We are now more or less into our sixth month of the SARS-CoV-2 epidemic (the novel coronavirus that is at the heart of COVID-19). As of today, the estimated number of infected Americans is just over six million, and between 175,000 (official state departments of health) and 185,000 (Johns Hopkins University) have lost their lives.
Unfortunately, this outbreak early on itself became infected with politics, and sides quickly were chosen and battle lines drawn.
It's an election year, so some of this is to be expected.
Fights about shelter in place orders, mask wearing, possible therapies, vaccine developments, how to measure the impact economically and medically, and myriad other battles were launched.
Recently a thread has appeared, quietly at first, but over the past few days, it has gathered momentum.
According to a weekly report issued by the US Centers for Disease Control and Prevention (CDC), somewhere on the order of 94 per cent of people who died with COVID-19 had one or more underlying conditions.
Many seized on this to claim that the epidemic is grossly overblown, and that "only" six per cent of those who died with confirmed SARS-CoV-2 infection died "from COVID-19." Something of a semantic debate has been going on for months about the differences between dying from COVID-19 (i.e., that the virus itself caused death) and dying with COVID-19 (you died from something else, and COVID-19 was just on board). The recent publication has caused the debate to reignite, and with more heat.
I am not a virologist or infectious disease doctor. I don't see or treat patients. I'm not a coroner or a medical examiner. It's not my job to assign cause of death.
I'm also not a politician who is looking at a tough re-election, or a challenger looking to parlay the pandemic into a means of election. Nor am I a political operative or pundit who gets paid to sway public opinion one way or the other.
I am an epidemiologist.
It's (part) of my job to look at health data from a public or population health perspective. Moreover, I spent several years working on research in both hepatitis-C (Hep-C) and HIV disease. I've seen and participated in all sorts of analyses - disease transmission models, outcomes research, interventional impact analyses.
Mortality modelling.
No-one knows for certain how many people at this point have actually been exposed, how many have been infected, or how many have actually died. With or due to COVID. We have estimates, and we have models on top of data.
I do know this, however.
Whether the 94% statistic is accurate, and whether people with comorbidity (what in my world is the term used to describe "underlying conditions"), you need to take the estimates of death seriously. You need to look at claims that, because "only six per cent of people who died had no underlying conditions" the problem is being made larger than it is, or that you can ignore the threat.
The truth is that a huge number of Americans over the age of 18 has underlying conditions. It is possible - even likely if you are over 40 - that you have at least one.
I know that I do.
Here is a paper published last month from the CDC on the prevalence of various chronic conditions in the US (https://www.cdc.gov/mmwr/volumes/69/wr/mm6929a1.htm#contribAff). The authors looked at a selected set of conditions believed to be associated with COVID mortality, including diabetes, obesity, heart disease, kidney disease, and chronic obstructive pulmonary disease (COPD). Data in various states, in cities and rural areas, were examined for people over the age of 18.
The research indicated that forty percent of the adult population had one or more of these conditions.
Two out of four.
The numbers turned out to be higher - close to 50% - in rural counties than in large, urban centres (39%).
Worse, prevalence rises with age. Far fewer people in their 20s had comorbidity than those over 50.
The arguments you are hearing that COVID-19 is not a serious problem because it, alone, has killed only six per cent of the 175-185,000 people are at best mistaken and at worst deliberately dishonest.
Please take the threat of COVID-19 seriously. Because the threat is serious. It is real.
Luckily, you are not helpless. As I said months ago at the outset, we are not helpless victims of fate. The final trajectory of SARS-CoV-2, its impact on you and people you care about is something you can affect. Your choices still matter. You can still have an impact.
Be smart.
Stay home unless you have to go out.
If you're going to be out, distance from other people if you can.
And if you can't, wear a mask.
