Commentary

Living in fear

 

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The wiped out bread section at Carrs Huffman/Craig Medred photo

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:

  1. Over 65 years of age.
  2. Male

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.

The danger

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:

“We obtain an overall infection fatality rate estimate for China of 0.66 percent, again with an increasing profile with age.”

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:

  1. Early testing aboard the ship focused on sick people, so some asymptomatic cases might have been missed.
  2. “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.”
  3. “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.

 

 

 

 

 

 

 

 

 

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20 replies »

  1. The biggest problem as I see it is that facts no longer matter for so many people, regardless of political affiliation, regardless of when they even know the facts, regardless of the obvious, and regardless of common sense. They were told it and they believe it.

    People, as a whole, are stupid. Everyday I am more and more amazed at just how stupid we as a species are.

    Got enough toilet paper, just return it since you couldn’t sell it…stupid. We need to be told repeatedly to wash out hands because we can’t figure it out…stupid. If you are sick stay home…stupid. Don’t get on a flying tube during a pandemic…stupid. Don’t go out more than needed during a pandemic…stupid. All of these government mandates are put out for one reason and it is because so many people are so stupid. If this were the disease that killed stupid people instead of the old and infirm we would all be a lot better off. Yeah we warehouse the old and infirm, but the stupid tax we pay is easily tenfold that cost. People of yesteryear only survived if they weren’t stupid, nowadays we elect them and promote them into positions of power, we give them money and tell them to breed and if they do breed we will give them more money, just stupid.

    Sorry about the rant, I’m just tired of all the stupid people.

    • “Don’t go out more than needed during a pandemic…stupid.”

      Steve O,
      Going outside is not a problem, especially in a place like Alaska where there is unlimited wilderness opportunities to stay away from others.
      The problem really is “going in” to stores and airplanes and hospitals, etc.
      What we are seeing is there are a lot of “inside cats” that like to hang out with one another.
      Alaskans should not forget that it is Spring and beautiful outside.
      Fresh air, exercise and sunshine all help strengthen your immune system and help the body build much needed Vitamin D.
      It also relieves the stress of watching the infection count tick up and up every day.
      The Yentna river is in excellent condition right now with a nice hard pack trail.
      With the snow pack we have, I am thinking the winter trail will be good for at least two more weeks for skiing, biking or riding.
      Don’t let the stupid people bring you down, just try and avoid personal contact with them right now more than ever.

      • Steve,
        This is the best part of spring, but may be coming to an end, time for endless mini storm fronts passing thru.Went for a great hike up to Blueberry knoll.
        Gov’t Peak was very tempting, but the ridge trail isn’t blown clear, and with a mostly southern exposure and nothing really to anchor the pack I declined, since I tend to do these things by myself.Might not get found for at least a month with the snow pack up there.

      • You’re right Steve, going outside and away from people is a good thing. It was stupid of me to say “Don’t go out more than needed during a pandemic” the stupid is strong, even with me!

    • Walla – Communism/Socialism. Have no fear, be stupid, the government will take care of you, the stupid. All by years and years of design. 100 years to be exact.

  2. What really scares me is “Lunch Bucket” Joe, Hillary, or Obama in charge at a time like this. What could possibly be scarier – 2 Dementia patients and a bigotted Community Agitator who all hate America? Now that really is scary!

    • Ya, the Bill Gates.. smart dude considering we have had numerous outbreaks that have killed millions already. One 5yrs earliers then his “prediction”. This Covid is nothing. Well, at least not yet.

  3. More people will go bankrupt than die of “Corona Beer” Virus. An alarming number of Alaskans were ill prepared even though we live in an active earthquake zone. One would have thought all would have hade a few months of canned and dried foods and other necessities(TP)………

  4. The waffling around about chloroquine and hydroxychloroquine is a bit odd. This stuff is extensively in-use, around the world. Hundreds of millions have used it, still use it for years & decades, probably billions over the last 70 years. Westerners have frequently been placed on a prophylactic chloroquine regimen, before venturing into a malaria-zone.

    Cholorquine is not without risk. In more than the right amount, it’s a serious toxin, and it’s easy to fatally OD, if you’re careless/stupid. Do not gobble it; if a little helps, more will help more? No.

    There is a variable “tolerance” factor. Many use it without any issue, but with some there can be side-effects. This is widespread issue with all manner of drugs, though.

    So what’s the problem? What’s the hang-up? Is it that the Med folks already know that oldsters tolerate it poorly? I have no idea if that is true: pure speculation. But there must be some reason why Dr. Fauci is waffling, playing-down the value of CQ.

    Otoh, it’s true, as Dave & Craig discuss, that the more-elderly haven’t got long on the clock, regardless. ‘Better yet’, they are generally no longer active participants in the economy, which yeah, is the ‘patient’ we’re most concerned about.

    On the other hand, we have dystopian literature portraying ‘death panels’ for the old, going back many generations. Although mostly not economically productive any more, many elderly remain very important social glue, a ‘touch-stone’ that keeps others going … to lose lot’s of the oldest at once is likely to be very bad for a society.

    In addition to “permanent” vaccines, there are also easier/quicker “short term” vaccines. In the old days, we who needed to get “shots” to serve in parts of the world with endemic dangerous diseases, had to get tested on-schedule to make sure we were still protected, and get “booster” shots or a full repeat.

    Scientifically & medically, it was the short-term vaccine that came first … and this remains a fast route to providing temporary protection. For example, it could serve to protect athletes going to the Olympics. When an outbreak appears to be happening in a nursing home … go in and vaccinate them all, even though the shorty-shot only work for a matter of weeks.

