As we hunker down in fear before a microscopic pathogen we cannot see, I am not ashamed to admit to being afraid.
But it is not the coronavirus COVID-19 that scares me. It is the thought of a global economic collapse driven by panic surrounding a virus because the reality is we cannot hunker long without the economy imploding.
Global commerce is the whale that sustains us, and it can only stay underwater for a limited time before it suffocates. And then we are in bigger danger than we are now.
Yes, I know, I should fear the virus. I am part of two dangerous cohorts:
The Sunday analysis out of The Centre for Evidence-Based Medicine at Oxford University reflects that the case fatality rate continues to jump dramatically with age from 0.32 percent for the 20-49 age group to 1.3 percent for the 50 to 59 age group and then pretty much doubling for every decade-sized age group thereafter.
By 80 or older, it’s up to 14.8 percent. If you are in that age group or have grandparents in that age group, the disease is indeed terrifying. If they are already suffering from cardiovascular disease, diabetes, lung disease or a few other ailments, the risk approaches horrific.
In Italy, a country in crisis, the new analysis noted, COVID-19 has declared war on the elderly; “the average age of deceased and COVID-19 positive patients was 79.5 years. The median age of the patients who died was more than 15 years higher than that of patients who contracted the infection (median age: patients who died 80.5 years – patients with infection 63 years).”
Oxford’s meta-analysis did, however, question whether the frightening COVID-claimed death rates coming out of Italy are accurate, noting there is a difference between those who die “with” COVID-19 and those who die “from” COVID-19.
This is no solace for the family’s of the dead, but the reality of life is that grandpa and grandma are eventually going to die. Compounding “with” and “from” in data reporting COVID-19 fatalities only adds to the anxiety that is good for none of the living who are going to be dealing with this disease for months if not years.
No matter what we do as a society to try to slow the spread of COVID-19 – and that’s all health officials are talking about when they describe “flattening the curve” – this disease is going to be with us for some time.
And what we know about chronic stress would indicate it can only serve to acerbate an already troubling situation.
“Chronic stress has a significant effect on the immune system that ultimately manifest an illness. It raises catecholamine and suppressor T cells levels, which suppress the immune system. This suppression, in turn raises the risk of viral infection,” as one highly cited, peer-reviewed study noted years ago.
Chronic stress has been linked to increases in rates of diabetes, asthma attacks, ulcers, atherosclerosis, and mental illnesses. There are suggestions as well of links to various cancers.
As of yet, no one has calculated how many people the pandemic fear of the moment might lead to worry themselves to death, but it is almost certain researchers will one day do so as public health officials today walk a fine line between informing people of the danger and scaring the bejesus out of them.
If you are old and are infected by COVID-19, there is every reason to be scared, too. The same is true if you suffer from heart disease, diabetes, lung disease, cancer or other preconditions.
A March 17 analysis from from the Italian National Institute of Health found 355 out of 358 fatalities examined in that country involved people with prior medical conditions. That study reported that of the dead:
- 49 percent had three or more health conditions
- 26 percent had two other ‘pathologies’,
- and 25 percent had one.
If you are healthy, however, and especially if you are young, the reasons to fear shrink. An international team of scientists trying to put their finger on the severity of COVID-19 looked at all the data from China, which has to date borne the brunt of this pandemic, and offered their conclusions in a paper published online 10 days ago:
The study has yet to be peer-reviewed, but it was completed by a team of about three dozen researchers associated with Imperial College London. It notes, in particular, that “at the start of an epidemic when diagnostic capacity is limited…estimates of the case fatality rate (CFR) may thus be biased upwards until the extent of clinically milder disease is determined.”
That is exactly where the world is at today. There is widespread fear spawned by a CFR that reflects the high number of deaths among those hospitalized with COVID-19 while little remains known about those who come down with milder forms of the disease.
Lara Woolfson, a 36-year-old Boston photographer, told Boston TV News that shortly after being diagnosed with the disease she spent “a full week of being in bed being the sickest I had ever been,” but recovered.
“I’m watching the stories that are coming out about the virus and they’re scary, terrifying,” she said, but they don’t match her experience.
The experiences of people like Woolfson, or those who might have contracted COVID-19 in an even milder form or remained asymptomatic, are what make it so hard for epidemiologists to get a handle on exactly how deadly COVID-19.
