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Coronavirus Speculations on Old Men and Bad Bugs
I have a couple of speculations relating to the COVID-19 pandemic.
I. No Country for Old Men?
It’s been widely reported that COVID-19 fatalities are heavily concentrated among the old, and that the fatality rate for men is significantly higher than for women. There is quite a bit of evidence for this, but it appears is that the risk of death may be extraordinarily concentrated among old men. This could explain some of the differences in death rates between countries. Perhaps it is countries with a high proportion of very old men (70+ and even 80+) that would be expected to have unusually high death rates.
I found the following graph from the WHO’s regional office in Europe (here), showing proportions of death by age and sex. They do not give a date, but it says that the source is data aggregated from Italy and Spain from reports of 18,590 deaths.
I found two further data sources for this and prepared my own graphs. The first is for Italy, based on a report of over 12,500 deaths through April 2 (the paper is here; population data by age and sex from here). Here’s the graph:
The green bars are the deaths per 100,000 overall, with the blue bars for men and the pink bars for women. You can see how the risk is extraordinarily concentrated among men over 70, and especially among men over 80. Overall, the deaths in Italy were 69% male and 31% female.
I found good information about this from New York state, which reports data by age and by sex but, unfortunately, not by age and sex (the data is here; population information from here). New York does not separately report the 90+ age category, but I was able to put together this graph comparing New York state and Italy:
The data follow the same pattern, though the rates are substantially higher for New York. Remember that this is data from Italy about a week ago, and Italy’s total deaths have increased by about 50% since then.
Overall, in New York state, COVID-19 deaths have been 61% male, 39% female. It would be interesting to have this information by age category.
There could be an interaction between population age and the degree of social contact among the old, which could cause a differential effect between countries. This is just a hypothesis, without supporting data (yet). The idea is that old men are particularly vulnerable, and death rates will be higher in areas: (1) with a large number of old men (obviously), and (2) where the old men have more social contact with others.
II. The Good Bug and the Bad Bug?
In a recently posted paper (here), Dr. Knut Wittkowski stated that there was evidence of at least two strains of the virus causing COVID-19, with different levels of fatality associated with the different strains. He suggested that a deadlier strain (I’ll call it the “Bad Bug”) emerged in Wuhan and then spread to South Korea, Iran, and Italy. One or more less deadly strains (I’ll call them the “Good Bug”) spread elsewhere, particularly to other parts of Asia and beyond.
There are now new stories reporting that the new coronavirus was present in New York earlier than previously thought, based on an analysis of mutations in the virus. Researchers found that “early city cases were not linked to later ones, which they found came from Europe,” according to the NY Post (here). An article in the NY Times (here) states that “the earliest cases identified in New York were not linked to later ones” and that the later viruses “were practically identical to viruses found around Europe.” Other teams cited in the NYT article found some infections traced to Washington State.
In contrast, a paper by some Yale researchers (here) analyzed cases in Connecticut, and found that most resulted from interstate travel, tracking back to Washington state, with few from Europe or Asia. Connecticut has a much lower death rate than New York, at present.
The Good Bug/Bad Bug hypothesis might explain the strange progression of COVID-19 in many places. I am frankly skeptical of efforts to contain the virus. Yet most of China, and South Korea and Japan, and many Asian countries have low death figures. In addition, though there is evidence that the disease arrived earlier on the West Coast, the death rates in Washington and California remain quite low (particularly compared to New York). There are also European countries with very high death rates (notably Italy and Spain, and increasing in France and the UK), while Germany has a very low rate.
What if the Good Bug infected much of China, much of Asia, and then the West Coast of the US and perhaps some fortunate European countries like Germany? And the Bad Bug infected Iran, then Italy and Spain, then other parts of Western Europe, and finally New York and New Orleans?
The Good Bug may have passed with little or no effect, and given immunity. Areas hit hard by the Bad Bug are the ones suffering higher numbers of deaths.
