iowaclimatescienceeducation--2020-11-27--Week in review – science edition

Week in review – science edition

A few things that caught my eye these past 10 ( ! )
weeks How changing content of clouds could influence climate change [ link ] Status and outlook for the climate change scenario framework [ link ] Forcing of western tropical Sought Atlantic sea surface temperate across three glacial-interglacial cycles [ link ] Earth greening mitigates surface warming by enhancing the efficiency in heat and water transfer ( i.e.
, aerodynamic resistance ) .
https : //advances.sciencemag.org/content/6/47/eabb1981… A very strong stratospheric polar vortex and other record-breaking phenomena made the Northern Hemisphere winter of 2019–2020 one of extremes .
[ @ @ @ @ @ @ @ attribution : Why values won ’ t go away [ link ] Geothermal heat persistently warms the ocean ’ s bottom ~2000 m by 0.3-0.5°C via seafloor vents .
With horizontal circulation heat accumulates over time .
The abyssal ocean was 6-10°C warmer 9k yrs ago and still much warmer 1k yrs ago .
[ link ] Coherent stream flow variability in Monsoon Asia over the past eight centuries links to oceanic drivers [ link ] How large does a large ensemble need to be ?
[ link ] No net warming in @ @ @ @ @ @ @ link ] Oligocene much warmer than previously thought ; this is difficult to explain & has implications for ice sheet stability .
[ link ] Water on Mars : discovery of three buried lakes [ link ] “ This is why hurricanes are bigger and longer-lasting and more intense than before.
” New study shows that ocean stratification is increasing .
[ link ] Michael Kelly : Warming is not the only threat [ link ] Michael Kelly : Until we get a proper roadmap , Net Zero is a goal without a @ @ @ @ @ @ @ the net economic impact of global warming mitigation targets under heightened damage estimates .
The cure is worse than the disease ?
[ link ] Compact nuclear fusion reactor is very likely to work [ link ] BTI : How to stop the wildfires [ link ] Extreme weather and marriage among girls and women in Bangladesh [ link ] Do we focus too much on IAMs & scenarios ?
Do alternative methods need a more prominent role ?
[ link ] “ The UN Secretary General António Guterres ’ s call for @ @ @ @ @ @ @ reduce emissions by 45 % by 2030 is a call to de-industrialise the country and abandon the population to a permanent low-development trap ” [ link ] The invisible elephant in the room with a Green New Deal is the staggering quantity of stuff that needs to be mined in order to build all the green machines , and where that mining and processing happens .
https : //dailycaller.com/2020/10/27/green-new-deal-laws-of-physics/… Michael Pollan : The sickness in our food supply [ link ] Pielke Jr : Global CO2 emissions are on the brink of a @ @ @ @ @ @ @ narrative that dense cities are better for the environment may be off .
Here ’ s new research from Australia .
http : //newgeography.com/content/006840-high-density-and-sustainability Perceptions of stereotypes applied to women who publicly communicate their STEM work [ link ] Kerry Emanuel : The perils of computing too much and thinking too little [ link ] Five ways to ensure that models serve society : a manifesto [ link ] If you average your own best guess with your best guess from the perspective of someone you often disagree with , you ’ ll @ @ @ @ @ @ @ is good !
https : //researchgate.net/publication/337275911_Taking_a_disagreeing_perspective_improves_the_accuracy_of_people ’ s_quantitative_estimates… Are climate scientists being too cautious when linking extreme weather to climate change ?
https : //phys.org/news/2020-10-climate-scientists-cautious-linking-extreme.html…

by Judith Curry
A few things that caught my eye these past 10 (!) weeks
Politics-free thread, please!
Climate science
Partitioning climate projection uncertainty with multiple large ensembles and CMIP5/6 [link]
How changing content of clouds could influence climate change [link]
Antarctic ice dynamics amplified by Northern Hemisphere sea-level forcing [link]
Status and outlook for the climate change scenario framework [link]
Forcing of western tropical Sought Atlantic sea surface temperate across three glacial-interglacial cycles [link]
Earth greening mitigates surface warming by enhancing the efficiency in heat and water transfer (i.e., aerodynamic resistance). https://advances.sciencemag.org/content/6/47/eabb1981…
A very strong stratospheric polar vortex and other record-breaking phenomena made the Northern Hemisphere winter of 2019–2020 one of extremes. [link]
Oreskes:Severe weather event attribution: Why values won’t go away [link]
Unraveling glacial hydroclimate in the Indo-Pacific warm pool [link]
Interannual variability in the North America carbon cycle [link]
Anthropogenic stresses on the worlds big rivers [link]
Geothermal heat persistently warms the ocean’s bottom ~2000 m by 0.3-0.5°C via seafloor vents. With horizontal circulation heat accumulates over time. The abyssal ocean was 6-10°C warmer 9k yrs ago and still much warmer 1k yrs ago. [link]
Combining modern and paleoceanographic perspectives on ocean heat uptake [link]
Coherent stream flow variability in Monsoon Asia over the past eight centuries links to oceanic drivers [link]
Moist heat stress extremes in India enhanced by irrigation [link]
How large does a large ensemble need to be? [link]
Enhanced warming constrained by past trends in equatorial Pacific sea surface temperature gradient [link]
Inherent uncertainty disguises attribution of reduced atmospheric CO2 growth to CO2 emission reduction [link]
Decadal and multi-decadal natural variability in European temperatures [link]
No net warming in Sweden over the last 210 years [link]
East Antartica has cooled substantially since 1986 [link]
Koutsoyiannis: Atmospheric temperature and CO2: hen-or-egg causality? [link]
Oligocene much warmer than previously thought; this is difficult to explain & has implications for ice sheet stability. [link]
Water on Mars: discovery of three buried lakes [link]
“This is why hurricanes are bigger and longer-lasting and more intense than before.” New study shows that ocean stratification is increasing. [link]
New synthesis article on ocean acidification & changing seawater chemistry from rising CO2 and the impacts on biological organisms, marine ecosystems, people, fisheries & aquaculture https:// annualreviews.org/doi/abs/10.114 6/annurev-environ-012320-083019 …
.
New study finds the modulation of cloud cover that drives decadal- and century-scale climate changes is thought to be either driven by internal variability or (more likely) by interplanetary factors operating within a 60-year cycle. https:// agupubs.onlinelibrary.wiley.com/doi/abs/10.102 9/2020GL089954 …
. Technology, impacts and policy
Michael Kelly: Warming is not the only threat [link]
Michael Kelly: Until we get a proper roadmap, Net Zero is a goal without a plan [link]
MIsconceptions of global catastrophe [link]
Approximate calculations of the net economic impact of global warming mitigation targets under heightened damage estimates. The cure is worse than the disease? [link]
Compact nuclear fusion reactor is very likely to work [link]
BTI: How to stop the wildfires [link]
Extreme weather and marriage among girls and women in Bangladesh [link]
America needs a modern electric grid [link]
Do we focus too much on IAMs & scenarios? Do alternative methods need a more prominent role? [link]
“The UN Secretary General António Guterres’s call for India to give up coal immediately and reduce emissions by 45% by 2030 is a call to de-industrialise the country and abandon the population to a permanent low-development trap” [link]
The invisible elephant in the room with a Green New Deal is the staggering quantity of stuff that needs to be mined in order to build all the green machines, and where that mining and processing happens. https://dailycaller.com/2020/10/27/green-new-deal-laws-of-physics/…
Michael Pollan: The sickness in our food supply [link]
Room-temperature superconductivity [link]
Pielke Jr: Global CO2 emissions are on the brink of a long plateau [link]
Re-imagining the Colorado River by exploring extreme events [link]
Plan for climate solutions takes Georgia-specific approach [link]
G20 countries projected to miss 1.5C targets by wide margin [link]
Maybe the narrative that dense cities are better for the environment may be off. Here’s new research from Australia. http://newgeography.com/content/006840-high-density-and-sustainability
About science and scientists
Perceptions of stereotypes applied to women who publicly communicate their STEM work [link]
Academic air travel has limited influence on professional success [link]
Science and politics really don’t mix [link]
Kerry Emanuel: The perils of computing too much and thinking too little [link]
Five ways to ensure that models serve society: a manifesto [link]
If you average your own best guess with your best guess from the perspective of someone you often disagree with, you’ll tend to be more accurate. Disagreement is good! https://researchgate.net/publication/337275911_Taking_a_disagreeing_perspective_improves_the_accuracy_of_people’s_quantitative_estimates…
Are climate scientists being too cautious when linking extreme weather to climate change? https://phys.org/news/2020-10-climate-scientists-cautious-linking-extreme.html…
Cancel culture has captured campus [link]
Beyond Kuhn and Feyerabend [link]
Pielke Jr: A ‘sedative’ for science policy [link]
Myside bias [link]
via Climate Etc.
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November 27, 2020 at 11:13AM


iowaclimatescienceeducation--2020-11-27--Andy Shaw: A Guide to the Green Industrial Revolution

