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Coronavirus seems to be hitting young people harder in Massachusetts than overseas, Beth Israel ICU doctor says

WBUR interviews Dr. Molly Hayes, a pulmonologist and director of the medical ICU at Beth Israel Deaconess Medical Center:

The reports from other countries were that this was happening mostly to older people who had illnesses to begin with. But we are seeing in Boston that this is happening to younger people who don't really have any predisposing illnesses like cardiac disease or cancers.

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Just wondering if the connection between youth and severe COVID-19 goes through two words Marijuana and Vaping

Prior to the arrival of the COVID-19 in significant numbers -- We've had a number of young people who have gotten very sick pulmonary-wise. A number of these patients ended up in the ICU on Ventilators.

Seems to me that quite recently the CDC and NIH had been on the case of "home-brew" or non-standard Vaping materials infused with Cannabis and various other things such as Vitamin E. There was evidence that this toxic brew could seriously damage the lungs of young people quite rapidly -- to the extent that their lungs looked as if they had been smoking for years.

I know that this is likely to engender a whole lot of hate posting -- but -- there it is

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Wow that had not occurred to me but that would make sense.

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Laying odds on it having to do with our excessive rates of Asthma.

New England and NY are the asthma capitals of the US, and MA usually tops the list for both school age children and adults - prevalence is 1.5 to 2 times the national average.

Asthma is a common comorbidity for COVID-19.

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Why are the rates of asthma so high for MA & NY?

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One theory is more distressed, older housing stock. Cockroach and rodent dander have been mentioned as culprits in asthma/allergy activation. Also, denser housing? Which allows those pests to infest homes and neighborhoods more easily? I never saw a roach in Brighton as a little kid until visiting an office in Allston...

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There's a correlation between living near a highway and higher child asthma rates.

The US probably has it worse in this regard because automakers had influence on public policy that led to higher use of personal automobiles in the US, and the higher asthma rates (and COVID-19 susceptibility) could well be a direct result of that.

(Why isn't Kinopio in this thread?)

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Nobody really knows. Theories are exposure to pollution, intense pollen seasons, mold, roaches and rodents ... all play a part.

What is known is that the child prevalence runs 12-14% in a given year and the adult prevalence runs 9-11% for active asthma. MA and NY compete yearly for top honors.

Even more critical: Around 15-20% of adults have had active asthma sometime in their lifetime!! Some people appear to grow out of it, but I have worked on studies of supposed adult onset asthma where 2/3 of the cases appear in people who were treated for asthma as children but did not have active asthma in adulthood until some occupational exposure reactivated it.

My off the cuff suspicion is that COVID-19 goes after people with "latent" asthma, too, as well as those with "active asthma".

These are big enough percentages (relative to other populations) to show up in the case vs. age counts.

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... lived with a smoker as a child and / or currently does.

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This is true for my mom, who grew up with a smoker, but not true for a good friend who does not smoke and her son has terrible asthma.

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However, MA smoking rates the same as the national average at 13.7% in 2018.

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_s...

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However, smoking pot in in Mass. households is now becoming normalized... not great for the lungs.

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Only for about a year or two, and then it kind of went away, but later on in life I was getting it again after/during exercise (exercise induced asthma).

But I remember as a kid having allergy tests done and finding out I was allergic to a whole slew of grasses, trees, weeds, and molds (I remember getting about 30 shots in my arm and stomach for this which was fun). If I recall correctly, a lot of this attributed to my asthma condition, which I assumed was due to the types of trees, grasses, etc that we have in the Northeast? Kind of like the people who go to Arizona and see their breathing issues disappear?

But yea, Asthma has a lot to do with this obviously.

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How would the asthma rates in the Northeast compare to Northern Italy or Hubei?

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At least in kids: 3.5% of the school age population (MA school kids = 12.4%)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224530/

I don't have stats for young adults, but the adult rates track the childhood rates in populations that are relatively static.

It also appears to be low in Hubei, at least as evaluated through a study of school children using symptom questionnaires - 3.2% had doctor diagnosed asthma and 4.2% reported wheeze. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1626161/

Not a definitive analysis, but it certainly points to NY and MA's asthma problem as a potential contributor to the shift in age statistics for COVID-19 hospitalization.

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That's an interesting hypothesis

However -- being as the doctor in question is a Pulmonary specialist -- you would think that she might be knowledgeable about Asthma

Perhaps to the point of asking the patients -- "Uh, do you have any breathing related allergies or have you had asthma attacks"

Besides -- asthma is more common in higher density inner-city neighborhoods than in the "Leafy Green" suburbs and while we don't know where her patients are from Middlesex and the other suburban counties have the bulk of the MA COVID-19 cases likely to interact with Beth Israel Deaconess Lahey and end up under her care

as of 4PM bulletin 03/26/20 from MA Public Health
https://www.mass.gov/doc/covid-19-cases-in-massachusetts-as-of-march-26-...

