While recovery rates are high, and mild-cases seem to be the rule not the exception, they do not tell the whole story of why we need to respect this novel virus.
I see it on Social Media every day when it comes to the Coronavirus, the battle of the birds: Chicken Little versus Oscar the Ostrich. And I have to admit, it's tempting to see both sides.
On the one hand, Coronavirus has a very high recovery rate and mostly kills people with sundry underlying conditions like age,diabetes and hypertension.
According to live data from worldometer, (at this writing) there have been 60,655,090 cases of Coronavirus world-wide, with 1,425,161 dead and 41,883,562 recovered. Of these 60,655,090 cases,17,346,367 are currently active. The vast majority (17,242,756 or 99.4%) are mild-cases and 103,611 (or 0.6%) are serious or critical cases. This would seemingly show a mild-level of danger. After-all, with 43,308,723 cases closed and only 1,425,161 dead (3%), there are many who feel this is an acceptable risk for human-kind to endure. And this is where the economic and civil liberties issues come into play. Does a society damage its economic and mental health (not to mention the tenants of personal choice and personal responsibility) over a virus that has a seemingly high recovery rate? From a purely statistical point of view, these people might have a valid point.
On the other-hand, as a novel virus, we are still learning much about the many collateral conditions that occur after a Coronavirus infection and its subsequent survival; things such as chronic fatigue and brain fugue; and new pulmonary, cardiovascular, neurological, and renal damage-- that may affect survivors for months (if not years) after an active infection has passed. (Perhaps for even an entire life-time). These patients are colloquially referred to as,"COVID long-haulers," however, the current medical term for it is post-COVID syndrome.
In an excellent article written by Katie McCallum for Houston Methodist Hospital's On Heath website entitled: Post-COVID Syndrome: What Should You Do If You Have Lingering COVID-19 Symptoms? Ms. McCallum explores this unfolding phenomenon. As a point of departure, her article states...
Even a mild case of COVID-19 can come with some pretty miserable symptoms, including debilitating headaches, extreme fatigue and body-aches that make it feel impossible to get comfortable.
To make matters worse, it's becoming more and more apparent that a subset of people who've"recovered" from COVID-19 will go on to experience symptoms that linger well beyond testing negative for the virus.
It goes on...
"We're seeing continued evidence that a fair-number of people who have had COVID-19 continue to feel the effects of this illness for weeks to months after recovering from the worst of their symptoms or complications," says Dr. Sandeep Lahoti, gastroenterologist at Houston Methodist who is leading the COVID-19 Recovery Clinic. "We still don't understand how long these symptoms can truly persist, but we do know that many of these people would benefit from specialized care and, in some cases, regular follow-up."
It is tempting to look at a relative term like,"a fair-number of people" and to dismiss it as ethereal and indefinite (which of course it is) except when you consider that as a novel condition resulting from a novel infection caused by a novel virus, it is not so much ethereal and indefinite as it is just plain unknown. Adding to this is the even more disconcerting unknown about the actual number or percentage of survivors affected, since the actual frequency of post-COVID syndrome is still largely up for debate with different studies finding this condition to be more or less common in various groups of people. As Dr. Lahoti states...
"Some studies show that only 10% of people with COVID will go on to develop post-COVID syndrome, while other studies are showing much higher percentages — some even suggest that up to 70% of people experience persistent symptoms."
In another piece by Yoni Heisler for BGR (Boy Genius Report) entitled, Call your doctor immediately if you experience these 4 symptoms, because it could be COVID-19 there does seem to be some new data suggesting that gastrointestinal issues alone may be an indicator of prolonged post-COVID syndrome. According to Mr. Heisler, researchers from the University of Alberta took a close look at 36 coronavirus studies and found that a handful of gastrointestinal issues tend to be associated with a positive coronavirus diagnosis. More specifically, the study specifically found that 18% of coronavirus patients exhibit the following gastrointestinal issues: loss of appetite, nausea, vomiting, diarrhea, and abdominal pain.
What’s more, the research found that 16% of coronavirus patients exhibit gastrointestinal symptoms exclusively. Individuals who experience a loss of appetite should be particularly cautious, the article states, as it’s a symptom that has previously been found to be correlated with severe coronavirus symptoms. What’s more, individuals who experience a loss of appetite as an early symptom are seemingly more likely to experience Long COVID, a phenomenon wherein coronavirus patients tend to experience symptoms for weeks and even months after leaving the hospital.
Since many in the"Oscar the Ostrich" crowd like to point-out that this virus is,"nothing more serious than the flu or any other seasonal respiratory infection," the gastrointestinal angle offers a tempting supposition. Will these folks next be dismissing serious gastrointestinal maladies as trivial "stomach flu" when in fact, it could be a far worse condition? And what about the supposition that Covid-19 isn't even really a respiratory virus at all despite its name?