Guest post from our good friend Andy Shaw ; taking a light hearted look at some pretty serious issues around Boris Johnson ’ s version of the Green New Deal .
Andy is also the powerhouse behind London based Comedy Unleashed who are still running , despite the batflu restrictions .
Book early and get along there to enjoy a pint , pizza and pisstake if you ’ re in the area .
Give Andy a follow on twitter to keep up with the latest .
The government has announced their Plan for a Green Industrial Revolution .
It will @ @ @ @ @ @ @ for cooking and cars to drive !
You may think that we already have these things , but this is a Green revolution , everything that we have got used to will be re-invented .
Boris Johnson ’ s 10 point plan includes heat pumps , hydrogen gas and batteries , but what is really going on ?
This is your 6 point guide .
Boris Johnson ’ s dad and his current girlfriend have a favourite colour and it is .. green !
This shows that green policies are popular across generations @ @ @ @ @ @ @ revolutionise our entire economy .
Sustainable living is not just popular in government circles , it is also fashionable amongst those who have a highly sustainable income .
The most successful people are happy to ensure that their second car is electric and that they pay a little extra for airline tickets .
Although the general public has not been consulted about the costs of the green revolution , everyone likes trees .
It is hoped that adding the word ‘ green ’ to the word ‘ jobs ’ will do the trick @ @ @ @ @ @ @ policies have succeeded in decimating the hospitality , travel and retail industry , so the boost in Green jobs is welcome .
The green economy will see a boom in certain white collar jobs : Carbon Auditors , Sustainability Directors , Green Consultants , Climate Conference delegates and Subsidy Form-Completion Experts will be in high demand .
Fortunes will be made by City traders dealing in the newly invented carbon credits .
A new breed of carbon tax collectors could be guided by carbon regulators , based in Whitehall .
Although de-industrialisation may @ @ @ @ @ @ @ manual work will be plentiful in the burgeoning Green economy .
Car mechanics can become loft insulators , steel workers will plant trees and then chop them for fire-wood .
Everyone will learn to replace their own boilers and cookers .
No longer will the working class enjoy the pride or wages of skilled and productive work , but we will applaud them for becoming ‘ key workers ’ during the coming decades of climate emergency .
3 .
We must act now !
Some have said that it was Carrie Symonds who @ @ @ @ @ @ @ but it was the Covid computer modellers that helped him to fully appreciate the power of the climate message .
The Prime Minister has watched in awe , as Neil Ferguson and SAGE produced frightening graphs that gripped the nation and forced government action .
We will soon see the same ‘ scenarios ’ deployed to show the coming waves of climate apocalypse .
By simply replacing ‘ Covid infection rates per 100,000 ’ , with ‘ CO2 parts per million ’ , the same charts can be reused to show the unfettered @ @ @ @ @ @ @ R ’ rate will be replaced by the ‘ Carbon ’ rate and every natural incident , from floods to heatwaves , will be shown as proof of the climate pandemic .
Joe Biden , will make climate change the centre point of US diplomacy .
Although previous administrations preferred to create alliances for wars in the Middle East or against an ‘ Axis of Evil ’ , the new President has declared war on a gas , carbon dioxide .
Although , the war may inflict greater casualties on US industry than @ @ @ @ @ @ @ it will invigorate American leadership amongst the western world .
Keen to rekindle the ‘ special relationship ’ , Boris Johnson has demonstrated that he is an ally in the climate war .
He aims to seal the alliance at the COP26 international climate conference , where he will show Churchillian vigour against the odourless gas .
Boris Johnson has promised to quadruple the number of wind turbines .
He sees a vision of concrete and steel spanning our oceans , in a bid to protect our beautiful natural environment .
On the @ @ @ @ @ @ @ the skies are clear and the air is still , we can admire the phalanxes of listless windmills far out at sea and know , that we did our bit to cool the globe .
Boris has announced that we could become “ the Saudi Arabia of wind ” .
Critics have suggested that this is hot air and windy rhetoric .
Cynics believe that a reliance on wind will make us we “ the North Korea of electricity ” .
Can we look forward mass rallies praising Dear Climate Leader ?
Either @ @ @ @ @ @ @ maintain the oceanic wind turbines to prevent them from becoming rusting hulks and to manage the ranks of diesel generators that spring into action when the wind doesn ’ t blow .
The government has brought forward the ban of petrol and diesel cars to 2030 .
For those of us who live in flats , we can look forward to the pleasure of driving to the nearest charging point in order to charge the battery long enough for the return journey .
For those of us who live in houses , we @ @ @ @ @ @ @ cables criss-crossing the pavements .
Although car batteries will need to be replaced every few years , it is hoped that don ’ t start to behave like mobile phones , that run out before the day is over .
Boris is hoping that the UK , in 2035 , will not resemble today ’ s Havana , where old petrol cars are maintained , for decades , by enterprising mechanics .
Environmentalists have raised the fear of mass climate migration .
Although they have painted a picture of poorer people moving to @ @ @ @ @ @ @ the green revolution will encourage westerners to migrate to an increasingly prosperous Asia .
Boris may have unleashed a revolution that he can ’ t control .
© Andy Shaw , 26th November 2020 Twitter : @ AndyShaw1

Guest post from our good friend Andy Shaw; taking a light hearted look at some pretty serious issues around Boris Johnson’s version of the Green New Deal. Andy is also the powerhouse behind London based Comedy Unleashed who are still running, despite the batflu restrictions. Book early and get along there to enjoy a pint, pizza and pisstake if you’re in the area. Give Andy a follow on twitter to keep up with the latest.
A Guide to the Green Industrial Revolution
The government has announced their Plan for a Green Industrial Revolution. It will bring electricity to light homes, gas for cooking and cars to drive! You may think that we already have these things, but this is a Green revolution, everything that we have got used to will be re-invented. Boris Johnson’s 10 point plan includes heat pumps, hydrogen gas and batteries, but what is really going on? This is your 6 point guide.
1. Green is popular!
Boris Johnson’s dad and his current girlfriend have a favourite colour and it is .. green! This shows that green policies are popular across generations and that the government is right to revolutionise our entire economy.
Sustainable living is not just popular in government circles, it is also fashionable amongst those who have a highly sustainable income. The most successful people are happy to ensure that their second car is electric and that they pay a little extra for airline tickets.
Although the general public has not been consulted about the costs of the green revolution, everyone likes trees. It is hoped that adding the word ‘green’ to the word ‘jobs’ will do the trick.
2. Jobs!
The government’s Covid lockdown policies have succeeded in decimating the hospitality, travel and retail industry, so the boost in Green jobs is welcome.
The green economy will see a boom in certain white collar jobs: Carbon Auditors, Sustainability Directors, Green Consultants, Climate Conference delegates and Subsidy Form-Completion Experts will be in high demand. Fortunes will be made by City traders dealing in the newly invented carbon credits. A new breed of carbon tax collectors could be guided by carbon regulators, based in Whitehall.
Although de-industrialisation may create mass unemployment for skilled workers, manual work will be plentiful in the burgeoning Green economy. Car mechanics can become loft insulators, steel workers will plant trees and then chop them for fire-wood. Everyone will learn to replace their own boilers and cookers. No longer will the working class enjoy the pride or wages of skilled and productive work, but we will applaud them for becoming ‘key workers’ during the coming decades of climate emergency.
3. We must act now!
Some have said that it was Carrie Symonds who persuaded Boris Johnson to act now, but it was the Covid computer modellers that helped him to fully appreciate the power of the climate message.
The Prime Minister has watched in awe, as Neil Ferguson and SAGE produced frightening graphs that gripped the nation and forced government action. We will soon see the same ‘scenarios’ deployed to show the coming waves of climate apocalypse. By simply replacing ‘Covid infection rates per 100,000’, with ‘CO2 parts per million’, the same charts can be reused to show the unfettered growth in climate catastrophe. The ‘R’ rate will be replaced by the ‘Carbon’ rate and every natural incident, from floods to heatwaves, will be shown as proof of the climate pandemic.
4. World leadership
Joe Biden, will make climate change the centre point of US diplomacy. Although previous administrations preferred to create alliances for wars in the Middle East or against an ‘Axis of Evil’, the new President has declared war on a gas, carbon dioxide. Although, the war may inflict greater casualties on US industry than previous conflicts, it is hoped that it will invigorate American leadership amongst the western world.
Keen to rekindle the ‘special relationship’, Boris Johnson has demonstrated that he is an ally in the climate war. He aims to seal the alliance at the COP26 international climate conference, where he will show Churchillian vigour against the odourless gas.
5. Wind power!
Boris Johnson has promised to quadruple the number of wind turbines. He sees a vision of concrete and steel spanning our oceans, in a bid to protect our beautiful natural environment. On the coldest of frost-bitten winter days, when the skies are clear and the air is still, we can admire the phalanxes of listless windmills far out at sea and know, that we did our bit to cool the globe.
Boris has announced that we could become “the Saudi Arabia of wind”. Critics have suggested that this is hot air and windy rhetoric. Cynics believe that a reliance on wind will make us we “the North Korea of electricity”. Can we look forward mass rallies praising Dear Climate Leader?
Either way, jobs will be created to maintain the oceanic wind turbines to prevent them from becoming rusting hulks and to manage the ranks of diesel generators that spring into action when the wind doesn’t blow.
6. Electric vehicles!
The government has brought forward the ban of petrol and diesel cars to 2030. For those of us who live in flats, we can look forward to the pleasure of driving to the nearest charging point in order to charge the battery long enough for the return journey. For those of us who live in houses, we can look forward to the sight of cables criss-crossing the pavements. Although car batteries will need to be replaced every few years, it is hoped that don’t start to behave like mobile phones, that run out before the day is over.
Boris is hoping that the UK, in 2035, will not resemble today’s Havana, where old petrol cars are maintained, for decades, by enterprising mechanics.
Environmentalists have raised the fear of mass climate migration. Although they have painted a picture of poorer people moving to western countries, it is possible that the green revolution will encourage westerners to migrate to an increasingly prosperous Asia. Boris may have unleashed a revolution that he can’t control.
© Andy Shaw, 26th November 2020 Twitter: @AndyShaw1
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November 27, 2020 at 09:54AM


iowaclimatescienceeducation--2020-11-27--Climate Alarmist Dana Ready To Bet Again On Global Warming. I’m In.

Not surprisingly , climate alarmist and Guardian contributor Dana Nuccitelli reported in to brag about winning the recent bet .
@ @ @ @ @ mustered the courage to express his willingness to bet again : Okay Dana , I @ @ @ @ @ and will bet 100 USD , applying the same conditions of the previous bet .
@ @ @ @ @ will be same or cooler than the 2011-2020 decade .
If you ’ re right @ @ @ @ @ have to concede man is causing a significant part of the surface warming – depending @ @ @ @ @ and the conclusions reached by objective scientists .

