Jan 16, 2023Liked by Jeremy Faust, MD

This is my experience from Aug. my 93 yr old father in law and his 87 yr old lady friend got Covid .My fil got Paxlovid ( getting a hold of that is another story!) and got better . His friend originally just had a mild cold and did not pursue Paxlovid despite my strong advice. She thought she was fine .She had a host of comorbidites which put her at risk She started coughing , constantly , and with it came a lot of pain- that was a preexisting problem . Ended up in the hospital with pneumonia. Was discharged after a few days but got worse again so was readmitted. I talked to her right before EMS came and she had severe conversational dyspnea. Not clear on all the details since I wasn’t family but I think she developed sepsis and a decision was made not to pursue aggressive treatment . So my father in law says the doctors said it wasn’t Covid that killed her. I know I am not a doctor ( retired critical care) but I strongly disagreed with that. She was chronically ill but in a steady state. Covid upset that balance. I would bet, as you allude to it Dr Faust ,that many deaths do not present the way they originally did in the year before vaccines . I think the medical community needs to admit that in certain cases if it wasn’t for Covid people would still be alive .

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Jan 16, 2023Liked by Jeremy Faust, MD

Thank you—for the sound data analysis. I wonder if Dr. Wen changed her thinking.

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Thank you and still so very sad that we are losing so many. It is like whiplash in the media and it is just exhausting trying to figure out we where are. Why is the White House Response Team not out front and center. I know we all have individual risks AND I feel like we need more reliable generalized guidelines. Sadly people have to be able and willing to subscribe to reliable sources, like yours. I am just trying how my family can live, be responsible and mindful of others all while not getting this awful virus. I have been way more cautious than most five shots, COVID twice. I am still only eating outside, test if I have symptoms, and need a break from the anxiety of it all. Wishing the virus would cooperate! Grateful to have you out there doing the hard work!

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Thanks Michael, and those are interesting points, yes.... I'm curious if Jeremy also has anything to say about my comments, particularly how to explain why excess mortality is even somewhat higher recently than it was during the (according to the CDC,WHO, etc) much deadlier Covid waves of 2021? And why would excess deaths now be higher in places (such as Massachusetts and other parts of New England, as well as in Spain, Italy and France, for example) where vaccination levels are considerably higher, than in various places with much lower vaccination levels that nevertheless have had lower levels of excess deaths, if in fact Covid continues to be the main driver of excess deaths?

I have a number of epidemiologist colleagues who are also clinicians at major university hospitals, such as the University of California, San Francisco , and nearly all of them say they haven't had a Covid patient in the ICU, let alone dying in the hospital, for up to a year now, so how to explain the apparently near invisible mountain of Covid deaths still happening out there?

It would be interesting to know what Dr Wen would make of these questions as well? Dr Faust has challenged her published article, but she evidently hasn't had the opportunity to respond, at least publicly?

Cheers, Daniel

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It looks like I will, with all due respect, be taking a rather different stance than the other commentators so far. That said, I'm glad that Dr. Faust, who I do highly respect, has raised the issue of excess mortality, something I have also been thinking about for a rather long time. In my book on COVID-19 published in July 2020, for example, I pointed out that -- despite pervasive warnings by many experts and journalists that the country of Sweden was fast becoming, as a New York Times headline put it, "the cemetery of Europe" due to its distinctly non-alarmist approach to the pandemic -- in fact excess deaths data at the time showed it to have much lower levels than many other developed countries. (And a year later, it ranked 27th lowest out of 30 European In terms of excess mortality, according to WHO data.)

However, while I agree with Dr Faust's analysis that examining excess deaths was a useful methodology early in the pandemic, nearly 3 years later there are just way too many other complex factors (and potentially confounding variables) to continue simply assuming, as we did in 2020, that the bulk of excess deaths are due to the coronavirus. Just a few of those many other potential causes are the massive increase in fentanyl overdoses as well as increasing obesity directly and indirectly related to the pandemic (and particularly to our response to the virus).

