The COVID Conundrum

My brother sent me an abstract from a study published by MedRXiv - "the preprint server for health sciences" which has some affiliation with Yale and Cold Spring Harbor Laboratory. The paper highlights the low COVID-19 infection fatality rate among younger populations and the progressively higher infection fatality rate for older populations.

Assessing the age specificity of infection fatality rates for COVID-19: Systematic review, meta-analysis, and public policy implications -https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v4

The results of the study are summarized thus: "This paper assesses the age specificity of the infection fatality rate (IFR) for COVID-19 using seroprevalence results from eight national studies , regional studies of 15 locations in Europe and the U.S, and five countries that have engaged in comprehensive tracing of COVID-19 infections. The estimated IFR is close to zero for children and younger adults but rises exponentially with age, reaching 0.4% at age 55, 1.3% at age 65, 4.5% at age 75, and 15% at age 85. We find that differences in the age structure of the population and the age-specific prevalence of COVID-19 explain 90% of the geographical variation in population IFR. Consequently, protecting vulnerable age groups could substantially reduce the incidence of mortality."

My brother sent me the report link with no context other than the email subject line: "By the numbers." Given the content of previous conversations, and my brother's somewhat blase attitude regarding the pandemic, it would be fair for me to assume that my brother was trying to put my mind at ease. My brother is 65 and I am 60, so the infection fatality rate we are confronting is fairly low at 1.3%, according to the study.

Maybe my brother finds that fatality rate "reassuring." Maybe he has adopted the Kirk Cousins "If I die, I die." philosophy or that of Texas Liutenant Governor Dan Patrick who told Fox News "There are more important things than living." I had to stop myself from leaping to the conclusion that my brother was suggesting that taking my life in my hands was a good idea.

My brother's "reassuring" data did not put my mind at ease. It only made me more concerned for him. The data conveyed to me that not only was COVID-19 a very real and ongoing concern, it has been around long enough to be widely studied and analyzed resulting in data sufficiently alarming as to cause "experts" to recommend measures to protect "vulnerable" populations - of which I may well be a member.

This is the funhouse mirror of COVID-19 research today. Different people view different data sets and draw different conclusions. My brother sees low infection fatality rates for certain populations and is reassured. I see infection fatality rates rising across different age groups and worry about my family, my community, myself. If one group is vulnerable, all are vulnerable.

It is not just infection fatality rates. Many observers lately have taken to claiming that the fatality rates are overstated. The rationale here - not widely endorsed by doctors, scientists, or experts - is that the high number of "co-morbidities" found in those who have died of COVID-19 suggests that they really didn't die of COVID-19 - ergo: fatality rates are overstated.

In other words, a patient who allegedly died of COVID-19 but who was overweight, diabetic, and suffered from hypertension or arteriosclerosis was already living on borrowed time. The cause of death might have been any one or a combination of those other conditions. Some that have used this rationale have tried to claim that only a few thousand people have died of COVID-19 ALONE, not the more than 180,000 identified as COVID-19 fatalities in the U.S.

Anyone who has watched a police procedural with the meeting between the pathologist and the detective knows well the language of pathology. The pathologist details the littany of wounds to the victim before concluding that the "fatal" blow was x. In the same way, there may be co-morbidities associated with COVID-19 victims, but COVID-19 is the fatal blow.

The reality is that the 180,000+ fatality figure in the U.S. is likely vastly understated because of the thousands of patients that died of COVID-19 before getting to a hospital and an official diagnosis, either because they could not afford to get to the hospital, were unable to, were afraid to, were told not to, or were turned away. Many infected by COVID=19 have been either asymptomatic or insufficiently symptomatic to warrant a test or a doctor's attention. Others have been advised by experts and friends to stay away from hospitals. This has certainly depressed COVID-19 diagnoses and death attributions.

The report my brother sent me did not put my mind at ease. It also didn't convince my employer to end our existing travel ban. It also didn't cause the industry I work in to ease industry-wide travel restrictions that have led to the cancellation of multiple international trade events and, soon, layoffs.

Without a cure or a vaccine for COVID-19 this is no time to be blase. This is a time to be vigilant and take care. A cousin of my wife, who is a professional pilot, mused that he hoped he could get the virus and "get it over with." I earnestly hope and pray he does not. I have a niece in Brazil who became infected and, thankfully, recovered, but her grandfather was less fortunate and passed away, alone, in a hospital in Porto Alegre.

We are asking teachers and professors and students to return to schools, colleges, and universities and the results have been mixed with infections spiking. We asked the workers to return to the production lines to make cars and, in large part, they have done so - but we should appreciate the sacrifice these individuals are making.

None of the data regarding COVID-19 is reassuring. It's all terrifying. We do our best to persevere and to protect ourselves, our families, and our communities. We can only defeat this organism with collective action. Deluding ourselves that it is "not so bad" will only lead to failure. Mask up!