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News analysis

Six months into the worst pandemic to sweep the globe since the Spanish Flu more than a century ago, it should now be clear to everyone that the SARS-CoV-2 virus that causes the sometimes deadly disease called COVID-19 is not going away.

Alaska emerged from a two-month-long lockdown intended the flatten the bell-shaped curve of epidemic acceleration that worked right up until the time the lockdown ended.

The state reported a record 46 new cases on Thursday,  almost three times as many as that peak of 17 back on March 23. Reported infections have been climbing steadily late May with no indication the peak of a new curve is anywhere near.

Part of the increase is clearly due to a jump in tests from less than 2,000 in March to almost 136,000 the other day. Over the same span of time, the rate of positive tests fell from 4.04 percent to 1.24 percent.

But the infection numbers, which the mainstream media reports like a sports box score with no context, are enough to scare the bejesus out of those who aren’t totally oblivious to the idea this disease could kill them.

There is no ignoring the fact that when it comes to the danger posed by COVID-19 some Alaskans – especially some older Alaskans – are in denial, which makes this a good point at which to consider Sweden, which has been scientifically recognized for its “high quality virtually complete register of all deaths.”

That register now tells an interesting story about who COVID-19 kills.

Global whipping child

Anyone who has been reading the mainstream media is likely aware of the narrative that Sweden made a mistake by foregoing a lockdown and simply advising its citizens of the dangers and the need to avoid each other to limit the spread of this contagious virus.

It has now been repeated over and over that the per capita death rate is higher in Sweden, a country of about 10 million people, than in the U.S., a country of about 330 million spread across most of a continent.

The narrative ignores the broad difference between the U.S. states, all of which have handled this pandemic differently, and the inherent social distancing in lightly populated states that pull the national death rate down.

Alaska per capita mortality stands at 2.3 per 100,000 at this time. New Jersey is at a national leading 174.8 per 100,000 – 76 times greater. New York is at 166.3 per 100,000.

In general, the states in the U.S. Northeast are pushing the death rate up while those west of the Mississippi are pulling it down.

Sweden’s death rate is 54.5 per 100,000, less than a third of that of New Jersey.

Sweden is a country about the size of California. California today has a death rate of 17.3 per 100,000, but the infection rate there is accelerating. The Mercury News in San Jose was this week reporting some hospitals in counties along the Mexican border are being “overwhelmed”  with COVID cases, forcing them to start transferring patients to hospitals in the San Fransisco area.

Still, there is no denying that Sweden’s death rate is much higher than that of the neighboring countries in Scandinavia and that Sweden screwed up, something that Anders Tegnell, the epidemiologist in charge of Sweden’s response to COVID, has admitted.

The elderly in the country were not adequately protected.

Sweden is home to almost 2 million people over 70 and the death rate among them can only be called horrifying. More than 5,000 are dead. The mortality numbers would indicate they died at a rate of about 260 per 100,000.

That’s more than one and a half times the rate in New York where refrigerator trucks stuffed with bodies lined the streets because the morgues didn’t have space for all the dead. 

The death rate among the elderly is, however, only half the story.

Two diseases in one

The Swedish data, which is more complete than that for most countries, paints a wholly different picture for those under 70. The death rate among those 8 million is closer to 7.5 per 100,000.

Only about 600 people under the age of 70 are dead. Subtract the 375 in the 60- to 69-age group, and the number drops to about 225. About 6.6 million Swedens are under the age of 60. 

The data would indicate a death rate among them of  3.4 per 100,000. People in Sweden are still dying from COVID-19 and that number will increase. But even it doubles by the end of the year, it will come up short of the normal, annual death rate for influenza and pneumonia in the country.

The World Health Rankings report a death rate of 9.17 per 100,000 for influenza and pneumonia in Sweden. The country has among the lower rates in the world. In Japan, where people regularly wear masks thinking those will protect them from infectious respiratory diseases the comparble death rate is more than two and half times higher at 24.28 per 100,000.

Deaths from influenza and pneumonia are – like COVID-19 – weighted toward the elderly who die at higher rates for all diseases. That makes it impossible to make direct comparisons between those death rates and those COVID-19 death rates for Swedes under 60.

Still, it is clear COVID-19 is a different disease for the young than the old. Sweden reports the death of only 69 people under age 50. The number drops to 25 under the age of 40, nine under the age of 30, and one under the age of nine.

What has been seen in Sweden is reflected around the world although that data is often not as complete. The latest U.S. Centers for Disease Control data shows that 97 percent of the more than 112,000 people it has recorded dead of COVID-19 in this country were 45 years of age or older.

The number of deaths in the group age 45 to 54, meanwhile, is about double that for all ages under 45, but in the bigger picture, people 55 and older still account for about 93 percent of COVID-19 deaths in this country.

