Reducing Covid-19 Fever

In the end, this flu season will be of greater interest to social psychologists and social and political historians than to virologists and epidemiologists.  Among an innumerate and paranoid population obsessed with its health, and which believes that the role of the government is to solve all problems, it was easy for the media to trigger a panic that would take down the markets and capsize the economy.  No public official or CEO can risk being viewed as irresponsible, and the decisions they’ve felt obliged to take have had devastating economic consequences for the majority of Americans. 

There are two ways of looking at the case fatality rate of Covid-19.[i] Originally, some high rates were reported:  3.2% (this figure, from WHO, was repeated by Bill Gates in an alarmist New England Journal of Medicine editorial), 2%, and 1.4%.  By the end of February, as the virus moved out Hubei province, estimates of the mortality rate were much lower.  As Anthony Fauci, et. al. reported in the NEJM on the 28th, “the case fatality rate may be considerably less than 1%.”  The authors go on to conclude that “this suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

In the deluge of coverage of the “epidemic,” how many reporters on TV or in print have bothered to repeat this information from the Director of the NHI’s National Institute of Allergy and Infectious Diseases?

For Fauci’s two worst-case scenarios, the epidemics of 1957-8 and 1968-9 (the politically incorrect “Asian Flu,” H2N2, and “Hong Kong Flu,” H3N2), approximately .44% to .67% of those infected died in 1957-8, and less than .5% in 1968-9.

If we assume a .5% case fatality rate for Covid-19, you could say that the virus is five times as lethal as normal flu in a bad season.  On the other hand, you could say, with equal accuracy, that 99.5% of those coming down with the flu will recover, versus 99.9% in a severe seasonal flu year, a difference of .4%.

But will anything like this number die? 

The CDC estimates the death totals for the two epidemics in the US to be 118,000 in ’57-8 and 100,000 in ’68-9.  The number of Covid-19 deaths in this country is now about 147

Are we going to see this figure go up by 80,000%?

There were about 178 million Americans in 1957, and about 206 million in 1968.  So .066% of Americans died of the flu in the first year, and .04% during the second epidemic.  If .066% of U.S. citizens died of Covid-19 this year, the death toll would be 217,800.  We have a ways to go.

***

I remember winning at the LA County Fair in 1968 a bobble-head doll of Chairman Mao on the base of which was written “So who you think cause Asian flu?”  Otherwise I have no recollection of this epidemic, as I surely would have if schools had closed.  And like Dr. Brian Joondeph, I can barely recall the 2009 swine flu virus, H1N1.  This was a particularly pernicious strain, in that it affected not primarily the elderly and people with serious underlying medical conditions, but the young and healthy. 

The worst flu outbreak of the last decade, in the 2017-18 season, was hardly newsworthy.  It was not a Presidential election year.  But 61,000 died according to the CDC.  The NFID estimates 80,000.  If we take the CDC’s figure, this represents only 10% of the cancer deaths for 2018, 609,640, and less than 9.5% of those dying from cardiovascular diseases, about 647,000.

Everyone is aware of the 1918 pandemic, the specter that lurks behind the media-stoked fears today.  But few people realize that only 10-15% of deaths are attributable to acute upper respiratory infections.  The rest are the result of secondary bacterial complications.  “Had no other aspect of modern medicine but antibiotics been available in 1918, there seems good reason to believe that the severity of this pandemic would have been far reduced,” one researcher concludes

***

This is not to say the Covid-19 is not a nasty strain, or that the draconian measures taken will not help prevent the spread of the disease.  If Americans had been harangued daily about washing their hands and maintaining social distance, and, especially, if visits to extended care facilities had been restricted, thousands of fewer people would have died two years ago.

In the end, the scaremongering is likely to boomerang.  The timing of the media was off.  As the number of cases plateaus and then declines before the end of May, there will be several consequences. 

President Trump will get credit for acting promptly and aggressively to keep the number of deaths in the hundreds rather than the thousands.  GOP ads will feature clips of Joe Biden condemning travel bans as “xenophobic,” which he mispronounces.

Israel will benefit if it can come up with the vaccine that it’s developing.  How many of the world’s 195 countries contribute anything to the health and well-being of the human race?

There may be another response.  Some people will be embarrassed in retrospect by their panicked shopping sprees, and especially hoarding the totemic toilet paper.

Still more will resent being manipulated by the media.  They will blame journalists for their 401(k) portfolios plummeting over 20%.  In fact the economy is fundamentally sound, and before the Republican convention in August, the markets are likely to have recovered and all the economic indices should be swinging upward.  The level of disesteem for reporters may sink below that for lawyers, politicians, and used-car salesmen.

There may even be increasing suspicion of the master Chicken Little narrative:  anthropogenic global warming.

Image credit: NationalPark Service


[i] The case fatality rate is the percentage of deaths per the total number of infected individuals, but this is obviously difficult to determine.  Many individuals harboring the virus are asymptomatic, or have something like a common cold.  And among those who do have flu-like symptoms, few report it.  Did you notify your doctor or the CDC the last time you had the flu?

