Covid hysteria: "How can a disease with 1% mortality shut down the United States?"

I've seen this shared a few times, and finally got annoyed enough to write a response:

How can a disease with 1% mortality shut down the United States?

Franklin Veaux

 

This time, re-posted by the aptly named "Insufferably Intolerant Science Nerd"

 

Original post:

"[Edit Nov 10, 2020: See new information at the end]

There are two problems with this question.

1. It neglects the law of large numbers; and
2. It assumes that one of two things happen: you die or you’re 100% fine.

The US has a population of 328,200,000. If one percent of the population dies, that’s 3,282,000 people dead.

Three million people dead would monkey wrench the economy no matter what. That more than doubles the number of annual deaths all at once.

The second bit is people keep talking about deaths. Deaths, deaths, deaths. Only one percent die! Just one percent! One is a small number! No big deal, right?

What about the people who survive?

For every one person who dies:

• 19 more require hospitalization.
• 18 of those will have permanent heart damage for the rest of their lives.
• 10 will have permanent lung damage.
• 3 will have strokes.
• 2 will have neurological damage that leads to chronic weakness and loss of coordination.
• 2 will have neurological damage that leads to loss of cognitive function.

So now all of a sudden, that “but it’s only 1% fatal!” becomes:

• 3,282,000 people dead.
• 62,358,000 hospitalized.
• 59,076,000 people with permanent heart damage.
• 32,820,000 people with permanent lung damage.
• 9,846,000 people with strokes.
• 6,564,000 people with muscle weakness.
• 6,564,000 people with loss of cognitive function.

That's the thing that the folks who keep going on about “only 1% dead, what’s the big deal?” don’t get.

The choice is not “ruin the economy to save 1%.” If we reopen the economy, it will be destroyed anyway. The US economy cannot survive everyone getting COVID-19.

Edited to add:

Wow, this answer has really blown up. Many people are asking about the sources, so here’s the basic rundown:

This model assumes that the question’s hypothetical is correct and the fatality rate is 1%. It also assumes for the sake of argument 100% infection. (In reality, of course, neither of these is a perfect match to reality. The infection rate will never hit 100%, but the fatality rate in a widespread infection is likely to be greater than 1%, because health care services will be overwhelmed.)

The statistics I used in this answer were compiled from a number of different sources. I spent quite a bit of time writing the answer. Unfortunately, I don’t have my search history in front of me, so I’ll attempt to re-compile them.

Some of the sources include:

What we know (so far) about the long-term health effects of Covid-19

Physicians have also reported an increase in inflammation of and damage to the heart muscle in Covid-19 patients. One study published in March found that out of 416 hospitalized Covid-19 patients, 19% showed signs of heart damage.

               Another study from Wuhan published in January found 12% of Covid-19 patients showed                       signs of cardiovascular damage. Other studies have since found evidence of myocarditis,                     inflammation of the heart muscle that can cause scarring, and heart failure in Covid-19 patients.

Now, physicians warn that Covid-19 survivors may experience long-lasting cardiac damage and cardiovascular problems, which could increase their risk for heart attack and stroke. Doctors also warn Covid-19 could worsen existing heart problems.

What We Know About the Long-Term Effects of COVID-19

“Some of the data that we’re getting now from the China studies, one study that was just published in JAMA Neurology showed that 36.4 percent of patients had neurologic issues,” said Dr. Sheri Dewan, neurosurgeon at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois. “One of the review articles that came out at the end of February discussed the possibility of virus traveling into the olfactory neurons, through the olfactory bulb, and into the brain.”

Lifelong Lung Damage: A Serious COVID-19 Complication

“Holes in the lung likely refers to an entity that has been dubbed ‘post-COVID fibrosis,’ otherwise known as post-ARDS [acute respiratory distress syndrome] fibrosis,” said Dr. Lori Shah, transplant pulmonologist at New York-Presbyterian/Columbia University Irving Medical Center.

            ARDS occurs when fluid builds up in tiny air sacs in the lungs called alveoli. This reduces                     oxygen in the bloodstream and deprives the organs of oxygen which can lead to organ failure.

            Post-COVID fibrosis, according to Shah, is defined as lung damage that’s irreversible and can                 result in severe functional limitations from patients, such as cough, shortness of breath, and                     need for oxygen. […]

              According to The Lancet, in a piece titled, “Pulmonary fibrosis secondary to COVID-19: A                   call to arms?,” the first series of hospitalized patients in Wuhan, China showed that 26 percent required intensive care and 61 percent of that subset developed ARDS.

What we know (so far) about the long-term health effects of Covid-19

Physicians report that patients hospitalized for Covid-19 are experiencing high rates of blood clots that can cause strokes, heart attacks, lung blockages, and other complications, Parshley reports.

For instance, physicians are seeing an uptick in strokes among young patients with Covid-19.

The blood clots also can travel to other organs, leading to ongoing health problems. For instance, pulmonary embolisms, which occur when the clots block circulation to the lungs, can cause ongoing "functional limitations," like fatigue, shortness of breath, heart palpitations, and discomfort when performing physical activity, Parshley reports. Similarly, blood clots in the kidneys can cause renal failure, which can cause life-long complications.

