Philip Greenspun’s Weblog

What is the most sensible scientifically informed response to a virus that attacks the obese and unfit? Sit at home next to the fridge for a year. Could this kill us? “Inactivity Drives 1 in 14 Deaths Globally, New Data Suggest” (Medscape, March 31):

The high cost of a sedentary lifestyle just became a bit more evident ― a new global study shows that inactivity drives up to 8% of noncommunicable diseases and mortality.

Physical inactivity, defined as engaging in less than 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week, is estimated to have caused 7.2% (95% CI, 5.4 – 9.0) of all-cause deaths and 7.6% (95% CI, 6.1 – 9.3) of cardiovascular disease (CVD) deaths, according to investigators led by Peter T. Katzmarzyk, PhD, associate executive director for population and public health sciences, Pennington Biomedical Research Center, Baton Rouge, Louisiana.

Note that the study was done using 2016 data. See “Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries” (BMJ)

What about the expectations that Americans would die from the disruption in non-Covid health care ordered by governors? “The Untold Toll — The Pandemic’s Effects on Patients without Covid-19” (NEJM, June 2020) had anecdotes, but no numbers. “Surge in Advanced Cancers Follows COVID-19 Into 2021” (MedPage Today, March 31, 2021) offers some survey data:

Two-thirds of radiation oncologists said new patients more often have advanced-stage disease at their initial clinic visit as compared with prior years. Consistent with data from multiple other sources, three-fourths of respondents said patients have skipped routine cancer screening, and two-thirds said COVID has interrupted treatment for existing patients.

“What we have learned one year into the COVID-19 pandemic is that radiation oncologists continue to see the harmful effects of the pandemic on our patients,” said Thomas J. Eichler, MD, chair of ASTRO’s board of directors, during a webinar to discuss the survey findings. “The data are clear that people with cancer are facing additional burdens in these difficult times.”

(bonus points to this doc for including the phrase “in these times”)

The same publication reminds us that feeling safe is not just about Covid-19. The director of abortion services at a clinic in Bangor, Maine writes “It’s Time for You to Be More Inclusive — Yes, You.”:

Small steps to support transgender patients go a long way in their healthcare

I recently saw a new patient seeking help addressing substance abuse issues. It was our first time meeting, so when I entered the exam room, I introduced myself with my name and my pronouns, as I always do. Before I even offered any advice or asked a question, the patient’s face lit up with a smile. She explained that she was a transgender woman, and hearing me introduce myself with my pronouns was a huge relief, because it showed her that I would treat her with respect.

She quickly opened up to me, describing how she was grappling with a host of challenges and stresses that were made even worse because other people in her life — including other doctors — didn’t understand, didn’t respect, or outright rejected her identity.

Something as simple as including your pronouns when you introduce yourself can indicate that you are an ally and contribute to a sense of safety and inclusion.

I say that I provide abortions, prenatal care, birth control or other resources to pregnant people, not just pregnant women, because all people deserve the right to make their own decisions about if, when, or how they want to have children, without facing judgement.

Separately, if there is a person on this planet who can get through a winter in Bangor, Maine without drinking heavily, consuming drugs, and considering a gender change, I would love to meet him/her/zir/them.

TLDR: If we denied children a year of school and spent $trillions, shouldn’t we have something to show for that?

The CDC sped up its tally of deaths in 2020 and now says that American deaths in 2020 were 16 percent higher than in 2019 (CNBC). COVID-19 is now highlighted as the third leading cause of death. If we adjust for U.S. population growth (somewhat difficult to assess because of the undocumented), that’s perhaps a 15 percent higher death rate.

Considering the loss of a year of education for American children, the loss of liberty for American adults, and $trillions in tax dollars flushed down the toilet, this seems like a spectacular failure. While our state governors issued orders to residents and Americans waited for Dr. Fauci to tell them whether it was safe to roast a turkey, Sweden continued to live within its existing framework of laws and customs, e.g., sending children to school, adults to the gym and social life, etc. Swedes did not don the hijab of the Church of Shutdown for hours each day. Sweden ended up with 10 percent more deaths than in 2019 (Statista; note that 2019 seems to have been an unusually death-free year in Sweden and also that, due to population growth, the 2020 death rate was, in fact, lower than the death rate in 2010). Sweden also has a growing population, so a total higher than 10 percent might translate to a rate that is 9 percent higher.

