A very "clever" virus- and a deadlier one than we knew
A large, peer-reviewed study of the COVID pandemic in New York, the epicenter of the crisis in the United States, published in the Journal of the American Medical Association shows that fully 70% of people admitted to the hospital with the disease did not have a fever.
This is one of several surprising findings in the study. Fever has generally been regarded as one of COVID's signature symptoms. But it has been known from the outset that symptoms are mild in the overwhelming majority of COVID patients, and it has become increasingly clear recently that a large percentage of victims have no apparent symptoms at all. Some 60% of the sailors on the COVID-stricken carrier USS Theodore Roosevelt who subsequently tested positive for antibodies to the virus never had any symptoms. It was the realization that so many carriers were asymptomatic that caused the Centers for Disease Control and Prevention (CDC) to reverse itself and urge that healthy Americans wear masks when venturing out in public or in unavoidable large groups of people, not to protect themselves but rather to protect other people, since any of us could be infected and be shedding virus without even knowing it.
I blogged recently about the large number of younger and middle-aged patients who have only mild symptoms and are seemingly well on the way to recovery when they suddenly have what are often fatal strokes. Elderly patients and those with underlying conditions continue to be at greater risk for the virus, as the JAMA study documents. But it's becoming clearer all the time the risk is far greater than we thought even to the young and otherwise healthy among us. Ischemic conditions involving compromised blood flow to the brain, resulting in a stroke; to the lungs, resulting in a pulmonary embolism; to the heart, causing a coronary thrombosis, or to other organs seem to be a prominent feature of a disease which has been known since the earliest days in Wuhan to cause gravely abnormal blood clotting and which attacks every organ and system in the body.
Again. those with underlying health problems are, of course, at the greatest risk, along with the aged. But it is only now becoming clear how grave a threat this poses to people not hitherto thought to be seriously threatened by COVID. In many cases, it seems, the symptoms of COVID-19 are mild. And then, you die.
The most widely-reported finding of the JAMA study sounds far more frightening than it is. 88% of those who had to be placed on ventilators- the shortage of which has been a major source of conflict between the Trump administration and state governors including New York's Andrew Cuomo- appeared from the statistics in the article to have died. A subsequent clarification, however, pointed out that these statistics only reflected the minority of cases in which patients had either died or been discharged from the hospital as fully recovered. The overwhelming majority of patients put on ventilators in New York remain under treatment and the outcome of their cases is unknown. Other studies have indicated that only around 20% of patients placed on ventilators during the New York COVID outbreak are dying, a number in line with the death rate for patients placed on ventilators because of other respiratory conditions in normal times.
In any case, as Dr. Anthony Fauci of the White House task force has pointed out many times, this coronavirus lives up to its name: it truly is novel. It seems incredibly contagious and efficient in transmitting itself through the population through non-symptomatic spread while attacking not only the lungs but every organ of the body, largely by creating blood clots. Because only serious cases requiring medical attention are reported and therefore counted in the statistics, it has been assumed that the death rate for COVID, even more so than for other diseases because of the large number of patients who apparently never get sick enough for their cases to be reported, is greatly inflated.
If they are accurate, in a mere twelve weeks, as many Americans have died in the COVID pandemic as died in the entire Vietnam War. But these new findings increasingly raise questions as to whether we might not be undercounting the deaths caused by the virus. Some have suggested that this may be by as much as half- that the 100,000 Drs. Fauci and Birx originally predicted may already have died, rather than the 50,000, we've heard about. I said earlier, at some point once the crisis has passed somebody is going to do a study of the number of "excess deaths" caused by heart attacks, strokes, and other causes explicable by COVID, compare it to a similar period in more normal times, and come up with a clearer idea of what the true death toll might be. It's already clear that Americans have died during these twelve weeks at a rate drastically enough higher than usual that such might be the case, though caution is in order here because domestic violence, suicides, and other contributing factors than the disease itself are probably responsible for this to some degree.
Dr. Deborah Birx, also of the President's Task Force, said the other day that social distancing will undoubtedly have to continue through the summer. But then, as the CDC and others point out, there will probably be a second wave of COVID of unpredictable severity in the fall. That's the way respiratory viruses seem to work; they recur seasonally. The 1918-1919 "Spanish flu" epidemic had three waves, and most of the deaths occurred during the second.
It's to minimize the chances of that happening this time and to prevent the second wave from getting out of hand that so many experts worry about opening things up too fast. And while there is no question that there have been absurdly severe restrictions in some places, and we would do well to avoid either extreme. But it seems as clear as it can be to me, at least- and, if the polls can be believed, to the majority of the American people- that the dangers of being too lax are much, much more serious than the dangers of being too careful.
ADDENDUM: But carelessness when it comes to this virus isn't new, and has always had advocates in high places. President Trump bragged early in his term that he didn't read his daily briefings because he was so smart that he didn't need them.
Well, apparently he did. Among all the other warnings he got- and ignored- were repeated alarms raised in those daily briefings as early as January as to just what we were facing. And it was only about three weeks ago that Mr. Trump acknowledged, for the first time, that COVID was a serious problem.
If we re-elect this guy, we deserve him.
ADDENDUM: Six times as many New Yorkers died between the beginning of the outbreak in February and now as ordinarily during the same length of time.
There is no way that, at least in NYC, the reported number of cases- and deaths- isn't way, way low.
ADDENDUM II: Testing at a Boston homeless shelter in April revealed that almost none of those who tested positive for COVID displayed there presented the classic symptom profile we've all read about, or anything close to it. More evidence that a far greater number of Americans have been infected by the disease- and probably died from it- than most of us even suspect.
