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This year in the USA we’ve had around 35 million cases of influenza with around 35,000 deaths, for a fatality rate of 0.1%. That’s a pretty typical year, although a couple of years ago we lost 80,000 people one flu season. That was considered to be a bad year, but it barely made the papers. After all, it’s influenza. It happens.
Meanwhile, we’ve had a grand total of 282 deaths from COVID-19 so far and not only has this made the papers, we’ve essentially shut down our society and our economy. This has struck me as odd from the beginning. I’ve had the feeling that I simply must be missing something. So I’ve spent the last few weeks reading all the data I could find on this topic from the World Health Organization, the CDC, and various other data sources. Today I read an outstanding article from Aaron Ginn. I know a lot more about COVID-19 now, but I’m still confused.
Let’s consider three countries and their experiences with COVID-19:
- Italy has 778 cases per million population, with a fatality rate of 8.5%.
- South Korea has 172 cases per million population, with a fatality rate of 0.1%.
- The United States has 67 cases per million population, with a fatality rate of 0.1%.
Italy has essentially locked down its entire country. South Korea has done very little in terms of public policy but has encouraged common-sense personal hygiene practices, like hand washing. The United States is somewhere in between. So suppose you’re a politician and you’re trying to explain the benefit of draconian government actions in response to this virus. How would you present your argument, based on those numbers?
The best controlled study group we have available for this disease is The Diamond Princess. From an infectious disease standpoint, this was close to a worst-case scenario. During its two-week “quarantine,” it turned into essentially a floating petri dish. It had 3,711 people on board, including staff and passengers. It started out with ten COVID-19 cases. Two weeks later, it had 705 cases, and seven of them died. What a fiasco.
But let’s stop and think about that for a moment. First of all, with 705 cases and 7 deaths, that means a fatality rate of 1%. And remember that this is an extremely elderly population, away from their homes, under living conditions that were far from ideal, in a closed environment that was absolutely flooded with the COVID-19 virus. Health care facilities were woefully inadequate. The average age on the Diamond Princess was 58, and 33% of the passengers were over 70. All seven of the deaths were in those over 70.
There were no children on board, to skew the numbers toward the more mild form of COVID-19 that children get. Only old people. Old people who are traveling, tired, away from home, and spending two weeks sitting in their tiny cabins in a floating petri dish being flooded with the COVID-19 virus. And of those 3,711 people, there were 7 deaths.
So of the 3,711 (mostly elderly) people trapped in that worst-case scenario, 0.2% of them died.
Surely we can do much, much better than that 0.2% fatality rate here.
The American population is much younger and healthier than the Diamond Princess passengers, we are not cooped up in a floating petri dish for weeks at a time, we have good health care facilities, and we can respond to problems much more quickly and intelligently than they did.
Plus, huge segments of our population are not seriously threatened by COVID-19. Children, for example.
An article in JAMA from February pointed out that of the 45,000 cases of COVID-19 in China at the time, only 2% were in children, and there were no deaths in children under 10. So far this flu season, we’ve lost 136 children to influenza. But COVID-19 does not seem to threaten kids. On March 8, the Korean Centers for Disease Control and Prevention reported that South Korea had 6,300 cases of COVID-19, but no deaths in anyone under 30.
The World Health Organization has been studying COVID-19 all over the world for months now, and reports: “Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around. And the children tend to have a mild disease.”
So children do not seem to act as a vector to give this disease to older family members. And if older family members give the disease to children in the home, children get only a mild form of the disease.
So why are we closing schools? Not due to data or evidence, that’s for sure. “Just to be safe.” Or “out of an abundance of caution – it’s all about the children.”
Ok, but these actions are not without consequences. Much of the hoarding and other unhelpful behaviors we’re seeing right now are not due to fear of the COVID-19 virus, but rather due to fear of ever-increasing government crack-downs on personal liberties.
As Mr. Ginn states, “Infection isn’t our primary risk at this point.”
I’ve spent an enormous amount of time reading, and trying to figure out why we’re responding this way to this virus. I now know a lot more about COVID-19, but I still don’t understand our response.
As I mentioned in a previous post, I think a big part of the problem is that we, as a society, have lost the ability to consider risk-benefit ratios with any semblance of reason or logic. The herd mentality and panic-mongering on social media don’t help. The conventional media earns a living on advertising dollars, so they endlessly repeat the scariest scenarios they can think of, to attract viewers. Politicians, of course, want to exaggerate every problem so they can portray themselves as our indispensable saviors.
There really is no one who is motivated to present a more reasoned perspective. No one.
Plus, people naturally love bad news and are skeptical of good news. A patient can come to me with a headache, I can do a complete history and physical, complete with labs and X-rays, and then finally tell the patient, “You’re fine. Go home and take some aspirin.” And they’ll respond, “Are you sure? I think something’s really wrong…”
Or I can have the exact same patient come in, with the exact same headache, and I can just walk in the door and holler from across the room, “You’ve got brain cancer. You’re gonna die.” And the patient will respond, “I knew it. I just knew it.” They don’t even question me. Because people love bad news.
So, in summary, I think we have a serious problem here, which has no clear solution. A very, very serious problem.
And it’s not COVID-19.
Note: I thank Aaron Ginn for his outstanding article. Please read the whole thing. Some of my writing above was based on (or in a couple of cases, shamelessly plagiarized from) his work. He covers a lot of topics that I skipped, he does a good job citing his sources, and he explains his logic clearly. It’s very long, and I was afraid that most would not read it, so I compiled the above summary. But please read Mr. Ginn’s article. It’s worth your time.