In a September 8, 2020 article by Doctor Kevin Kavanagh, MD for Infection Control Today entitled, Is COVID-19 Primarily a Heart and Vascular Disease? Doctor Kavanagh explores the growing body of evidence that we at The Socratic Review posited early in 2020, that SARS-CoV-2 is not a respiratory infecting virus at all, but rather, a virus (most likely cardiovascular in its approach) who's effects cause respiratory and gastrointestinal distress. To extract a particular section of the article in its entirety:
Concerns for cardiovascular involvement of SARS-CoV-2 have been present since the early genesis of the pandemic. A research paper from China found that 20% of COVID-19 hospitalized patients developed heart disease and thromboembolic events happened in 31% of those in the ICU. Another from Germany reported ongoing myocardial inflammation in 60% of 100 recently recovered patients with COVID-19.
However, cardiovascular disease has been assumed by many to be a manifestation of severe COVID-19; and not from direct infection of the virus, but instead, from small vessel disease caused by the hypercoagulation of the blood.
All of that changed last-week with the publication of three reports. The first was from Penn State Health which reported that 15% of Penn State athletes who tested positive for COVID-19 had myocarditis. These were young athletes and included both mildly symptomatic and asymptomatic individuals. As a result of these findings, the Big 10 and Pac 12 postponed their football season.
Whereas these questions (and daily developments surrounding them) may seem as novel as the virus itself, they really aren't in any historical sense. Humankind has often had to weigh relative dangers of a disease with the relative benefits of ignoring it, especially as knowledge of the disease grew. This has been a question not just for individuals, but for governments, from time immemorial.
In my opinion (and here I will put in the disclaimer that I am neither a doctor nor a medical professional) mortality, when it comes to a novel virus, should be only one concern as it relates to public health, and not even the largest.
Let's take polio as an example from the past. In the 1949 table provided (as extracted from JSTOR ), in 1948, the last finalized year on the table, there were 27,680 polio cases resulting
in 1,895 deaths, or a 6.85% mortality rate. Like Coronavirus, polio in 1949 had limited treatment options and a vaccine, though in development, was still six-years away. As a matter of fact, as noted in this extract from the CDC (U.S. Centers for Disease Control)...
(The) Polio vaccine was licensed in the United States in 1955. During 1951-1954, an average of 16,316 paralytic polio cases and 1879 deaths from polio were reported each year (9,10). Polio incidence declined sharply following the introduction of vaccine to less than1000 cases in1962 and remained below100 cases after that year. In 1994, every dollar spent to administer oral poliovirus vaccine saved $3.40 in direct medical costs and $2.74 in indirect societal costs (14). The last documented indigenous transmission of wild poliovirus in the United States occurred in 1979. Since then, reported cases have been either vaccine-associated or imported. As of 1991, polio caused by wild-type viruses has been eliminated from the Western Hemisphere (16). Enhanced use of the inactivated polio vaccine is expected to reduce the number of vaccine-associated cases, which averaged eight cases per year during 1980-1994 (17).
An important point of note here is this section...
In 1994, every dollar spent to administer oral poliovirus vaccine saved $3.40 in direct medical costs and $2.74 in indirect societal costs.
Herein lies what should be a primary concern regarding Coronavirus; the direct medical and societal costs. Certainly for the families of the 1,895 people who died of polio in 1948, the death of their loved one was sad, even tragic; especially if it was a child (which was overwhelmingly the case). But what about the families of the other 25,785 patients who survived? In those days before any form of disability accommodation, survivors became a tremendous burden on their families both financially and emotionally. It is tempting to say they were not; that people who are spared the loss of a loved one are grateful for that survival under any circumstances, and to a certain degree that is undeniably true. That does not however eliminate, or even ameliorate the actual realities incumbent upon survival if that survival means expensive, specialized long-term care.
So, where does that leave us as a society? Under normal circumstances, human-beings react to the unknown in one of two ways: the cautious approach it with caution and the reckless approach it with verve. This unknown however, has been so misrepresented and politicized that the cautious have been derided and the reckless either celebrated or disdained to such a point of conflation, that whether you are Chicken Little or Oscar the Ostrich, (or some bird in between) you are seemingly on a crash-course with violent opposition.
We at The Socratic Review sympathize with both sides. In our March 13th, 2020 feature: A Pox Upon Your House: The Real Danger of Plagues we explored the fact that in spite of governments utilizing every power at their disposal during the Black Death, 1/3 of Europe's population perished and took with it the entire post-Roman societal structure of feudalism.
An extract...
