Is There Any Justification for Politicizing the Cause of Death? Measles and Beyond

[Ellecram]

I live in a town not far from Jefferson County.

I read though some FB posts over the weekend and discovered so many comments from the masses who have no basic understanding of disease and public health. They will eventually drag us back to the Dark Ages. It’s disheartening.

[PhillyGuy]

Today’s Pennsylvania measles death announcement is from Mifflin County:

Coroner Andrea Alcalde via Facebook

Again, we have an elected GOP country coroner whose statement makes no mention that there is an immunization which can prevent this.

I, and I’m guessing, a couple million others, did get an email yesterday, from Penn Medicine, with the subject “Measles cases on the rise in our region.” That communication does advise immunization:

Vaccination is the best way to protect yourself and your loved ones against measles.

[DSeid]

Yeah I don’t know if I hold the coroner office to a high standard on public health communication? Not their job really.

[PhillyGuy]

Re last post, I live in one of the Democratic Party controlled counties in the outbreak area, and we have a separate county Health Department that is publicizing need for immunzation:

Health | Chester County, PA - Official Website

So I don’t think our coroner needs to jump in on public health communication.

It is better now that the GOP coroners are admitting the cause of death. But, bad as many of the non-fatal measles cases are, I think fatalities present a strong educational opportunity. I’m afraid that there will eventually be deaths in some of the counties with a Democratic Party elected coroner and no health department, and we will see how they treat it.

[JRDelirious]

“died OF” vs. “died WITH” and how much attention to give “contributing causes” was always a discussion in mortality reports, and had spiked after the coming of HIV, but ISTM that at least in the USA it truly blew up big after the politization of Covid-19 response. And of course at the opposite end of the spectrum you have the people who yell and scream about the vaccine shots and “Turbo Cancer”

The large number of elected lower-level officials in the USA is a legacy artifact of the Old Times when you did not have a large civil service bureaucracy of trained professionals and as citizens you’d be left to fill necessary jobs by election or sortition among yourselves. With time in many of those jurisdictions it just became “the way we do it” and enshrined in local statute or state constitutions.

[PhillyGuy]

@JRDelirious

“died OF” vs. “died WITH” and how much attention to give “contributing causes” was always a discussion in mortality reports, and had spiked after the coming of HIV, but ISTM that at least in the USA it truly blew up big after the politization of Covid-19 response. And of course at the opposite end of the spectrum you have the people who yell and scream about the vaccine shots and “Turbo Cancer”

I’m not sure to what extent you are disagreeing with me, but in case it is substantial:

Because HIV is hardly ever cured, and treatments are good, sure, it is normal to die with HIV, not of. But because measles symptoms last roughly nine days, it would be an enormous coincidence if someone died of something else during those nine days.

Now, when someone dies of measles, they often will have had some other medical diagnosis that made them more vulnerable to measles death. Although I have criticized the GOP coroners, and will continue to do so when their county has no health official recommending immunization, this from one of them, interviewed by the Atlantic, is a fair description of what may happen:

Furlong, the Jefferson County coroner who investigated the 40-year-old woman’s death, told me that although the woman had conditions that made her vulnerable to measles, and was on supplemental oxygen, she was active before she contracted the virus. She cooked for her family and cleaned the house. Measles killed her in about a week. “If she wouldn’t have got the measles, would she still be alive today? I say yes,” Furlong, a Republican who is also the mayor of Summerville, said.

Anti-vaccine types may read this and think that the case is irrelevant because they aren’t on oxygen. But if you add up all the semi-rare conditions that could make a person more vulnerable to fatal measles – it includes HIV – you have a significant portion of the population there and probably at least one friend or relative in that group. I am in the group because of chronic lymphocytic leukemia which is unlikely to kill me, but makes me (and the many people who have it without knowing) more vulnerable to infections.

Also, for every measles death during the days when it is symptomatic, there may be another months later, when their immune system is still depressed by the measles (see immune amnesia), that cannot be linked to the measles even though they will still be alive without having gotten it.

[DrDeth]

FYI from Politifact-

RFK Jr. says the US has the ‘sickest children’. That’s False

Health Secretary Robert F. Kennedy Jr. said despite high healthcare spending, the U.S. is failing its children on an unprecedented level…Some data shows chronic disease rates are rising and children in the U.S. have a higher mortality rate than children in other developed countries. But Kennedy’s statement ignores the major reductions in childhood illness and death achieved over the last 200 years, and he’s wrong that the U.S. has the “sickest children” in history.

