Allllright, that night was heal on earth and did not get _better_ after seeing that trending. But I'm awake right now and at least 6% alive.

Let's see, where to start. Let's talk about comorbidities. That's a fun topic and one people get... really wrong. A lot. https://twitter.com/jnesselr/status/1299985650599358464

Minor disclaimer here, I'm not a medical professional, I just really love data and learning about things. If you see something that's incorrect and you're an expert, please poke me so I can fix it or add your own thread that I'll try to highlight.

Why do people get it wrong? Because it technically has multiple definitions. The crux of the matter is that it's just multiple conditions that exist simultaneously. Of note:

1. It's not just about how you died and applies to the living too.
2. They do not have to be related.

3. They aren't just physical conditions. e.g. if you have severe depression and you attempted to overdose because you were trying to commit suicide, depression would probably be put as a comorbidity assuming it was known about. That's regardless of whether you lived or not.

4. Some comorbidities are pre-existing conditions and some are caused by the other thing that killed you. (Side note, I hate saying 'killed' here because again comorbidity doesn't just refer to death, but since we're going to be focusing on COVID deaths, I'll be doing that a lot)

An example of this is the flu. The flu kills people. Well... sorta. You'll see pneumonia a lot as a comorbidity here. Pop quiz, what killed them, the pneumonia or the flu? The answer is a resounding "I don't know". If they didn't get pneumonia would they have survived?

That's a solid "maybe". That's what makes comorbidity interesting and useful to report on. Now I'm going to talk about the flu more, but I want to emphatically state that COVID is not the flu. The reason that I'm going to talk about the flu more real quick is because

we have more data on it (sorta), we know more about it, what makes it complicated, how to deal with it, and most importantly because they both manifest as respiratory infections and therefore are likely to have similar comorbidities.

Let's start with the data. Did you know that

hospitals aren't actually required to report on influenza death. Nor are they required to test people (adults specifically I think). Nor are the tests perfectly accurate. ALSO, results of all tests may not be available for like... 2 years, worst case. Now the CDC is actually

pretty forthcoming with this info. Check out the 2017-2018 flu numbers and disclaimers: https://www.cdc.gov/flu/about/burden/2017-2018.htm

I'm going to be referencing the 2017-2018 year because it was _bad_. Like, record setting bad. They estimated 45 million cases and 61 thousand deaths.

Now, I'm not a medical person, I just really really like data. What that means is that I'm not going to speculate on why that year was so bad. The CDC does publish its data on how many infections they believe were averted, so check that out for that year: https://www.cdc.gov/flu/about/burden-averted/2017-2018.htm

I bring this data up because it's useful to look at it from a bad year for influenza, and to point out that data sometimes takes a bit to collect even on things we're familiar with. The CDC just assumes influenza data is under reported btw. Fun times.

Back to comorbidity. Who wants to guess what some of the comorbidities (a word which is starting to not sound like a real word in my head) of influenza are? Yes, you, the shy kid in the back. Age ranges? Yep! Diabetes! Also yep! Sepsis! Eww gross, what's that! But yep!

Asthma and other diseases that affect the lungs as well as heart and other circulatory related problems are also in there. What's useful to note here is that some of those things are caused by the flu and other things are inherent factors that make the flu deadlier.

Why these things though? Well, the really oversimplified version is that respiratory infections make it hard to breathe and get oxygen to things that need it. Sepsis is a "fun" one because it's basically where your body fought so hard, everything got inflamed, and you might die.

Things that make it harder to regulate stuff in your body like diabetes turn into playing life on extra extra hard mode when you add the flu. The point is that while not having the comorbidity might have helped, knowing what else was going on helps us understand risks better.

Back to COVID and the "Only 6%" crap. First off, let's go back to reporting and testing like we did with the Flu. The CDC suspects that they're delayed somewhere between 1 to 8 weeks on some of these numbers. That's because of how long it takes to go from death to when the

data was available for the CDC to measure it. Side note, I'm pulling this data now from ( https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm) and that footnote is in there.

Another important footnote that I think people are ignoring is that if there's two conditions on top of COVID that caused the death,

then those totals are counted in both areas. You can't just sum up the numbers. As I pointed out before, comorbidities aren't just pre-existing conditions. This is really what it comes down to. People screaming about "only 6%" are acting like all of these deaths were people right

on the edge of kicking the bucket and COVID just *poked* them over the edge. It's absolute bullshit. COVID is similar to the flu with some of its issues and complications which is why we see a ton of similar comorbidities.

Now I know some asshat is going to say "COVID is just

the flu" and I want you to know that you should feel stupid in advance for buying into that garbage. BUT. It's okay, because we have DATA. Sweet *sniff* sweet data.

On that same CDC link above, we actually get a breakdown of pneumonia from COVID and pneumonia from the flu.

There's a section with "Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza" in the title. Part of the reason this is broken down this way is that some states aren't actually reporting all of the COVID deaths as COVID to make the numbers seem lower

than they really are. Comorbidities to the rescue! The idea is we have a few pieces of data:
1. Pneumonia from other years both with and without influenza
2. Pneumonia with or without COVID but without influenza
3. Pneumonia with COVID but without influenza

4. Pneumonia with or without COVID but with influenza.

This gives us a better idea of how much pneumonia is related to COVID vs the flu vs something else.

My goal here is to give you a sense of why comorbidity is useful for data purposes and why it's reported.

Even based on the 2017-2018 flu season, which was really bad, we have ~13% of the number of cases but we just passed 300% of deaths. Even if the 6% number was accurate in any way, we'd still be at ~18% for the number of deaths. Still worse than the worst flu.

I mentioned the flu numbers for 2017-2018, but for 2016-2017 we have 5.1 million with the flu and only 5,200 deaths. 6% of 183k is ~11k which means we'd already be double a more average flu season and that's at that bullshit 6% number.

At 6% of deaths, if the assumption is that everyone gets infected, that's over 600k deaths. Still enough to seriously screw up our economy.

We could also look at "excess deaths" which is a fascinating chart: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

I highly recommend "Excess deaths with and without COVID-19" because that chart also helps us get an idea of when and how hospitals might be overloaded or falsely reporting it as not COVID when it was. Lots of interesting stuff there.

Anyway, just to give this thread some sort of end:

1. COVID is dangerous, take it seriously
2. Knowing things is your friend
3. Data is fun but can't replace your real friends that you can't see anyway because of this god damn pandemic and how absolutely we're fucking it all up.