With almost 6 months into COVID-19 in the USA since the first official case, the public health situation is still scary. Data and figures from the official U.S. Department of Health & Human Services, particularly the recent data release from the Centers for Disease Control and Prevention show around 50.000 new cases of Covid-19 every day again (see figure).
By using the data and calculating a simple linear trend shows the following evolution in case no policy change occurs.
Using a seasonality in the calculation of about 3 weeks (=20days) the evolution looks much different with huge margins of error.
Hence, all is possible by chart analysis or the language of investors. Public health analysts would rather look at the disaggregated state by state or even county be county detailed analysis. A seasonality of 3 weeks could make sense. With a high level Covid-19 cases in one state people move (also with Covid-19) to other states for one week exporting the virus. After 2 more weeks incubation, case numbers rise in this receiving area, which will make visitors (and the virus) move back again. A oscilating pattern of the spread of the virus will result, making a nationwide lockdown much more likely. In natural sciences (Video-Link)we call this coupled oscillation, here of Covid-19 between several US-states. (take Florida and New York for example).
Now, let us apply the same simple statistical modelling to the international level. As we enjoy Summer in Europe , in the southern hemisphere of the world Winter, Covid-19 and the flu are spreading there now. When we shall move from Autumn to Winter, we might receive another wave of cases from the other part of the world.
Conclusion: Get prepared for another wave as of now. Helping the global South now, saves lives in Autumn and Winter also in Europe. Simple isn’t it. Let’s just act accordingly (the not so simple part). Train health care professionals (95.000 of them got infected in the US and 500 !!! died).
In times of live or die questions, country comparisons are informative. It is the time to endorse, again and again, complete transparency to facilitate learning across borders (see recently The Guardian 13.5.2020). China has not been very transparent at the onset of the Covid-19 pandemia. Other countries should not follow this track in terms of lack transparency. This appies equally to transparency of hospital and care professionals doing amazing jobs in these critical times. No doubt about this. In order to learn about the need for qualified employees in this crisis, I recommend the full thread of the tweets from “Mary Poppins” on what it means to administer a respiratory machine to a patient.
The experience needed, the understanding of medical processes are only part of the story. Stress, mental overload, burn-out due to long-term shift-work and irregular working hours including frequent (unpaid?) overtime and lack of sufficient training may cause more fatalities than would otherwise be the case. Teamwork across shifts and weekends has to be effectively coordinated. Medication profiles need to updated and understood for adequate application from all team members not only the medical doctor or shift supervisor. In emergency situations panic control mechanism also are relevent features that have to be learned and experienced. In a previous analysis of data from 18.000 nurses in Canada we could provide evidence of the importance of some of these measures. Transparency is key. Cover-ups of past failures cost dearly in this global pandemia. Full paper.
It is normal business for demographers to deal with mortality and the statistics of mortality. The latest data I found from official European statistics from Eurostat refer back to 2015. They mention 571.000 potentially avoidable deaths in the Europen Union of the 1.7 Million deaths among the population younger than 75 years of age, the lower bound of average life expectancy. A look at the leading causes of preventable death shows that prevention of deaths due to alcohol, smoking and environmental causes beyond suicide could safe more than 200.000 lifes per year! Please pause a while in front of these figures.
In Germany we deplore more than 900.000 deaths each year and according to the statistical office on an average day during the year we have 2100 persons leaving us. In a severe case of influenza these death rates jumped for example in February 2018 to more than 3.100 persons in one day. Hence, keep calm and carry on with taking Covid-19 seriously, but no reason to panic.
Taking a look at our Belgian neighbors, the public health statistics on Belgian Mortality show a cycllical pattern of mortality with peaks in January for the influenza period and sometimes on hot summer days.
