About 2.8 million people per year die in the United States from heart disease, cancer, injuries and various other illnesses, according to the data compiled by the Centers for Disease Control (CDC).
On paper, those COVID-19 deaths amount to a 3.6 to 8.6 percent increase in American deaths. In reality, the percentage will be lower.
How much lower? No one knows.
But what is known is that COVID-19 strikes heavily at those with heart disease, diabetes, cancer and other pre-existing illnesses.
Italian doctors who examined the charts of 355 patients who died in that country reported to the American College of Cardiology that they found “heart disease (in) 30 percent; diabetes, 35 percent; active cancer 20 percent; and other serious conditions.”
Doctors in China have reported similar findings as have officials at the CDC. A CDC study released Tuesday reported, that “among all COVID-19 patients with complete information on underlying conditions or risk factors, 184 deaths occurred; 173 deaths (94 percent) were reported among patients with at least one underlying condition.
“These results are consistent with findings from China and Italy, which suggest that patients with underlying health conditions and risk factors, including, but not limited to, diabetes mellitus, hypertension, COPD, coronary artery disease, cerebrovascular disease, chronic renal disease, and smoking, might be at higher risk for severe disease or death from COVID-19.”
Given that some people who die “COVID-19 related deaths,” as the Boston Globe refers to these fatalities, were destined to die from pre-existing conditions such as cancer and heart disease before the year is out, the number of people reported dying from those diseases is sure to drop in 2020.
How much will it drop? Again, no one knows.
What is also obvious is that many if not most Americans are now living in fear of the newest disease to threaten in ways they never lived in fear of those old, established diseases.
“The coronavirus death toll surged past 4,000 in the United States on Tuesday, eclipsing the total from the 9/11 terror attacks as New York City traded ‘Ground Zero’ for ‘epicenter,'” reported USA Today.
The headlines have stirred a social panic which complicates current government efforts at social distancing, according to a team of researchers at the University of Hawaii, who note that “humans are hardwired to seek safety in numbers, but not hardwired to shelter in place.”
In crisis, people seek the safety of the herd. Their instinctive clustering when turned loose from their jobs during a time of crisis has led fearful cities around the country to shut down beaches, parks and other public spaces amid concerns Americans left to their own devices cannot safely practice “social distancing.”
San Francisco closed playgrounds, dog parks and picnic areas, told residents to stay off golf courses and sports courts, banned most construction, and extended until May 3 a “stay-at-home” order as one of the country’s oldest “sanctuary cities” tried to turn itself into an urban interment camp.
The city went well beyond President Donald Trump’s national, month-long directive for “social distancing,” which basically says Americans need to stay at least six feet apart to minimize the risks of infecting each other.
And at this point it would appear no government can really do too much in terms of controlling the citizenry. And worried American media appears to believe Trump is doing too little.
Although COVID-19 deaths – 80 percent of which strike down people over age 65, according to the data – differ greatly from war deaths – which overwhelmingly kill young men in the prime of life – mainstream media and some health authorities are quick to point out that anyone can come down with the disease.
“Many New York Coronavirus Patients Are Young, Surprising Doctors,” Bloomberg headlined Wednesday, although this should not have come as a much of a surprise. China, where the disease is believed to have originated, was reporting similar infection rates across all but the very youngest age groups from the beginning of the pandemic.
After studying global infection rates, researchers reported on Monday in The Lancet, a respected medical journal, that “our underlying assumption, that attack rates (ie. the probability of becoming infected) do not vary substantially by age, is consistent with previous studies for respiratory infections.”
The big difference with COVID-19 is not in who gets infected, but who dies. The dead are overwhelmingly elders in significant part because they are more likely to harbor the pre-existing conditions noted above.
After “adjusting for demography and under-ascertainment,” the researchers wrote, “we obtained a best estimate of the case fatality ratio in China of 1.38 percent with substantially higher ratios in older age groups (0.32 percent in in those aged less than 60 years versus 6.4 percent in those aged 60 years and older), up to 13.4 percent in those aged 80 years or older. Estimates of case fatality ratio from international cases stratified by age were consistent with those from China….
“Our estimated overall infection fatality ratio for China was 0.66 percent.”
The latter number is the key one epidemiologists have been trying to ferret out since the pandemic began. It defines the general risk of dying from this disease. As Oxford University’s Our World in Data puts it:
The infection fatality rate for the common flu in the U.S. is around 0.1, meaning COVID-19 is generally about seven-times more deadly. But the math isn’t that simple given The Lancet data indicating the disease is about 20 times more deadly for those over 60 than for those under 60.
Given the nature of the patients most threatened by COVID-19, some doctors have suggested a path somewhat different from the one now being followed by many states and municipalities, including those in Alaska which have issued stay-at-home orders for everyone but essential workers.
(Editor’s note: No one should take any of what follows as a suggestion to ignore state-at-home orders or abandon social distancing or intensified personal hygiene. All are fundamental means of avoiding any infectious disease. Protect yourself.)
Writing in the New York Times in late March, Dr. David Katz, the founding director of the Yale-Griffin Prevention Research Center at the aforementioned university, compared the global battle against COVID-19 to a real blood-and-guts war, and then made this observation:
“This can be open war, with all the fallout that portends, or it could be something more surgical. The United States and much of the world so far have gone in for the former.”
