Corona in Context

We’ve noticed that in the media at least (and we have said plenty about how unhelpful they can be) that some people seem to react negatively to attempts to put the current virus concern in context—in other words to provide background information that could be helpful in terms of deciding how we should react to this, or what your own personal level of concern should be.

Why the resistance? For some people perhaps, this exercise comes across as trivializing their own emotions, or “shoulding on them,” that is telling them what they “should” feel, which is never, ever helpful.

Or, as sadly seems to happen with all science these days, some people make everything political. They want to believe that such-and-such a democrat or republican is right and their opponents are wrong, and they will believe or not believe information based on “confirmation bias.” In other words, if they hear something that confirms what they already believe to be true, they remember it and approve of it, and they ignore or forget what contradicts their beliefs.

You can see examples of that every day if your local news website still allows comments, every time someone who belongs to a minority group is arrested for a crime. (As an aside, what is it

about news sites that induces particularly horrible people to comment on the articles?)

For others, however, since they lack “context” to interpret the input they are getting from public sources, they are not able to accurately assess the risks they face, and assume that they are facing an unprecedented event with unique virulence. Therefore, they experience harmful and unnecessary anxiety, that might be helped by knowing more “context,” that is, how relatively common or virulent this current virus concern actually is.

Disclaimer: that follows is to suggest that you run out and expose yourself to a virus onpurpose, or that you should act in a social irresponsible manner.

Context #1

How common is the “coronavirus” really?

While this is being written, the Bing search engine lists the oddly specific number of worldwide cases as 1,365,004.

Over a million! That seems like a lot. But the world population, according to the World Population Clock at this writing is about 7.8 BILLION people. This is the American billion, which is 1,000 million.

This infection rate is 0.02%, 2 out of 10,000 people overall. On average, you would have to meet 5,000 people in a day, to meet one person with known infection. That’s obviously just statistics, of course—if you work in a hospital as a nurse you might meet all 20 or 30 people with COVID-19 in your metropolitan area during your work day on the infectious diseases ward. And since at this point anyone with known or suspected infection is staying inside or hospitalized, the average person going about their business might met none of them, even in the unlikely event that they did get up close with 5,000 people that day.

Now, hidden in this is a good/news bad news scenario. This post is about context, good or bad, not about denying risks. The good news is that it turns out that most people who do develop an infection with this virus will have no or mild symptoms.

This is an important point, because based on some article queries we have received, many people seem to have assumed some doomsday scenario should they actually contract this virus. The worry they and their loved ones would instantly become extremely ill and then die.

Nothing could be further from the truth, something even the most politicalized person should be grateful about. Instead, you may not even notice you have it, or just get a “cold.” This is especially true for children and teenagers, who seldom show any significant symptoms at all.

Experts estimate that 80% plus of people who get this virus will have no symptoms or mild symptoms.

What is the bad news in that?

The bad news is that people who might not know they are infected, or think that only have cold symptoms, might not isolate themselves and therefore they could increase the spread of the virus. And although, again, the usual mildness of symptoms for most people is a plus, there are people for whom infection could be much more serious.

Context #2 What is my risk? AM I GOING TO DIE? WHAT ABOUT MY LOVED ONES?

This is an important question. Thankfully, we now have access to plenty of data that allows us to answer it.

Basically, the COVID-19 virus behaves like a typical serious respiratory virus in terms of who gets the worst of it. That would be the elderly and people who are already in poor health.

Another way that this virus acts like the typical serious respiratory virus is that there are going to be a few people who don’t fit into that demographic; young, healthy people, athletes even, who are going to get sick and die. Medical science doesn’t know why certain people are affected this way, but it is something that happens. It is, however, very rare.

Let’s look at some data. Let’s look at North Carolina’s data, to find a more representative state for most Americans than NYC/NJ. This is from their Department of Health and Human Services dashboard, as of April 7, 2020.

The testing criteria in North Carolina are fairly stringent—you need a fever, plus cough/shortness of breath AND either close contact with a documented case, or a negative flu test.

Even so, North Carolina reports doing 41,082 tests. Only 3,221 were positive, meaning that 37,861 or 91% of people who had significant respiratory symptoms and met other criteria did NOT have coronavirus.

As of April 7, of those people with significant symptoms—fever, cough, shortness of breath, 354 were in the hospital. Forty-six had died. If we assume that everyone who died got a test beforehand as stated on the website, then there is an overall death rate in North Carolina of 1.4%, which is in line with most wealthier places’ experience.

But that basic rate doesn’t tell us enough. North Carolina does provide us with some more breakdown. Numbers are rounded so might not add up to 100.

Age range      Percent cases   number of cases   number of deaths  death rate for serious cases

0-17 (18yrs)            1%                           32                               0                        none

18-24(7yrs)             8%                           258                             0                        none

25-49 (25 YEARS)   42%                        1353                           3                        0.02%

50-64 (15yrs)          29%                         934                             6                       0.6%

65+ (??yrs)              20%                        644                            37                       6%

There are a number of things you might notice about these data, once your attention is drawn to them. One is that the age ranges are all different. 18 years, seven years, 25 years…what gives? Unfortunately, part of this is definitely scaremongering. Public health officials are used to shouting to try and get people’s attention. They think that if they don’t hide how little this virus actually affects younger people, said young folks would just start holding raves and house parties every night or something.

Another problem with these unequal divisions is that they don’t reflect the very real difference between being 25 and being 49, or being 65 and being 90. We can assume that the risk, such as it is, increases with age, but is it linear? Does it jump up after 40? Or 60? These data do not tell us.

What it does tell us, which might be hard to hear after weeks of relentless media hype, is that people under 50 this virus is simply no big deal, in terms of the effect on their own health. In North Carolina people under 50 account for 51% of people with significant symptoms, but only 3 deaths in the entire state on April 7. Probably more people in North Carolina managed to autoerotically asphyxiate themselves during the reporting time span.

Of course, the fact that their deaths were very rare is probably no consolation to the people who did die and their families. As with all serious respiratory virus, there are always the unusual young individual, who for reasons we do not always know, passes away from the infection.

For more all-important context—in North Carolina in 2018, 1,437 people died in motor vehicle accidents, 1494 committed suicide, and last flu season, which officially lasts to 5/16/2020, 159 people died of the “flu.”

Every death is tragic and important on a personal level to the person involved and their loved ones. Public health measures however, are about the greatest good with the most efficient allocation of resources, and these figures of context suggest that that is not happening here.

Again, though, good news, bad news. We are not here to claim that there is nothing to be concerned about. But if you’re under fifty, you’re fine. You can still get really sick, or sick enough to warrant testing, but mostly you won’t and if you do you are going to recover. The older you get, and especially if you are in your late seventies and up, the more you might have to be concerned. We know from data from countries that don’t offer or have available intensive care treatment for older adults with respiratory illnesses that for people over 80 this is a serious problem.

So, put your concern where it will do the most good. Help an older person avoid social contact—say by running errands for them, or dropping and picking things up for them outside their door. Call them on the phone or contact them and check on them frequently. Make sure they have masks and are following good hygiene techniques if they have to go to the doctor. And don’t go around the elderly if you think you have been exposed to any serious viral illness.