First, there is no question that COVID-19 is a significant pandemic worthy of our collective international attention. There are currently almost 127,000 confirmed cases worldwide, most of which are concentrated in China, South Korea, Italy, and Iran. Second, there is no question that this is a virulent virus with a mortality rate of approximately 3.4% which is 34 times more virulent than influenza. Should all nations take appropriate precautions with regards to personal hygiene, health screening, preventive immunization (particularly against influenza and pneumonia), and self-imposed isolation if infected to prevent spread to vulnerable persons? Absolutely.
That being said, here are some facts that confound most of my colleagues in the healthcare professions based upon the world’s radical economic response to this particular disease entity.
- While COVID-19 is 34 times more virulent than influenza, influenza is 1,000 times more prevalent and each year infects one billion people and causes 650,000 deaths worldwide. In the United States alone, there have been 40,000 deaths since January 1 from influenza and nobody hears anything about this on television. What is more incredulous is that almost 50% of Americans choose not to be immunized against influenza or pneumonia which has a significant impact on mortality and morbidity rates.
- Most cases of COVID-19 are either mild (>80%) or sub-clinical; thus, it is impossible to both identify the true incidence of the disease nor to prevent its transmission as the majority of people who carry the virus will be unaware.
- Most individuals under the age of 60 who are in good health and have no significant underlying medical condition (e.g. hypertension, heart disease, lung disease, diabetes, cancer, immunosuppression) are at little (if any) risk of dying from this disease. COVID-19 is most dangerous to the frail elderly, particularly those with significant underlying conditions, thus, there should be different recommendations for these two groups as the potential consequences from exposure to this disease are significantly different.
- All of our preventive measures (social isolation, cancellation of group events, screening etc.) will decrease the short-term magnitude of the problem but not the total number of individuals infected. The bell curve will simply be flatter and spread over a longer period. This is good for healthcare organizations that will be potentially overwhelmed but will not change the overall incidence and prevalence of the disease. In addition, spreading the curve out over time through social isolation and cancellations will have a devastating impact on our economy which will impact individuals’ healthcare insurance and employee benefit coverages which can also directly increase risk to individuals with any significant healthcare condition. Unfortunately, our government’s denial of the magnitude of the problem eliminated the possibility of effectively doing this with widespread testing as that window is now past.
- COVID-19 while significant, is by far not the most dangerous viral infection we have encountered. SARS (which originated in China) had a mortality rate of 10%, MERS (which originated in the Middle East) had a mortality rate of 34%, and the infamous Spanish Influenza pandemic of 1918, killed almost 100 million people or 5.4% of the world’s population, most of whom were young and healthy.
What all of this means is that we should be vigilant and take common sense precautions and particularly protect those most vulnerable to a life-threatening infection. What we should not do is to manage this problem with fear, anxiety, and the political impact of an election year. Let healthcare and public health officials take charge and ask all of our politicians to step aside and defer to the experts who manage worldwide epidemics and pandemics on a daily basis based upon expertise and science and not on political expediency.