Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS–CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
• Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.
• Live virus swab- a swab of one’s nose or throat to gather virus to see if you are CURRENTLY infected
• Antibody test- a blood test to measure antibody to the virus, to see if WERE infected, also called a serology test

Recent Numbers Estimating the Mortality Rate of COVID-19

Here are some numbers for the mortality rate for COVID-19 over time, including based on the current numbers:

• Earlier this year the WHO estimated the total mortality rate for COVID-19 to be 4%, meaning about 3.4 out of every 100 people infected with the SARS-CoV-2 virus would not live.
• As nations saw the number of COVID-19 cases start to slow down, mortality rates from many countries began to look more like 9%
• Today, if you look at reported numbers of cases and deaths in the US, you will find the mortality rate for America is 7%
• Today, for Ohio that number is 4%
• Today, in New York (state) that number is 7%.

So that the range of chances of dying from COVID-19 in the US range around 4-8%, or about 6%.  But as those who read our post on Real Answers about Cross-Currents, will recall that two unknowns push these mortality rates to be both MORE and LESS.   The mortality rate may be much lower if we increase the number we say were infected.

The Impact of the Great Expansion of Estimates of How Many are Asymptomatic on Estimates of Mortality Rate

Now we will see how spreadability, or contagiousness, plays into severity.  If the SARS-CoV-2 virus is spreading far more than we know, hidden from view because so many have no symptoms, then the mortality rate is LESS.

Here is an example.  Today’s American mortality rate across the US is at 5.7% as just noted.   But instead of taking the official number of infected people at 890,198, the number of actually positive swabs of the throat or nose for live virus, we look at estimates of how many Americans had the infection by antibody surveys.  But as we saw above, early results of antibody surveys in LA and NY state suggest the US has far more than 850,000+ cases of COVID-19, maybe as many as 13-45 million.  That range alone means we do not yet know for sure, but let’s guess that about 32 million of us, about 10% of America, has been infected.  If that is so, then the 50,000 deaths would give us a chance of dying from all those infected as 50,000/32 million or 0.15%.  Clearly a chance of dying from COVID-19 of 0.15% is LESS than the 5.7% cited above.

But even that is not a sure estimate.  We may have MORE cases, people infected, that we thought because so many infected have no symptoms.  But again, the experience in NYC has demonstrated that many people infected with COVID-19 died at home or in nursing homes, suddenly, and never diagnosed as dying from COVID-19.  We can never know those numbers.  Some adjustments for the number who have died cited in Pennsylvania, France, and Wales suggest that if we did count all recent, very dramatic jumps in people who have died as caused by the pandemic, the number who have died should be adjusted upwards by about 33%.   A third more deaths would take the US count from its current estimate of 50,000 to 66,666.  Using this number, 66,666, yields a US mortality rate for COVID-19 at 0.2%, only a bit higher than the 0.15% estimate above.

Now, a mortality rate of around 0.15-0.2% is not very high, it is clearly LESS than once thought.   But this is entirely because of the vast number of people infected with the SARS-CoV-2 virus who have few or no symptoms.   But at the same time, if we look at the number of Americans dying from COVID-19, every week, and compare it to the number of Americans dying of past flu seasons, flu pandemics, car crashes, cancer, and heart disease, COVID-19 is MORE than almost all of them.

Take a look at the graph New Atlantis drew on this question:

The main point is that this graph allows one to see the rate of death from all these causes, and as time has gone on COVID-19 has outstripped them, almost all of them, and since this graph was made.  https://www.thenewatlantis.com/publications/not-like-the-flu-not-like-car-crashes-not-like

Getting a Handle on Just How Bad is this Pandemic: How the Concept of Hot Spots Might Put All the Pieces Together

The above tour of numbers is a bit bewildering.  These next two points present a summary of the trends.

1. Not such a terrible pandemic.   Some new information suggests that COVID-19 is LESS of a problem.   These include good information really bolstering the idea that there is a vast number of people who get the infection but don’t get sick, at least 50%, likely more, of all infected.  As a result the overall mortality rate is LESS than we thought.
2. This is a catastrophic pandemic.  At the same time, the information tells us that COVID-19 is MORE of a problem.  There are more unexplained deaths from COVID-19 than the official count suggests.  COVID-19 deaths are now MORE, even at our low estimate of them, than ANY other cause of death.  And very disturbing is how there are MORE problems that happen from the infection.  It is no longer just a lung problem, but as posted this week, also a heart, kidney, brain, clotting, toes, liver problem.