Not surprisingly, climate alarmist and Guardian contributor Dana Nuccitelli reported in to brag about winning the recent bet.
Then one day later he mustered the courage to express his willingness to bet again:
Okay Dana, I’m in against you and will bet 100 USD, applying the same conditions of the previous bet. I say the 2021-2030 decade will be same or cooler than the 2011-2020 decade.
If you’re right again, then I might have to concede man is causing a significant part of the surface warming – depending on what the data suggest and the conclusions reached by objective scientists.
Donate – choose an amount
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November 27, 2020 at 09:42AM


iowaclimatescienceeducation--2020-11-27--UVB Activation of AMPs Production in the Skin and the Innate Respiratory Immunity

Acute viral respiratory infections , including COVID-19 , are strongly correlated with vitamin D insufficiency .
They are also strongly seasonal , peaking in the winter , when the availability of the UVB component of sunlight is low .
UVB is known for inducing production of vitamin D in the skin .
However , vitamin D supplementation has shown little or no effect in the prevention of respiratory infections in adults .
Thus , UVB light provides the immune system with essential benefits that are not produced by oral vitamin D supplements .
This paper posits that UVB light stimulates @ @ @ @ @ @ @ ( AMPs ) in the skin .
These AMPs are carried by the blood to the respiratory tract and enhance innate respiratory immunity .
AMPs are also referred to as “ natural antibiotics , ” because they protect not only against microbes but also enveloped viruses , including influenza and coronaviruses .
The skin and respiratory tract surfaces play a similar role in the body – acting as a barrier between the body and the external world .
Many of the same AMPs , including cathelicidin , are produced and act in the @ @ @ @ @ @ @ the intestines , and some blood cells .
Cathelicidin is carried by the blood .
This paper provides additional evidence that exposure to UVB in sunlight or artificial UVB sources , in safe amounts , depending on skin phototype ( dark skin might need 5-6 times more exposure than light skin ) , is necessary for maintaining normal innate immunity .
Vitamin D supplements can not replace UVB exposure .
Currently ( at the end of November 2020 ) , the increase in COVID-19 infections , in the northern hemisphere , matches seasonality @ @ @ @ @ @ @ among respiratory infections .
Its seasonality has been observed in both hemispheres .
The inverse correlation between sunlight UV and SARS-COV-2 positivity [ 1 ] has been reported .
The increase in COVID cases is happening slightly ahead of the regular flu season .
A significant part of the population has had less than usual sunlight exposure in the previous months , due to COVID-19 precautions .
The seasonal character of influenza has been noted for long time [ 2 ] .
This seasonality is linked to low exposure to the UVB ( @ @ @ @ @ @ @ , which results in insufficient levels of vitamin D. Among other effects , vitamin D is required for AMPs production , so the increase in the respiratory infections in winter was linked to seasonal impairment of the AMPs production [ 3 ] .
In the US , respiratory infections boom in the winter and almost disappear in the summer and the death rate is 25 % higher in the winter than in the summer [ 4 ] .
Many observational studies have shown that moderate UVB exposure led to sharp decrease in respiratory @ @ @ @ @ @ @ ] reports weekly inverse correlation between sunlight and spread of 2009 H1N1 zoonotic influenza virus ( “ swine flu ” ) .
The lack of UVB exposure and low levels of vitamin D are strongly associated with each other and with a susceptibility to respiratory infections .
The hypothesis that UVB exposure can be replaced with vitamin D supplementation , in order to maintain innate respiratory immunity , has somehow become entrenched .
This flawed belief continues to persist despite multiple studies in which oral supplementation with vitamin D has shown no or @ @ @ @ @ @ @ .
Although common wisdom in mid latitudes of Europe held that moderate exposure to sunlight is beneficial [ 8 ] , such research has not been encouraged [ 9 ] .
Vitamin D is produced by the skin when it is exposed to UVB light .
It can also be also ingested with the food .
Either way , it is inactive until metabolized in the liver to 25 ( OH ) D ( 25-hydroxy-vitamin D ) .
25 ( OH ) D then further metabolizes to 1,25 ( OH ) D ( @ @ @ @ @ @ @ well as many other organs , including the skin and epithelial cells of the respiratory tract .
The human innate immune system responds to pathogens without the need to recognize them .
This is in contrast to the adaptive immune system , which needs to recognize the particular pathogen , before counteracting it with antigens or T-cells .
This makes AMPs critically important in the defense against novel respiratory viruses , such as SARS-CoV-2 , which are not recognized by the body .
Cathelicidins and other AMPs are the tools of the innate @ @ @ @ @ @ @ microbial membranes , and also alert the rest of the immune system to act [ 10 ] , [ 11 ] .
LL-37 ( having precursor protein hCAP18 ) is the only known human cathelicidin .
In the skin , cathelicidin serves as a chemical shield .
Cathelicidins are produced from keratinocytes [ 17 ] , in many tissues in the skin to epithelial cells of the lungs [ 12 ] .
Some blood cells also produce AMPs .
Cathelicidin production in the skin is induced by UVB ( as explained below ) @ @ @ @ @ @ @ infection [ 10 ] .
For a long time , it has been observed how rarely sunburns ( severely damaging skin and suppressing adaptive immune system ) lead to opportunistic infections .
When the skin is damaged , AMPs are produced .
Their primary role is the local anti-microbial protection of the damaged skin , but they also travel in the blood [ 13 ] and can protect respiratory tract .
LL-37 was shown to directly inhibit the influenza virus in humans [ 14 ] .
In 2005 , Mallibris et al .
@ @ @ @ @ @ @ exposed buttocks of eight volunteers to UVB [ 15 ] .
The study summarized the results in the title “ UVB Upregulates the Antimicrobial Protein hCAP18 mRNA in Human Skin.
” One-time exposure of a single buttock to the minimal erythema dose of UVB led to 2.3x increase of hCAP18 level in the exposed skin , within 24 hours .
This amount of UVB can not significantly increase the body ’ s vitamin D levels .
Thus , the production of extra hCAP18 was solely due to the UVB stimulation , not increased @ @ @ @ @ @ @ ] , concluded cautiously that sunlight “ activates an arm of innate immunity within the skin.
” In addition to hCPA18/LL-37 production , Zasloff suggested a few other mechanisms .
Other experiments [ 17 ] with UVB successfully induced defensins and other universal AMPs in keratinocytes .
This lead to the conclusion that UVB exposure increases local production of AMPs and boosts innate immunity [ 18 ] .
In hindsight , it is not that surprising that the skin reacts to ultraviolet irradiation similarly to how it reacts to other stimuli , such @ @ @ @ @ @ @ light might increase production of AMPs in the skin through increased local production of 1.25‐dihydroxyvitamin D from 25 ( OH ) D. Cathelicidin and other AMPs , produced in the skin , travel in the blood to other parts of the body , including the epithelial surfaces of respiratory system , boosting innate respiratory immunity .
It is also possible that UVB activates blood cells , passing through the exposed skin and capable of producing AMPs ( neutrophils , macrophages , lymphocytes , etc . )
, and they produce AMPs in other @ @ @ @ @ @ @ does not noticeably increase LL-37 levels in the blood [ 19 ] , [ 20 ] , even when it significantly increases 25 ( OH ) D levels .
[ 20 ] reported that a subgroup of the experiment subjects had ~20 % increase of LL-37 concentrations , corresponding to 200 % increase in 25 ( OH ) D concentrations in the blood following ergocalciferol supplementation .
This relation is insignificant , and might be explained by their initial deficiency of 25 ( OH ) D and/or sunlight exposure , not known the @ @ @ @ @ @ @ decrease in sickness with supplementation .
The supplementation was Vigantol – vitamin D dissolved in triglyceride .
Multiple studies from 1930s demonstrated significant improvement of respiratory immunity from taking cod liver oil [ 5 ] , which contained not only vitamin D , but also Omega-3 fatty acid , and vitamin A .
The effect of combined vitamin D / Omega-3 supplementation is a promising avenue for research .
A word of caution : some sources say that modern techniques of cod liver and other fish oil preparation remove most vitamin D. [ @ @ @ @ @ @ @ an inverse correlation between sunlight UV and COVID-19 mortality , .
This might be due of the anti-inflammatory effect of vitamin D and is out of the scope of this paper .
Exposure to UVB in sunlight or artificial UVB sources , in proper amounts and adjusted by skin phototype ( dark skin might need 5-6 times more exposure than light skin ) , is necessary for maintaining normal innate immunity .
Vitamin D supplements do not produce the same benefits or immunity as UVB exposure .
UVB stimulates production of cathelicidin and @ @ @ @ @ @ @ blood cells travelling through skin .
These AMPs are carried by the blood to the respiratory tract surfaces and enhance innate respiratory immunity .
No funding was provided for this work .
Thanks to AO for the contribution to this paper .
• None I bent backward in order not to say that the ozone hoax is behind the suppression of the research on the UVB health benefits .
Nevertheless , this article has been rejected by preprints.org .
• None People who wear masks outside further decrease the amount of the beneficial @ @ @ @ @ @ @ is surprisingly rarely mentioned in the discussions of the response to COVID-19 , but it is what protects most people from getting sick when from exposure to SARS-COV-2 .
[ 1 ] Tang L , Liu M , Ren B , Wu Z , Yu X , Peng C , et al .
Sunlight ultraviolet radiation dose is negatively correlated with the percent positive of SARS-CoV-2 and four other common human coronaviruses in the U.S. Sci Total Environ 2021 ; 751:141816. https : //doi.org/10.1016/j.scitotenv.2020.141816 .
[ 3 ] Cannell JJ , Zasloff M @ @ @ @ @ @ @ Giovannucci E. On the epidemiology of influenza .
Virol J 2008 ; 5:29. https : //doi.org/10.1186/1743-422X-5-29 .
[ 4 ] Grant WB , Bhattoa HP , Boucher BJ .
Seasonal variations of U.S. mortality rates : Roles of solar ultraviolet-B doses , vitamin D , gene exp ression , and infections .
19th Vitam Workshop 2017 ; 173:5–12 .
https : //doi.org/10.1016/j.jsbmb.2017.01.003 .
[ 7 ] Martineau AR , Jolliffe DA , Hooper RL , Greenberg L , Aloia JF , Bergman P , et al .
Vitamin D supplementation to prevent acute @ @ @ @ @ @ @ meta-analysis of individual participant data .
BMJ 2017 ; 356 : i6583 .
https : //doi.org/10.1136/bmj.i6583 .
[ 9 ] Lucas RM , Ponsonby A-L .
Considering the potential benefits as well as adverse effects of sun exposure : Can all the potential benefits be provided by oral vitamin D supplementation ?
UV Expo Guid Balanc Approach Health Risks Health Benefits UV Vitam Proc Int Workshop Int Comm Non-Ioniz Radiat Prot Munich Ger 17-18 Oct 2005 2006 ; 92:140–9 .
https : //doi.org/10.1016/j.pbiomolbio.2006.02.019 .
[ 10 ] Schauber J , Gallo RL .
@ @ @ @ @ @ @ target for control of the skin ’ s immune response ?
Exp Dermatol 2008 ; 17:633–9 .
https : //doi.org/10.1111/j.1600-0625.2008.00768.x .
[ 11 ] Heilborn JD , Nilsson MF , Sørensen O , Ståhle-Bäckdahl M , Kratz G , Weber G , et al .
The Cathelicidin Anti-Microbial Peptide LL-37 is Involved in Re-Epithelialization of Human Skin Wounds and is Lacking in Chronic Ulcer Epithelium .
J Invest Dermatol 2003 ; 120:379–89 .
https : //doi.org/10.1046/j.1523-1747.2003.12069.x .
[ 12 ] Bals R , Wang X , Zasloff M , Wilson JM .
The @ @ @ @ @ @ @ of the human lung where it has broad antimicrobial activity at the airway surface .
Proc Natl Acad Sci 1998 ; 95:9541. https : //doi.org/10.1073/pnas.95.16.9541 .
[ 13 ] Zanetti M. The Role of Cathelicidins in the Innate Host Defenses of Mammals .
Curr Issues Mol Biol 2005. https : //doi.org/10.21775/cimb.007.179 .
[ 14 ] Tripathi S , Tecle T , Verma A , Crouch E , White M , Hartshorn KL .
The human cathelicidin LL-37 inhibits influenza A viruses through a mechanism distinct from that of surfactant protein D or defensins @ @ @ @ @ @ @ .
https : //doi.org/10.1099/vir.0.045013-0 .
[ 16 ] Zasloff M. Sunlight , Vitamin D , and the Innate Immune Defenses of the Human Skin .
J Invest Dermatol 2005 ; 125 : xvi–xvii .
https : //doi.org/10.1111/j.0022-202X.2005.23924.x .
[ 17 ] Gläser R , Navid F , Schuller W , Jantschitsch C , Harder J , Schröder JM , et al .
UV-B radiation induces the expression of antimicrobial peptides in human keratinocytes in vitro and in vivo .
J Allergy Clin Immunol 2009 ; 123:1117–23 .
https : //doi.org/10.1016/j.jaci.2009.01.043 .
[ 18 @ @ @ @ @ @ @ Sunny Sides of UVR-Induced Immunosuppression : Photoimmunology Revisited .
J Invest Dermatol 2010 ; 130:49–54 .
https : //doi.org/10.1038/jid.2009.217 .
[ 19 ] Bergman P , Norlin A-C , Hansen S , Rekha RS , Agerberth B , Björkhem-Bergman L , et al .
Vitamin D supplementation in patients with frequent respiratory tract infections : a randomised and double-blind intervention study .
BMJ Open 2012 ; 2 : e001663 .
https : //doi.org/10.1136/bmjopen-2012-001663 .
[ 20 ] Bhan I , Camargo CA , Wenger J , Ricciardi C , Ye J , Borregaard @ @ @ @ @ @ @ of 25-hydroxyvitamin D and human cathelicidin in healthy adults .
J Allergy Clin Immunol 2011 ; 127:1302-1304.e1 .
https : //doi.org/10.1016/j.jaci.2010.12.1097 .