We rate that False.

and this-

No evidence illegal immigration caused US measles outbreaks

[PhillyGuy]

Earlier in the thread, someone criticized the Shapiro administration for, as I recall, supposedly jumping to announce a death without giving time to first work with the local GOP coroner. This morning’s paper Philadelphia Inquirer had a story explaining what happened:

Records show the state tried to reach him

Now emails from the coroner’s office, obtained by The Inquirer through an open-records request, show that state officials made significant outreach to Diamantoni, far beyond his prior statements acknowledging only that his deputy spoke with state officials shortly before the news conference.

In fact, doctors from the state health department had tried to contact his office about the case for days, with increasing urgency. At one point, a doctor told one of Diamantoni’s staffers that they were ready “24/7” to speak with someone from the office.

Yet two weeks after the announcement, he continued to emphasize the state’s lacking communication in an in-person interview with The Inquirer. “I have not received any information directly from the state [health] department,” he said on Sept. 9.

By then, his statements had enabled President Donald Trump’s health secretary, Robert F. Kennedy Jr., to question whether the deaths reported in Pennsylvania were real.

[Chronos]

@PhillyGuy

Because HIV is hardly ever cured, and treatments are good, sure, it is normal to die with HIV, not of.

The other complication with HIV is that HIV, itself, almost never directly causes death. What it does is weaken your immune system to the point that almost any other disease, including ones that the immune system usually fights off so quickly that nobody ever notices them, can kill you.

[PhillyGuy]

A likely example of politicization of the cause of death is the elected GOP Franklin County Pennsylvania coroner trying to hold back newspaper reporting. This story was published yesterday:

Inquirer takes legal action over sealed measles death records - No other Pa. county outside of Franklin has challenged The Inquirer’s right to access death record information

A Franklin County judge ordered that information about a measles-related death be sealed from public review, prompting The Philadelphia Inquirer to take legal action. . . .

“This kind of information is critically important not just for journalists, but for researchers, doctors, and the public to understand whether there is a critical public safety issue,” said Paula Knudsen Burke, Pennsylvania-based attorney for the national nonprofit Reporters Committee for Freedom of the Press, which provides free legal services to journalists and is representing The Inquirer. “We have to understand, as a society, how people die.”

The Inquirer’s petition argued that Pennsylvania’s Right-to-Know Law does not give people special privacy protection because of their religion. The petition also argues that under state law, deceased individuals do not have privacy rights, and that even if such privacy rights existed, the coroner “is without authority to assert them.”

P.S. My link is behind a paywall. Americans will hopefully have a library card number that can be used to get past it.

[PhillyGuy]

I wouldn’t say this is politicizing. But my county, run by Democrats, has a health department (something low tax GOP counties mostly do not have) with nurses that are going farmdoor to farmdoor to give free measles shots, and take-up is high. And touch wood, no deaths in our county yet.

Adults make up two-thirds of measles cases in Pennsylvania, presenting unique challenges

When measles cases started being reported, Franklin, the [Chester] county public health director, and her team got to work.

“We are doing a pretty traditional and pretty typical public health response,” she explained. “The state is doing the same thing in counties that don’t have a health department.”

Department staff conducts contract tracing and investigations for measles cases. . . .

Staff have vaccinated people in almost 450 homes, with most visits averaging 10 people at a time. One nurse vaccinated 70 people in just one house. “Sometimes they’re inviting their neighbors or their extended families from other homes, which is super cool because we go to one home and we can do [many vaccinations],” Franklin said.

This approach is important because it reaches people who might otherwise struggle to get to the health department. People in the Plain community do not regularly visit doctors, and making a trip can be onerous, especially when people travel with a horse and buggy.

“[They’re] making their livelihood off the land. You can’t just leave,” Franklin said. “The Plain community, it’s not ‘we are against vaccines.’ It’s sometimes they don’t know.

P.S. Pennsylvania county officials are elected in odd-numbered years. So the R to D flips this week are unlikely to help with measles.

[PhillyGuy]

@PhillyGuy

“The Plain community, it’s not ‘we are against vaccines.’ It’s sometimes they don’t know.

Commenting on my own last post, I do not think this is the total story.

What Amish oppose more than vaccines is insurance. So for them, the MMR is expensive if gotten at the nearest pharmacy. As for traveling to the health department, where vaccines are free, that is far from the Amish area and the roads there are not set up for buggies. So they would have to pay for a taxi or get an English (non-Amish) friend to take them. There is reluctance to do that except in emergencies.

What about the GOP MAHA anti-vaccine types? The measles outbreak does not seem to have hit them much yet. When it does, there will be a bigger problem.