26 March 2020

COVID is not FLU, life in the time of Coronavirus

Farflung correspondents, 

You STILL see people comparing COVID to the seasonal flu. This is not only not correct medically, it is potentially dangerous disinformation. This piece (Johns Hopkins) gives a very quick rundown of some of the differences, but one crucial difference that is frequently discussed among epidemiologists when interviewed by objective and probing journalists, but not penetrating the more general media, is this: the flu kills, relatively infrequently, not generally by directly damaging the tissues of the lungs, but sort of like a careless visitor who leaves the door open so the axe murderer gets in. Flu weakens the body and its immune system, allowing opportunistic, usually bacterial, pneumonia to get a foothold. What weakens the system is not so much the virus itself but the body's own inflammatory response. This happens more frequently, of course, to older and generally less healthy people. The 1918 flu, for reasons that have never been fully and satisfactorily explained, preferentially affected younger people, especially men, but that is not true of flu in general, or of coronavirus disease (including other coronaviruses). 

COVID, on the other hand, IS the axe murderer. It directly damages the lungs, and can, in fortunately relatively infrequent cases, cause very rapid progression from healthy to absolutely critical condition and even death, within days. It is, apparently, slightly MORE contagious than ordinary flu. But the reasons it is so threatening is not only that it has an overall death rate in the vicinity of 10x typical seasonal flu, it also has a much higher incidence of serious illness, requiring hospitalization, which has the potential to completely overwhelm medical systems worldwide. This is already happening in many areas.

The fact that COVID sharply skews upwards in people over 50 and with generally poor health, especially COPD and asthma, is well known by now. People over 70 are at significantly greater risk even in the absence of underlying conditions, and people over 80 even moreso. The virus also preferentially, to a certain extent, kills men more often than women. But, from most reports, the presence of underlying health deficits is even more of a risk factor than age alone. These observations are in part still anecdotal; a clear scientifically verified profile of this disease has not yet been developed. 

Two additional points that many people fail to appreciate. It is completely meaningless to compare the death rate from COVID to car accidents or seasonal flu. These things are already present, to their full extent, in our society, and we have adapted to their effects. COVID, even now, is just getting started on its massive worldwide tsunami of NOVEL infection, to which no one, except the limited number who have already recovered, has immunity. Eventually, it will mutate (because any pathogen that has strains that are fatal to a significant fraction of their hosts will tend through natural selection, running at hundreds of thousands of times faster in viruses than in macroscopic organisms, to mutate into less lethal forms). Also,  we will develop a vaccine or effective antivirals, or, through ordinary development of herd immunity that eventually happens even without intervention... but in any case, eventually, the epidemic will subside. In the meantime, it is not primarily the raw numbers of deaths, but the complete breakdown of our ability to deliver medical care, to COVID victims or anyone else, that is of greatest concern. 

The ancillary, but also very serious, effects on the global economy are also reasons not to follow our president's idiotic advice, but to follow protocols designed to turn the curve down and begin to reduce infections. (Because if we go into a cycle of repeated lockdowns and easing up, but never really get the virus under control, we will see little if any economic recovery (who will go to the movies when their family members are sick and can't get a hospital bed?), and in the end the overall effect of the epidemic will be far worse, not better. Virtually everyone with a clear understanding of the disease and fundamentals of economics, including most Republicans not entirely beholden to the president, agree with this. The British briefly tried the "let it ride, herd immunity" route, but quickly realized it was a disaster, and now Boris Johnson sounds almost exactly like Tony Fauci. 

A second point, less important perhaps but not too well known, is that it appears that this virus often causes PERMANENT damage to the respiratory systems of those who become critically ill but recover. The flu and even bacterial pneumonia do not typically do this to as great an extent. This effect is still being evaluated, and as far as I know remains anecdotal, but you can be pretty sure there will be scientific papers published on it soon. 

Stay well, stay home, if you do have to go out, keep your distance. We will get through this. Bad as it is, it is self-limiting, and if we pull together as a country and even as a world, we may be in a better position to put the pieces back together afterwards, and even have an opportunity to jettison some of the more self-destructive behavior we've been engaging in as a species for the last number of years. I remain guardedly optimistic on that score. 



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