This is just a hypothesis, for discussion.
ChiCom delenda est.
Published in Healthcare
As long as I’m binge commenting here, one last point:
While my gut sense is that the discrepancy in case numbers between the two coasts is most likely explained by “social distancing works + random differences in infection rates at the time the measures were imposed”, if I had to guess a next-most-likely explanation for the differences, it would be either a) different climate conditions between the coasts (even though they’re both moderate coastal environments, there are still numerous subtle differences that could be important) or b) subtle differences in human-human interactions. For example, the NYC and Boston metro areas see quite a bit more public transportation utilization than Seattle, SF or LA. There are also quite a few differences in density and residential structures between the areas.
This isn’t exactly earth-shattering, but it raises an important point: there are ALWAYS subtle factors that play oversized roles in the transmission of infectious diseases. In the case of SARS, whether or not residents of Hong Kong had water in the trap below the floor drain of their bathrooms (a drain that doesn’t even exist in most western bathrooms) was a major determinant in who got the disease, and was a very easy fix.
There are probably all sorts of very simple ways to block SARS-CoV-2 transmission that don’t require stay-at-home orders. But the only way to find them out is to actually expose people to the virus. Which we’re too afraid to do – either in public or in real life.
So we live in a vicious circle: we can’t find the subtle-but-effective ways of controlling the virus without letting people get infected, but we won’t let people get infected until we know more about how to control the virus.
This is what I’m most worried about – the possibility that our “zero tolerance policy” has the unintended consequence of basically keeping this thing alive for much, much longer than it otherwise would be.
That is also why my most optimistic take is that hopefully our ridiculously incompetent reactions were actually several steps behind the curve, and there is much reason to believe that this is possible. And while I’m not particularly confident about any one theory, I do find reason to be cautiously optimistic. Consider all the graphs and charts that we’ve seen over dozens of years with respect to everything. We look at gun violence trends compared to bans on certain firearms and magazines and expect to see some impact at certain points in time. We look at traffic accidents or DUIs or any number of other things in order to analyze whether public policy is actually working. These things aren’t 100% reliable, but they are worth looking at. One thing I’ve noticed is that (much like with climate change) when I see someone touting lockdowns as being super effective, they show me a downward sloping chart. Yet, when you zoom out and look at the chart in a much larger context, you don’t see changes in trend that should correspond with these actions, wereas you do see blips for things like monday-reports, testing availability, etc… which shows that those numbers are sensitive enough that they should tell us something more than what we’re seeing.
In the end, we will discover that this virus was something totally different than what we were expecting, and likely in very strange ways. Just as there is no justifiable reason to assume the best, there is also no reason to write off the possibility that some of those surprises might work in our favor, especially when at least some of the evidence appears to be pointing in that direction.
That said, I fully understand your objections. As a lawyer, I am accustomed to finding and addressing the best arguments on both sides, rather than simply pretending they don’t exist. With everything, it is a balancing test rather than an easy black-and-white answer.
So … I remain cautiously optimistic.
I appreciate your comments, and your obvious knowledge on the subject. Thank you.
You’ve made a few comments similar to those I just quoted. My admittedly uninformed impression of the relevance of a two-strains argument isn’t that transmission is the important distinguishing factor, but rather that virulence is the important factor. In that case, we would expect to see both more death and more cases in a city (e.g., NYC) predominately infected by a high-virulence strain: more deaths because that’s what “high virulence” implies; cases because a disproportionate number of all cases are diagnosed when patients present in distress — again something we would expect to see more of with a highly virulent strain.
I do understand the argument that we would have noticed the difference in genetic makeup and found a correlation with apparent virulence. I simply don’t know to what extent current research would have led to such an analysis. And, if testing in California has been focused largely on patients in distress, as it has been in most places, that might tend to select for a (possibly minority) portion of the infected population afflicted with the same more virulent strain as is found in NY.