Covid reality sets in

February 22, 2023. The material below I collected and posted a year ago. It provides good context for today's Wall Street Journal articles (see attached PDFs), namely that it is more like the flu, meaning it will be with us forever, that annual shots are likely to be the new routine (perhaps with a better, more refined, effective and less problematic vaccine than the ones rushed out to us this year, often without FDA approval), and that we will have to learn to live with this reality.

Joe Biden’s Presidency Is Incredible—No, Really - WSJ.pdf

Download PDF • 236KB

Covid-19 Could Become Like the Flu if More People Get Vaccinated - WSJ.pdf

Download PDF • 466KB

The strategies to fight Covid have failed and evolved over the past eighteen months, including flattening the curve, ventilators and respirators, sending sick elderly back to die in their nursing home, ignoring co-morbidities, often ineffective, 'false' PCR tests and the labs that process them, lockdowns, masks and the idea that we could eliminate the virus if only everyone stayed locked down long enough, after saying the lockdown would be only two weeks, that masks were unnecessary, that two million Americans would die, and -- from Dems -- that they thought the vaccine was useless as long as it came from Trump but now it is essential when it is managed by Biden. Biden, Harris, Cuomo...they all rejected the vaccine. Now they swear by it, bit not for their allies, just for those they desire to control.

So here is the old report:

1. Death certificate data: COVID-19 as the underlying cause of death

September 16, 2020

One in 3 death certificates were wrong before coronavirus. It's about to get even worse. USA Today 11 May 2020

2. We Could Be Vastly Overestimating the Death Rate for COVID-19 — Here’s Why

DEVELOPMENT & SOCIETY : Health, Social Development, Statistics

2020•04•15 Nina Schwalbe United Nations University

Since many of us are experiencing homeschooling these days, it seems a good time for a math refresher. Once the number of infections is determined, this becomes the denominator in our public health calculation. The number of deaths is our numerator.

Numerator (number of deaths)/denominator (number of people infected) x 100 = infection fatality rate

We know the virus spreads very fast once it is introduced to a population. That means many of us in the general population are or were already infected with the virus — whether or not we have symptoms.

However, instead of counting us all in the denominator — in many countries including the US — only people sick enough to go to the hospital are counted. People sick enough to go to the hospital are more likely to need critical care, and patients in critical condition are more likely to die than patients with mild symptoms. This means the fatality rate looks higher than it really is.

Further, even when we are testing — depending on the type of test used — we may only be counting people who are actively infected, not those who had it and are thus currently immune. This again will lead to an underestimate of the denominator.

What does it mean? It means that the denominator (number of infections) is smaller than it should be, so the numerator (number of deaths) has a lot of power. In this case, the result is that the death rate (numerator divided by denominator) reported is higher than it should be. In other words, by not counting the people who don’t need hospital care, we are massively over-projecting the percent of infected people who die of COVID-19. It’s a dangerous message that is causing fear all driven by a false denominator.

3. VERIFY: No, COVID-19 deaths are not being inflated by car crash deaths. But that is NOT the real problem. The problem is in treating Cov-19 as the trigger, rather than the final step in the dying process. Or in treating co-morbidities as the result of Covid-19, and not as a pre-existing condition.

"Typically, when somebody dies of COVID-19, they don't just drop dead from the virus," Anderson says. "The virus causes other conditions like pneumonia, or respiratory distress.”

The CDC reports that in 94% of COVID-19 deaths, a person died with comorbidities. Those can be conditions a person already had, or ones that COVID-19 causes. Anderson gave us an example of why.

"In some instances, you may have cases where somebody was already dying of COPD. Let's say they're in end-stage COPD, they may be a week or two away from death, and they get COVID-19. Then the cause of death certifier has to make a decision." Anderson lays out the questions a death certifier would ask. "Okay, so what initiated the chain of events here? Was it the COPD? Or was it the COVID-19? Would the person have likely survived for longer if they had if they hadn't gotten the virus? Or did that virus really just jumpstart the chain of events?”

In this cause of death analysis that thousands of medical professionals are performing around the country, their goal is to figure out what started the process that caused them to die.

A UCSF study of nursing home deaths found some startlingly high mortality rates.

The average length of stay before death was 13.7 months, while the median was five months. Fifty-three percent of nursing home residents in the study died within six months. Men died after a median stay of three months, while women died after a median stay of eight months. Aug 24, 2010

4. Hospital Payments muddle the COVID-19 Death Count

By Angelo Fichera

Posted on April 21, 2020

One YouTube video with Jensen’s interview, viewed 42,000 times, was titled “US: Hospitals Get Paid More to List Patients as COVID-19…” That video was then posted in a Facebook group called “X22 Report [Geopolitical]” with a caption referencing the specific dollar amounts that read in part: “This also explains the inflated amount of covid deaths.” Nearly 3,000 users shared the video from that post.

“So, hospitals get an extra $13,000 if they diagnose a death as COVID-19,” a widely shared meme on Facebook claimed. “And an additional $39,000 if they use a ventilator!” One post of the meme, shared by hundreds, was captioned: “And then we wonder why the numbers of deaths are embellished…”

The figures cited by Jensen generally square with estimated Medicare payments for COVID-19 hospitalizations, based on average Medicare payments for patients with similar diagnoses.

Medicare — the federal health insurance program for Americans 65 and older, a central at-risk population when it comes to COVID-19 — pays hospitals in part using fixed rates at discharge based off a grouping system known as diagnosis-related groups.