PREPRINT
Key Words: vitamin D, innate immunity, respiratory infections, COVID-19, SARS-CoV-2, sunlight
Summary
Acute viral respiratory infections, including COVID-19, are strongly correlated with vitamin D insufficiency. They are also strongly seasonal, peaking in the winter, when the availability of the UVB component of sunlight is low. UVB is known for inducing production of vitamin D in the skin. However, vitamin D supplementation has shown little or no effect in the prevention of respiratory infections in adults. Thus, UVB light provides the immune system with essential benefits that are not produced by oral vitamin D supplements.
This paper posits that UVB light stimulates production of cathelicidin and other antimicrobial peptides (AMPs) in the skin. These AMPs are carried by the blood to the respiratory tract and enhance innate respiratory immunity. AMPs are also referred to as “natural antibiotics,” because they protect not only against microbes but also enveloped viruses, including influenza and coronaviruses.
The skin and respiratory tract surfaces play a similar role in the body – acting as a barrier between the body and the external world. Many of the same AMPs, including cathelicidin, are produced and act in the skin, the respiratory tract surface, the intestines, and some blood cells. Cathelicidin is carried by the blood.
This paper provides additional evidence that exposure to UVB in sunlight or artificial UVB sources, in safe amounts, depending on skin phototype (dark skin might need 5-6 times more exposure than light skin), is necessary for maintaining normal innate immunity. Vitamin D supplements cannot replace UVB exposure.
Intro
Infection Seasonality
Currently (at the end of November 2020), the increase in COVID-19 infections, in the northern hemisphere, matches seasonality expectations. COVID-19 is not an exception among respiratory infections. Its seasonality has been observed in both hemispheres. The inverse correlation between sunlight UV and SARS-COV-2 positivity [1] has been reported. The increase in COVID cases is happening slightly ahead of the regular flu season. A significant part of the population has had less than usual sunlight exposure in the previous months, due to COVID-19 precautions.
The seasonal character of influenza has been noted for long time [2]. This seasonality is linked to low exposure to the UVB (wavelengths 280-320 nm) component in sunlight, which results in insufficient levels of vitamin D. Among other effects, vitamin D is required for AMPs production, so the increase in the respiratory infections in winter was linked to seasonal impairment of the AMPs production [3]. In the US, respiratory infections boom in the winter and almost disappear in the summer and the death rate is 25% higher in the winter than in the summer [4]. Many observational studies have shown that moderate UVB exposure led to sharp decrease in respiratory infections [5]. [6] reports weekly inverse correlation between sunlight and spread of 2009 H1N1 zoonotic influenza virus (“swine flu”).
The lack of UVB exposure and low levels of vitamin D are strongly associated with each other and with a susceptibility to respiratory infections. The hypothesis that UVB exposure can be replaced with vitamin D supplementation, in order to maintain innate respiratory immunity, has somehow become entrenched. This flawed belief continues to persist despite multiple studies in which oral supplementation with vitamin D has shown no or little respiratory immunity benefits [7].
Although common wisdom in mid latitudes of Europe held that moderate exposure to sunlight is beneficial [8], such research has not been encouraged [9].
Vitamin D
Vitamin D 3 is produced by the skin when it is exposed to UVB light. It can also be also ingested with the food. Either way, it is inactive until metabolized in the liver to 25(OH)D (25-hydroxy-vitamin D). 25(OH)D then further metabolizes to 1,25(OH) 2 D 3 (1.25‐dihydroxyvitamin D 3 ) in the kidneys as well as many other organs, including the skin and epithelial cells of the respiratory tract.
Innate Immune System & AMPs
The human innate immune system responds to pathogens without the need to recognize them. This is in contrast to the adaptive immune system, which needs to recognize the particular pathogen, before counteracting it with antigens or T-cells.
This makes AMPs critically important in the defense against novel respiratory viruses, such as SARS-CoV-2, which are not recognized by the body. Cathelicidins and other AMPs are the tools of the innate immune response. Cathelicidins dissolve viral and microbial membranes, and also alert the rest of the immune system to act [10], [11]. LL-37 (having precursor protein hCAP18) is the only known human cathelicidin. In the skin, cathelicidin serves as a chemical shield. Cathelicidins are produced from keratinocytes [17], in many tissues in the skin to epithelial cells of the lungs [12]. Some blood cells also produce AMPs.
Cathelicidin production in the skin is induced by UVB (as explained below), or by the local injury or infection [10].
Results
For a long time, it has been observed how rarely sunburns (severely damaging skin and suppressing adaptive immune system) lead to opportunistic infections.
When the skin is damaged, AMPs are produced. Their primary role is the local anti-microbial protection of the damaged skin, but they also travel in the blood [13] and can protect respiratory tract. LL-37 was shown to directly inhibit the influenza virus in humans [14].
In 2005, Mallibris et al. conducted a study, in which they exposed buttocks of eight volunteers to UVB [15]. The study summarized the results in the title “UVB Upregulates the Antimicrobial Protein hCAP18 mRNA in Human Skin.” One-time exposure of a single buttock to the minimal erythema dose of UVB led to 2.3x increase of hCAP18 level in the exposed skin, within 24 hours. This amount of UVB cannot significantly increase the body’s vitamin D levels. Thus, the production of extra hCAP18 was solely due to the UVB stimulation, not increased vitamin D levels.
Zasloff [16], concluded cautiously that sunlight “activates an arm of innate immunity within the skin.” In addition to hCPA18/LL-37 production, Zasloff suggested a few other mechanisms.
Other experiments [17] with UVB successfully induced defensins and other universal AMPs in keratinocytes. This lead to the conclusion that UVB exposure increases local production of AMPs and boosts innate immunity [18].
In hindsight, it is not that surprising that the skin reacts to ultraviolet irradiation similarly to how it reacts to other stimuli, such as physical injury or infection.
UVB light might increase production of AMPs in the skin through increased local production of 1.25‐dihydroxyvitamin D from 25(OH)D. Cathelicidin and other AMPs, produced in the skin, travel in the blood to other parts of the body, including the epithelial surfaces of respiratory system, boosting innate respiratory immunity. It is also possible that UVB activates blood cells, passing through the exposed skin and capable of producing AMPs (neutrophils, macrophages, lymphocytes, etc.), and they produce AMPs in other tissues as well.
Vitamin D Supplementation does not noticeably increase LL-37 levels in the blood [19], [20], even when it significantly increases 25(OH)D levels.
Discussion
[20] reported that a subgroup of the experiment subjects had ~20% increase of LL-37 concentrations, corresponding to 200% increase in 25(OH)D concentrations in the blood following ergocalciferol supplementation. This relation is insignificant, and might be explained by their initial deficiency of 25(OH)D and/or sunlight exposure, not known the to researchers
[19] demonstrated a decrease in sickness with supplementation. The supplementation was Vigantol – vitamin D 3 dissolved in triglyceride. Multiple studies from 1930s demonstrated significant improvement of respiratory immunity from taking cod liver oil [5], which contained not only vitamin D, but also Omega-3 fatty acid, and vitamin A. The effect of combined vitamin D / Omega-3 supplementation is a promising avenue for research. A word of caution: some sources say that modern techniques of cod liver and other fish oil preparation remove most vitamin D.
[21] and [22]reported an inverse correlation between sunlight UV and COVID-19 mortality,. This might be due of the anti-inflammatory effect of vitamin D and is out of the scope of this paper.
Conclusions
Exposure to UVB in sunlight or artificial UVB sources, in proper amounts and adjusted by skin phototype (dark skin might need 5-6 times more exposure than light skin), is necessary for maintaining normal innate immunity. Vitamin D supplements do not produce the same benefits or immunity as UVB exposure. UVB stimulates production of cathelicidin and other AMPs in the skin and/or certain blood cells travelling through skin. These AMPs are carried by the blood to the respiratory tract surfaces and enhance innate respiratory immunity.
No Competing Interests
The author declares no competing interest.
No funding was provided for this work.
Acknowledgements
Thanks to AO for the contribution to this paper.
An author's remark
I bent backward in order not to say that the ozone hoax is behind the suppression of the research on the UVB health benefits. Nevertheless, this article has been rejected by preprints.org. People who wear masks outside further decrease the amount of the beneficial UVB. The innate immunity is surprisingly rarely mentioned in the discussions of the response to COVID-19, but it is what protects most people from getting sick when from exposure to SARS-COV-2.
References
[1] Tang L, Liu M, Ren B, Wu Z, Yu X, Peng C, et al. Sunlight ultraviolet radiation dose is negatively correlated with the percent positive of SARS-CoV-2 and four other common human coronaviruses in the U.S. Sci Total Environ 2021;751:141816. https://doi.org/10.1016/j.scitotenv.2020.141816.
[2] CANNELL JJ, VIETH R, UMHAU JC, HOLICK MF, GRANT WB, MADRONICH S, et al. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129–40. https://doi.org/10.1017/S0950268806007175.
[3] Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J 2008;5:29. https://doi.org/10.1186/1743-422X-5-29.
[4] Grant WB, Bhattoa HP, Boucher BJ. Seasonal variations of U.S. mortality rates: Roles of solar ultraviolet-B doses, vitamin D, gene exp ression, and infections. 19th Vitam Workshop 2017;173:5–12. https://doi.org/10.1016/j.jsbmb.2017.01.003.
[5] Umhau J. Vitamin D and Influenza 2008.
[6] Slusky DJG, Zeckhauser RJ. Sunlight and Protection Against Influenza. Econ Hum Biol 2020:100942. https://doi.org/10.1016/j.ehb.2020.100942.
[7] Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017;356:i6583. https://doi.org/10.1136/bmj.i6583.
[8] Goldstein M, Kagan B. Benefits of tanning (Personal Communication) 1980.
[9] Lucas RM, Ponsonby A-L. Considering the potential benefits as well as adverse effects of sun exposure: Can all the potential benefits be provided by oral vitamin D supplementation? UV Expo Guid Balanc Approach Health Risks Health Benefits UV Vitam Proc Int Workshop Int Comm Non-Ioniz Radiat Prot Munich Ger 17-18 Oct 2005 2006;92:140–9. https://doi.org/10.1016/j.pbiomolbio.2006.02.019.
[10] Schauber J, Gallo RL. The vitamin D pathway: a new target for control of the skin’s immune response? Exp Dermatol 2008;17:633–9. https://doi.org/10.1111/j.1600-0625.2008.00768.x.
[11] Heilborn JD, Nilsson MF, Sørensen O, Ståhle-Bäckdahl M, Kratz G, Weber G, et al. The Cathelicidin Anti-Microbial Peptide LL-37 is Involved in Re-Epithelialization of Human Skin Wounds and is Lacking in Chronic Ulcer Epithelium. J Invest Dermatol 2003;120:379–89. https://doi.org/10.1046/j.1523-1747.2003.12069.x.
[12] Bals R, Wang X, Zasloff M, Wilson JM. The peptide antibiotic LL-37/hCAP-18 is expressed in epithelia of the human lung where it has broad antimicrobial activity at the airway surface. Proc Natl Acad Sci 1998;95:9541. https://doi.org/10.1073/pnas.95.16.9541.
[13] Zanetti M. The Role of Cathelicidins in the Innate Host Defenses of Mammals. Curr Issues Mol Biol 2005. https://doi.org/10.21775/cimb.007.179.
[14] Tripathi S, Tecle T, Verma A, Crouch E, White M, Hartshorn KL. The human cathelicidin LL-37 inhibits influenza A viruses through a mechanism distinct from that of surfactant protein D or defensins. J Gen Virol 2013;94:40–9. https://doi.org/10.1099/vir.0.045013-0.
[15] Mallbris L, Wiegleb Edström D, Sundblad L, Granath F, Ståhle M. UVB Upregulates the Antimicrobial Protein hCAP18 mRNA in Human Skin. J Invest Dermatol 2005;125:1072–4. https://doi.org/10.1111/j.0022-202X.2005.23872.x.
[16] Zasloff M. Sunlight, Vitamin D, and the Innate Immune Defenses of the Human Skin. J Invest Dermatol 2005;125:xvi–xvii. https://doi.org/10.1111/j.0022-202X.2005.23924.x.
[17] Gläser R, Navid F, Schuller W, Jantschitsch C, Harder J, Schröder JM, et al. UV-B radiation induces the expression of antimicrobial peptides in human keratinocytes in vitro and in vivo. J Allergy Clin Immunol 2009;123:1117–23. https://doi.org/10.1016/j.jaci.2009.01.043.
[18] Schwarz T. The Dark and the Sunny Sides of UVR-Induced Immunosuppression: Photoimmunology Revisited. J Invest Dermatol 2010;130:49–54. https://doi.org/10.1038/jid.2009.217.
[19] Bergman P, Norlin A-C, Hansen S, Rekha RS, Agerberth B, Björkhem-Bergman L, et al. Vitamin D 3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open 2012;2:e001663. https://doi.org/10.1136/bmjopen-2012-001663.
[20] Bhan I, Camargo CA, Wenger J, Ricciardi C, Ye J, Borregaard N, et al. Circulating levels of 25-hydroxyvitamin D and human cathelicidin in healthy adults. J Allergy Clin Immunol 2011;127:1302-1304.e1. https://doi.org/10.1016/j.jaci.2010.12.1097.
[21] Lansiaux É, Pébaÿ PP, Picard J-L, Forget J. Covid-19 and vit-d: Disease mortality negatively correlates with sunlight exposure. Spat Spatio-Temporal Epidemiol 2020;35:100362. https://doi.org/10.1016/j.sste.2020.100362.
[22] Whittemore PB. COVID-19 fatalities, latitude, sunlight, and vitamin D. Am J Infect Control 2020;48:1042–4. https://doi.org/10.1016/j.ajic.2020.06.193.
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iowaclimatescienceeducation--2020-11-27--New industry report questions government’s 2030 car ban

