Let's discuss mortality and long-term primary impacts caused by the pandemic. This is the 6th installment is a series about COVID-19. We'll save economic and other secondary impacts for next time.
Sorry for the long break between entries -- I've had a couple things going on, and this one took longer than some of the others to put together.
Original reported death rates
On March 1, 2020, China was reporting ~4.1% of known cases ended in death. Italy was reporting over 7% around the same time, and by mid-March Italy was shutdown and recommending others do the same, though they were reporting closer to China's 4% by then. With a US population of ~310,000,000, a 4% death rate would have resulted in possibly over 12 million dead. For good reason, the whole world was apprehensive.
As you likely recall, there was a great push to "bend the curve." The most immediate need for that was to decrease the strain on health systems, but another aim was to give time for the world to understand how to better treat the disease. That has luckily been partially successful.
When President Trump recently went to Walter Reed Hospital, he took remdesivir, dexamethasone, an antibody cocktail, and vitamin supplements, plus supplemental oxygen. Only the last was a treatment widely used at the beginning of the pandemic.
Here are some of the pharmaceutical approaches that have had varying degrees of success:
- Drugs that calm the immune system, like dexamethasone and hydrocortisone. Steroids have been, by far, the most effective, decreasing the death rate by up to 1/3rd for those on ventilators, and 1/5th for those on oxygen.
- Antiviral drugs, like remdesivir, have also shown promise. They do not appear to actually decrease risk of death, but they do decrease time in the hospital (from 15 to 11 days). That decrease helps flatten the curve, decrease overall spending and fatigue on the system, and in general is more helpful than it might appear at first blush. A related item is the interferon-beta enhancers, which appear to be showing promise.
- Antibodies, like from the plasma of those who have recovered and from the lab, have shown some impact, but the studies as of yet haven't been conclusive. President Trump recently received a cocktail of antibodies to help his immune system.
Some treatment paths haven't been well explored but show a bit of promise, such as Vitamin D supplements, and even high doses of Vitamin C. And putting patients on blood thinners has been effective enough that it is common practice now.
A couple of areas that have been explored but showed no efficacy were HIV and malaria drugs. Neither showed any benefits, so only the side effects were left.
There have also been non-pharmaceutical approaches to treatment that have resulted in better outcomes:
- Keeping patients at home unless they need to be in the hospital, freeing up hospital resources while keeping patients from incurring costs or risks.
- Delaying ventilation as long as possible, keeping the trauma of that treatment from causing negative outcomes.
- A somewhat effective treatment is having COVID-19 patient lie in a prone position.
All of this has meant that health systems have been able to focus more attention on each patient that needs the attention, which is the main reason to bend the curve in the first place. And it works.
Death rates now
It appears that the likelihood of death, if you are infected, is somewhere around 0.6%, about 1/7th what it was was feared to be in March, and about 6 times as bad as the seasonal flu. Using the same math I used earlier, if everyone in the US gets it, that leaves 1.86 million dead, or rougly 1.3 million if it takes 70% to reach herd immunity, assuming that the vast majority of people that get it will not get it again anytime soon ... which is a very large assumption. Even though you see people want to argue otherwise, we are only around 10% infected so far ... which roughly matches these numbers.
It still matters where you are, of course. Assuming you are in a country where you can get good care, and assuming that there is neither a breakthrough in treatment or an evolution of the pathogen, the major concern is transmission. If you are in New Zealand, you basically aren't getting it, but if you are in the mid-west of the US a couple months after the Sturgis biker rally ... you have more to worry about.
Here are a couple more detailed ways to view it, either week by week or just by the changing rates and what it tells us. And don't forget to look at excess deaths, too, as we know that different countries (even different states) report whether COVID is the cause of death differently.
Now, of course, everyone knows that COVID is not an equal-opportunity killer. By far, the biggest risk factor is age. If you are under 50, you chances are dying are less than 1%, for sure. But the numbers go way up from there, and once you get into your 80s, the chances are more than 1/8, and maybe as high as 1/5.
Beyond that, there are comorbidities that matter quite a bit. If you have diabetes, heart disease, hypertension, COPD, or cancer, your rates are much, much higher. And men have worse outcomes, too -- roughly 3/5ths of the deaths are men.
And, as should not be a surprise to anyone paying attention to how these things usually go, it is worse to be a person of color. Black people are 5 times as likely to be hospitalized and twice as likely to die.
It is definitely interesting to see how people deal with the fact that they could easily be carriers but are less likely to die themselves. It is a real-life trolley problem variant: If it will inconvenience you but is unlikely to kill you, but much more likely to kill someone else, what do you do?
Long-term primary impacts
With the 220k deaths already in the US, and the numbers headed toward a 3rd spike and likely to keep going until we get a vaccine or there is a huge change in the populace's approach, mortality is a big deal. But what seems to me to be a bigger deal than most people realize are the long-term impacts from those that get it but do not die.
First, there is the list of people that keep COVID for a long, long time. These "long haulers" have the same symptoms as other people, but the symptoms just won't go away. They cannot work or think or function normally. That's a small but substantial group, and worth mentioning just because you can have the primary symptoms for ... no one knows how long.
Beyond those, the disease appears to do significant damage to people. A few of the major areas are heart, lung, and neurological:
- Heart damage: As high as 75% of adults with COVID have damage done to their heart, even when the symptoms are light. How long will we be dealing with that? How many people will have heart attacks or other problems for years to come, with shorter life spans and quality of life?
- Lung damage: Unsurprisingly, people have lung damage, and while most of the severe damage goes away in most people, there are many that have visible damage months later, and it is suspected that the lungs may be more susceptible to pathogens later.
- Neurological damage: Besides the long haulers, some other people are having lingering effects including headache, dizziness, lingering loss of smell or taste, muscle weakness, nerve damage, and trouble thinking or concentrating.
Beyond that, there is growing evidence that those infected with COVID-19 sometimes develop kidney damage and contract both type-1 and type-2 diabetes in the short term, and there is a group that will be monitoring long-term effects. Because diabetes has so many comorbidities, this could important for years to come.
One of the major symptoms of COVID is inflammation, and that and other immune responses can persist and cause long-term damage. Beyond the above, this can lead to all sorts of nastiness, including increased susceptibility to virtually everything.
So, even if we ignore that we will have maybe 10 times the number of annual flu deaths this year, we will have a long tail of health consequences for years -- probably decades -- to come, caused by COVID-19. Implementing an effective long-term strategy to decrease these primary issues is vital. The US has not yet done so, as the 3rd spike as we head into flu season shows.
Next time, I'll discuss economic impacts, plus secondary impacts caused by responses to the pandemic, including mental health, fear of going to the doctor, philanthropic decline, and others.
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