The Centers for Medicare & Medicaid Services has classified COVID-19 cases with existing groups for respiratory infections and inflammations. A CMS spokesperson told us exact payments vary, depending on a patient’s principal diagnosis and severity, as well as treatments and procedures. There are also geographic variations.

An analysis by the Kaiser Family Foundation looked at average Medicare payments for hospital admissions for the existing diagnosis-related groups and noted that the “average Medicare payment for respiratory infections and inflammations with major comorbidities or complications in 2017 … was $13,297. For more severe hospitalizations, we use the average Medicare payment for a respiratory system diagnosis with ventilator support for greater than 96 hours, which was $40,218.”

It is true, however, that the government will pay more to hospitals for COVID-19 cases in two senses: By paying an additional 20% on top of traditional Medicare rates for COVID-19 patients during the public health emergency, and by reimbursing hospitals for treating the uninsured patients with the disease (at that enhanced Medicare rate).

Both of those provisions stem from the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act. The CARES Act created the 20% add-on to be paid for Medicare patients with COVID-19. The act further created a $100 billion fund that is being used to financially assist hospitals — a “portion” of which will be “used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured,” according to the U.S. Department of Health and Human Services.

As the Kaiser analysis noted, though, “it is unclear whether the new fund will be able to cover the costs of the uninsured in addition to other needs, such as the purchase of medical supplies and the construction of temporary facilities.”

Either way, the fact that government programs are paying hospitals for treating patients who have COVID-19 isn’t on its own representative of anything nefarious.

“There’s an implication here that hospitals are over-reporting their COVID patients because they have an economic advantage of doing so, [which] is really an outrageous claim,” Gerald Kominski, senior fellow at the UCLA Center for Health Policy Research, told us. And, he said, any suggestion that patients may be put on ventilators out of financial gain, not medical need, “is basically saying physicians are violating their Hippocratic Oath … it would be like providing heart surgery on someone who doesn’t need it.”

Robert Berenson, an institute fellow at the Urban Institute, said the notion that hospitals are profiting off the pandemic— as some of the social media posts may imply — isn’t borne out by facts, either.

Berenson said revenues appear to be down for hospitals this quarter because many have suspended elective procedures, which are key to their revenue, forcing some hospitals to cut staff. He surmised that potential instances of patients being wrongly “upcoded” — or classified as COVID-19 when they’re not — are “trivial compared to these other forces that are affecting hospital finances.”

Berenson and others we spoke with also said that hospitals have profound disincentives for “upcoding,” which can result in criminal or civil liabilities, such as being susceptible to being kicked out of the Medicare program.

Jensen himself said in a phone interview that he was not alleging widespread medical fraud.

“Do I think people are misclassifying? No,” Jensen said. He said his concerns centered on what he deemed “less precise standards” for certifying deaths promulgated by the U.S. Centers for Disease Control and Prevention, and how deaths classified as COVID-19 without corroborating positive test results could lead to an over-counting.

The CDC guidance says that officials should report deaths in which the patient tested positive for COVID-19 — or, if a test isn’t available, “if the circumstances are compelling within a reasonable degree of certainty.” It further indicates that if a “definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID-19 on a death certificate as ‘probable’ or ‘presumed.'”

“If we think it’s presumptive … we can go ahead and put down COVID-19,” Jensen said, “or even in some situations, even if it’s negative.” He pointed to the example of a 38-year-old man in Minnesota whose death was attributed to the coronavirus even though he tested negative.

The man’s mother, however, told the St. Paul Pioneer Press that doctors determined the test result was likely a false negative. It’s not known exactly how common false negatives are in the U.S., but public health experts and doctors have raised concerns about many instances of tests showing negative results even when all other indicators point to COVID-19.

Fact sheets for different COVID-19 tests from the Food and Drug Administration note that a “negative result does not exclude the possibility of COVID-19. When diagnostic testing is negative, the possibility of a false negative result should be considered in the context of a patient’s recent exposures and the presence of clinical signs and symptoms consistent with COVID-19. The possibility of a false negative result should especially be considered if the patient’s recent exposures or clinical presentation indicate that COVID-19 is likely, and diagnostic tests for other causes of illness (e.g., other respiratory illness) are negative.”

As for the accuracy of the death toll, other experts have previously told us that while it’s true that some deaths attributed to COVID-19 likely would have occurred regardless of the disease, other factors — like the deaths of undiagnosed COVID-19 victims, including those that occur at home — contribute to a more significant problem of under-counting the deaths. New York City recently added more than 3,700 victims to its death toll to account for presumed cases. The CDC’s national count now makes note of how many cases and deaths were deemed “probable.”

Jensen said he actually believed there could be both instances of under-counting and over-counting of COVID-19 cases and deaths — but said that “if there’s an over-count it’s conceivable that that could down the road translate to increased dollars in terms of some of the recovery dollars from COVID-19.”

When it comes to the $100 billion fund to help providers, future grants by HHS are supposedto focus on providers in areas hit hard by the outbreak, among others. But the initial allocation of $30 billion from that $100 billion fund to assist hospitals wasn’t distributed in that way. Instead, it was based on prior Medicare business.

A Kaiser Health News analysis found that the distribution of that initial $30 billion resulted in hospitals in states less affected by the pandemic — such as Minnesota, Nebraska and Montana — being given funding that worked out to be about “$300,000 per reported COVID-19 case.” In New York, which has the highest number of COVID-19 cases, the grant money amounted to “only $12,000 per case.”

5. The Imperial College forecast of deaths; two-thirds were going to die anyway.

6. The World Food Programme estimates the number of people facing acute hunger this year could nearly double -- to 265 million.