A new report commissioned by a number of car firms has questioned the UK government ’ s decision to ban new petrol and diesel vehicles from 2030 , calling for a broader approach to achieve net zero carbon emissions by 2050 .
Commissioned by manufacturers as diverse as Honda , Aston Martin , McLaren and Bosch , ‘ Decarbonising Road Transport : There is no silver bullet 2020 ’ contains a number of recommendations , from decarbonising the legacy fleet to greater transparency on the part of OEMs with regard to their whole vehicle CO2 output .
It stresses that @ @ @ @ @ @ @ .
With 40 million vehicles on the road at an average age of 8.3 years , it flags up a concern that the emissions from the UK ’ s huge legacy fleet will need to be addressed in order to achieve net zero by 2050 .
While it acknowledges that tailpipe emissions are part of the problem , the report ’ s authors from Decarbonising Road Transport suggest that the government should focus on the wider aspect of ‘ well to wheel ’ in order to deliver a zero carbon transport network .
@ @ @ @ @ @ @ the process of manufacturing electric cars produces 63 % more CO2 emissions than a petrol or diesel equivalent .
The post New industry report questions government ’ s 2030 car ban appeared first on The Global Warming Policy Forum ( GWPF ) .

A new report commissioned by a number of car firms has questioned the UK government’s decision to ban new petrol and diesel vehicles from 2030, calling for a broader approach to achieve net zero carbon emissions by 2050.
Commissioned by manufacturers as diverse as Honda, Aston Martin, McLaren and Bosch, ‘Decarbonising Road Transport: There is no silver bullet 2020’ contains a number of recommendations, from decarbonising the legacy fleet to greater transparency on the part of OEMs with regard to their whole vehicle CO2 output.
It stresses that a one-size-fits-all approach is unlikely to work. With 40 million vehicles on the road at an average age of 8.3 years, it flags up a concern that the emissions from the UK’s huge legacy fleet will need to be addressed in order to achieve net zero by 2050.
While it acknowledges that tailpipe emissions are part of the problem, the report’s authors from Decarbonising Road Transport suggest that the government should focus on the wider aspect of ‘well to wheel’ in order to deliver a zero carbon transport network. It states that recent research shows that the process of manufacturing electric cars produces 63% more CO2 emissions than a petrol or diesel equivalent.
see also The Battery car delusion
The post New industry report questions government’s 2030 car ban appeared first on The Global Warming Policy Forum (GWPF).
via The Global Warming Policy Forum (GWPF)
https://ift.tt/2HH0mvi
November 27, 2020 at 07:36AM