Also from the CNBC article:

It typically takes researchers 11 months after the end of the calendar year to investigate “certain causes of death and to process and review data.” While the daily total Covid death figures reported by the CDC are timely, they can underestimate the actual number of deaths because of “incomplete or delayed reporting.”

For those who believe that humans are in charge of the coronavirus, I imagine that the take-away from these data will be to double down on shutdowns and masks. The assumption will be that, absent our heroic sacrifices, deaths in the U.S. would have been 300 percent higher in 2020 than in 2019, so holding the increase to only 16 percent demonstrates how effective shutdowns and masks are. That masked-and-locked California and wide-open Florida are right next to each other in states ranked by Covid-19 death rate (

) will not be cause to question the assumption that masks and lockdowns are highly effective. (Note that California’s COVID-19 death rate is substantially higher than Florida’s if you consider the over-65 population that is actually vulnerable to COVID-19. Florida has roughly 50% more seniors as a percentage of its population.)

Finally, let’s not forget that our 2020 aggregate deaths also include deaths caused by the shutdown, e.g., people who didn’t get the cardiology procedures that they would have had, extra drug overdoses, etc.

Readers who love masks and shutdowns: Given that deaths in 2020 were 16 percent higher than in 2019, how many American lives do you think were actually “saved” compared to if state governors and local government had done nothing (so we’d still have had Trump funding the vaccines, the CDC messing up initial testing, etc., but there would have been no shutdowns, no masks, and kids would have been in school; we still would have had media hysteria, so presumably a lot of the elderly/vulnerable and elite would have hidden in bunkers voluntarily). We’re fatter than the Swedes and COVID-19 loves to kill the fat, but plenty of Swedes are also overweight. (But don’t count the 20 lbs. that people gained during the year that their governors ordered them to spend next to the fridge!)

Related:

• Friend in Texas runs, but cannot hide, from coronavirus
• We ran but could not hide: more than half of Americans have now had COVID-19

Americans are currently living under a forecast of “impending doom” from our CDC Director. Let’s review how folks in Minnesota reacted when their doom was forecast by scientists.

From March 25, 2020, “Governor Walz Issues Stay at Home Order for Minnesotans”:

Modeling released today by the Minnesota Department of Health and University of Minnesota predicts that more than 70,000 Minnesotans could die from COVID-19 if we take no action. The Governor’s two-week order to stay home is forecasted to significantly slow the spread of COVID-19 and allow the state time to make key preparations for the pandemic.

14 days to flatten the curve!

A year later, Matt Malkus looked at this.

Over the past 12 months, nearly 7,000 people in Minnesota actually did die with or from COVID-19, 0.12 percent of the estimated 5.7 million population (though not even Yale knows how many undocumented Americans live in America). So if we believe the model estimate of 70,000 dead, we could say that the cower-in-place keep-schools-closed-for-a-year strategy worked! How does the 0.12 percent death rate compare to what happened in give-the-finger-to-the-virus Sweden, from which many Minnesotans can trace their ancestry? This list of countries by COVID-19 death rate puts Sweden at a 0.13 percent COVID death rate (Sweden automatically tags anyone with a positive PCR test as a “COVID death”).

(As in Massachusetts, Minnesota does not include deaths by age or age group on their dashboard. Only “cases” are published and therefore a reader is left with the impression that COVID-19 primarily afflicts young and middle-aged Minnesotans:

if you had to guess the median age of a COVID-19 death from this chart you might pick 38 (it was 82 in Massachusetts before the data were pulled from the dashboard). Where Minnesota provides comprehensive charts, though, is in “COVID-19 Data by Race/Ethnicity”:

COVID-19 is exposing what has always been true: racism is pervasive and persistent. … We know that communities of color and Indigenous communities don’t need data to verify their experience. … In developing the dashboard, we knew it was important to provide descriptions that accompany the data to provide context so that false information and misunderstandings do not perpetrate harmful rhetoric and racial disparities.

For those prejudiced whites who might try to avoid their Latinx brothers, sisters, and binary resisters as carriers of disease… the Minnesota government anti-racism specialists helpfully explain that “Latinx Minnesotans are testing positive for COVID-19 at nearly 3 times the rate of white Minnesotans.”)

Related:

• From 1.5 months after the lockdown, a version of the scientists’ code on GitHub