In March of 2020 my blog, Should We Really Panic About the New Coronavirus COVID-19, raised a lot of hackles among my readers. Many thought I was minimizing the dangers of the novel virus and perhaps not taking it seriously enough. At the time, I am embarrassed to say, I closed the article with the quote “And get rid of those silly face masks. They aren’t doing you any good.”
Well, I’ll take the hit on the face masks, which are widely accepted to be of benefit (although no one can say for certainty in what conditions and at what range of social distancing). The tragic death toll, if it is accurate, far exceeds what I and some others in the medical community predicted. Back then there were basically two schools of thought: that the virus would be not as dangerous as advertised, or far worse. But before you take me directly to the woodshed for a good thrashing, let’s examine what has happened in seven months and gain some perspective.
In that blog of earlier this year I based my sentiment regarding the potential dangers of COVID-19 on researching early statements and prognostications from institutions as respected as Yale, Harvard, The British Medical Journal, the World Health Organization (WHO), the National Institutes of Health (NIH), and medical luminaries such as Anthony Fauci (director of the National Institute of Allergy and Infectious Diseases, a division of the NIH), Tedros Ghebreyesus (director-general of WHO) and Francis Collins (director of NIH). In particular, the physicians I mentioned had, in the early days after COVID-19 came on the scene, advised in general terms that people should (at that time) pretty much go on about their business (do what one normally does), that “COVID-19 does not transmit as effectively as influenza” and the relative danger to the average American was low.
As the rates of infection climbed and the death toll rose to the level we see today, it became apparent that even the brightest and most respected physicians could not predict how severely a given pathogen can affect populations. Yes, these doctors, and others, all tempered their views as more became known of the dangers inherent in the virus and all of them heightened the alarm. But let us look at what is and isn’t known about the virus now and look back on my earlier blog to see what I got wrong, and right.
First the indisputable: the diseases caused by the novel coronavirus infection are wide ranging, and in the majority of infected people not severe. The Kaiser Family Foundation insisted back in April that “…the majority of people…are expected to be asymptomatic or recover without needing special treatment.” This has indeed proven to be the case. Supporting this is data from the CDC which was valid through August 8th, 2020, indicating the COVID-19 survival rates among different age groups:
Age 0-19: 99.997%
Age 20-49: 99.98%
Age 50-69: 99.5%
Age 70+: 94.6%
Bear in mind that the CDC statistics are speculative, based on varying risk degrees. That is why continued caution, employing CDC guidelines regarding safe practices, is still advised
But despite the favorable survival statistics and evidence that most people infected are without symptoms or recover, the inescapable fact is that over 210,000 people have died from or with the disease. I say “from or with” because no one really knows if the infection in all patients was the determining factor or not as the cause of death. The conspiracy-minded among us have expressed the view that since hospitals receive more money from Medicare when a diagnosis in a given patient or the cause of death lists COVID-19, then the infection and death statistics must be exaggerated. Actually, a recent article in Scientific American says the opposite; if anything the numbers are an underrepresentation of reality.
In fact, a recent report shows that, not surprisingly, mortality is up across the board in 2020. Total deaths collated during the 2020 coronavirus outbreak are far greater than those attributed to COVID-19 solely. The report from eurekalert.org, says:
“For every two deaths attributed to COVID-19 in the US, a third American dies as a result of the pandemic, according to new data publishing Oct. 12 in the Journal of the American Medical Association. The study, led by researchers at Virginia Commonwealth University, shows that deaths between March 1 and August 1 increased 20% compared to previous years—maybe not surprising in a pandemic. But deaths attributed to COVID-19 only accounted for 67% of those deaths.”
Whether this reflects a delay in diagnosis and treatment of other diseases, an inability or restrictions in accessing care or other factors is not clear.
But evident now is that in even young and healthy people, infection with the novel coronavirus can lead to rare and unusual residual organ damage in the brain, heart, lungs and other vital tissues. In some adult patients, the emergence of strokes and other neurologic sequelae have also been observed. But as thought from the start, patients with concurrent disease (and that is a lot of Americans), the elderly, the immune-compromised and minorities are particularly vulnerable.
Looking back on what I wrote in March, I contend that social distancing added to the common sense approaches I advocated at the time (handwashing, extra caution for the elderly, patients with immune deficiencies and those with other comorbidities) still will afford adequate protection for the vast majority of people. I and doctors like me could not have foreseen the super-spreader actions that have occurred with protests and actions from all sides of the political spectrum. With infection rates and hospitalizations now rising in over 30 states, prudence and caution (continued social distancing, handwashing, mask wearing indoors and outside if a six-foot distance cannot be maintained) are warranted until either highly effective and affordable treatment protocols or widely distributable safe and an effective vaccine is available.
So was I wrong? Partially, I think. Off base on the masks, for sure. Wrong on the measures that will protect most people most of the time (handwashing, extra caution for the vulnerable, etc.)? I don’t think so. And while the death toll is a terrible indicator of the dangers we face, that does not alter the fact that the CDC itself reported that 94% of COVID-19 deaths were in people who had other chronic diseases. Again, that should not alter our caution or reduce efforts to curtail the spread of the virus. We should still be following all the guidelines that the CDC puts out. The large number of chronically sick Americans alone speaks volumes about the extra caution at-risk populations should exercise. And super-spreading among young and healthy carriers? That’s a tough one. You can’t isolate the nation’s young people by force. Not without a revolution.
A final word on vaccines. Despite the Herculean efforts now put forth to get a safe and effective vaccine to all those who will need it, I would not hold my breath. There are so many hurdles to overcome, not only in development but in distribution as well, that it may be quite a while until a vaccine is even part of the solution.
For more with Dr. Sherer, click here for his podcast and video interviews, and here to buy David’s book, Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out.