iowaclimatescienceeducation--2020-11-28--Cause of Death: A Primer

Cause of Death: A Primer

There has been massive media attention on Covid-19 deaths – and there have been a lot of them .
The CDC as of noon on 26 November 2020 was reporting that there have been 259,005 total Covid-19 deaths in the United States .
Yet anyone who reads widely is aware that there have been reports of a motorcycle accident victim being reported as a Covid death .
There are many who correctly report that all people dying from or with Covid and even suspected of dying from-or-with Covid-19 are all being counted as certified reportable must-make-the-headlines Covid-19 Deaths .
[ @ @ @ @ @ @ @ rather detailed explanation of what leads to the situation in which we find ourselves regarding Covid-19 Deaths reporting .
Those who want a better understanding of the issue should continue reading .
Readers with no or little interest can just accept this brief synopsis : “ It ’ s Complicated ” and move on to other posts . ]
Various experts , journalists , bloggers , and pundits tells us that “ Covid Deaths ” are being over-counted , mis-counted and even under-counted .
Other pundits and media-reported experts desperately try to reassure @ @ @ @ @ @ @ and real – and that we should all stay concerned and follow all government mandates – which vary from “ reasonable ” to “ obviously based on magical thinking ” ( closing bars and restaurants at 10 PM because that ’ s when the Corona Virus Zombies attack ) — all this despite various governments having different and contradictory mandates ( or even an absence of mandates ) and the various States in the United States following differing rules and policies on Covid Deaths reporting .
Those reporting “ facts ” like “ @ @ @ @ @ @ @ ” ( based on this CDC comorbitity data ) are sadly mistaken and misinform the general public , just adding to the general confusion on the subject .
Doctors , Coroners and Medical Examiners will calmly explain that “ Cause of Death ” is complicated and not simple .
And they are right .
Most of us think that when a person dies , it is obvious what killed him/her .
But that is just not the case .
In fact , everyone dies of a combination of ” heart stoppage ” [ @ @ @ @ @ @ @ breathing ” which eventually leads to “ brain death ” .
But these are not usually listed as the Cause of Death on a death certificate .
Covid Deaths are being counted and reported based on advice from the CDC , who has based its advice on advice from the ( .pdf ) .
More on what that means later .
The Primer : What is meant by ?
When a person dies in a hospital or other setting , there is some doctor , coroner or medical examiner that fills out a @ @ @ @ @ @ @ Doe has died and reports the date , time , place , Social Security number and other personal details along with the circumstances and sequence of events that led to that death .
Here ’ s a CDC-annotated image of the Cause of Death portion of a typical death certificate : We are interested here only in Parts I and II .
Let ’ s look at a CDC example : This patient had Coronary Artery Disease for seven years — which led to Coronary artery thrombosis from which the patient suffered for @ @ @ @ @ @ @ myocardial infarction ( heart attack ) after which he survived for 6 days until — his heart ruptured resulting in death within minutes .
Conditions contributing to his/her death were diabetes , COPD , and smoking .
Each of these “ significant conditions contributing to death , but not resulting in the underlying cause ” are themselves known to cause a wide range of other serious conditions .
For instance , smoking is believed to cause COPD and heart disease .
Diabetes can cause cardiovascular diseases “ including coronary artery disease with chest @ @ @ @ @ @ @ , stroke and narrowing of arteries ( atherosclerosis ) .
” Notice that there is a dedicated section “ 35 ” asking “ Did tobacco use contribute to death ?
” For this patient , the doctor chose “ Yes ” – thus the CDC will count this death as one of the 480,000 annual tobacco deaths .
Let ’ s look at another example ( from the same document ) : This person suffered from noninsulin dependent Diabetes mellitus , often called Type 2 Diabetes , for 15 years .
As sometimes @ @ @ @ @ @ @ into a Hyperosmolar nonketotic coma in which she/he remained for 8 weeks before finally succumbing to Acute renal failure ( kidney failure ) .
The family of the patient would have told friends and neighbors that their loved one died of kidney failure .
They may have mentioned this was probably the end-of-line result of his/her long-term diabetes .
Type 2 Diabetes is known to cause the following conditions : Heart and blood vessel diseases , Nerve damage ( neuropathy ) , Kidney damage ( as in this patient ) , Eye damage @ @ @ @ @ @ @ and even Alzheimer ’ s disease .
It is clear that this second patient died of acute kidney failure – “ Acute kidney failure is most common in people who are already hospitalized , particularly in critically ill people who need intensive care ” — and is not necessarily a direct result of diabetes – but assumed in this case as kidney damage can be caused by diabetes .
The death certificate Part I sequence is reasonable and represents the doctor ’ s professional opinion .
So , you call the Cause of @ @ @ @ @ @ @ was the Cause of Death of each ?
Did diabetes kill them both ?
The first patient via atherosclerosis which kicked off the sequence in Part I ?
The second from the diabetes induced coma or was the coma from simply caused by being in intensive care ?
Or was it the first patient ’ s life-long cigarette smoking causing the coronary artery disease ?
Or would you , as this doctor did , start the death sequence with his/her seven years of Atherosclerotic coronary artery disease ?
In each case , there @ @ @ @ @ @ @ and could have been correctly entered by the attending physician , a coroner , or later by a medical examiner .
The above are pretty common examples – long-term conditions which lead to the next condition that finally leads to death .
We don ’ t see the personal information part of the Death Certificate so we don ’ t know the age of these patients .
The age of the patient is often key to Cause of Death – but is not to be used as a cause itself .
And then @ @ @ @ @ @ @ diagnostic codes .
Someone goes through every death certificate filed and translates the diseases and conditions the doctors , coroners and medical examiners enter in Parts I and II into ICD-10 codes ( soon to be ICD-11 codes ) .
There are so many codes that there are many online look-up tools and apps to help medical staff code up office visits and others to code up Cause of Death certificates .
The first Death Certificate above might be coded : “ E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma @ @ @ @ @ @ @ lines “ c ” and “ b ” .
This diagnosis is billable .
This app helpfully informs the staff if the ICD-10 code they select is “ billable ” – if not billable , we can safely suspect that office assistants coding office visits can search for a true but alternate diagnostic code that is billable .
“ All conditions mentioned on a death certificate ” are translated to ICD-10 codes and eventually tabulated “ for statistical and research purposes ” .
In our two sample Death Certificates , there are ten @ @ @ @ @ @ @ each of the ten condition codes eventually , at the CDC and WHO level , gets a little “ tick-mark ” – a plus one – added to the number of deaths involving that ICD-10 code .
Thus the huge number of deaths reported for which smoking is claimed to be the cause , as we see in this next quote from the CDC : Most people simply accept those statements as fact , though they know of no one who put a cigarette in their mouth , lit up , and died @ @ @ @ @ @ @ years of public health anti-smoking/anti-tobacco education we have been taught that smoking or otherwise using tobacco can lead to a long list of health problems , many of which cause or contribute to the eventual death of the smoker .
In this case , a life-time of tobacco use is referred to , by public health officials , as a “ cause ” of death – though it probably would not be listed as a cause on a death certificate .
Despite not being listed as a cause on the Death Certificate , @ @ @ @ @ @ @ that smoking is “ the leading cause of preventable death ” .
As in many complicated subjects , there are varying definitions in use for the same terms – in this case “ cause of death ” .
There is the general everyday use – like “ something that directly causes the death of a person , if it hadn ’ t happened , they wouldn ’ t have died ” .
So , a person gets lung cancer , probably or presumably because they had been a life-long smoker , and dies @ @ @ @ @ @ @ they died of lung cancer but accept that smoking led to that death .
It is this definition that the WHO uses above .
But it is not the official definition that is to be used on a Death Certificate as Cause of Death , which is in the quote far above , labelled Part I .
Those readers who watch any of the popular crime and police television series know that Cause of Death in trauma deaths is even more complicated — “ homicide , accident or suicide ?
” — though @ @ @ @ @ @ @ as having almost paranormal insight – “ blunt trauma to the head…but that ’ s not what killed him.
” One last quote from the handbook for medical examiners : : Cause of Death determination and reporting is complicated and highly dependent on the training and opinion of the person making the report .
This is from the CDC ’ s weekly Covid report .
See the Column 2 heading ?
It says “ All Deaths Involving Covid-19 ( U07.1 ) 1 ” .
The keyword is INVOLVING .
To be perfectly clear @ @ @ @ @ @ @ CDC , as collected by the National Center for Health Statistics , are All ( every one ) Deaths ( people dying ) that Involved Covid-19 .
See the little footnote indicator “ 1 ” ?
Footnote 1 says : “ COVID-19 deaths are identified using a new ICD–10 code .
When COVID-19 is reported as a cause of death – or when it is listed as a “ probable ” or “ presumed ” cause — the death is coded as U07.1 .
This can include cases with or without laboratory confirmation.
@ @ @ @ @ @ @ Covid-19 was the immediate cause of death .
At least , to be even clearer , not necessarily what you , the average reader , would consider THE cause of death .
So , what exactly are they counting when the CDC and WHO report Covid-10 Deaths ?
The World Health Organization ’ s official guidelines are : Note that the Death Certificate — Cause of Death Part II is “ Other significant conditions contributing to… ” .
So , there is where Covid-19 ( ICD code U07.1 ) would be written for @ @ @ @ @ @ @ t “ caused , or is assumed to have caused ” but only contributed to the death .
If the decedent was a “ Covid case ” then he/she becomes a “ Covid Death ” if they die .
Read on .
.
.
For the general public , who want to know “ How many people are being killed by the SARS-CoV-2 Pandemic ?
” , this definition does not supply the answer to their question .
The vagueness and breadth of these definitions is exacerbated , in this “ possibly-too-broad ” @ @ @ @ @ @ @ to define “ What is a Covid-19 case ?
” .
We see that the WHO definition of a Covid death includes “ a probable or confirmedCOVID-19 ” .
So , how do WHO and the CDC define or advise doctors how to define/determine a Covid-19 case ?
So , by this definition , I could at this very moment be declared to be a Covid-19 case .
I have muscle pain ( myalgia ) and a headache — two symptoms – — and yesterday , I had a cough — and , @ @ @ @ @ @ @ and doctors are both rushed and spooked by the pandemic , there might be “ no alternative more likely diagnosis ” , in their minds at least .
( Of course , I have these symptoms for reasons well known to me and my personal physician but this might not save me in the ER . )
Especially if they also ask me a bunch of epidemiological questions : So , if I were in the Emergency Room , the ER doctor might ask me these questions : Do you know anyone who @ @ @ @ @ @ @ you been in close contact with them for more than 10 minutes ?
Have you attended any meeting with more than 10 people in the last 14 days ?
Have you been to church or a party ?
Have you visited a restaurant or a bar ?
Any YES epidemiologically qualifies me as a Covid case .
More questions : Do you wear a face mask whenever you are out of your own home ?
in your car ?
in WalMart ?
at the park ?
while mountain biking ?
Any NO qualifies @ @ @ @ @ @ @ You can see how easy it is to be classified as a Covid-19 case .
And they haven ’ t even tested me yet .
( Read the link to see why even testing wouldn ’ t save me . )
They would report me as a Covid case even if I tested negative – I might not be positive “ yet ” .
And while I describe my pending Covid-19 Case classification jokingly , it is a very real scenario .
And , heaven forbid , were I to die of almost @ @ @ @ @ @ @ the next 14 days , I would become another Covid-19 Death statistic .
As most of us know by now , advanced age is a key factor in the vast majority of Covid-19 deaths : Eighty percent ( 80 % ) of Covid-19 deaths are of those 65 years of age of or older – and a full one-third of the deaths occur in those over 85 years .
If you are an adult today , then you were born between 1925 and 2000 .
At your birth , you could expect to @ @ @ @ @ @ @ between 58 to 72 years , depending on your birth year .
Those who are dying at 85 or older had a life expectancy at birth of less than 61 years .
[ My life expectancy at birth was about 66 years – so I have beaten the odds and hope to continue to do so for many years more . ]
If this does not seem significant to you , I ’ ll repeat the CDC quote on reporting cause of death for the elderly – those 65 year of age or @ @ @ @ @ @ @ certification : The elderly decedent should have a clear and distinct etiological sequence for cause of death , if possible .
Terms such as senescence , infirmity , old age , and advanced age have little value for public health or medical research .
Age is recorded elsewhere on the certificate .
When a number of conditions resulted in death , the physician should choose the single sequence that , in his or her opinion , best describes the process leading to death , and place any other pertinent conditions in Part II.
@ @ @ @ @ @ @ – kh ] For the elderly , the aged , the older citizen , which comprise the majority ( 80 % ) of Covid-19 deaths , any illness or condition that leads to breathing problems is prone to being classified as a Covid case , and thus a Covid-19 death in “ a clinically compatible illness , in a probable or confirmed COVID-19 case ” .
• Make no mistake , there are lots of people dying deaths that involve confirmed , assumed , or suspected Covid-19 .
• Somewhere between “ Most @ @ @ @ @ @ @ those deaths involved other conditions that were already killing the patients – sometimes slowly , sometimes rapidly .
• The official health organizations have their own reasons for what they are counting and they are counting exactly what they say they are counting – but it is not what you or I would expect them to count .
They are counting , as the CDC does , “ All Deaths Involving Covid-19 ” .
• The Covid-19 Death statistics represent the counts of the WHO , the CDC and other National and State @ @ @ @ @ @ @ often mistakenly thinks those counts mean deaths in which Covid-19 was the immediate cause of death – deaths in which the person was killed by Covid-19 .
That is not the case – it is far more complicated than that .
• The common citizen would have grave doubts about including each and every one of those dead people in the count of “ Deaths Caused by Covid-19 ” if they were tasked with the job of reviewing all of the details of each death .
Our citizen might make up our own @ @ @ @ @ @ @ Old Age complicated by Pneumonia initiated by a viral respiratory infection : maybe Covid-19 or influenza or the common cold ” .
• Doctors ( and here ) , Coroners and Medical Examiners are not immune to taking easy shortcuts .
The official definitions for Covid-19 cases ( in the essay ) make it an easy choice for hurried doctors , and official guidance requires at least Covid-19 ’ s mention on Death Certificates , under a vast array of normal circumstances during this pandemic .
This is exacerbated by RT-PCR tests returning @ @ @ @ @ @ @ small amounts of viral RNA fragments in asymptomatic people .
I have mentioned previously that I come from a medial family and studied the prerequisites for medical school in university , before changing majors for personal reasons .
Our home was filled with the joys of new life and the sorrow of babies ’ and children ’ s deaths .
My generation fought and died by the thousands in the misguided military intervention in Viet Nam – some of these were my cousins and high school and college friends .
We are all @ @ @ @ @ @ @ Covid-19 , the illness caused by the SARS-CoV-2 virus , is shortening the lives of thousands in the United States and around the world .
One blessing is that it is mostly shortening the lives of those who have already had a life – as opposed to stealing the entire lives of our children and young people .
Public health organizations have valid reasons for counting “ All Deaths Involving Covid-19 ” using their own internal definitions , which are suitable for epidemiological studies and research when combined with all the other information @ @ @ @ @ @ @ That statistic , created with their surveillance and epidemiological definitions , is not suitable for release to the general public without a long and complicated explanation – releasing just the number , and labeling it as Covid-19 Deaths is a form of misinformation .
The media , politicians , health agencies and governments have utterly failed to effectively communicate the reality of Covid deaths , failed to illuminate the caveats and complexities of Cause of Death reporting and instead of have repeatedly just reported this “ Big Number ” in a usage that @ @ @ @ @ @ @ Address your comments to “ Kip… ” if speaking to me .

