COVID-19 Cases are not Harmless
As usual, the likely source of President Donald Trump’s recent statement on 99 percent of COVID-19 being “totally harmless” is transparent. I’m guessing someone on his staff, like many Americans, went to the Worldometers web site, saw 99 percent of cases currently listed as “mild” (during March and April 4 or 5 percent of cases were listed as critical) and that became translated somehow into “totally harmless.”
There are at least a half-dozen ways in which this statement is dangerously misleading. First, many of those who have survived the coronavirus continue to suffer symptoms, some debilitating. Doctors suspect that impacts to the heart, lung, and brain may be long-lasting and possibly permanent. Since it is a new illness, there is no way to know for certain. It is irresponsible to speculate prematurely.
Trump’s statement recalls the old medical joke that minor surgery is something that happens to other people. While many people have few if any symptoms despite testing positive, which is a large reason for the disease’s rapid spread, those who do get hit hard by the coronavirus have a very rough ride, even if they get through the illness apparently unscathed.
More important, this framing minimizes the risk to younger people who are now getting infected in droves. Cases nationally have surged to 50,000 or 60,000 a day and have exceeded or come close to 10,000 daily in Texas and Florida. Being young drives the fatality risk way down. But it clearly does not prevent some much younger Americans from becoming ill and even dying. As many as 1 in 5 COVID-19 cases may require treatment in a hospital: this is driving the rate of ICU use in hospitals to new daily highs in Texas, Florida, Arizona, and California.
And if they are careless, or if living close together allows no other choice, this newer group of younger people who are contracting COVID-19 will eventually spread it to the older Americans who are trying to elude it. This pattern will tend to undercut the gains that were made through the common sacrifice of sheltering-in-place over previous months.
Once again, there is no certainty about the COVID-19 case fatality rate. While it is nominally in the 5 percent range in the US and in other hard-hit countries, the assumption is that many coronavirus cases, possibly as many as 10 for every case that is identified, go unobserved and under the radar. Some credible experts think that the rate for an entire population in a country with excellent medical care may be as low as 0.6 percent, even lower than the imputed 1 percent case mortality rate to which the President is presumably alluding.
But, to echo Inigo Montoya’s famous line from The Princess Bride: “I do not think it means what you think it means.” While 1 percent sounds small, from a risk assessment perspective it is a high number. If 1 percent of all drivers were killed each year—and their chances of dying increased measurably with each car they passed—the roads would be a lonely place. And if 1 percent of air travelers died each year in plane crashes (odds of one in one hundred), civil aviation would not exist. (The existing annual odds of dying in a plane crash, by one common estimate, are one in eleven million.)
In the case of COVID-19, no one is sure how and whether a vaccine will be found, or whether immunity from the disease, once a patient is recovered, is long lasting. (Early studies have not been encouraging on that score.) Only 5-10 percent of Americans have been exposed to COVID-19 to date. This means that at least 2/3rds of Americans (up to the presumed “herd immunity” level of 70 percent or so) are still vulnerable to exposure. Even at the lowest rate of potential mortality, this means that millions of deaths are still a theoretical possibility.
To be sure, many people have an individual mortality risk factor that is close to zero, and not everyone will get sick. But once again, we lack a full accounting of what the COVID-19 risk factors are. Those who minimize coronavirus risk frequently compare it to areas in which, from an international public health standard, the U.S. has done a terrible job in reducing casualties--such as road accidents and firearms-related deaths.
But even in these problematic areas we know roughly what the annual numbers of deaths and injuries will be and understand many of the risk factors, meaning that individuals have a better chance to avoid being victims. By contrast, until we have a much fuller and clearer knowledge of COVID-19 and have more defenses against the disease, including the details of how transmission takes place, trying to “live with the virus” – the subtext of the President’s remarks--is a bad bargain.
And if our luck is poor and it happens to turn out that immunity is short-lived, or that a vaccine has a limited duration, dodging these odds each year is a much steeper task. In the meantime, the virus has considerable room left to run, and we need to respond and plan accordingly.