Suffice to say, the disease is twice as dangerous for those 45 to 54 as it is for those younger than 55, and the risk steadily and markedly increases with age from then on. Some of this –  it is unclear how much – is connected to the fact that a lot of older Americans already suffer from chronic illnesses – heart disease, various cancers, diabetes, kidney disease, AIDS and a variety of other ailments that would have proven deadly a century ago but now can now be managed with modern medicines.

This is not to say that a lot of younger people don’t catch COVID-19 or suffer significantly before their bodies beat it back. A lot of younger people who catch the disease and survive describe it as a living hell as did Mille Porsild, an Iditarod Trail Sled Dog Race musher who fell ill. 

The state of Alaska reports 83 percent of the people diagnosed with COVID-19 here are under the age of 60, but the state reports the death of no one under the age of 30.

Two people in the 30 to 39 age group have died, but all of the rest of the deaths in the state have been of people 50 or older. And people 60 and older account for 14 of the state’s 17 fatalities. 

Another path?

When the COVID-19 pandemic was first erupting in the U.S., Dr. David Katz, the founding director of Yale University’s Yale-Griffin Prevention Research Center and a past president of the American College of Lifestyle Medicine, suggested the country accept the age-related dangers of COVID-19 and respond accordingly by protecting the most vulnerable Americans and letting everyone else go back to work.

On his web page, he continues to push what he calls the #TotalHarmMinimization plan. Basically, it calls for social distancing and good personal hygiene from everyone coupled to a scaled system of increasing protections for those over age 60 or suffering from illnesses that make them more susceptible to COVID-19.

Healthy people age 60 to 74 would be discouraged from working anywhere other than from home, advised to avoid social gatherings, and told – like everyone else – to avoid high-risk individuals. Those 75 and older would be restricted from schools, worksites and social gatherings; allowed regular testing and health monitoring; and more.

The idea – whether fronted by Katz or anyone else – has recieved little attention in the mainstream media since Katz wrote a column for the New York Times (NYT) suggesting an economy-wrecking response to the pandemic could be “worse than the disease.”

There was near immediate push back from other medical professionals and from the media.

Nine days later, Katz appeared on CNN where NYT Science and Health writer Donald McNeil called the op-end “an extremely dangerous way of thinking” and demanded the doctor “take that paper back and apologize for it because I think it provided a scientific underpinning for (President) Donald Trump to say things like the cure is worse than the disease.”

McNeil called for a lengthy lockdown to save lives, arguing “we’re not going to be able to think about our 401Ks or take retirement at the time we want to. We’re going to have to think about getting enough calories, for perhaps the next year until a vaccine is here.”

Since then, with the economy faltering and peaceful Black Lives Matter demonstrations sometimes morphing into riots in some U.S. cities full of young Americans out of work, the idea of a year-long lockdown has shown itself unrealistic and the country is going to back work on the premise that universal face coverings are the solution.

Whether that is the case or not though is unclear.

A U.S. National Academy of Sciences study suggesting they are the magic bullet has been criticzed by hundreds of researchers who think it so badly riddled with “methodological flaws” that it should be withdrawn. 

And French researchers have concluded that “compulsory mask wearing helps resume activity but has no impact on the epidemic.” They suggested it might even make things worse by encouraging people to closely mingle instead of socially distance.

“In our calibration, with an 82 percent reduction in virus transmission, the total effect of compulsory mask wearing remains positive but its impact is quite small: The reported cases and cumulative deaths are nearly indistinguishable with and without masks,” Cecile Aubert and Emmanuelle Augeraud-Veron from the 579-year-old University of Bourdeaux reported.

“The overall dynamics of the reported number of cases is nearly unchanged, and the number of deaths weakly decreases. The lack of impact of masks on epidemic dynamics comes from a crowding out effect: Compulsory mask wearing reduces the peak distancing effort level by one sixth. This negative impact is compensated for in the transmission process by the effectiveness of the mask at protecting others. (But) if mask wearing happens to be less effective than the 82 percent we use, it’s overall effect can be negative on transmission. This holds even though we assume that individuals do not believe that the mask protects them.”

As with so much of the material in the mountain of COVID-19 research pouring out of universities from around the world, the study has yet to be peer reviewed. But it’s hard to argue with its conclusion that masks help resume activity.

Nationwide, as in Alaska, Americans are masking up and going back to work even though the number of new COVID-19 cases in the U.S. have been climbing steadily and steeply since late June.

Worldometers

More than 61,000 new infections and 960 deaths were reported in the country Thursday, according to the the Worldometers tracking site. 

The efforts to protect the vulnerable suggested by Katz are nowhere to be found. It would look a lot like the U.S. is masking up and going the Sweden route without admitting it is going the Sweden route.

And the situation is now so tangled in the partisan politics that have been making the nation ever more tribal for years that is seems that some people – like the NYT’s McNeil – don’t really want to talk about options for mitigating the pandemic’s economic and death tolls for fear that if things get better, Trump’s chances of re-election might improve.