When similar scientific data emerges from several different locations it must be taken as confirming a truth.
More extensive screening for the COVID-19 virus from California, New York, Florida, Germany and Iceland show the same picture. Viral infection was far more prevalent in the population than estimated, and in fact the previous estimates may be off by a factor of 10 to 80. In other words, there seem to be 10 to 80 times more people infected by the virus than were previously identified by our testing process.
These people either had minimal symptoms and did not seek medical attention or were completely asymptomatic. This begins to give us a more accurate definition of that denominator that was missing at the beginning of the outbreak. We know how many people have been hospitalized and how many people have died from this infection, and now there is a better picture of how many people are actually infected.
We use mortality rates as a marker of how deadly a disease is, and with this revision in the extent of spread, it appears that the mortality rates for COVID-19 are close to those of seasonal influenza.
COVID, like influenza, is tougher on the elderly. Using Centers for Disease Control statistics as of Feb. 1 through May 6, and using the current standard testing count methods, mortality rates for those infected under the age 55 is about one-third of 1 percent. Ages 55 to 64 have a rate one-half of 1 percent; 65 to 74 is less than 1 percent; and the mortality rate for those over 75 is 2.6 percent.
If we make the assumption that those mortality rates are overestimated by a factor of 10, and this is the low end of those re-estimation figures, then we divide those mortality numbers by 10 to get us to a more accurate set of mortality figures. For example, the mortality rate for COVID over the age of 75 becomes less than three-tenths of 1 percent.
The COVID virus appears more contagious than influenza, but that may be misleading. When the influenza season starts, the virus enters a population with some background immunity and that has been at least partially vaccinated. COVID-19 has entered a population without that buffer of partial immunity, and so spreads more widely.
That there is this large reservoir of minimally symptomatic COVID infections has generated fear that this leads to a dangerous source of unidentified disease spread. However, this large number of previously infected people are now likely immune; in other words, they are now vaccinated. A virus moves more slowly when parts of a population are immune and act as a buffer to slow the spread of infection.
Sweden took a more open societal approach to the COVID infection, and this week reported that 25-30% of the population of the capital Stockholm is now immune. Given that widespread influenza vaccination is usually about 50% effective, this would not appear to be a bad start.
People with underlying medical issues have much more difficulty handling the virus. Those with heart or lung disease, those with cancer or immune deficiencies, and people with diabetes get more severely ill. Unfortunately, two risk factors for a more severe infection, those of high blood pressure and obesity, are common in the U.S. New York state statistics from last week revealed that 96% of their hospitalized COVID population had preexisting medical conditions.
Our people are terrified of COVID-19, but by CDC statistics from Feb. 1 to May 6, 60% more people died of pneumonia than died from COVID. Pneumonia has always been with us, yet has not paralyzed society.
We now have a conundrum in deciding what to do with this outbreak. We have the responsibility to protect our fellow citizens who are at risk for more severe infections. We also have a lockdown leading to students losing educational time, graduates whose careers can’t get started, 30- and 40-year-olds losing their jobs or losing their businesses, 50-year-olds who can’t put money away for retirement, and retirees who nest eggs are cratering. Most of them appear to be at a very low medical risk from the COVID-19 virus.
There seems to be a growing middle ground consensus strategy of putting into place targeted protections for the vulnerable, while allowing those in the population at very low risk of severe infections to restart their economic activities to the benefit of everyone. Those same statistics out of New York state demonstrated that 66% of people hospitalized for COVID infections had been those who had stayed at home, and not those who were out working in essential jobs.
Many states are taking their first tentative steps at opening their economy. There will be more infections because of it, and there is no way around it. Just as in a time of war, we have a choice of being paralyzed by fear or living with it. There is no way to avoid all risks in living; we just need to be wise in managing to minimize those risks. Sometimes there is no good choice, just the better of the bad choices we are given.
Jay Fleitman, MD, of Northampton writes a monthly column. He can be reach ed at opinion@gazettenet.com.