The threats from Covid-19: Beyond the fake news

Fake news as discussed by the conversation.

The media paints a very misleading picture as to the main threat presented by Covid-19. Covid-19 forces governments into lockdowns and range of economically damaging measures. Even the least caring most economics first governments.

It is risk of overloading all hospitals that forces lockdowns.

People do get sick and even die, and while that is a huge problem, that is not itself the threat that closes down economies. The number one threat is the hospitalisation rate, not the death rate.

Covid-19 outbreaks, if left unchecked, has the same effect as closing every hospital in the state. Cases overload medical systems to the point where there is no ability to admit new patients, not just for Covid-19, but for anything. To let Covid-19 ‘rip’, and not respond with the measures to control spread, is to enter a phase where the medical system has to start turning away patients who without medical care will die. This ‘no care available’ then applies to all patients: Cancer patients, heart patients, accident victims or anyone who needs medical care.

I am reminded of the line “He gave me choice, if I didn’t do it he would shoot me!”. What technically is a choice, can be described as no choice since one option is not even worth considering.

For societies, a completely overloaded medical system with no capacity for giving care to patients requiring admission is not an option. Taking no steps in the face of that threat is inconceivable, which is why every jurisdiction in the world, despite whatever the earlier posturing has been, has taken action when that threat materialises.

The fake news is that administrations are making a choice between the liberties of all and the lives of some. The ‘choice’ is between complete collapse of the medical system, and ‘giving in’. In the end: there is no choice.

The health threats in perspective:

  1. The hospitalisation rate.
  2. Spread: Every Case is a danger to others.
  3. The rate of Serious Illness & Long Term Effects
  4. The death rate.

1. The hospitalisation rate & Liberties.

Around 20% of people testing positive to Covid-19 are normally require admission to hospital. While this varies with age, even for children, around 10% require admission to hospital. Consider Wuhan in Late January, or northern Italy in March 2020. Medical staff become faced with having to choose who lives or dies. It is hard to imagine what would happen if you need to attend hospital seeking treatment for broken leg, when the hospital has insufficient resources or beds to allocate to patients who will die without treatment.

This is the first area when any comparison with diseases such as influenza is not even possible. Influenza simply does not overload the hospitals system. This makes Covid-19 in this respect not just twice as bad or six times as bad as influenza, it is simply not comparable at all in terms of overloading the hospital system.

Reality is, when the medical system reaches critical a point, even those supporting liberty over health are left with ‘no choice’. Measures against the virus will always happen, there is no choice. Consider the US state of Arizona. The Governor of Arizona, is an example seems a natural champion of favouring individual freedoms even over public health, however even he has backtracked on masks in the face of a health system at breaking point.

The fact that in the end rising hospital case number presents states with no choice means that some level of restrictions, lockdowns, masks and quarantines are inevitable. The more people who conscientiously object, the longer the time such measures apply. Every one in society is affected by these measures, so an individual, this is the inescapable face of Covid-19.

2. Spread: Every Case is a danger to others.

Yes, an infected person could become seriously ill, and even die. But most individuals will not. In fact, provided the health system does remain functional, there is normally around a one percent chance of an infected person dying. However, the way Covid-19 spreads, each infected person represents a greater danger to others than to themselves.

An infected person on average infects more than 2 others, who in turn infect others. If this continues unchecked, soon 1 original case results in 100 infections. By that point, it has reached the stage where 1 person will die, just most likely not the original person.

Statistically, each infected person is more likely to trigger others dying, than to die.

3. The Rate of Serious Illness & Long Term Effects

With a mortality rate of less than 1%, and even that rate skewed towards the elderly, most people are unlikely to die. But even for those who survive, Covid-19 is not totally harmless. Relative to influenza or other corona viruses, this is another area where Covid-19 breaks new ground in terms of the threat level. When Covid-19 is well managed and deaths kept in check, the some total of negative health outcomes for those who survive the disease could have the potential to be a more significant problem than the deaths.

In fact, Covid-19 is primarily a neurological disease. It damages the nervous system and that includes the brain. As the main way the virus enters the body is, through the respiratory system, a key area prone to damage is the respiratory system, which is the response that most often causes death.

Note that the symptoms from the respiratory system, only indicate how infected the respiratory system is, not how the virus affects the overall person. Long term symptoms, such as chronic fatigue syndrome, do not seem to correlate with the severity of symptoms during infection.

COVID-19 patients may be at risk of developing the neuroimmune condition ME/CFS that depletes one’s energy. ME/CFS, which leaves 75% of those affected unable to work and 25% homebound or bedridden, impacts 15 million to 30 million people worldwide, and symptoms may be triggered by an infection, according to the National Institutes of Health. Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, says some diagnosed with coronavirus are showing symptoms that resemble those seen in ME/CFS patients.