-- for the counties likely to interact with BI-Lahey
Plymouth 138
Essex 247
Norfolk 292
Suffolk 448
Middlesex 538

Here are the age groups [of those who tested positive]
≤19 years of age 53
20-29 years of age 425
30-39 years of age 433
40-49 years of age 386
50-59 years of age 437
60-69 years of age 329
≥ 70 years of age 352

Perhaps we can find similar data from NY and NYC where the statistics would be much more solid

I'm keeping my marker on some kid in the burbs Vaping Cannabis until someone shows me concrete evidence to the contrary.

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She's a clinical treatment expert. Unless she has had public health training or some other experience with epidemiology she may not have been aware of the prevalence of asthma.

However, it is vastly more likely that she is just too busy right now to think about it much or look up the larger context. My niece is an ER nurse near Chicago and she's never seen her ICU more than full, let alone 2x capacity.

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Dr. Hayes is not a lunch specialist - she's a lung specialist.

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Maybe both?

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tryin' to get your your facts straight or somethin'?

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How many young people in Massachusetts are showing up to the hospital versus those who aren't because they only have mild symptoms/the symptoms are indistinguishable from a spring cold and they're turning those cases away and refusing to test them?

Also -- a lot of those young people probably do have conditions that would make them more likely to require critical care, but said conditions were never detected before. You know those stories of those young athletes drinking an energy drink and suddenly dropping dead? Those kids had things like heart murmurs or other things which never really showed up because they were otherwise in good shape.

Only fools said that the young were immune. Or the healthy -- all viruses put strain on body systems, and strain it enough and things will break. This also happens with "regular" pneumonia and "regular" flu. Even strep throat is known to cause cardiovascular damage -- and how many people are worried over that?

Germany is doing heavy testing and their numbers are showing large case numbers but few deaths and vastly in the elderly and infirm as was expected. Similar to South Korea. As good as they are testing, they are still missing large portions of the population especially since this doesn't show who HAD it. Without that, nobody knows where in what point the regional outbreaks are.

We need wide sentinel testing, and we need wide antibody testing once that is available. Without the information from that data, all guesses are just swings in the dark and stories like this are just fear porn. Testing is going to cost a lot of money but it is a drop in the bucket compared to the economic and personal costs.

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Do we have those numbers for China, Italy, or even Washington state for comparison?

Washington, California, and anywhere in Canada (especially British Columbia) would be good comparisons for the cannabis/vaping hypothesis. Washington legalized marijuana before Massachusetts did; B.C. and California legalized it at around the same time as Massachusetts, but cannabis use was normalized and common in both places before it was here, despite being on-paper illegal.

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We need wide sentinel testing, and we need wide antibody testing once that is available. Without the information from that data, all guesses are just swings in the dark and stories like this are just fear porn. (emphasis mine)

Ann, you have come up with the most sensible, sane, and reasonable response about this virus.

When fear and mania rule the roost, a lot of things are forgotten. For example, the media is so obsessed with whipping up fear and anxiety (by concentrating on death) that they miss the big picture, such as...

- those who don't have and will never get the disease
- those who have the virus but show no symptoms
- those who get a mild version of the virus and fully recover
- those who get a more serious form of the virus, require hospitalization but fully recover
- those who are hospitalized, but recover with post-illness damages

Understandably, the hospitals want to avoid being overwhelmed with virus cases (hence the social distancing and stay-at-home advisories), but seeing the bigger picture will help us a lot more to mitigate the spread of the disease than a constant diet of fear porn.

Of course, the more testing that comes on line will also help determine how bad off we really are. If the death rate stays constant or increases slightly despite the spike in cases, the state can then concentrate on protecting the most vulnerable to the virus. It will also give the hospitals a huge advantage - there will be some who have to be hospitalized and require respirators, but the majority of those who are asymptomatic or have mild symptoms can self-isolate and then fully recover at home.

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Out of the entire article, the only thing remotely resembling the headline is this vague, noncommittal, and essentially contentless assertion in the second paragraph--

"I think what we're seeing in Boston is that it's actually younger people who are getting sick," said Hayes, a lung specialist who directs the medical intensive care unit at Beth Israel Deaconess Medical Center. "The reports from other countries were that this was happening mostly to older people who had illnesses to begin with. But we are seeing in Boston that this is happening to younger people who don't really have any predisposing illnesses like cardiac disease or cancers."

The rest of the article just explains how ventilators work and how difficult it is to treat people in an ICU.

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