This is one of several surprising findings in the study. Fever has generally been regarded as one of COVID's signature symptoms. But it has been known from the outset that symptoms are mild in the overwhelming majority of COVID patients, and it has become increasingly clear recently that a large percentage of victims have no apparent symptoms at all. Some 60% of the sailors on the COVID-stricken carrier USS Theodore Roosevelt who subsequently tested positive for antibodies to the virus never had any symptoms. It was the realization that so many carriers were asymptomatic that caused the Centers for Disease Control and Prevention (CDC) to reverse itself and urge that healthy Americans wear masks when venturing out in public or in unavoidable large groups of people, not to protect themselves but rather to protect other people, since any of us could be infected and be shedding virus without even knowing it.
I blogged recently about the large number of younger and middle-aged patients who have only mild symptoms and are seemingly well on the way to recovery when they suddenly have what are often fatal strokes. Elderly patients and those with underlying conditions continue to be at greater risk for the virus, as the JAMA study documents. But it's becoming clearer all the time the risk is far greater than we thought even to the young and otherwise healthy among us. Ischemic conditions involving compromised blood flow to the brain, resulting in a stroke; to the lungs, resulting in a pulmonary embolism; to the heart, causing a coronary thrombosis, or to other organs seem to be a prominent feature of a disease which has been known since the earliest days in Wuhan to cause gravely abnormal blood clotting and which attacks every organ and system in the body.
Again. those with underlying health problems are, of course, at the greatest risk, along with the aged. But it is only now becoming clear how grave a threat this poses to people not hitherto thought to be seriously threatened by COVID. In many cases, it seems, the symptoms of COVID-19 are mild. And then, you die.
The most widely-reported finding of the JAMA study sounds far more frightening than it is. 88% of those who had to be placed on ventilators- the shortage of which has been a major source of conflict between the Trump administration and state governors including New York's Andrew Cuomo- appeared from the statistics in the article to have died. A subsequent clarification, however, pointed out that these statistics only reflected the minority of cases in which patients had either died or been discharged from the hospital as fully recovered. The overwhelming majority of patients put on ventilators in New York remain under treatment and the outcome of their cases is unknown. Other studies have indicated that only around 20% of patients placed on ventilators during the New York COVID outbreak are dying, a number in line with the death rate for patients placed on ventilators because of other respiratory conditions in normal times.
In any case, as Dr. Anthony Fauci of the White House task force has pointed out many times, this coronavirus lives up to its name: it truly is novel. It seems incredibly contagious and efficient in transmitting itself through the population through non-symptomatic spread while attacking not only the lungs but every organ of the body, largely by creating blood clots. Because only serious cases requiring medical attention are reported and therefore counted in the statistics, it has been assumed that the death rate for COVID, even more so than for other diseases because of the large number of patients who apparently never get sick enough for their cases to be reported, is greatly inflated.
If they are accurate, in a mere twelve weeks, as many Americans have died in the COVID pandemic as died in the entire Vietnam War. But these new findings increasingly raise questions as to whether we might not be undercounting the deaths caused by the virus. Some have suggested that this may be by as much as half- that the 100,000 Drs. Fauci and Birx originally predicted may already have died, rather than the 50,000, we've heard about. I said earlier, at some point once the crisis has passed somebody is going to do a study of the number of "excess deaths" caused by heart attacks, strokes, and other causes explicable by COVID, compare it to a similar period in more normal times, and come up with a clearer idea of what the true death toll might be. It's already clear that Americans have died during these twelve weeks at a rate drastically enough higher than usual that such might be the case, though caution is in order here because domestic violence, suicides, and other contributing factors than the disease itself are probably responsible for this to some degree.
Dr. Deborah Birx, also of the President's Task Force, said the other day that social distancing will undoubtedly have to continue through the summer. But then, as the CDC and others point out, there will probably be a second wave of COVID of unpredictable severity in the fall. That's the way respiratory viruses seem to work; they recur seasonally. The 1918-1919 "Spanish flu" epidemic had three waves, and most of the deaths occurred during the second.
It's to minimize the chances of that happening this time and to prevent the second wave from getting out of hand that so many experts worry about opening things up too fast. And while there is no question that there have been absurdly severe restrictions in some places, and we would do well to avoid either extreme. But it seems as clear as it can be to me, at least- and, if the polls can be believed, to the majority of the American people- that the dangers of being too lax are much, much more serious than the dangers of being too careful.
ADDENDUM: But carelessness when it comes to this virus isn't new, and has always had advocates in high places. President Trump bragged early in his term that he didn't read his daily briefings because he was so smart that he didn't need them.
Well, apparently he did. Among all the other warnings he got- and ignored- were repeated alarms raised in those daily briefings as early as January as to just what we were facing. And it was only about three weeks ago that Mr. Trump acknowledged, for the first time, that COVID was a serious problem.
If we re-elect this guy, we deserve him.
ADDENDUM: Six times as many New Yorkers died between the beginning of the outbreak in February and now as ordinarily during the same length of time.
There is no way that, at least in NYC, the reported number of cases- and deaths- isn't way, way low.
ADDENDUM II: Testing at a Boston homeless shelter in April revealed that almost none of those who tested positive for COVID displayed there presented the classic symptom profile we've all read about, or anything close to it. More evidence that a far greater number of Americans have been infected by the disease- and probably died from it- than most of us even suspect.
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