Good Morning. Today I am writing to you with new information about the virus in the first wave. But I also take the opportunity to change the subject and recommend my favorite books of the year.
1. ✍️ What do the death certificates say?
The INE has published the certificates from January to May and they bring a lot of new information. What we knew is that an abnormal excess of deaths was observed, but now a fundamental detail is added: the cause of each one.
The conclusions of the article with Grasso and Andrino:
1. Covid was the first cause of death until May. The death certificates confirm something we already suspected. The coronavirus was the first cause of death in spring. A disease that did not exist in 2019 caused more deaths than any other cause (and almost as many as all forms of cancer combined).
2. There were many more deaths than officially confirmed. Death certificates attribute 46,000 deaths to covid as the first cause of death, but the number of confirmed deaths remained at 28,000 deaths (just 60%). This second figure is the only one that the Ministry of Health notifies daily in its reports and the one that it sends to international organizations.
- Doctors certified 32,500 deaths whose cause is “Covid-19 with an identified virus”, but also added another 13,000 deaths that they attribute to the disease with their diagnosis, although without a test, and which are considered “suspicious” cases. The discrepancy is not a surprise. First, because in those months the ability to do PCR tests was limited. But also because there were people who died far from hospitals.
3. Most of the abnormal deaths were covid. It is an incognito that is cleared. 95% of the excess deaths observed compared to 2019, those abnormal that occurred during the epidemic and confinement, were registered with the covid as the cause.
–
- It is a debate that is closed. We knew there were 48,000 excess deaths, Thanks to the information from the civil registries, but it was possible that some of them were due to other pathologies: confining ourselves, fear of the hospital or health stress. These pathologies may increase somewhat, but little compared to the virus.
4 Covid deaths may still be missing. The graph shows the excesses (and deficits) of deaths this year compared to 2019, for each cause. It caught my attention that there are some causes that rebounded in March – and only in March! -, which could be misdiagnosed covid or comorbidities. That would explain why they rebounded in March, when the virus was less well known, and then fell in April even though we were still confined and with hospitals under tension. This specific peak is observed in diseases of the circulatory and respiratory systems, which are two typical complications of covid.
–
- Other causes decreased with the confinement. Traffic accidents, falls, and other external causes did.
5. Another terrible fact: 13,700 people died in the residences. They died there physically. Not counting other residents who died in the hospital. Of those 13,700, half died with suspicion but without a test. Deaths in residences were double the normal in those months. Partly because of Covid, but not only.
Thousands of people who would have died in hospitals ended up dying at home or in residences.
- Deaths from circulatory diseases fell 8% in hospitals (2,000 fewer deaths), but rose 16% in nursing homes (1,200).
- Deaths from respiratory diseases fell 15% in hospitals (2,500), to rise 28% in residences (750) and 14% in homes (555).
- As for cancer victims, they fell in hospitals (2,200 fewer deaths) and increased a lot in homes, where they went from 11,096 to 14,275. Perhaps there were worse diagnoses, people who chose not to go to the hospital or who could not get there.
. Good for the INE. I do not want to stop celebrating the great work of the INE with this information. Their publication has been brought forward a year and offer detailed, downloadable and well explained data.
???? 2. What is the advantage of rapid antigen tests?
On Sunday we visually explain two of its advantages. With them you can speed up the diagnoses, so that you can isolate “express”, and if you also launch a good scan, you can avoid opportunities for new infections.
Its main strength is speed. If you go to the doctor with symptoms, instead of waiting 2-3 days for a PCR, you will know if you are positive in 15 minutes.
And its sensitivity is better than expected. We knew that 20% of the PCR positives were missing. But there is good news: they are usually patients with low viral load and who often will not transmit the disease.
–
To better understand the advantages of testing quickly, we have made a step-by-step animation. So the best thing is that you see them directly: How antigen testing is changing the pandemic. There is also an English version.
???? 3. Interesting readings
I don’t want to resist making some typical end-of-year list. This week I am going to start with the books that I have enjoyed the most. (They have nothing to do with this newsletter, but actually they do.)
— Bloody hoursby Casey Cep (KO Books). My favorite book of 2020. The story of True-Crime that Harper Lee couldn’t write. It is a book about an event: “For Reverend Willie Maxwell, becoming a widower was proving to be a very lucrative business.” But also the exploration of a question about Lee, the famous author of Kill a Mockingbird: Why did you never write a second book? It was reviewed by Michael Lewis.
— The huntersby James Salter. (Salamander). This week Chuck Yeager, the pilot who broke the sound barrier, died; the most just possessor of “What you have to have”, according to Tom Wolfe, who dedicated a book to that unnameable quality that governed the lives of elite pilots. But the best novel to understand that closed world – absurd and transcendent, as all closed worlds – is Salter’s novel.
— Station eleven, by John Mandel (Kailas). I loved this novel, which has regained popularity for one simple reason: it is a post-disaster story after a flu pandemic. But it is original and not pessimistic. It can be read like a love letter to today’s world, like the author told Tyler Cowen: “I thought it might be interesting to reflect and write about the modern world contemplating its absence, just like you talk about a person with a eulogy. It can be read as a love letter to electricity, to air travel, to antibiotics, to insulin, all those accessories of civilization that we tend to take for granted ”.
— A promised landby Barack Obama (Debate). I have not finished it yet, but I liked the first part. There is something fascinating about peering into Obama’s youth, when nothing in his life suggests that he is going to be a historical figure. I am interested in the origins of exceptional people before they are: they often don’t seem like it. A good podcast with that look was Making Obama (and Making Beyoncé).
— My Next Guest, con David Letterman (Netflix). Since I am leaving the books, but without abandoning Obama, I have liked David Letterman’s interviews with a lot of people. The president’s is fine, as are Belinda Gates and Kim Kardashian. What I love about the show – I’m really envious – is Letterman’s incredible ability to instill his curiosity and fascination with each and every person on the couch.
Can you help us? Forward this newsletter to your contacts or tell them to sign up here. You can write me with clues or comments to my email: [email protected] ????.
– .