In the end, this flu season will be of greater interest to social psychologists and social and political historians than to virologists and epidemiologists.  Among an innumerate and paranoid population obsessed with its health, and which believes that the role of the government is to solve all problems, it was easy for the media to trigger a panic that would take down the markets and capsize the economy.  No public official or CEO can risk being viewed as irresponsible, and the decisions they’ve felt obliged to take have had devastating economic consequences for the majority of Americans. 

There are two ways of looking at the case fatality rate of Covid-19.[i] Originally, some high rates were reported:  3.2% (this figure, from WHO, was repeated by Bill Gates in an alarmist New England Journal of Medicine editorial), 2%, and 1.4%.  By the end of February, as the virus moved out Hubei province, estimates of the mortality rate were much lower.  As Anthony Fauci, et. al. reported in the NEJM on the 28th, “the case fatality rate may be considerably less than 1%.”  The authors go on to conclude that “this suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

In the deluge of coverage of the “epidemic,” how many reporters on TV or in print have bothered to repeat this information from the Director of the NHI’s National Institute of Allergy and Infectious Diseases?

For Fauci’s two worst-case scenarios, the epidemics of 1957-8 and 1968-9 (the politically incorrect “Asian Flu,” H2N2, and “Hong Kong Flu,” H3N2), approximately .44% to .67% of those infected died in 1957-8, and less than .5% in 1968-9.

If we assume a .5% case fatality rate for Covid-19, you could say that the virus is five times as lethal as normal flu in a bad season.  On the other hand, you could say, with equal accuracy, that 99.5% of those coming down with the flu will recover, versus 99.9% in a severe seasonal flu year, a difference of .4%.

But will anything like this number die? 

The CDC estimates the death totals for the two epidemics in the US to be 118,000 in ’57-8 and 100,000 in ’68-9.  The number of Covid-19 deaths in this country is now about 147

Are we going to see this figure go up by 80,000%?

There were about 178 million Americans in 1957, and about 206 million in 1968.  So .066% of Americans died of the flu in the first year, and .04% during the second epidemic.  If .066% of U.S. citizens died of Covid-19 this year, the death toll would be 217,800.  We have a ways to go.

***

I remember winning at the LA County Fair in 1968 a bobble-head doll of Chairman Mao on the base of which was written “So who you think cause Asian flu?”  Otherwise I have no recollection of this epidemic, as I surely would have if schools had closed.  And like Dr. Brian Joondeph, I can barely recall the 2009 swine flu virus, H1N1.  This was a particularly pernicious strain, in that it affected not primarily the elderly and people with serious underlying medical conditions, but the young and healthy. 

The worst flu outbreak of the last decade, in the 2017-18 season, was hardly newsworthy.  It was not a Presidential election year.  But 61,000 died according to the CDC.  The NFID estimates 80,000.  If we take the CDC’s figure, this represents only 10% of the cancer deaths for 2018, 609,640, and less than 9.5% of those dying from cardiovascular diseases, about 647,000.

Everyone is aware of the 1918 pandemic, the specter that lurks behind the media-stoked fears today.  But few people realize that only 10-15% of deaths are attributable to acute upper respiratory infections.  The rest are the result of secondary bacterial complications.  “Had no other aspect of modern medicine but antibiotics been available in 1918, there seems good reason to believe that the severity of this pandemic would have been far reduced,” one researcher concludes

***

This is not to say the Covid-19 is not a nasty strain, or that the draconian measures taken will not help prevent the spread of the disease.  If Americans had been harangued daily about washing their hands and maintaining social distance, and, especially, if visits to extended care facilities had been restricted, thousands of fewer people would have died two years ago.

In the end, the scaremongering is likely to boomerang.  The timing of the media was off.  As the number of cases plateaus and then declines before the end of May, there will be several consequences. 

President Trump will get credit for acting promptly and aggressively to keep the number of deaths in the hundreds rather than the thousands.  GOP ads will feature clips of Joe Biden condemning travel bans as “xenophobic,” which he mispronounces.

Israel will benefit if it can come up with the vaccine that it’s developing.  How many of the world’s 195 countries contribute anything to the health and well-being of the human race?

There may be another response.  Some people will be embarrassed in retrospect by their panicked shopping sprees, and especially hoarding the totemic toilet paper.

Still more will resent being manipulated by the media.  They will blame journalists for their 401(k) portfolios plummeting over 20%.  In fact the economy is fundamentally sound, and before the Republican convention in August, the markets are likely to have recovered and all the economic indices should be swinging upward.  The level of disesteem for reporters may sink below that for lawyers, politicians, and used-car salesmen.

There may even be increasing suspicion of the master Chicken Little narrative:  anthropogenic global warming.

Image credit: NationalPark Service


[i] The case fatality rate is the percentage of deaths per the total number of infected individuals, but this is obviously difficult to determine.  Many individuals harboring the virus are asymptomatic, or have something like a common cold.  And among those who do have flu-like symptoms, few report it.  Did you notify your doctor or the CDC the last time you had the flu?