The London researchers, however, believe they were able come up with a good estimate based on the polymerase chain reaction (PCR) “testing of international Wuhan (China) residents returning on repatriation flights.” Their calculation, the study adds, “is consistent with the IFR (infection fatality rate) observed to date in passengers on the Princess Diamond cruise ship.”
An IFR of 0.66 is about seven times that of the common flu, and higher than the rate for the H1N1 flu that was declared a pandemic in 2009. But it is lower than for severe acute respiratory syndrome (SARS) or MERS – two other coronaviruses which have proven deadly in recent times.
The London scientists were sadly skeptical the spread of the disease can be contained and warned that “much of the world will experience very large community epidemics of COVID-19 over the coming weeks and months.”
In that context, it is worth a look at the closest thing to a laboratory experiment conducted with COVID-19 and humans.
Floating test tube
After COVID-19 was diagnosed in February on board the Diamond Princess, a cruise ship owned by Princess Cruises, the Japanese government responded by ordering everyone on the ship held there in quarantine.
The Japanese handling of the incident was widely criticized for maximizing the exposure of passengers and crew to COVID-19. Due to how the situation was handled, a Japanese expert on contagious diseases who went aboard the Diamond Princess felt more threatened by COVID-19 there than he had been Ebola while working in Africa or SARS while working in China, the BBC reported.
Basically, what the Japanese did was turn the Diamond Princess into a floating test tube for a study on the transmission of COVID-19. The results of that accidental experiment were on March 12 reported in Eurosurveillance, a journal on infectious disease surveillance, epidemiology, prevention and control.
“After the scheduled two-week quarantine came to an end, a total of 634 people including one quarantine officer, one nurse and one administrative officer tested positive for SARS-CoV-2,” the study reported. “These individuals were among a total of 3,711 passengers and crew members on board the vessel.”
Thus 17 percent of those aboard the Diamond Princess came down with the disease while confined with known COVID-19 carriers, or 83 percent of those aboard escaped infection after being dangerously exposed in the eyes of at least one expert on infectious diseases.
The situation can be viewed either way.
“Of 634 cases, a total of 313 cases were female and six were aged 0–19 years, 152 were aged 20–59 years and 476 were 60 years and older,” the study said.
Thus 75 percent of those infected were 60 or older. This reflects what has been seen in China and Italy, although it is unclear why older people are more susceptible to COVID-19 than younger people. And it is worth noting the Diamond Princess sample is weighted toward old people who made up the majority of cruise ship passengers.
“Of the 634 confirmed cases, a total of 306 and 328 were reported to be symptomatic and asymptomatic, respectively,” the study says.
This would mean that about 52 percent of those infected didn’t get sick, and that of the total number of people aboard the Diamond Princess only 8 percent (306/3,711) experienced health issues related to their exposure to COVID-19.
Of those, six or about 2 percent have been reported to have died.
The scientists did note some serious limitations to their study, however:
- Early testing aboard the ship focused on sick people, so some asymptomatic cases might have been missed.
- “Most of the passengers were 60 years and older,” which might have led to an underestimate of what the proportion of asymptomatic cases might be in other populations “if older individuals tend to experience more symptoms. An age standardized asymptomatic proportion would be more appropriate in that case.”
- “The presence of symptoms in cases with COVID-19 may correlate with other factors unrelated to age including prior health conditions such as cardiovascular disease, diabetes, and/or immunosuppression. Therefore, more detailed data documenting the baseline health of the individuals including the presence of underlying diseases or comorbidities would be useful to remove the bias in estimates of the asymptomatic proportion.”
The researchers reporting in Eurosurveillance lacked access to the latter data. Where it has been collected elsewhere, it shows COVID-19 striking hard at those with so-called comorbidities.
In China, the data indicates that less than 1 percent of people lacking pre-existing conditions die if identified as sick with COVID-19, and the Chinese percentage appears inflated because of the lack of information on mild and asymptomatic cases in that country.
That said, the Eurosurvelliance researchers did conclude that the Diamond Princess experiment underlined the value of social distancing.
“Most of the infections on board the Diamond Princess cruise ship appear to have occurred before or around the start of the two-week quarantine…which further highlights the potent transmissibility of (this) SARS-CoV-2 virus, especially in confined settings,” they wrote. “To further mitigate transmission of COVID-19 and bring the epidemic under control in areas with active transmission, it may be necessary to minimize the number of gatherings in confined settings.”
So hunker down.
And then hope or pray, if you pray, that when we’re done hunkering we will have flattened the curve enough that everyone can go back to work before an economic stutter becomes an economic meltdown.