He warned against the all-out-war strategy as have some others, including scientist Carl Heneghan. Heneghan heads the Centre for Evidence-Based Medicine at Oxford University, and expressly cautioned against the sort of lockdowns now taking place in many countries around the world.
“…There (can) be little doubt that the price of lockdown to society and economic paralysis is likely to be paid for generations to come,” he wrote. “In the short term economic devastation seems certain, imposing a heavy penalty on us and probably successive generations.”
In a bold challenge to the prevailing wisdom, he and colleague Tom Jefferson called the lockdown a false promise.
“Lockdown is going to bankrupt all of us and our descendants and is unlikely at this point to slow or halt viral circulation as the genie is out of the bottle,” they wrote. “What the current situation boils down to is this: is economic meltdown a price worth paying to halt or delay what is already amongst us?”
The idea has gained some traction in the medical community, but not much. Political leaders, meanwhile, have largely gone in the opposite direction. The United Kingdom suggested it might let the virus spread enough to create what is known as “herd immunity,” but quickly backed away when some scientists and the public protested.
The Dutch suggested the same idea, backed away, but are now studying it. Meanwhile there is the suggestion from many scientists that herd immunity is in some way inevitable.
In Singapore, which dealt with an early outbreak of COVID-19 and is now facing another wave of infection, Teo Yik Ying, the dean of the Saw Swee Hock School of Public Health at the National University of Singapore, on Thursday told CNBC, he expects hot spots of infection to shift around the globe until enough people who have caught it develop antibodies to fight it off.
At that point, the disease becomes unable to easily jump from person to person and fades out. This is herd immunity. Unfortunately, some pathogens – most notably the flu – are able mutate and again return.
Katz and Heneghan have suggested that the best way to get herd immunity might be to shelter those vulnerable to fatal COVID-19 infections and let the disease run much like the flu in the rest of the population.
“The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are ‘mild’ and do not require specific medical treatment,” Katz argued in his NYT op-ed. “The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are.”
But responding to COVID-19 in this way at a population-level generally runs counter to the beliefs of Western societies that prize individuals. The mere possibility that a previously unknown disease could kill younger people – and it has – appears to terrify much of the Western world.
Thus Katz’s suggestion of an alternative approach aimed at protecting the elderly and those at risk because of ill health while putting everyone else back to work has to date gained no political support.
Whether it will ever gain serious consideration is an unknown, but there are more than a handful of scientists who share Katz’s concerns about long term problems inherent in the current strategy.
“If we succeed in slowing the spread of coronavirus from torrent to trickle, then when does the society-wide disruption end?” Katz asked. “When will it be safe for healthy children and younger teachers to return to school, much less older teachers and teachers with chronic illnesses? When will it be safe for the work force to repopulate the workplace, given that some are in the at-risk group for severe infection?
“When would it be safe to visit loved ones in nursing homes or hospitals? When once again might grandparents pick up their grandchildren?
“There are many possible answers, but the most likely one is: We just don’t know. We could wait until there’s an effective treatment, a vaccine or transmission rates fall to undetectable levels. But what if those are a year or more away?”
The answer to most of those questions to date have been driven by fear. The public and political view is that COVID-19 needs to be stopped and stopped now, although there is no hope that is going to happen.
When health professionals talk about “flattening the curve,” something which does appear to be working, they are not talking about reducing the number of COVID-19 infections. They are talking about spreading them out over a longer period of time to reduce the number of people in need of hospitalization when infections reach their peak.
The belief is that if the peak can be held down, more people can be treated more effectively in hospital and thus fewer people will die, though people will die. Lots of people will die.
The federal prediction of 100,000 to 240,000 deaths is based on continuation of the curve-flattening provisions in place across the country today. Those provisions vary from state to state but are approaching the point of a nationwide lock down.
As death rates climb, protective measures aimed at keeping Americans in their homes and away from each other are only increasing. Thirty-eight states now have formal stay-at-home orders in place.
Florida, which had been reluctant, just joined them. Gov. Ron DeSantis had “resisted issuing a statewide order of this kind up until this point more than 30 days after the first case of the virus was reported in Florida, but on Wednesday, as Florida’s coronavirus cases neared 7,000, including more than 80 dead, he said it was time,” Orlando’s WKMG News reported.
New York has been under such an order since March 20, but the number of infections and the death toll continue to rise. Many states and cities with lock downs plan to continue them at least through the end of this month.
University of Alaska Anchorage researchers have warned the Municipality of Anchorage that the university’s COVID-19 model indicates the current policy of sheltering in place in the state’s largest city should tamp down the number of infections, but “predicts a rebound of cases will occur in July.
The reality is that no one knows exactly how or where this pandemic ends, but all the experts are talking about it ending the way most similar pandemics have ended and that is with some form of acquired human resistance to the pathogen, either through herd immunity – as in the case of the Spanish flu – or thanks to some form of vaccination – as was the case with small pox which once had a case fatality rate of 30 percent. (Three out of 10 people who came down with the disease died.)
“A pivot right now from trying to protect all people to focusing on the most vulnerable remains entirely plausible,” Katz wrote in his March 20 NYT op-ed. “With each passing day, however, it becomes more difficult. The path we are on may well lead to uncontained viral contagion and monumental collateral damage to our society and economy. A more surgical approach is what we need.”
Now, Americans can all only hope that Katz was wrong, and that we aren’t headed for “monumental collateral damage.”