Additionally, there are several severe environmental health hazards which we have gotten used to. Not much fuzz in public about these increased death rates any more. They include many preventable deaths as well. The deadly cocktail of fine particle dust in high traffic countries combined with peaks in temperature and ozone levels yield preventable peaks in death tolls across Europe not just in Belgian, different from region to region and city to city or suburbs or proximity to risky areas. No prove available yet, just coincidence data that need close monitoring. Please follow up on the web page of Epistat and the B-momo project.The EuroMoMo-project and data can be followed on the new webpage, commented by tagesschau.de on the 23.4.2020. Late data reporting as accused for UK by the Financial times needs to be followed closely for all countries.
Students should build their statistical methods skill and get ready to use the statistical software R for further analyses useful to produce nice figures and even better advanced analyses.
Die am 13.1.2020 im PNAS veröffentlichte Studie zu Alternsprozessen des Ginkgobaums, der mehr als 1000 Jahre alt werden kann, lassen eine alte Weisheit des Alterns wieder aufleben. Die Balance bestehend aus neuem Wachstum von Zellen und dem Absterben von Zellen beschreibt den Alterungsprozess bei Langlebigkeit. Am Beispiel des langlebigen Ginkgo biloba beschreiben die Autoren den biologischen und genetisch-bedingten Alterungsprozess. Die deutsche Wikipedia-Seite weist interessante Abweichungen zu der englischsprachigen Seite auf. Neben mehr Hinweisen auf potentielle Effekte bei verschiedenen medizinischen Indikationen kann natürlich ein Hinweis auf Goethe nicht fehlen. Hatte er doch den Baum bereits literarisch verewigt in seinem Gedicht von 1815 “Ginkgo biloba”. Kein Wunder also, dass er Ginkgobaum in Deutschland nahezu mythische Kraft zu besitzen scheint. Vereinzelt finden sich Fanseiten des Ginkgo im Internet. Spannend ist jedoch auch der japanische Mythos um den Ginkgo. Selbst die Atombombe von 1945 hatte ein Haus zerstört, doch der benachbarte Ginko blieb erhalten und ist heute ein Denkmal der Hoffnung. Hier schließt sich der Kreis zur Alternsforschung. Wie beeinflussen soziale Kontexte, im Extremfall Kriege, die Genetik und Epigenetik? Wir bleiben dran an dem Thema.
Photo copyright: Jean-Pierre Chéreau & Roger Culos
Ginkgo Biloba, 1815 Gedicht von Johann Wolfgang von Goethe (1749-1832)
- Ginkgo Biloba
- Dieses Baums Blatt, der von Osten
Meinem Garten anvertraut,
Giebt geheimen Sinn zu kosten,
Wie’s den Wissenden erbaut,
- Ist es Ein lebendig Wesen,
Das sich in sich selbst getrennt?
Sind es zwey, die sich erlesen,
Daß man sie als Eines kennt?
- Solche Frage zu erwiedern,
Fand ich wohl den rechten Sinn,
Fühlst du nicht an meinen Liedern,
Daß ich Eins und doppelt bin?
Some surveys in the social sciences remain a reference due to their interesting scope of questions included. The Canadian National Survey of the Work and Health of Nurses is such a survey since they “dared” to ask a representative sample of 18.000 nurses, health care workers and care assistants questions including medication errors, fall injuries, and complaints of older adults in Canada. The study by Zafar Mehdi, Ramzi Nasser, Hildegard Theobald and myself reveals the importance of further training and sufficient staffing to prevent medication errors, fall injuries and other complaints of patients. DOI: 10.5539/gjhs.v11n3p111
Besides the interesting results of this study based on a little used data set, the study should encourage and reward transparency of medical practices and analyses (relevant in #Covid-19). Hopefully many other studies, ideally with longitudinal designs, will build on this interesting kind of data collection. Evidence-based human resource policies should not stop in front of hospitals and care institutions. Unfortunately, such sensitive data are still rarely collected, although conclusions are helpful for nurses, patients and society as a whole.
The Link to the paper in the Global Journal of Health Sciences and the download is free of charge here. For science policy it is interesting to notice that the paper was part of a self-financed Ph.D. of Zafar Mehdi, accepted at the University of Vechta recently.