Friday, April 24, 2020

Co-Morbidity


























Never have so many used a word so much with less idea of what it actually means.
Even Vizzini stands in humble awe. The serial failures are currently scream-worthy.

So what does it really mean?

Here's that bastion of low-cost truthiness, Wikipedia:
Co-Morbidity: the presence of one or more additional conditions co-occurring with a primary condition; in the countable sense of the term, a comorbidity is each additional condition.
Here's Google Dictionary:
Co-Morbidity: the simultaneous presence of two chronic diseases or conditions in a patient.
Nota bene: the operative word for both definitions is presence. I put it to you: Were you ever present when someone died? Were you therefore responsible for their death? Was anybody/everybody else who was present similarly culpable?

If you can answer this here, thus endeth the lesson. If not, plow on.

So, what are some likely co-morbidities, in common experience?
For examples, let's look at the Grand Slam of Death:
1) Obesity
2) Hypertension
3) Diabetes
4) Chronic Renal Failure

Let's explain. Since this will help you, because all of the above are frequently observed co-morbidities of a poor outcome when combined with SARS-CoV-2, AKA Kung Flu.

Obesity. You're a fat ass. Like more than 20% over your ideal maximum healthy body weight. This has consequences, over time. (Think years to decades). Like

Hypertension. A resting blood pressure anything greater than 140/90. because carrying all that extra flab forces your heart to have to push blood through miles of extra fat, to service the whole body, it has to push harder. Combined with atherosclerosis, the aging and hardening of your arteries, which you can't help because you're old enough to have eaten enough double cheeseburgers, and your body's metabolism, having passed the Rubicon of middle age, has now gone from Magnum P.I. to Higgins.

Diabetes. In this case, Type II, i.e. the old adult version, as opposed to Type I, which is people whose Islets of Langerhans, in their pancreas, aren't making any or enough insulin anymore, which usually begins in childhood. In Type II, your body makes insulin, it even makes enough for a normal-sized person, but when you get fat, the cells tell the insulin, which brings the sugar into the cells, in essence, "F**k you, we don't take that card any more." So the sugar stays in free circulation, making it harder for you to get fine blood circulation to your feet (so you get infections, and even gangrene, from simple wounds that don't heal, because lousy circulation) to your eyes (so you get progressively blind), and to your kidneys, which then progressively fail. If you want to be legless, blind, and tied to a dialysis machine three days a week, for three or four hours a day, until you die - early - just ignore your obesity, hypertension, and diabetes. As a bonus, the diabetes demands your kidneys process more and pee more, right when they can't, and also the extra osmotic pressure drives up your blood pressure, which is already too high, and when you use meds to absorb the extra sugar you should be cutting back on, it makes you fatter. Special bonus: the nerves in your heart muscle, the ones that let you sense pain, die. So frequently, your first clue about a heart attack is keeling over dead. This is what's known in medical terms as a "vicious circle". And the kidney disease becomes

Chronic Renal Failure. Chronic, meaning long-term, permanent, and progressive until total.
So now, all the crap your kidneys (which, with your liver, are the body's main filters, exactly like oil filters on an engine) used to filter out and excrete, only gets pulled out at dialysis, along with the extra fluid you can no longer pee. If all of this sounds like a hellish existence, it's because it is. No points for guessing what sort of hip pocket lecture I give to new-onset hypertensives and non-compliant diabetics, who still have all their body parts, while it's yet early enough not to be the walking hulk I describe at the end of the process. Scaring the hell out of people like that is the best way I know to save their lives, while it's yet early enough to make a difference. Kind of like the "No Swimming" signs upstream from Niagara Falls.

Pay attention now, this is where we blow your minds, and correct your misimpressions of the meaning of co-morbidities in Kung Flu, or anything else.

NONE of these conditions kills anyone.

Let me fine tune that for you.





NONE OF THESE CONDITIONS KILLS ANYONE.

Do they contribute, indirectly, sometimes even directly?
O Hell yes they do. That's why we treat them, and want you to get them under control, to put off paying the Reaper the bill we all owe, for as long as possible.
But trying to pin things on them is the same misguided sensibility that would stop obesity by banning forks and 40 oz. sodas, and putting 10-day waiting periods on Oreos and Twinkies.