Guest Essay by Kip Hansen – 27 November 2020
There has been massive media attention on Covid-19 deaths – and there have been a lot of them. The CDC as of noon on 26 November 2020 was reporting that there have been 259,005 total Covid-19 deaths in the United States.
Yet anyone who reads widely is aware that there have been reports of a motorcycle accident victim being reported as a Covid death. There are many who correctly report that all people dying from or with Covid and even suspected of dying from-or-with Covid-19 are all being counted as certified reportable must-make-the-headlines Covid-19 Deaths.
[Note: This is a long and rather detailed explanation of what leads to the situation in which we find ourselves regarding Covid-19 Deaths reporting. Those who want a better understanding of the issue should continue reading. Readers with no or little interest can just accept this brief synopsis: “It’s Complicated” and move on to other posts. ]
Various experts, journalists, bloggers, and pundits tells us that “Covid Deaths” are being over-counted, mis-counted and even under-counted. Other pundits and media-reported experts desperately try to reassure us that Covid Death counts are correct and real – and that we should all stay concerned and follow all government mandates – which vary from “reasonable” to “obviously based on magical thinking” (closing bars and restaurants at 10 PM because that’s when the Corona Virus Zombies attack) — all this despite various governments having different and contradictory mandates (or even an absence of mandates) and the various States in the United States following differing rules and policies on Covid Deaths reporting. Those reporting “facts” like “US Covid-19 Deaths overestimated by 17 times” (based on this CDC comorbitity data) are sadly mistaken and misinform the general public, just adding to the general confusion on the subject.
Doctors, Coroners and Medical Examiners will calmly explain that “Cause of Death” is complicated and not simple. And they are right. Most of us think that when a person dies, it is obvious what killed him/her. But that is just not the case. In fact, everyone dies of a combination of ”heart stoppage” [cardiac arrest] and “cessation of breathing” which eventually leads to “brain death”. But these are not usually listed as the Cause of Death on a death certificate.
Covid Deaths are being counted and reported based on advice from the CDC, who has based its advice on advice from the Council of State and Territorial Epidemiologists (.pdf). More on what that means later.
The Primer: What is meant by Cause of Death ?
When a person dies in a hospital or other setting, there is some doctor, coroner or medical examiner that fills out a death certificate – officially certifying that John/Jane Doe has died and reports the date, time, place, Social Security number and other personal details along with the circumstances and sequence of events that led to that death.
Here’s a CDC-annotated image of the Cause of Death portion of a typical death certificate:
We are interested here only in Parts I and II.
“Part I This section on the death certificate is for reporting the sequence of conditions that led directly to death. The immediate cause of death, which is the disease or condition that directly preceded death and is not necessarily the underlying cause of death (UCOD), should be reported on line a. The conditions that led to the immediate cause of death should be reported in a logical sequence in terms of time and etiology below it. The UCOD, which is “(a) the disease or injury which initiated the train of morbid events leading directly to death or (b) the circumstances of the accident or violence which produced the fatal injury” (7), should be reported on the lowest line used in Part I.” [ source: CDC here – .pdf ]
Let’s look at a CDC example:
This patient had Coronary Artery Disease for seven years — which led to Coronary artery thrombosis from which the patient suffered for 5 years — which led to Acute myocardial infarction (heart attack) after which he survived for 6 days until — his heart ruptured resulting in death within minutes. Conditions contributing to his/her death were diabetes, COPD, and smoking. Each of these “significant conditions contributing to death, but not resulting in the underlying cause” are themselves known to cause a wide range of other serious conditions. For instance, smoking is believed to cause COPD and heart disease. Diabetes can cause cardiovascular diseases “including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis).” Notice that there is a dedicated section “35” asking “Did tobacco use contribute to death?” For this patient, the doctor chose “Yes” – thus the CDC will count this death as one of the 480,000 annual tobacco deaths.
Let’s look at another example (from the same document):
This person suffered from noninsulin dependent Diabetes mellitus, often called Type 2 Diabetes, for 15 years. As sometimes happens, this diabetes sufferer eventually went into a Hyperosmolar nonketotic coma in which she/he remained for 8 weeks before finally succumbing to Acute renal failure (kidney failure). The family of the patient would have told friends and neighbors that their loved one died of kidney failure. They may have mentioned this was probably the end-of-line result of his/her long-term diabetes. Type 2 Diabetes is known to cause the following conditions: Heart and blood vessel diseases, Nerve damage (neuropathy), Kidney damage (as in this patient), Eye damage, Slow healing, Hearing impairment, and even Alzheimer’s disease.
It is clear that this second patient died of acute kidney failure – “Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care” — and is not necessarily a direct result of diabetes – but assumed in this case as kidney damage can be caused by diabetes. The death certificate Part I sequence is reasonable and represents the doctor’s professional opinion.
“In certifying the cause of death, any disease, abnormality, injury, or poisoning, if believed to have adversely affected the decedent, should be reported. If the use of alcohol and/or other substance, a smoking history, or a recent pregnancy, injury, or surgery was believed to have contributed to death, then this condition should be reported. The conditions present at the time of death may be completely unrelated, arising independently of each other; or they may be causally related to each other, that is, one condition may lead to another which in turn leads to a third condition, and so forth. Death may also result from the combined effect of two or more conditions.” Source CDC Medical Examiners’ and Coroners’ Handbook on Death Registration (.pdf)
So, you call the Cause of Death of these two patients. What was the Cause of Death of each? Did diabetes kill them both? The first patient via atherosclerosis which kicked off the sequence in Part I? The second from the diabetes induced coma or was the coma from simply caused by being in intensive care? Or was it the first patient’s life-long cigarette smoking causing the coronary artery disease? Or would you, as this doctor did, start the death sequence with his/her seven years of Atherosclerotic coronary artery disease? In each case, there are several sequences that would be reasonable and could have been correctly entered by the attending physician, a coroner, or later by a medical examiner.
The above are pretty common examples – long-term conditions which lead to the next condition that finally leads to death. We don’t see the personal information part of the Death Certificate so we don’t know the age of these patients. The age of the patient is often key to Cause of Death – but is not to be used as a cause itself.
“Common problems in death certification The elderly decedent should have a clear and distinct etiological sequence for cause of death, if possible. Terms such as senescence, infirmity, old age, and advanced age have little value for public health or medical research. Age is recorded elsewhere on the certificate. When a number of conditions resulted in death, the physician should choose the single sequence that, in his or her opinion, best describes the process leading to death, and place any other pertinent conditions in Part II.” [ source: CDC my bolds – kh ]
And then this:
“For statistical and research purposes, it is important that the causes of death and, in particular, the underlying cause of death, be reported as specifically and as precisely as possible. Careful reporting results in statistics for both underlying and multiple causes of death (i.e., all conditions mentioned on a death certificate) reflecting the best medical opinion. Every cause-of-death statement is coded and tabulated in the statistical offices according to the latest revision of the International Classification of Diseases. “ Source CDC Medical Examiners’ and Coroners’ Handbook on Death Registration (.pdf) – my bold — kh
There are over 69,000 ICD-10 diagnostic codes. Someone goes through every death certificate filed and translates the diseases and conditions the doctors, coroners and medical examiners enter in Parts I and II into ICD-10 codes (soon to be ICD-11 codes). There are so many codes that there are many online look-up tools and apps to help medical staff code up office visits and others to code up Cause of Death certificates. The first Death Certificate above might be coded: “ E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma” – which would cover Part I lines “c” and “b”. This diagnosis is billable. This app helpfully informs the staff if the ICD-10 code they select is “billable” – if not billable, we can safely suspect that office assistants coding office visits can search for a true but alternate diagnostic code that is billable. “All conditions mentioned on a death certificate” are translated to ICD-10 codes and eventually tabulated “for statistical and research purposes”. In our two sample Death Certificates, there are ten different diseases and conditions mentioned. Thus each of the ten condition codes eventually, at the CDC and WHO level, gets a little “tick-mark” – a plus one – added to the number of deaths involving that ICD-10 code.
Thus the huge number of deaths reported for which smoking is claimed to be the cause, as we see in this next quote from the CDC:
“Smoking is the leading cause of preventable death.Worldwide, tobacco use causes more than 7 million deaths per year. If the pattern of smoking all over the globe doesn’t change, more than 8 million people a year will die from diseases related to tobacco use by 2030. Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day.” [ source: CDC here ]
Most people simply accept those statements as fact, though they know of no one who put a cigarette in their mouth, lit up, and died as a direct result. Through many years of public health anti-smoking/anti-tobacco education we have been taught that smoking or otherwise using tobacco can lead to a long list of health problems, many of which cause or contribute to the eventual death of the smoker. In this case, a life-time of tobacco use is referred to, by public health officials, as a “cause” of death – though it probably would not be listed as a cause on a death certificate. Despite not being listed as a cause on the Death Certificate, the CDC and WHO unequivocally tells us that smoking is “the leading cause of preventable death”.
As in many complicated subjects, there are varying definitions in use for the same terms – in this case “cause of death”. There is the general everyday use – like “something that directly causes the death of a person, if it hadn’t happened, they wouldn’t have died”. So, a person gets lung cancer, probably or presumably because they had been a life-long smoker, and dies from the lung cancer. We know they died of lung cancer but accept that smoking led to that death. It is this definition that the WHO uses above. But it is not the official definition that is to be used on a Death Certificate as Cause of Death, which is in the quote far above, labelled Part I.
