Pandemic or Syndemic: How Deadly COVID-19 Isn’t

We are not just in the midst of a pandemic, which simply means a disease is occurring all over the world.  Rather, we are also experiencing a syndemic -- the aggregation of two or more concurrent epidemics or disease clusters with biological interactions that exacerbate COVID-19’s prognosis and burden. In other words, either of the diseases by themselves may be manageable, but when combined they create a more damaging or even lethal situation.  Here’s the good news, though: many of the comorbidities are controllable.

Sadly, as of November 13th, some 4,613 Hoosiers have died due to the Corona Virus according to the State Health Department, but is this number accurate?  I will argue that it is much lower and the overall death rate from COVID-19 is much lower too.  For example, out of 236,565 positive test results in Indiana, there have been 4,613 deaths, which is about 1.9 percent (4,613 ÷ 236,565). However, this is a mortality statistic, not the disease’s actual “death rate,” which is what concerns most people.

COVID-19’s actual death rate, formally known as the Infection Fatality Rate (IFR), is much lower.  The IFR includes all infections and specifically those, due to a lack of symptoms or other reasons, are not otherwise detected.  The IFR, therefore, requires a random sampling process to determine how many people are positive across the state. 

According to Indiana University’s study, published in September in the Annals of Internal Medicine, Indiana's IFR for “noninstitutionalized persons older than 60 years” is about 1 in 50, slightly below 2%. These deaths in the State are “…approximately 2.5 times greater than the estimated IFR for seasonal influenza, 0.8% (1 in 125), among those aged 65 years and older”.

The same study demonstrated that the overall IFR for non-institutionalized adults within Indiana was .26% or roughly 1/3 of one percent of all those infected (3 in 1000).  COVID-19 is dangerous, and it is certainly not some government conspiracy (though the response to it has become very highly politicized and confusing), but it is not anywhere near as deadly as the 1.9% (2 in 100) we regularly hear about. Nonetheless, it spreads quickly and can inundate hospitals even with non-lethal cases, which leads to a host of other problematic issues.

Still, even that .26% IFR is too high because we know that 51% of Hoosier fatalities were over 80 years old and that 94% of them had at least one serious comorbidity that may actually have caused death. 91% of all COVID-19 deaths were over 60 years, and they too had a 94% probability of at least one comorbidity. In other words, an 80-year old who died of cancer but had COVID-19 at autopsy, technically died of COVID-19 for Indiana’s tracking purposes.  This will severely warp the data.

Even more worrisome than that for anyone who died with merely suspected COVID-19 symptoms, that death was ascribed solely to COVID-19, artificially inflating the death toll.  The State Health Department does not conduct this practice for other diseases. That is, you don’t die of the flu if you are in a motorcycle crash and happen to cough before dying. 

The top comorbidities in Indiana are Hypertension (high blood pressure), Diabetes, Chronic Pulmonary Obstructive Disease, renal (kidney) issues, and Congestive Heart Failure.   Any one of these comorbidities could have been the actual cause of death in people classified as COVID-19 deaths.  This is especially the case earlier in the year when many deaths were ascribed to COVID-19 based upon symptoms and not testing.

Knowing the flaws in data collection means that the IFR rate is even lower than that.26% number. Due to COVID-19’s politicization and the confusing information put out since the initial outbreak, many people who know better are not willing to stand up publicly and say so for fear of repercussions.  I have personally talked with doctors treating COVID-19 patients and infectious disease experts who have validated the above analysis, but who do not want to go on the record, fearing personal and professional persecution.

We must also stop comparing COVID-19 to the flu because they are not measured or tracked in the same way.  The CDC states it “…does not know exactly how many people die from seasonal flu each year. There are several reasons for this. . . . [M]any flu-related deaths occur one or two weeks after a person’s initial infection . . . because influenza can aggravate an existing chronic illness (such as congestive heart failure or chronic obstructive pulmonary disease)” – all of which is true for COVID-19.  Unlike COVID-19, the CDC doesn’t track every flu death because it’s virtually impossible to say whether COVID-19 caused the heart attack or if a weak heart led to a fatal COVID-19 death.

What makes this worse is that the top comorbidities are virtually all self-inflicted or, at least, mostly preventable! If we counted all the deaths that were attributed to or had complications from diabetes the way we count COVID-19 fatalities, that number would be greater than 270,000 Americans every year.

The major root causes of co-morbidity cases in the US are overeating, poor food choices, and smoking.  Overindulging in an unbalanced diet with too much sugar, fat, and other foods clogs and hardens arteries and increases fat accumulation, which can cause kidney issues, and lead to obesity.  Obesity leads to high blood pressure, kidney disease, and diabetes, which can lead to congestive heart failure.  Smoking is the primary cause of Chronic Pulmonary Obstructive Disease. High blood pressure results from obesity and excessive alcohol use.  Too little proper exercise is also a major root cause.

This means that the two greatest indicators of risk for any given COVID-19 patient are advanced age and obesity.

Further, according to the American Institute for Economic Research, in an article titled “Death by Lockdown,” the CDC has counted some 98,000 “excess deaths” in 2019 through October 3 that are not directly related to COVID but, instead, to our response to the disease.  The result has been increased drug overdoses, suicides, alcoholism, homicides, and untreated depression.  This the result of policies of “mandatory human separation, economic downturn, business, and school closures, closed medical services, and general depression that comes with a loss of freedom and choice.”

It is time for us to stop debating about masks and vaccines unless one is in the high-risk groups mentioned above.  Should we be careful? Of course!  The recent news of 2 sources of vaccine with greater than 90% effectiveness is outstanding, but we would do much better to combine this with a risk-based approach protecting those people most in peril, rather than trying to throw an unmanageable virus barrier around every single person. 

We need to get back to the “old normal” and stop looking to politically expedient isolation and economic shutdowns.  Now it is time to work toward a “new normal” of lifestyle changes that reduce the rate and impacts of these comorbidities and improve our health and resistance to all disease.  It turns out that the effects of COVID-19 are not quite the public health crisis they have been made out to be, but are more akin to the other personal health issues—all those heathy lifestyle issues that your doctor has been warning you about for decades.

Sources

https://www.coronavirus.in.gov/2393.htm

https://www.regenstrief.org/COVID-19-dashboard/

https://www.acpjournals.org/doi/10.7326/M20-5352

https://news.iu.edu/stories/2020/09/iupui/releases/24-scientists-determine-death-rate-COVID-19-general-population.html

https://professional.diabetes.org/sites/professional.diabetes.org/files/media/sci_2020_diabetes_fast_facts_sheet_final.pdf

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32131-0/fulltext

https://www.cdc.gov/flu/about/burden/faq.htm

https://www.heartland.org/news-opinion/news/is-the-official-COVID-19-death-toll-accurate

https://cbs12.com/news/local/man-who-died-in-motorcycle-crash-counted-as-COVID-19-death-in-florida-report

https://www.aier.org/article/death-by-lockdown/

Image:  COVID-19. Public Domain.