Memo: The Antibiotics Hypothesis and New York City Spring 2020
Subject to updates/revisions
Question: Did sudden withdrawal of antibiotics contribute to the New York City spring 2020 death spike?
Available data do not support the hypothesis that failing to use or prescribe antibiotics in the hospital or outpatient was a significant contributor to the NYC death spike.
King et al (2020) show 37% and 10% increases for azithromycin prescriptions dispensed in New York State in March and April 2020 compared with the three-year baseline.1
Walsh et al (2023) reported over 90% of intubated patients COVID patients in an academic hospital in NYC during a two-week period in spring 2020 received antibiotics.
Data obtained via public records request for the daily number of blood cultures (BCs) taken in New York City’s public hospitals (n=11) show a ~50% base-to-peak increase in BCs taken after 15 Days to Slow the Spread was declared. Whether and how that relates to antibiotics disbursement is unclear.2 The peak in BC orders taken preceding the peak in deaths (all causes) by roughly two weeks suggests decisions about whether to use antibiotics were made.3
The belief that people presented to the emergency room in need of antibiotics, were denied prescriptions, and then got worse at home and died there or in the hospital would require additional data and individual record review to substantiate.
This belief is not supported by time-series data of various kinds, including 911 calls, ambulance dispatches, and ED visits and is contradicted by the orders given to paramedics (EMTs and FDNY) and cardiac arrest data.4 Insofar as medications go, there is better support for mass euthanasia of existing and admitted hospital patients than there is for sudden withdrawal of antibiotics as a driver of deaths.5
I suspect there was a systematic transfer of care home residents into hospitals in early 2020, before and during the emergency period, but my efforts to test this hypothesis have been stymied. To the extent that hospital patients or nursing home residents were denied antibiotics or other care in the weeks or months preceding the pandemic declaration, and their deaths either prolonged or digitally “pushed forward,” the Antibiotics Hypothesis could make sense.6
My request to the NYC public hospital agency for daily or weekly doses of all antibiotics administered to all patients from 1/1/2017 - 12/31/2022 is three months overdue.
For an overview of some of the serious problems surrounding the New York City spring 2020 mass casualty, see article below:
From study: “…in March 2020, the number of patients dispensed azithromycin prescriptions exceeded the historical average in 11 states (Supplemental Table 2): New York (37% higher in 2020 than 2017–2019 average), New Jersey (32%), Florida (16%), Oklahoma (7%), Louisiana (6%), Georgia (5%), Alabama (5%), Texas (3%), Mississippi (3%), Arkansas (2%), and Idaho (1%). In April 2020, the number of patients dispensed azithromycin prescriptions was lower than the historical average in all states except New York and New Jersey, where 2020 numbers exceeded historical averages by 10%.” (p. 655) https://pmc.ncbi.nlm.nih.gov/articles/PMC7799289/
Data for 2017-2019 requested but denied. The February dip in BC orders is notable and slightly discrepant with daily deaths in February, but without data from prior years it is hard to say whether the decrease is normal.
BC orders taken then dropped below baseline while deaths returned to normal, which is unexpected.
That said, I doubt the daily death curve represents a real-time event and believe it could be manipulated in one or more ways.