    Temporary vaccines and ‘fade’ contributed somewhat to the difficulty of “eradicating” some diseases. So Medicine may have a (knee-jerk) reaction against using them at all. In fact though, they may be just what the doctored ordered, in our situation, and they are fast to develop.

    In all likelihood, we probably got the modern Sci-Tech, big-Pharma Cavalry comin’ over the hill on the run.

  5. Great reporting Craig,
    The risks of dying are fairly small, good gambling odds that your going to live.But some think the total number of people dying is the only metric to measure.
    If your peeing out your b*tt,your probably not going to work.Now multiply that by whatever total you want to plug in,keeping in mind that it infects in a mathematical progression.On average 2.5 more people per infection.
    The costs to society globally will be staggering,while Im fairly confident we’ll sail through this just fine, we are literally looking at global economic output grinding to zero, if let to play out on its own.
    This will reset future economic growth (besides the obvious valley we are staring at),back a few notches.The debt load alone will be onerous for at least a generation.
    That will be for state and nation.

    Damn fine wx today, not as warm as yesterday, but still great.This is the best part of spring imo, get out and enjoy it.

    https://www.axios.com/coronavirus-latest-news-quick-highlights-57a186a3-7547-45bf-852a-83019849d8d5.html

    • Thanks, Dave. I couldn’t bring myself to put this observation in the story, but for some countries – Italy being one of them – the long-run consequences might turn out to be a net positive at a population level.

      Italy is already spending 16.5 percent of its GDP to support retirees, and looked to be head toward an unsustainable 20 percent by 2040. It has tried to fix that ,but it’s politically loaded issue: https://www.barrons.com/articles/in-italy-pensioners-are-pawns-in-a-fiscal-showdown-51567809403

      Nature might help shrink the population of old Italians closer to the number working Italians can support. Horrible for the families of the dead, but one way to fix things.

      On my way home from a snowshoe in today’s beautiful sun, it stopped to visit a neighbor on Social Security and we got to joking about how if Millenials figure this out we best be on the lookout for some of them trying to come running to hug us.

      • Craig,
        Demographically speaking, most western first world and asian (china/japan specifically) are screwed.There birth rates aren’t keeping up,(Mao’s one family,onechild idea, coming back like a boomerang).
        We are barely net positive birth/death rates, potential for fiscal pain (S.S,Medicade/care,pensions etc) is HUGE.
        This $trillion bug problem doesn’t help any(‘cept for knocking a few off the rolls).There is a global financial liquidity problem which surfaced around Sept,its cause is going to be one of those rear view mirror things.The virus just pushed us off the cliff.
        While there was probably no way for us as a nation to realistically prevent this,no realistic way to see it coming, it will certainly limit our ability to grow.
        For our state especially, it really was/is The Perfect Storm.
        May we please live in less interesting times

  6. Nice to know one party is hard at work helping those in need the most:

    “Speaker of the House Nancy Pelosi’s new stimulus bill would mandate nationwide “ballot harvesting,” allowing party operatives to return other people’s ballots to polling places without “any limit” on the number of ballots.

    “Ballot harvesting” was legalized in California in 2016, and first used in the 2018 midterm elections. It allows anyone to drop off someone else’s mail-in ballot at a polling station. There is no process for vetting or verifying those delivering the ballots — no background checks or identification requirements. Democrats dropped hundreds of thousands of ballots off at polling stations in 2018, helping Democrats as they flipped seven Republican seats.

    The practice is illegal in most other states, largely because it is susceptible to fraud and intimidation.”

    I know, I know, “never let a good crisis go to waste”.

  7. My brother living on Long Island, NY, contracted this about a month ago. He has been down for 4 weeks now. He still feels fatigued and his breathing is better than it was. I asked him if he got tested and he told me that the only way to get tested there is to be Rich or Famous.
    Go Figure!!

  8. The virus has spread throughout Europe, yet most analyses are centered around Italy (where there is a large elderly population) and hospitals were running at their capacity before the pandemic occurred.
    Looking at other countries like Germany (where citizens are more fit) should help some people feel better about getting out and enjoying the fresh spring air and sunshine.
    “While the pandemic has hit Germany with full force, with Johns Hopkins University noting… 22,364 confirmed infections by Sunday morning, only 84 people are so far reported to have died.
    This means Germany currently has the lowest mortality rate of the 10 countries most severely hit by the pandemic: 0.3% compared with 9% in Italy and 4.6% in the UK…
    The age profile of those affected in the first few weeks has also been younger than in other countries, many of them fit and healthy people returning from skiing resorts in Austria or Italy, which would also help explain the low mortality rate.”

    https://www.theguardian.com/world/2020/mar/22/germany-low-coronavirus-mortality-rate-puzzles-experts

    • It’s worse than you thought. I think some new coronavirus might have gotten into my computer and done that. I coronavirus loose in the tubes would be a true nightmare.

      That said, I fixed it and appreciate the cloud editing. Go enjoy the sun.

      • Just a tiny bit of heartburn with the Infection Fatality Rate. I do know that stat is what we have but am gonna play that old saw- we have just about zero in test data. There will be much more in the next couple of weeks. Some are predicting an overall IFR of less that 1/2 of one percent. That is going to change some thinking in D.C.
        Regarding the writing about Italy’s demographics and a possible long term benefit to them, I would point out that the “warehousing” of our seniors in America is a major industry. It seems to be a “protected” industry at this time. As we look back on this maybe folks will say that other than those at risk our procedures were a gross overreaction.

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