Heart damage

Physicians have also reported an increase in inflammation of and damage to the heart muscle in Covid-19 patients. One study published in March found that out of 416 hospitalized Covid-19 patients, 19% showed signs of heart damage.

               Another study from Wuhan published in January found 12% of Covid-19 patients showed                       signs of cardiovascular damage. Other studies have since found evidence of myocarditis,                     inflammation of the heart muscle that can cause scarring, and heart failure in Covid-19 patients.

Now, physicians warn that Covid-19 survivors may experience long-lasting cardiac damage and cardiovascular problems, which could increase their risk for heart attack and stroke. Doctors also warn Covid-19 could worsen existing heart problems.

The numbers in this answer were made from extrapolations about percentages of COVID-19 long-term effects reported in a range of studies on Google Scholar, assuming a hypothetical 100% US infection rate and a 1% fatality rate. Of course, in reality, a high infection rate would cause the mortality and comorbidity rates to skyrocket, so if anything, these numbers are conservative.

Wear your damn masks, people."

 

Response:

There's massive selection bias going on here

All the linked studies are of people who were hospitalised and are not reflective of the general population who get covid, the vast majority of whom have mild symptoms or are even asymptomatic. Even in February, 81% of cases were found to be mild - and this is just for people with symptoms. The CDC's current best estimate is that 40% of infections are asymptomatic.

So let us examine one of the hysterical claims, that 18% of those infected with covid "will have permanent heart damage for the rest of their lives" (based on 1% mortality and "for every one person who dies... 18 of those will have permanent heart damage for the rest of their lives".

This is presumably based on the first linked paper, "Association of Cardiac Injury with Mortality in Hospitalized Patients With COVID-19 in Wuhan, China", which reports that "cardiac injury occured in 19.7% of patients during hospitalization". For simplicity, let's assume that cardiac injury is permanent and that results from that one hospital can be extrapolated to the general population.

Another paper, Estimates of the severity of coronavirus disease 2019: a model-based analysis estimated that even among those aged over 80, only 14.8% of those infected with covid would require hospitalization (for those aged 70-79 it was only 7.9% - and it got way lower for those even younger).

Since both papers (on cardiac injury and hospitalization) are based on Chinese data, we can use China's median age of 38 to do our calculations. Rounding up, we can take the hospitalization rate of 0.443% for age 40-49 (note: the median age of the US is also 38, though obviously comorbidities will mean Americans will suffer more from covid than Chinese - even absent factors like pre-existing immunity and the BCG).

So based on Chinese data, we'd expect 0.087% of those who get covid to have "permanent heart damage for the rest of their lives". In other words, out of every 10,000 people who get covid, less than 9 will have "permanent heart damage for the rest of their lives" (assuming no re-infection).

To put it another way, if you get covid, your odds of "permanent heart damage for the rest of your life" are 1 in 1,150. In contrast, in the US in 2018, your odds of *dying* from a motor-vehicle crash are 1 in 106. So maybe the US should shut down the country over car crashes. And this assumes that everyone will get covid - a paper by Neil Ferguson et al estimated that only 81% of the US and British populations would be infected over the course of the pandemic. When you consider that Ferguson was behind the discredited Imperial College model that wildly over-exaggerated covid cases, and has repeatedly over-estimated risks in the past, we are confident in treating 81% as an upper bound. So the true odds of covid complications would be even lower.

Furthermore, covid has become less serious as the epidemic has progressed as we become better at treating it and the virus seems to be mutating to become less deadly; naturally long term side effects would diminish too

Plus even ignoring this, 1% as a mortality rate was exaggerated: even as of 9 Sep, the estimated IFR (infection fertility ratio - taking into account all cases) for covid was significantly lower than 1%

Here is a peer reviewed paper published by the WHO and authored by John Ioannidis, a Stanford professor who's worked in medicine and epidemiology

 

Infection fatality rate of COVID-19 inferred from seroprevalence data

"Results I included 61 studies (74 estimates) and eight preliminary national estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118–500 COVID-19 deaths/million people and 0.57% in locations with > 500 COVID-19 deaths/million people. In people < 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%."

This was based on papers published as of 9 Sep

Perhaps one might still try to object, claiming that if the health care system were overwhelmed, not just would death rates rise but also long term disabilities. Yet, note that the same paper with data on hospitalization rates by age also noted that the estimated IFR for mainland China was 0.66% - based on data between Jan 1 and Feb 11, where 74% of deaths occured in Wuhan. During much of that period, hospitals in Wuhan were overwhelmed, so the 0.66% IFR already accounts for some of that effect.

More specifically, another paper, Early epidemiological assessment of the transmission potential and virulence of coronavirus disease 2019 (COVID-19) in Wuhan City, China, January–February, 2020, modelled the time-delay adjusted IFR for Wuhan by day and even at its highest (presumably corresponding to when hospitals were most overwhelmed), the upper estimate never exceeded 0.5%.

 

Note too that covid is not unusual in having long term side effects - seasonal influenza is linked to elevated heart attack and stroke risk, as well as pneumonia and even disability.

To say nothing of how the RCTs tell us that there is poor evidence for masks, but that is another story.