Those readers who watch any of the popular crime and police television series know that Cause of Death in trauma deaths is even more complicated — “homicide, accident or suicide?” — though those TV Medical Examiners are always portrayed as having almost paranormal insight – “blunt trauma to the head…but that’s not what killed him.”
One last quote from the handbook for medical examiners:
“Precision of knowledge required to complete death certificate items The cause-of-death section in the medical examiner’s or coroner’s certification is always a medical opinion. This opinion is, of course, a synthesis of all information derived from both the investigation into the circumstances surrounding the death …. It represents the best effort of the medical examiner or coroner to reduce to a few words his or her entire synthesis of the cause of death.” [ emphasis in the original – kh ]
Bottom Line : Cause of Death determination and reporting is complicated and highly dependent on the training and opinion of the person making the report.
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Reporting of Covid-19 Deaths
Here’s the pivot point on Covid-19 Deaths:
This is from the CDC’s weekly Covid report. See the Column 2 heading? It says “All Deaths Involving Covid-19 (U07.1)1”. The keyword is INVOLVING. To be perfectly clear, what is being reported by the CDC, as collected by the National Center for Health Statistics, are All (every one) Deaths (people dying) that Involved Covid-19. See the little footnote indicator “1”?
Footnote 1 says: “COVID-19 deaths are identified using a new ICD–10 code. When COVID-19 is reported as a cause of death – or when it is listed as a “probable” or “presumed” cause — the death is coded as U07.1. This can include cases with or without laboratory confirmation.”
Not just verified cases in which Covid-19 was the immediate cause of death. At least, to be even clearer, not necessarily what you, the average reader, would consider THE cause of death.
So, what exactly are they counting when the CDC and WHO report Covid-10 Deaths? The World Health Organization’s official guidelines are:
2. DEFINITION FOR DEATHS DUE TO COVID-19 A death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). …. A- RECORDING COVID-19 ON THE MEDICAL CERTIFICATE OF CAUSE OF DEATH COVID-19 should be recorded on the medical certificate of cause of death for ALL decedents where the disease caused, or is assumed to have caused, or contributed to death. [ my emphasis – kh source: WHO here .pdf ]
Note that the Death Certificate — Cause of Death Part II is “Other significant conditions contributing to…”. So, there is where Covid-19 (ICD code U07.1) would be written for any death in which Covid wasn’t “caused, or is assumed to have caused” but only contributed to the death. If the decedent was a “Covid case” then he/she becomes a “Covid Death” if they die. Read on . . .
For the general public, who want to know “How many people are being killed by the SARS-CoV-2 Pandemic?”, this definition does not supply the answer to their question. The vagueness and breadth of these definitions is exacerbated, in this “possibly-too-broad” sense, by the definitions being used to define “What is a Covid-19 case?”. We see that the WHO definition of a Covid death includes “a probable or confirmedCOVID-19 case ”.
So, how do WHO and the CDC define or advise doctors how to define/determine a Covid-19 case?
Clinical Criteria At least two of the following symptoms: fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder(s) OR At least one of the following symptoms: cough, shortness of breath, or difficulty breathing OR Severe respiratory illness with at least one of the following: Clinical or radiographic evidence of pneumonia, OR Acute respiratory distress syndrome (ARDS). AND No alternative more likely diagnosis [ source: CDC here ]
So, by this definition, I could at this very moment be declared to be a Covid-19 case. I have muscle pain (myalgia) and a headache — two symptoms – — and yesterday, I had a cough — and, if I have reported to the ER and doctors are both rushed and spooked by the pandemic, there might be “no alternative more likely diagnosis”, in their minds at least. (Of course, I have these symptoms for reasons well known to me and my personal physician but this might not save me in the ER.) Especially if they also ask me a bunch of epidemiological questions:
“Epidemiologic Linkage One or more of the following exposures in the 14 days before onset of symptoms: Close contact** with a confirmed or probable case of COVID-19 disease; OR Close contact** with a person with: clinically compatible illness AND linkage to a confirmed case of COVID-19 disease. Travel to or residence in an area with sustained, ongoing community transmission of SARS-CoV-2. Member of a risk cohort as defined by public health authorities during an outbreak. **Close contact is defined as being within 6 feet for at least a period of 10 minutes to 30 minutes or more depending upon the exposure. In healthcare settings, this may be defined as exposures of greater than a few minutes or more. Data are insufficient to precisely define the duration of exposure that constitutes prolonged exposure and thus a close contact.” [ source: see previous quote ]
So, if I were in the Emergency Room, the ER doctor might ask me these questions: Do you know anyone who isn’t feeling well? Have you been in close contact with them for more than 10 minutes? Have you attended any meeting with more than 10 people in the last 14 days? Have you been to church or a party? Have you visited a restaurant or a bar? Any YES epidemiologically qualifies me as a Covid case. More questions: Do you wear a face mask whenever you are out of your own home? in your car? in WalMart? at the park? while mountain biking? Any NO qualifies me as a Covid case epidemiologically.
You can see how easy it is to be classified as a Covid-19 case. And they haven’t even tested me yet. (Read the link to see why even testing wouldn’t save me.) They would report me as a Covid case even if I tested negative – I might not be positive “yet”.
And while I describe my pending Covid-19 Case classification jokingly, it is a very real scenario. And, heaven forbid, were I to die of almost anything (except obvious trauma) in the next 14 days, I would become another Covid-19 Death statistic.
As most of us know by now, advanced age is a key factor in the vast majority of Covid-19 deaths:
Eighty percent (80%) of Covid-19 deaths are of those 65 years of age of or older – and a full one-third of the deaths occur in those over 85 years. If you are an adult today, then you were born between 1925 and 2000. At your birth, you could expect to live (life expectancy at birth) between 58 to 72 years, depending on your birth year. Those who are dying at 85 or older had a life expectancy at birth of less than 61 years. [My life expectancy at birth was about 66 years – so I have beaten the odds and hope to continue to do so for many years more.]
If this does not seem significant to you, I’ll repeat the CDC quote on reporting cause of death for the elderly – those 65 year of age or older.
“Common problems in death certification: The elderly decedent should have a clear and distinct etiological sequence for cause of death, if possible. Terms such as senescence, infirmity, old age, and advanced age have little value for public health or medical research. Age is recorded elsewhere on the certificate. When a number of conditions resulted in death, the physician should choose the single sequence that, in his or her opinion, best describes the process leading to death, and place any other pertinent conditions in Part II.” [ source: CDC my bolds – kh ]
For the elderly, the aged, the older citizen, which comprise the majority (80%) of Covid-19 deaths, any illness or condition that leads to breathing problems is prone to being classified as a Covid case, and thus a Covid-19 death in “a clinically compatible illness, in a probable or confirmed COVID-19 case”.
Bottom Lines:
It is complicated.
Make no mistake, there are lots of people dying deaths that involve confirmed, assumed, or suspected Covid-19.
Somewhere between “Most” and “Almost All” of those deaths involved other conditions that were already killing the patients – sometimes slowly, sometimes rapidly.
The official health organizations have their own reasons for what they are counting and they are counting exactly what they say they are counting – but it is not what you or I would expect them to count. They are counting, as the CDC does, “All Deaths Involving Covid-19”.
– but it is not what you or I would expect them to count. They are counting, as the CDC does, “All Deaths Involving Covid-19”. The Covid-19 Death statistics represent the counts of the WHO, the CDC and other National and State public health agencies. The general public often mistakenly thinks those counts mean deaths in which Covid-19 was the immediate cause of death – deaths in which the person was killed by Covid-19. That is not the case – it is far more complicated than that.
– deaths in which the person was killed by Covid-19. That is not the case – it is far more complicated than that. The common citizen would have grave doubts about including each and every one of those dead people in the count of “Deaths Caused by Covid-19” if they were tasked with the job of reviewing all of the details of each death. Our citizen might make up our own sensible classifications: such as: ”Old Age complicated by Pneumonia initiated by a viral respiratory infection: maybe Covid-19 or influenza or the common cold”.
in the count of “Deaths Caused by Covid-19” if they were tasked with the job of reviewing all of the details of each death. Our citizen might make up our own sensible classifications: such as: ”Old Age complicated by Pneumonia initiated by a viral respiratory infection: maybe Covid-19 or influenza or the common cold”. Doctors (and here), Coroners and Medical Examiners are not immune to taking easy shortcuts. The official definitions for Covid-19 cases (in the essay) make it an easy choice for hurried doctors, and official guidance requires at least Covid-19’s mention on Death Certificates, under a vast array of normal circumstances during this pandemic. This is exacerbated by RT-PCR tests returning “positive” test results for very small amounts of viral RNA fragments in asymptomatic people.
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Author’s Comment:
I have mentioned previously that I come from a medial family and studied the prerequisites for medical school in university, before changing majors for personal reasons. Our home was filled with the joys of new life and the sorrow of babies’ and children’s deaths. My generation fought and died by the thousands in the misguided military intervention in Viet Nam – some of these were my cousins and high school and college friends.
We are all sad when lives are cut short.
Covid-19, the illness caused by the SARS-CoV-2 virus, is shortening the lives of thousands in the United States and around the world. One blessing is that it is mostly shortening the lives of those who have already had a life – as opposed to stealing the entire lives of our children and young people.
Public health organizations have valid reasons for counting “All Deaths Involving Covid-19” using their own internal definitions, which are suitable for epidemiological studies and research when combined with all the other information being collected to produce that statistic. That statistic, created with their surveillance and epidemiological definitions, is not suitable for release to the general public without a long and complicated explanation – releasing just the number, and labeling it as Covid-19 Deaths is a form of misinformation.
The media, politicians, health agencies and governments have utterly failed to effectively communicate the reality of Covid deaths, failed to illuminate the caveats and complexities of Cause of Death reporting and instead of have repeatedly just reported this “Big Number” in a usage that is seems to be intentionally misleading.
Opinions vary on this subject.
Address your comments to “Kip…” if speaking to me.
Thanks for reading.
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