Is it really perhaps all about prior conditions?

From Sweden’s death toll unnerves its Nordic neighbours by Richard Milne.

Denmark, Finland and Norway are debating whether to maintain travel restrictions on Sweden but ease them for other countries as they nervously eye their Nordic neighbour’s higher coronavirus death toll.

Sweden has the highest mortality rate per capita at this stage of the epidemic, according to a Financial Times tracker that uses a seven-day rolling average of new deaths. It has overtaken the UK, Italy and Belgium in recent days.

Frode Forland, specialist director in infectious diseases at the Norwegian Institute of Public Health, told the Financial Times keeping borders closed had “a certain infectious-disease logic” while a big difference in infection rates remained between countries. “The situation is quite different now between Norway and Sweden,” he said.

I have seen a couple of sites where there are discussions of this. One commenter observes that it was their impression that most of the Covid-19 deaths in Sweden were among the elderly in long-term care facilities and among immigrants. Among the Scandinavian countries, Sweden has by far the largest number and most recent immigrant populations, having taken in some 165,000 during the Syrian civil war. Not only are the numbers large but the integration and adjustment to life in Sweden has been de minimis.

Another commenter notes:

Sweden's biggest problem is that their Nursing and LTC systems relies on a few big facilities as opposed to lot of smaller ones. Covid got in some of them early on and once it got in, it was dang near impossible to get out. Half their deaths or so are connected to LTC in the Stockholm area. The other big center of deaths are recent immigrants (of which Sweden has way more of than any other Nordic) who live in multi-generational households. Once you get outside of those two populations, Sweden's death toll is basically nil.

I cannot adjudge the accuracy of the statement but it seems plausible.

And it dovetails with something I have been mulling the past few days.

Our current discussion is about Covid-19 deaths being concentrated among the elderly and among those with prior conditions.

But I wonder. Is age actually a factor in the risk or is it primarily co-morbidities and prior conditions?

It appears from recent reports that 40% of American Covid-19 deaths are among those resident in assisted living facilities. But who lives in assisted living facilities? The elderly. And what is one of the chief characteristics of the elderly? Prior conditions.

I do not dispute that the death rates among the elderly are far greater than those below 50 but is it because they are elderly or is it because they have health priors.

If we turn a blind eye to age and focus on health instead, what are the findings so far. It appears that a wide range of co-morbidities or prior-conditions are predictive of elevated death rates. COPD, lung impairment, cancer, obesity, high blood pressure, low Vitamin D, suppressed immune systems, etc.

I have seen reports seeming to suggest 90% and more of hospital deaths are associated with one and more comorbidity factors.

In the US, there has been much talk about the disproportionate impact on African-Americans and speculation about whether that reflects poorer service provision or some other form of systemic bias.

What if all this identity classification is nonsense? What if the sole predictor are the co-morbidities?

What if African Americans are harder hit because of a greater prevalence of obesity and higher blood pressure? What if the elderly have higher deaths rates simply because of prior conditions?

If that is true, then it shifts our approach. Don't shut things down based on race or age. Focus only on prior conditions. The population of African Americans with high blood pressure and obesity has to be smaller than the population of African Americans. The population of elderly with priors is much smaller than the superset of elderly.

This drives a change in focus from locking down the population to targeting the much smaller group with priors.

Its this line in the comment above which crystalizes the idea.

Once you get outside of those two populations, Sweden's death toll is basically nil.

Here in Georgia, deaths have been concentrated in the black community in the southwestern part of the state (a region with generally poor health conditions associated with obesity and blood pressure), among poorer blacks in Atlanta (same) and among the very ill elderly (all co-morbidities.) Deaths among the healthy of any age, race, or geography have been exceptionally rare. Among some 1,600 deaths to date, I would be surprised if even as many as 200 were among the population with no prior conditions. I would guess it more likely that less than 100 have been deaths among the healthy with no prior-conditions.

In all the many dozens of discussions I have had in the past couple of months, I know of no one directly who has had Covid-19. Only one person has known of someone who has had it in their own direct network. And the only incident of anyone knowing of a Covid-19 death in their extended network (a friend's, friend's uncle) who was post surgery with a compromised immune. If I listen to people in my network, basically people who are in some fashion more or less like me, there is no Covid-19 crisis.

Which proves nothing directly, but it does not refute the hypothesis that it is all about prior conditions.

I wonder if our bad habit of classifying people by identifiable groups (race, religion, geography, age, etc.) hasn't misled us when we should have been focusing on medical conditions all along.