Are We Overreacting to COVID-19?

My recent thoughts on COVID-19:

Here’s an editorial from the New England Journal of Medicine published yesterday (March 26th): Link

“On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%. In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

“Either children are less likely to become infected, which would have important epidemiologic implications, or their symptoms were so mild that their infection escaped detection, which has implications for the size of the denominator of total community infections.”

In an NPR article on why death rates from Coronavirus can be deceiving (Link), the author says this:

“In Italy, about 10% of people known to be infected have died. In Iran and Spain, the case fatality rate is higher than 7%. But in South Korea and the U.S. it’s less than 1.5%. And in Germany, the figure is close to 0.5%.

So what gives?

The answer involves how many people are tested, the age of an infected population and factors such as whether the health care system is overwhelmed, scientists say. Also, because of the way countries monitor pandemics like the coronavirus, he says, the case fatality rate tends to decrease over time. The reason: When a new disease first shows up, testing usually focuses on severely ill people who are at high risk of dying. Later on, testing is more likely to include people with milder illness who are less likely to die.

That’s what happened with West Nile virus, which appeared in the U.S. in 1999. At first, when scientists only knew of about a few dozen cases, it appeared the mortality rate was higher than 10%. But wider testing eventually found hundreds of thousands of people who’d been infected but never got sick enough to notice. Today, more than 3 million Americans have been infected and studies show that fewer than 1% become seriously ill.”

Looking at real time data for Coronavirus statistics, it shows 25,360 deaths and 559,351 confirmed cases.

25,360 / 559,351 = 4.5% fatality rate

The problem with that figure is that the denominator only counts people who have been tested and tested positive. How many people have it and aren’t tested either because their symptoms are mild or because they can’t get a test (test shortages, they don’t meet the (sometimes strict) testing requirements, etc? If we are capturing 25% of the cases with testing, then the new denominator is 2,237,404.

25,360 / 2,237,404 = 1.1%

Personally, I don’t think we’re catching even 25% of the cases with testing, so that number could be well south of 1%. Whatever the number is, we have to compare it to the cost of the public policies we’ve chosen which are hurting the economy and leading to job losses. Some people view this as a people dead vs money thing. And that’s wrong. It’s people dead vs people dead. Unemployment kills people too.

If the fatality rate is down around 1% or lower and in line with other common ailments, our global reaction would be an overreaction. To be consistent, we have to ask ourselves why didn’t we implement similar policies and crash the economy over SARS or MERS or swine flu or even regular flu every winter? We need to keep things in perspective.

If coronavirus is more akin to a common cold or seasonal influenza, is decimating the global economy like we’re doing a practical solution to this? The stock market has lost $6 trillion dollars in wealth and millions of jobs could be lost. We’re gearing up to spend trillions more with these recent spending bills. According to one estimate, as many as 25 million jobs worldwide could be lost. The low estimate is 5 million jobs. The International Labour Organization “calculated that there could be as many as 35 million more people in working poverty around the world than before the pre-coronavirus estimate for 2020.”

Is anyone out there running the numbers on how many people will die and how much economic value will be erased by a global recession that may be caused by our reaction to COVID-19, and then comparing those numbers to what coronavirus may do? What’s worse: the virus or our reaction to it?

I’m no politician and I don’t get to make decisions, but my vote for what we should do would be to put out a voluntarily quarantine order for any high risk population: the elderly, immune compromised people, etc. and have the low risk, healthy population keep working hard and working intelligently (maintain social distancing guidelines (6 feet), washing hands, etc.) to slow down the spread AND keep the economy running.

That’s my two cents. If this virus is as dangerous as some are saying then it means all of the reaction we’ve done so far and all the economic losses are justified. If this is more akin to an aggressive seasonal flu, we’ll be adding insult to injury and paying for it for years to come.

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