Looking at this history, it's tempting to find a statist solution to the problem. "If only the governments had done more," the reasoning goes-- "the results might have been better."
This is a misleading supposition however, because the flaw was not in the response of the governments to the crisis at the time; the power structures in place took the threat very seriously, and did everything within their power to control the crises. It was the basic social contract that was flawed; since no government can provide protection in exchange for anything, because protection cannot be guaranteed.
This is perhaps a valid point for the Oscar the Ostrich crowd, since no portion of the social contract between citizens and their government can truly guarantee safety or protection; that is the province of individuals. However, the civil libertarian point breaks-down rather quickly as well, as explored in another piece from March 17th, 2020 entitled The Limits of Liberty: Where Fist Meets Nose.
An extract...
If we use the same logic as we did with the inalienable right to life above, one could argue that if my health is immanently jeopardized, and you come at me with an undetectable virus, I have every ethical (and legal) right to dissuade you from infecting me. But should this right to health extend to preemptively banning all people I come in contact with because I think they may have an undetectable virus? In my opinion (from a personal freedom position) the answer is "yes," because your rights end where my nose begins (or if current epidemiology is correct-- three feet from my nose)*
The piece concludes with a prophetic warning...
Civil libertarians everywhere need to be mindful of this, because the statists are taking notes. If we do not temper our own liberty voluntarily (with discretion) from time to time with private isolation and good-sense regarding the purchase of food and supplies, we will only invite more stringent curtailments the next time around. Perhaps when"equitable climate" is defined as a right by the buffet loving populists.
The root of all this boils down to a reserve of commonsense, whether you are Chicken Little or Oscar the Ostrich, a free society should make wise decisions regarding public health not just on the number of people potentially killed, but in the overall financial stability of the nation in both the short and the long-term.
For business owners this is a perennial problem; the employees who feel that their self-importance or (financial needs) outweigh getting 80% of their colleagues sick, cost private businesses billions of dollar in lost revenue and labor-less wages every year. Now we are faced with a novel virus that even without the unrelenting law of the exponent, will immobilize millions and cost billions. Consider for a moment that as of October 2020 there is an abnormally low number of U.S. workers, 124,170,000 to be exact as reported by statista.com, at an average weekly salary of $994.00 per the Bureau of Labor Statistics. If 1% get infected this week that will be 1,241,700 new cases out of the work force for two-weeks, a cost of $2,468,499,600. If they infect 2 people, that makes it another $4,935,757,500, and so on. Now let's say 3% of those 1,241,700 perish (37,251) that will leave 1,204,449 survivors, if only 5% suffer from short or long-term disability, that is 60,222 workers at $994.00 per week or $59,861,115 per week in lost wages; $3,112,777,996 per year, and so on, and all based on extremely conservative numbers and off a considerably reduced workforce baseline.
Whether you are a civil libertarian, a fiscal conservative, a socialist, statist or social democrat, these numbers provide no basis for ignoring every effort to spare the country additional infections. If simple humanity at not wanting your friends or family to suffer even a minute or minimal case of a very unpleasant virus, the chance of moving millions of workers into an early disability retirement should shock you into action. And really, why is what is being recommended so bad? Masks and curtailing non-essential shopping and travel? Really? Is a family holiday, a shopping excursion, or a drink with friends really worth it in the long-run? From either a personal inconvenience or an economic standpoint?
And for the many who post various sundry world domination theories ranging from bio-metrics to the use of masks as a means to impersonalize, subject and dehumanize individuals, I find these theories not only unfounded and dangerous but downright historically inaccurate. An excellent example is a piece from History entitled When Mask-Wearing Rules in the 1918 Pandemic Faced Resistance. In the case of the Spanish Flu, we were dealing with a deadly (albeit straightforward) viral infection. Here we are dealing with a less deadly but more virulent (and less straightforward) viral infection. And mask-wearing is only one component (and a relatively minor one at that in-light of its limited ability to do anything but mitigate risk). The real winner (with the highest reward) is patience. If we form any public health policy, it should be centered on that; how to evoke patience and alleviate stress, so people are less inclined to pursue risk. Threats are obviously not sufficient (nor should they be) public policy should offer a few carrots along with the sticks.
Of course, in a republic where the people are the government, that is a personal question for the populace to answer; but it should be noted as mentioned above...
Civil libertarians everywhere need to be mindful of this, because the statists are taking notes. If we do not temper our own liberty voluntarily (with discretion) from time to time with private isolation and good-sense regarding the purchase of food and supplies, we will only invite more stringent curtailments the next time around.
The choice is ours. We can only hope that in 10 years-time, we realize we chose wisely.
*Editor's Note: Now six-feet.
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