 

[marting]

I must be missing something, because I'm not seeing much of an anomaly.

That doesn't look out of the ordinary to me. I'd expect it to be #1 in respiratory disease deaths; it can be dangerous and an extremely high percentage were infected. Less than homicide makes it look not so bad.

Absolutely. Covid-19 deaths are quite low for kids but still higher than influenza/pneumonia was in 2019 (Fig. 2). Arguably, the deaths, because of the very high infection rate, would indicate it's not more lethal to kids since a smaller percentage got flu/pneumonia in 2019.

What gets me is that the mortality for kids didn't decline (even though low) in spite of a high rate of prior infection and vax. In 2020 few kids had prior infection and weren't vaxxed.

 

[dann]

Thinking about it a bit more, the overall death rates are still well within keeping of other countries, so it almost looks like it's a catch-up. The oldies didn't die earlier in the pandemic due to Japan stamping it out hard, and now people have relaxed it's ploughing through them.

Don't you usually argue that oldies dying from Covid-19 would have died in a couple of weeks anyway? 'Already wearing toe-tags', or something like that. Now you seem to be saying that it was not the case, i.e. that "stamping it out hard" was not only possible but actually saved lives for months and years, lives that will now be lost because the virus has been allowed to spread and is consequently "ploughing through them."

 

[dann]

Absolutely. Covid-19 deaths are quite low for kids but still higher than influenza/pneumonia was in 2019 (Fig. 2). Arguably, the deaths, because of the very high infection rate, would indicate it's not more lethal to kids since a smaller percentage got flu/pneumonia in 2019.

What gets me is that the mortality for kids didn't decline (even though low) in spite of a high rate of prior infection and vax. In 2020 few kids had prior infection and weren't vaxxed.

You seem to think of prior infection merely in terms of a benefit to the immune system. However, The coronavirus can attack multiple organs and weaken overall immunity for months. Its impacts are evident in global death rates that remain high. (Bloomberg, Dec 14, 2022)