Day 146: Because Lying to the Public Went So Well the First Time

It's summer and the CDC has come out of its hole to tell some more howlers. In a surprise move, they removed being over 65 from the list of high risk factors, even though 80% of US deaths have been in those over 65. Since that's also the case for the flu, we'll give them a pass on that one, even though technically it means that all the killing-grandma panic has been, shall we say, somewhat misplaced. (That is, you were already killing grandma when you let the flu rip through society unimpeded.)

Perhaps most notably, they lowered their threshold for high risk from obesity from a BMI of 40 (morbidly obese) to a BMI of 30 (obese). Though to be honest, PlagueBlog hadn't even noticed their previous stance was so extreme (they went down two obesity classes, BMI 40+ and 35–40), because the science has always been behind class I obesity (BMI 30–35) already being a significant risk factor.

The remaining high-risk list is unobjectionable: "people with chronic kidney disease, chronic inflammatory lung disease, obesity, serious heart conditions, sickle cell disease, Type 2 diabetes, and weakened immune systems because of organ transplants."

Next, despite six months of accumulated science about COVID-19, they get to the howler: some people who "may" be at high risk. It's a long list of people, some of whom are at lower risk than the average person: smokers and pregnant women. Many studies have shown the prophylactic effect of smoking against COVID-19; that the CDC would invert this result and claim smokers are may be a high risk group is hurting PlagueBlog's ears with the howler.

It also casts doubt on the rest of the "may be high risk" list: undifferentiated asthma sufferers, those with liver disease or thalassemia, the demented, the lung-damaged, the otherwise immune-compromised, and those with "diseases that affect blood flow to the brain". The only ones who clearly belong on a high risk list are the Type I diabetics and those with high blood pressure (who appear on such lists often enough that it's unclear why the CDC is waffling here).

As for the "may be high risk" to pregnant women, the CDC cites their own report, even though it shows the opposite result (emphasis added for your reading convenience):

Symptom status was reported for 65.2% of pregnant women and 90.0% of nonpregnant women; among those with symptom status reported, 97.1% of pregnant and 96.9% nonpregnant women reported being symptomatic. Symptomatic pregnant and nonpregnant women also reported similar frequencies of cough (51.8% versus 53.7%) and shortness of breath (30.1% versus 30.3%). Pregnant women less frequently reported headache (40.6% versus 52.2%), muscle aches (38.1% versus 47.2%), fever (34.3% versus 42.1%), chills (28.5% versus 35.6%), and diarrhea (14.3% versus 23.1%) than did nonpregnant women.

Data were available on presence and absence of underlying chronic conditions for 22.9% of pregnant women and 35.0% of nonpregnant women. Chronic lung disease (21.8% pregnant; 10.3% nonpregnant), diabetes mellitus (15.3% pregnant; 6.4% nonpregnant), and cardiovascular disease (14.0% pregnant; 7.1% nonpregnant) were the most commonly reported chronic conditions. Data were not available to distinguish whether chronic conditions were present before or associated with pregnancy (e.g., gestational diabetes or hypertensive disorders of pregnancy).

Hospitalization was reported by a substantially higher percentage of pregnant women (31.5%) than nonpregnant women (5.8%) (Table 2). Data were not available to distinguish hospitalization for COVID-19–related circumstances (e.g., worsening respiratory status) from hospital admission for pregnancy-related treatment or procedures (e.g., delivery). Pregnant women were admitted more frequently to the ICU (1.5%) than were nonpregnant women (0.9%). Similarly, 0.5% of pregnant women required mechanical ventilation compared with 0.3% of nonpregnant women. [...]

No difference in the risk for death between pregnant and nonpregnant women was found (aRR = 0.9, 95% CI = 0.5–1.5).

PlagueBlog is hard-pressed to believe a story of disease progress in which pregnancy produces fewer initial coronavirus symptoms yet requires more medical treatment, and then, at the very point of mechanical ventilation, somehow saves pregnant women from (excess) actual deaths. Instead, PlagueBlog recalls the utility of death, the great equalizer, in showing the real COVID-19 status of a nation or a group. In this case, it appears that pregnant women are receiving a different standard of care than non-pregnant women (partly because pregnancy attracts extra medical attention even in the best of circumstances, not to mention the lack of accurate COVID vs. pregnancy data noted in bold above), but are otherwise just as young, healthy, and COVID-resistant as other women their age.

P.S. Massachusetts cases are up a fifth of a percentage point today.