Returning to normal…but what’s normal?
As the nation and the world turns toward reopening the world to business, there has been a lot discussion of whether we could ‘return to normal’, but what does that mean exactly and how do we know when get back to normal? We have lived with numerous causes of death that are higher in number than we are seeing for Covid, yet we did not shut down our country for any of these other causes. In other words, we accepted as ‘life’ that there are many things cause death but we continue to go through life without stopping.
We should not have to complete end or stop Covid 19 before we ‘return to normal’. ‘Norma’l includes yearly deaths many times that caused by Covid 19.
We get daily briefings and headlines about Covid new cases and new deaths from the US and around the world. To date (April 27, 2020) there have been 1,004,942 Covid 19 cases and 56,527 deaths. However, the view of the number of actual cases has drastically changed in the last week. The availability of antibody tests, which can determine if someone has been infected, has resulted in several reports that the actual number of people that were infected may be somewhere between 16 to 80X higher than this value (up to 21% of the population). This means the actual number of Covid 19 cases may in the range of 16,000,000 to 80,000,000. This makes the fatality rate between .34 and .07%. This is in the range of the seasonal flu. New York: Nearly 3 million infections – not 276,000
The early concern over Covid 19, which caused the nationwide lockdown were basically two concerns. The first was the seemingly high fatality rate which was generally reported to be between 5 and 10% back in March. The second was the concern that the number of infected patients would overwhelm our health and hospital systems, and whether we could treat everyone who needed help.
As it turns out now, fortunately, neither of those concerns happened. The fatality rate is most likely be well under 1% and may be in the range of the seasonal flu. There was not one city, including the hottest spot, New York where there was a shortage of beds, intensive care units or ventilators.
The shelter in place and closing of businesses undoubtedly helped to slow the spread of the virus, but perhaps not as much as we previously thought. Before antibody testing, we were operating under the fact the 1 million people had been infected. In a country of 370 million, this would seem to say that the lockdown was very effective. However, the antibody testing now suggests that the number of people infected may be as much as 80 million! This means that the lockdown was not nearly effective as we thought. It also means that the vast majority of those who were infected did not need hospital care and had no or minor symptoms.
As plans are being considered to how reopen America’s business, the question is what state of health are we going to return to or accept?
To try and answer this question, it is useful to examine the top 10 causes of death in the US in 2018. The CDC reports:
| Cause | Deaths | Deaths/100,000 |
|---|---|---|
| Accidents | 1671,27 | 48 |
| Alzheimer's | 122,019 | 31 |
| Cancer | 599,274 | 149 |
| Diabetes | 84946 | 21 |
| Heart Disease | 655,381 | 164 |
| Kidney | 52,386 | 13 |
| Lower Respiratory (COPD) | 159,486 | 40 |
| Seasonal Flu | 59120 | 15 |
| Suicide | 48,344 | 9 |
| Covid 19 4/27/2020 | 56,527* | 15* |
- Covid 19 Numbers still increasing, but rate of increase has slowed
Note that as a society, we did not shut down our businesses or go into lockdown over these numbers. In particular, it interesting to note that in the 2018 season, flu claimed more lives than Covid 19 has caused to date (although Covid 19 is sure to increase further). We also did not stop driving cars even though over 100,000 per year die from car accidents.
It would seem reasonable that if Covid 19 statistics could be brought into line with these other causes of death that we would be back to ‘normal’.
A key factor to consider is that Covid was much more fatal to those over 65. Currently 79% of the Covid 19 deaths were in people over the age of 65. The 65 and older group represents just 16% of the population. The data strongly suggests that those over 65 may suffer more fatalities. The younger you are, the less likely that Covid will be fatal, even if you get infected.
When businesses open up, both businesses and individuals may have different behaviors depending on the age of the people involved.
Although, there has been a long and strong voicing that Covid 19 is not the flu, it acts more and more like a flu the more we study it. It has been thought that Covid 19 was more contagious than the flu, but the recent finding that the number of infections known may be off by many millions, it is not clear how much more contagious it is. As I always state, comparing Covid 19 to the flu is NOT downplaying the seriousness of Covid 19 – instead it is a reminder that the seasonal flu has always been deadly (25,000-60000 fatalities a season and up to 60 million infections) and will continue to be so.
I will discuss vaccines in an upcoming blog, but it is critical to note that the data regarding the seasonal flu is WITH an annual vaccine. There is no current vaccine for Covid 19, so Covid 19 statistics should look much better once a vaccine is found. However, it is very important to know that the seasonal flu vaccine does NOT always work well. The effective of the seasonal flu vaccine has varied from 10 to 50% depending on the year. Hopefully, the Covid 19 vaccine will perform much better.