Dying of, dying with and dying because of coronavirus

Covid-19 discussion, bring your own statistics
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Fishnut
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Dying of, dying with and dying because of coronavirus

Post by Fishnut » Thu May 14, 2020 1:25 pm

I've been struggling to work out how to compose this post and can't come up with anything sensible so it's just going to be a bit of a brain-dump. Sorry.

I've been finding myself thinking a lot about the distinctions 'dying of', 'dying with' and 'dying because of' coronavirus. When the outbreak started I wasn't that worried by it. I kept reassuring myself that the majority of people who were getting sick were old or infirm and therefore living on borrowed time anyway. If it wasn't coronavirus that got them it'd be something else so while every death is a tragedy this is just hastening the inevitable - they were dying 'with' coronavirus, it was their underlying conditions that really killed them. I've educated myself in the intervening couple of months and am thoroughly ashamed that I ever held and espoused those views.

For one thing, many of those who are dying were not 'due to die'. They could have had many more years of life ahead of them. Rory Kinnear wrote a really moving piece following the death of his sister from coronavirus. She had life-defining disabilities but she could have lived a lot longer had she not caught the virus,
...it was coronavirus that killed her. It wasn’t her “underlying conditions”. Prior to her diagnosis, she hadn’t been in hospital for 18 months – an unusually care-free period for Karina. No, it was a virulent, aggressive and still only partially understood virus that was responsible, a virus that is causing thousands of people, despite the unstinting bravery of the medical staff of this country, to say a distanced goodbye to relatives who would still be alive had they not contracted it.
One reason I feel so ashamed of my prior views is that I was unintentionally saying that disabled lives were less worthwhile, less full, less worth fighting for. This piece by a disabled activist was one of several that really shook me out of that attitude, by not only writing so powerfully of the value of her own life (and making me feel vile that views like mine were forcing people to have to explain that they deserve to live) but by showing the difference in the way disabled people view their own lives compared to the way able-bodied people expect them to view their lives. Most importantly, it explains the ethical issues with using 'quality of life' as a marker for whether or not to offer life-saving treatment and the importance of including the patient in that assessment.

I've come to the conclusion that saying someone died 'with' coronavirus is a cop-out. It's a way of trying to reassure healthy people that they're ok, they won't get it, they won't die, it's just those 'other' people, those people with underlying conditions that need to worry. Which is a great way of othering people who do have underlying conditions, despite them accounting for 20% of the population according to a Lancet study. Chances are that many 'healthy' people aren't as invulnerable as they thought. It's also a way of trying to pretend that the figures aren't as bad as they look - "oh, they'd have died in the next few months regardless" - even when that's untrue.

So that's of/with. The other part is the 'because of'.

The messaging at the beginning of the outbreak strongly encouraged people to avoid seeking medical help unless they really needed it. It was phrased in such a way that it could easily be taken to mean that unless you were really sick with coronavirus you shouldn't bother your doctor or local A&E department. This wasn't just me being pedantic about phrasing, when I was helping to run my local coronavirus volunteer group I had several elderly people contact me because they were worried that they couldn't ask the doctor about anything other than coronavirus. I wrote to our local health centre and got a public statement from them assuring people that they were still helping people even if they weren't infected.

It seems that the messaging has been too effective, and A&Es are now seeing a 57% drop in attendance compared to this time last year. Doctors are worrying that people are not getting the treatment they need. While things like traffic accidents will understandably be reduced, strokes, heart attacks and the like won't. Cancer referrals are also down, in some places by more than 75%. It seems that people are avoiding the doctors either out of fear of catching the virus if they go to the doctors/hospital or concerns that they'll be overwhelming an already overwhelmed system.

Some of these people will die as a result of delayed treatment. Some of them have probably already died and are in the 'excess mortality' statistics. Their deaths are because of the pandemic but it wasn't the virus that got them, it was our reaction to it. Do they get included in the statistics? If we're trying to find out the virulence of the virus I guess not, but if we're trying to see what impact it's had on our society then I'd argue we have to.

I'm sh.t at conclusions, especially after ramblings like this. I guess the TL:DR is that a lot of lives are being lost because of this pandemic, even if it isn't solely the virus pulling the plug, and splitting hairs - unless you're trying to answer specific questions - is pointless.

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JQH
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Re: Dying of, dying with and dying because of coronavirus

Post by JQH » Thu May 14, 2020 4:15 pm

There was certainly a lot of talk about "underlying conditions" in the early days. I'm not sure this was playing down the value of the lives of people with disabilities (I speak as someone with a brace of "underlying conditions" btw) as playing down the seriousness of the epidemic itself.

The lives that are clearly undervalued are those of low paid working class people forced back to work this week. Even if their work-place is made safe (and it's a big if), the public transport they are obliged to use is not.
And remember that if you botch the exit, the carnival of reaction may be coming to a town near you.

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Fishnut
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Re: Dying of, dying with and dying because of coronavirus

Post by Fishnut » Thu May 14, 2020 4:37 pm

JQH wrote:
Thu May 14, 2020 4:15 pm
The lives that are clearly undervalued are those of low paid working class people forced back to work this week. Even if their work-place is made safe (and it's a big if), the public transport they are obliged to use is not.
Totally. One of my neighbours (we walk our dogs around the same fields so we see each other occasionally) runs a woodworking company and is trying to open on Monday but can't get any PPE. It seems crazy that the NHS and other essential workers are still struggling to get adequate protection and we're now adding in another layer of demand from non-essential workers.

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sTeamTraen
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Re: Dying of, dying with and dying because of coronavirus

Post by sTeamTraen » Thu May 14, 2020 7:46 pm

JQH wrote:
Thu May 14, 2020 4:15 pm
There was certainly a lot of talk about "underlying conditions" in the early days.
There was a lot of accidental (or not) conflation of "underlying issues" and "Stage 4 cancer, chemo stopped, can you still sign this bit of paper?". The "underlying issues" that make a big difference to COVID-19 mortality include things like heart conditions and diabetes. Probably 30% or more of people over 50 would be counted as having a significant "underlying condition", even though most have a prospect of 30 or more years of life ahead of them.

Arguably the whole point of a healthcare system is to treat people with chronic conditions of varying disease of severity.
Sitting in a sleazy snackbar sucking sickly sausage rolls

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Woodchopper
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Re: Dying of, dying with and dying because of coronavirus

Post by Woodchopper » Fri May 15, 2020 9:35 pm

I’ve been arguing on Facebook with one of the ‘Covid hysteria’ bunch who thinks we should all go back to normal as it’s no worse than flu.

On presenting him with mortality data he retorted that the deaths didn’t matter as “almost all” are in care homes and “Anyone who is in a care home in basically in the ante-chamber to the mortuary.”

Pretty much sums up the attitude.

I don’t think I’ll bother replying.

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