What kills people?
(Pay attention here: this is human physiology, in two words:)
Cardio-respiratory failure.
Due to any number of pathologies.
Like any form of shock. Obstructive, hypovolemic, distributive, or neurogenic.

Will Obesity kill you? No. But cardio-respiratory failure, secondary to being fat as a house, and your heart failing to be able to do its job as a direct result, will kill you deader than canned tuna. Years early, as a rule.

Will Hypertension kill you? No. But it will give you a huge and ongoing increased risk for heart attack, or a stroke, which will induce cardiogenic shock, or neurogenic shock, or cerebral edema, or a brain aneurysm that pops and fills your skull with blood, which, having no place to go, squeezes your brains out the little hole at the base of the skull, which tends to shut off your pulse, blood pressure, and respiratory drive.
Which is cardio-respiratory failure.

Will diabetes kill you? No. But it'll give you a diabetic coma, unleash diabetic ketoacidosis, as your body tries to eat itself, gets dehydrated, you go into circulatory shock, and die.
From cardio-respiratory failure.

Will chronic renal failure kill you? No. Unless you skip dialysis for a couple of visits. And one of the by-products not being filtered out is potassium, which normally ranges from levels of 3.5-5 mmol/L (or 3.6-5.2 mmol/L depending on whose lab/reference you're using). But you skipped visiting your artificial kidneys a couple of trips, so your potassium level is north of 6 or 7, maybe 8, perhaps even all the way to 9 mmol/L.
( 9 mmol/L is much like Stage V of Cancer: it is equal to the ECU: the Eternal Care Unit, at Forest Lawn mortuary and cemeteries, hereabouts).

{Trade secret: Lethal injection, when carried out, consists of three drugs:
1) A sleep-inducing agent, like Valium, Versed, etc., to knock you out, so you miss watching/experiencing the final act.
2) Succinylcholine, a synthetic derivative of curare (yes, exactly like from natives' blow-darts) which paralyzes your muscles, including those used for breathing, for long enough to kill you. We do the sleep agent first, because being conscious, and unable to breathe, is suffocating while wide awake, and rather terroristically panic-inducing. We're usually talking mass murderers here, but I'm still not willing to add torture to the execution, as a general rule, amusing as it might be. Slippery slopes and all.
3) Potassium. Because every muscle in you body needs an electrolyte balance, and sodium, potassium, etc. go back and forth to make your muscles work. But get the potassium too high, and you shut off the muscles. So what? Well, you may recall your heart is a muscle, and rather important, since it beats about 37M times/yr until you die. So when your potassium gets to about 9, everything stops moving. Including your ticker. In seconds after a suitable KCl bolus, BTW.
So we turn off your consciousness, your breathing, and your heart, like flicking off light switches.
Which causes: cardio-respiratory failure.

And you - or Mack The Knife - have now paid the state the debt owed for capital crimes.
O frabjous day! Callooh! Callay! But again, we digress.}

So in you come, after skipping your dialysis serially, with your potassium headed for the final elevator stop before the afterlife, and then your heart stops, and we can't get it going to get you back, most times.
Cardio-respiratory failure.

So what?
Having these things with Kung Flu, doesn't mean you died from them instead of from Kung Flu.
Could they have made it easier to get Kung Flu?
Hell yes, from what I've seen published.
Could they make it a bit easier for Kung Flu to kill you?
Hell yes, because your heart is already strained from obesity, hypertension, and your kidneys weakened or failed from diabetes, and thus you have poorer reserves of cardiac or respiratory stamina, or electrolyte imbalances, or sepsis, or twelve other things Kung Flu does to you.

So what kills you, virtually every stinking time:
Cardio-respiratory failure! Because of Kung Flu!

NOT because of obesity, hypertension, diabetes, or renal failure.
Those just made you a juicier target, and a slower moving prey.

Fat antelopes die of cardio-respiratory failure too, because the lion bit down on their wind pipe, and severed their jugular, and clawed their hindquarters open and bloody.
She/he caught them because they were fat, but what killed them was the lion, not their fat ass.

When you get mugged and killed in a robbery, because of a Rolex and a diamond pinkie ring, you die of cardio-respiratory failure from getting shot in the heart. Wealth didn't kill you, the mugger did. Wealth just made you a juicier target.

When you get raped, it's the rapist who rapes you.
You got raped because rapists are evil douchebags, not because of your short skirt and high heels.