How to put these opposing trends into perspective?

• IT’S A BRAND NEW DISEASE- keep in mind the whole story of COVID-19 is only 5 months old, every week, every month may change the nature of the virus and the illnesses it causes, AND our understanding will only grow as we learn more.
• WE ARE LUCKY THAT SO MANY INFECTED WILL BE FINE- the current patterns demonstrate that many people can be infected and not get sick, even at all, that’s good news
• THE DAMAGE DONE AND STILL AHEAD IS INDEED SEVERE AND HORRIFYING- COVID-19 remains a frightening threat, because a certain, fairly large number, of people do get sick, very sick, and many die

The concept of HOT SPOTS may turn out to be helpful here, and explain how all three of these true facts of COVID-19 can be understood to be all three true.

Most of us have observed how COVID-19 tends to erupt in sudden, terrifying clusters.   It is not a disease that blandly covers the planet causing the same experience of the disease everywhere.  Not at all.  We know, the pandemic was on fire in Wuhan, then in Italy and Iran, in NYC and Albany GA, communities seemed suddenly to sink into the disaster of a hot spot.

To be clear, the pandemic has struck everywhere.  The hot spot idea is NOT to say that anywhere is spared.  The story, so far, of NYC and Cleveland illustrates this point.  NYC is a hot spot, on the planet, it is THE hot spot right now.  Cleveland is not a hot spot.  We are actually closing ER’s for lack of need, and our ICU’s are simply not full.

And yet, even in the relative quiet of Cleveland, the SARS-CoV-2, tragedy is here.  People have lost their lives in horrible circumstances, many have had terrible illnesses they have survived not knowing what the long-term will be.  And a further point here, everyone in NYC knows the danger is at hand, but even outside hot spots that is so, as we will see in the next few paragraphs.

There is no coincidence in this phenomenon.

It appears, time will tell, that two features of this pandemic create such focused areas of suffering against the background of widespread danger.

The first is the terrible contagiousness of this virus.  That means if you give the virus a chance, if you open the door without watching, one case becomes 6, 6 becomes 36, 36 becomes 216 all in about 3 weeks, and even just 10 such rounds leads just one case becoming 60 million cases, if the spread is not interrupted.   

The second feature of this pandemic, unique in human history, is that humanity has figured out a way for enough of all of humanity to isolate themselves well enough to slow the spread of this virus.  It is remarkable.  But it also means that if we slip, if we fail to isolate cases, the terrible power of this virus to multiply, 6-fold each round, can suddenly cause a true eruption of cases, a hot spot.

Here is how this phenomenon of hot spot might explain the paradox of this pandemic, that the infection leaves at least half infected essentially unharmed, and yet at the same time clearly also causes true devastation.  A powerful demonstration of this synthesis is the tragedy that hit the people of Albany, Georgia.  All it took was for this small town to gather for 2 funerals, that was all, and the town was plunged into a terrible loss of life, overwhelmed hospitals, dangerous shortages.

In this tragic story we see that though this virus only makes about 50% of those it infects ill, it spreads so rapidly, and therefore can reach large numbers of infected so quickly and in an exponential acceleration, that the 50% who get sick become a large number with all the suffering and loss of life that comes with the severe disease this virus obviously can inflict.

The point is that communities that achieve isolation techniques sufficient to stop the spread may not experience massive devastation from this virus, but every community, every neighborhood, is at risk for this virus to indeed devastate, even with the large percentage of those who will have no symptoms and the resulting drop in mortality rate this implies.

BOTTOM LINES

And so, here is where we stand:

1. COVID-19 remains widely present.  Staying at home has slowed its spread, but when we come back to work and play, it remains ready to roar through the 90% of us still not infected.
2. It is good that many of us who will be infected will be OK, but when surges threaten, we must be able to be aware of them RAPIDLY, to isolate those infected before the surge becomes a massive hot spot.

Some good news, some bad news, but the danger remains, we can make a difference but only by either remaining totally isolated or with not just truly widespread testing available to all, but also deep contact tracing, and true isolation of all infected.

Here is to your health,
Dr. Arthur Lavin