By the way, as some readers may already know, a number of anti vaccine folks also like to talk about the current excess deaths situation, claiming the reason that excess mortality remains higher than normal almost everywhere (notice I said "almost") is because considerable numbers of people are dying from the vaccines.

In my view, and in that of many of my epidemiologist colleagues, it's not scientifically sound to automatically assume that any one factor, such as Covid 19, accounts for the above normal level of excess deaths. For starters, there is a major contradiction that would need to be explained: If one believes (unlike the vaccine skeptics) that the vaccines can prevent deaths to a considerable extent, then how to account for the fact that the continuing above-normal levels of excess deaths is occurring not only in almost all places, but those levels are about the same (and often considerably higher!) in countries with some of the highest vaccination levels in the world, compared to excess deaths levels in countries with much lower levels? How can this observation be explained, if indeed the disease is the main reason behind the excess deaths?

Furthermore, there's a perhaps interesting exception: one of the very few economically develped countries that continues to have a normal level of excess deaths is... Yes, Sweden. (The anti vaccine folks claim this is merely a "statistical anomaly," since Sweden is one of those countries with very high vaccination levels, and perhaps it is just a chance statistical outlier?) Yet personally I find it worth at least musing that it also happens to be almost the only country in the world that has pursued a very different approach to Covid, since the very beginning? The Swedish people I've asked about this, including several top notch epidemiologists, say that because schools were never closed, the economy wasn't shut down and thus people weren't thrown out of work, etc and because a climate of panic and fear was never generated in the country, therefore they also haven't experienced so many of the unintented consequences of such pandemic measures that were commonplace elsewhere, including drug overdoses, alcoholism, suicides and worsening of other health/lifestyle indicators such as obesity...

Moreover, and while I realize that Dr. Faust apparently disagrees, FYI I find a current article in The Economist (www.economist.com/finance-and-economics/2023/01/15/why-health-care-services-are-in-chaos-everywhere) to offer a likely more compelling explanation for the current excess deaths situation, e.g.:

This collapse in the quality of health care is contributing to an astonishing rise in “excess deaths”—those above what would be expected in a normal year. In many rich-world countries 2022 proved deadlier even than

2021, a year of several big waves of covid. Monthly deaths across Europe are currently about 10% higher than expected...

In this regard, while I certainly appreciate that you don't want to scoop yourself re your forthcoming paper in a medical journal, that issue does also seem germane,so I will be very curious to see what you will be publishing about this...

Finally, Dr Faust (if you were able to read this far; sorry for the longish comment), although I know you probably disagree with at least most of what I've written here, you also seem like a truly good, decent scientist and person, so if possible I would greatly appreciate it if you could forward my commentary to Dr Wen; thanks much!


Daniel Halperin, PhD, Adjunct Full Professor in Global Public Health, University of North Carolina, Chapel Hill; danielhalperin.web.unc.edu ; https://www.amazon.com/Facing-COVID-Without-Panic-Epidemiologist-ebook/dp/B08D25GQX6

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So grateful for this opinion. It seems ludicrous to me that anyone would skew COVID death data in the direction of an over count. As an immune compromised person, I did what many did, I stayed away from hospitals especially when there were no vaccines. I had another TIA on Jan. 6, 2020 (go figure) and refused ER for that reason. Finally went in and was kept overnight. (Later found out that 2 of my attending nurses opted not to get the first COVID vax even though they could have). Thereafter stayed away when cases were high. Many times people like myself are actually keeping our disease maintenance in some control but when we get COVID (or as I was warned about even flu pre-pandemic as you have referenced) it zooms in on our vulnerable systems. So we are still dying of COVID. And now patients are trying to catch up on their care, hospitals lost $$$ from less surgeries and procedures, docs overwhelmed, radiology depts overwhelmed and we have to wait 4 to 6 months for appts. Don't have to tell you, ER's already overwhelmed well before pandemic because so many forced to use them for "regular" healthcare because of an inadequate healthcare system. Thanks for your critical thinking and caring.

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