Those of you mistakenly or deliberately trying to pretend (co-morbidity = proximate cause of death) are not only wrong, and functionally dumb, you're using the excuse that the victim's skirt was too short, their heels were too high, and they had it coming.

Which is definitionally incorrect, morally reprehensible, and also not very bright.
Please, stop doing that.

People don't drop dead from just old age. Nor just obesity. Nor just hypertension. Nor just diabetes. Nor just chronic renal failure. To a certainty, those things hasten their deaths and shorten their days. But they don't abruptly drop at 2000/week in one city alone because of those things.

They're dying of Kung Flu, which is inducing cardio-respiratory failure, from lungs full of goo, from coagulopathy, from God Only Knows (and pathology is going to start telling us, to a certainty), because they had Kung Flu.

NOT because they had co-morbidities.
To say the latter was causative puts the cart before the horse, and only shows you lack the basic understanding of how this works.
Kung Flu is the lion, the robber, the rapist.

So for crying out loud, stop waving your hands as if you have an "AHA!" moment when it turns out that large numbers of the dead had one or more of those conditions.
This is America: nearly half the country is obese (haven't you been to a Wal-Mart, or even just the "people of Wal-Mart" site?), and a third probably have hypertension, diabetes, or both. You may as well claim they died because they had arms and legs.

Now, if you can find an example of someone driving a snowmobile off a cliff, eaten by wolverines, struck by lightning, or fell in a wood chipper, and whose death was then lumped into the daily Kung Flu death stats, by all means, call that silly b.s. out, loud and clear. But somebody dying in the ICU, with bilateral multifocal pneumonia, a tube down their throat, in NYFC or Bugtussle, amidst a pandemic, is overwhelmingly likely to be a Kung Flu death, until proven otherwise.




Extra credit: Go look up post hoc, ergo propter hoc , and his little brother that starts with cum. They are examples of how not to deduce truth and discover reason.

4 comments:

Unknown said...

I really wish that this post could be pinned to the top of the Drudge Report every day until this is over, because based on my experience the first thing people do when confronted with the ChiComVid19 numbers is go "COMORBIDITY!!!"

If someone is working on taking care of themselves and getting treatment for their cormorbid condition but they get Kung Flu and die, why should that death not be recorded in the ChiComVid19 numbers? They were fine in spite of the additional problem until they got Kung Flu.

~Rhea

Aesop said...

Now you know how I've felt every time some halfwit tries to tell me "they died of their co-morbidities".

It's like telling me their toenails killed them.

Matt Bracken said...

It's amazing how resolutely ignorant the flu-bros are. First, they caused Trump to lose at least one precious month of getting ready, which lost us the chance to follow the track of Taiwan or Australia. Now, they shrug off 50,000 Covid deaths in 5 weeks, which is a year's worth of flu.

And it appears the RO, lockdown and all, has only been beat down to about RO 1, so our 2,000 deaths a day are going to continue for quite some time. 2,000 X 365 = 730,000 at the present pace.

"Just the flu, bro!" And many of them absolutely and resolutey refuse to wear any kind of masks in closed public places like the grocery store or post office, spewing out their virus boogers if they are asymptomatic carriers.

And as Nassim "Black Swan" Taleb and others have pointed out, if everybody wears even 50% effective cotton masks (when around other people in public, especially indoors) the combined reduction in the chance of transmission between two persons is 75%. And the benefits increase from there, because there are less viral boogers floating around to infect 3rd and 4th parties, or to land on surfaces to be picked up by others.

They figured this out in 1918, and it took us a century to un-learn it.

I made a couple mask memes for the cause.

Masks were a big part of how our forebears defeated Spanish Flu without a vaccine. They beat the RO down under 1 until it disappeared.
https://i.imgur.com/s6JITbM.jpg

"Don't infect me, bro!" Why to wear masks around people in public.
https://i.imgur.com/IC8471g.jpg

Zeroh Tollrants said...

I selfishly like wearing a mask in public. My jawline hasn't looked this trim and taut since I was in my 20s.
Plus, adding a pair of dark glasses and a head covering makes getting ready to go out a breeze because I can skip makeup and hair styling. Honestly, if it wasn't so damn hot in the South, I would've already purchased a burka or two, with the added bonus of everyone getting out of my way AND being given special unearned rights due to the fear of offending my (faux) religious minority rights. :D