COVID-19 patients may be at risk of developing the neuroimmune condition ME/CFS that depletes one’s energy. ME/CFS, which leaves 75% of those affected unable to work and 25% homebound or bedridden, impacts 15 million to 30 million people worldwide, and symptoms may be triggered by an infection, according to the National Institutes of Health. Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, says some diagnosed with coronavirus are showing symptoms that resemble those seen in ME/CFS patients.

“The ME/CFS community is saying 80% of us had some sort of virus and that went away, and we’re still stuck with all of these symptoms,” said Sanna Stella, an Oak Park resident who was diagnosed with ME/CFS. “If you’re a patient, you really have to listen to your body and not all those ‘shoulds’ we tell ourselves. … Because if you keep pushing, for some of these patients, it really will make things a lot worse.”

medicalexpress.com

There are also indications that Covid-19 can trigger Parkinson’s disease,

Severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), a pathogenic homolog of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), invades the brain through ACE2,1 and SARS-CoV-2 might be neurotropic too. SARS-CoV-2 also enters cells via the ACE2 receptor,1 which is widely expressed in the CNS, including in the striatum,2 where the virus might precipitate or accelerate neurodegeneration.34 SARS-CoV-2 might infiltrate the CNS directly through the olfactory or vagus nerves, or haematogenously. This infection could, in turn, prompt cytotoxic aggregation of proteins, including α-synuclein. This hypothesis is supported by evidence in animal models that viral infections can trigger α-synucleinopathies in the CNS.5

The lancet.

as well as indications of Encephalitis lethargica linked to Covid-19, as also happened to people following 1918 pandemic. The loss of taste, and smell, as often are the earliest and seemingly mild symptoms of Covid-19, are clear indications neurons are being damaged, and particularly with smell, neurones the have a direct link to the brain.

Then there is ‘COVID-19 related stroke in young individuals (Lancet)’ as well as increasing risks from heart disease, particularly from the approximately 1/6th of the population already susceptible.

In summary: if a 20 year old and a 80 year old both catch Covid-19, the 80 year old is more far more likely to die in the next month, but the 20 year old is very likely to lose more years of their life.

The risk of death is heavily biased towards the elderly, the risk of losing years of your life, or qualify of life, is biased towards those with the most remaining years.

Certainly, we already know a greater number of people have negative long term health outcomes than the number who die during the initial illness. It is too early to know the full extent of long term health problems.

4. The Death Rate: Your chance of Dying.

Simply, it is not all about the death rate.

Provided hospitals are not already overrun with other cases and people can be treated in hospital, the death rate and your chance of dying from Covid-19 is far is least of the risk of worries from the pandemic.

Remember, Covid-19 is not ‘binary‘. It is not that you either have it or you do not, but rather, how badly do you have it? People exposed to a very high initial infection, such as medical care workers or people who are overly cavalier about becoming infected, can die from Covid-19. However, in a managed outbreak, where at least others are taking precautions and your exposure level is moderate, statistics are on your side. Of course, statistics can sound great until you become one.

With pandemic measures in place and the amount of virus somewhat under control, the death rate from a typical Covid-19 infection for otherwise fit and healthy people can be comparable with influenza. So if you were not worried about influenza, as long as people are social distancing, the social distancing itself will be more painful than an infection for many people.

For example, in countries like Australia or New Zealand, there may be less deaths in 2020 from Covid-19, than there were deaths in 2019 from influenza. Of course, with pandemic measures in place in 2020, there are almost zero deaths from influenza in 2020. The death rate from Covid-19 under pandemic conditions is around 6x that of influenza per recorded infection, which is still under 1% of confirmed cases. Of course, more than 20x the number of people requiring hospitalization than with influenza, and once hospitals are overrun the death toll could reach as high as 10% of cases! However, having measures to ensure hospitals are not overrun, means less cases of Covid-19 than there are influenza in a normal year, as society can afford to be more careless with influenza.

The death rate is a serious potential problem, but with lockdowns and other measures in place, for most people, the death toll is the least serious actual problem, at least while under conditions where containment is successful.

Conclusion.

Deaths from Covid-19 is itself not the main problem for most people. In fact, even if the health system becomes overrun and 10% of population were to die from Covid-19, the long term effects from a completely failed health system would still be worse than the direct death toll from Covid-19 itself.

In the normal situation, it is the measures required to keep things normal and the health system functional that affects everyone. Further, while even if infected very few people will die unless the have a very severe case, any failure to take precautions early enough would most likely mean the spread of their infection will result in at least one death. Further, while dying is unlikely, suffering long term negative health impact from a case of Covid-19 is a very real threat.

It is a pity that media gives little focus to the main threats. Given the hospitalisation rate is even more critical than the number of deaths from Covid-19, is is problematic that less data is given each day on percentage of hospital capacity than the more headline grabbing number of deaths. A better explanation of the threats would make dealing with the problems far easier.

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