Tuesday, March 24, 2020

UPDATED: Definitely Not Just Oldies--The 'Simple' Solution

Earlier in Not Just Oldies I noted that European healthcare officials were reporting that--contrary to earlier impressions--Covid-19 is not simply an "old persons' disease. For example, at that time reports were coming out of France that of critical cases over 50% were over the age of 60. Netherlands was reporting similar statistics.

Now the CDC is reporting, according to NBC, that American statistics reflect the European experience. Of course, the disease still skews old, but it takes in a large swath of people still in the prime of life. For example:

Centers for Disease Control and Prevention, which, after studying more than 4,000 cases in the U.S., showed that about
40 percent of those hospitalized were ages 20 to 54.
Among the most critical cases, 12 percent of intensive care admissions were among those ages 20 to 44, while 36 percent were for those 45 to 64.
About 80 percent of people in the U.S. who have died from COVID-19 were 65 and over, with the highest percentage among those over 85.

So, nearly half of critical cases fell between the ages of 20 and 64. The worst outcome (death) was heavily among those over 65, but that's a lot of critical care patients in the two middle quartiles using up increasingly scarce healthcare resources.

The point is, the "simple" solution that has been appearing recently in opinion columns--quarantine people over 65 and allow the rest of the population to roam free--urns out after even a cursory examination of the data to be not so simple at all. In some very real sense the mortality or death rate gives a false impression. People who die no longer occupy an ICU bed. I'm going to bet that those who survive this disease after entering an ICU will have occupied space for far longer than those who died. That's the devilish thing about this pandemic--it 'attacks' our actual healthcare system as much as individuals. Attacks and overwhelms. Allowing people in the middle two quartiles to roam freely invites collapse of our healthcare system because hospitalization rates for Covid-19 are far, far higher than for seasonal flu. The more freely roaming people from the two middle quartiles who become infected, the more that rate will come back to haunt the entire healthcare system. This is what 'flattening the curve' is really about, far more than about the mortality rate alone.

Another problem with this concept of "returning to normal" and readily allowing widespread infection is the growing body of evidence that Covid-19 attacks body organs. In particular, there are signs that lung function can be permanently impaired by 20-30%--even after "full recovery." That is not an outcome that we should wish to lightly take for granted. Hopefully the specific medications like forms of chloroquine in combination with other medicine will offer a truly simpler strategy that avoids these complications.

Have I mentioned recently that THIS IS NOT THE FLU? It's time to stop pretending.

UPDATED:  Don Surber links to a very informative article from the Irish Times that talks about Didier Raoult, The man who may stop COVID-19. Raoult is the scientist who came up with the blend of Chloroquine and Azythromycin that has shown such promising early results. Surber ends with this:

Be cautious, but hopeful. 
French health minister Olivier Véran said, "The history of viral disease is strewn with false good news, disappointments and reckless risks." 
Medicine.Net cited Raoult's test and said, "This follows encouraging in vitro results obtained by a Chinese team led by Xueting Yao, from Peking University Third Hospital, Beijing, China, which were published online by the journal Clinical Infectious Diseases on March 9th. However, the data were deemed insufficient by the infection community to recommend the compound as a treatment. 
"Moreover, chloroquine is not listed among the four treatments studied as part of the recently launched European clinical trial piloted by Inserm, which includes 3200 severe hospitalized patients, including 800 French patients. 
"Chloroquine was ruled out due to the risk of interactions with other medications for common comorbidities in infected patients, and because of possible adverse effects in patients undergoing resuscitation." 
Fair warning.

IOW, Chloroquine may not be for everyone. No simple solution. But it could yet be a significant factor.


  1. If I understood Fauci in the NBC article, he did not know anything about whether these youngsters, for lack of a better term, had underlying conditions.

    1. There IS a better term--comorbidities. That's an aspect they're still looking at.

      However, as Cassander demonstrated in comments yesterday, the entire US population is riddled with 'comorbidities.'

      As I argue above, the number that really matters is the number of hospital admissions together with those admitted to ICU beds. That tells us whether we're reaching a real danger point. What total infections is a rough indicator for is whether those really critical numbers may grow rapidly in the future.

  2. Mark, you wrote

    "Centers for Disease Control and Prevention, which, after studying more than 4,000 cases in the U.S., showed that about 40 percent of those hospitalized were ages 20 to 54."

    So that amounts to about 1600 cases age 54 or under.

    I'm wondering, in case you have access to the data, did the same data disclose what percent of the 1600 54-and-under cases who were hospitalized had underlying, or chronic disease, conditions?

    I'm also wondering what percentage of each age group among the 4000 (under- and over-55) died?

    (Also, FWIW, not minimizing concern over the risk of lung damage to those who survive...)

    1. I have no knowledge re comorbidities. Re death rates among groups it does say: "About 80 percent of people in the U.S. who have died from COVID-19 were 65." Don't know whether you can do any valid calculation. The latest death count in the US stands at 582.

    2. "The latest death count in the US stands at 582."

      Suggesting that perhaps...perhaps...116 far...are under age 65.

      FWIW, my questions are generally aimed at sussing out an answer to the question whether there is a safe strategy to put some Americans back to work.

  3. Interesting info on Italy:

    And the ages:

    Interesting symptom is loss of smell.

    1. Tx, Ray. I saw the 2nd one yesterday, will get to the first soon.

  4. More info on Italy.

    1. Makes you wonder. What does it say about a society where the excess flu related deaths exceed those of the US, often by a significant margin, yet the population is only a fraction of ours? And it's not as if Italy is Third World--except, apparently, with regard to public health concerns.

  5. Maybe they have more Chinese virus carriers that we do.