Why are we acting so crazy if people aren’t really dying from this!?!

“We are informing you that one student in 7th grade tested positive for Covid and a second 7th grade student is symptomatic and waiting for test results.  All students in 7th grade are considered “exposed” due to the student testing positive and they will need to remain quarantined at home through Friday, September 18th.” And thus it starts.

It took just over a week of schooling before the above message came by email. My 7th grader is now in quarantine. Fortunately she is not sick and wasn’t in close proximity to the infected kids (as far as she knows) so she didn’t likely get infected. Since there were a few kids who tested positive they sent the entire grade home. Unfortunately the news has put our house is in a minor state of turmoil. I know every other 7th grade family has had their lives unsettled as much or more than ours. For many it is much more than an inconvenience.

These repercussions are driving many people understandably to push back on the various restrictions in place. One source of this push back is fueled by data showing fewer coronavirus related deaths, even as the case numbers were rising. Many of the arguments I typically hear are some variation on the following:

• We shouldn’t be so panicked because the virus kills such a small number of people.
• The virus is clearly getting weaker.
• You doctors are overreacting, there have been no serious cases in our area in several months and people aren’t really wearing masks. We must have herd immunity, otherwise the numbers would have increased by now!

Let’s take these one at a time.

We shouldn’t be so panicked because the virus kills such a small number of people

While it is true and fortunate that the case fatality rate with COVID-19 is low and that almost everyone infected will survive this argument misses some important points.

1. The hospitalization and death rates do not have to be so high to cripple a city’s healthcare system. With a major surge in cases, the hospitals become ineffective and there will be increases in deaths from other illnesses – people who would have survived if the hospitals weren’t overrun.
   • The best data we have comes from the the untreated population of the Diamond Princess cruise ship outbreak. About 14% of these unfortunate vacationers had disease severe enough to need hospitalization. If we extrapolate to the 3 million people who live in my metro area and assume that 10% of the population is infected this would mean 42,000 people would be hospitalized. Even if the real numbers were a fraction of that it would devastate all the city’s hospitals and spell disaster for anyone who needs or delivers medical care.
2. The number of deaths are down because most people are complying with social distancing, masking, isolation, and quarantine. Stopping these measures is like opening the gates to the lion exhibit at the zoo because nobody has been mauled yet.
3. Even though it kills a small percentage of people, a small percentage can still be a lot of people (200,000 and counting in the US).

The number of deaths are down because most people are complying with social distancing, masking, isolation, and quarantine.

The virus is clearly getting weaker

There is no evidence to suggest that the virus itself has become less lethal. There are genetic changes to this virus but these are small and largely inconsequential. Possible explanations for how the virus itself could be just as lethal but cause few deaths are as follows:

1. High risk people are being super strict. They are staying away from gatherings and following all guidelines strictly. There has been a clear shift to younger and healthier people getting infected (that was the population that is least compliant with public health recommendations in the early summer). With fewer high risk people getting infected the total number of deaths with go down even if the virus is just as deadly.
2. Masks, social distancing, quarantine, and isolation decrease the amount of virus that people are exposed to when they get infected. There is evidence that people who are infected with a smaller number of viral particles will have a less severe infection.
3. We are getting better at treating the virus. As an example, the use of one medication dramatically decreased mortality in hospitalized COVID-19 patients.

There may be other factors as well. The important thing is that there are many reasons to explain the declines in death rates other than a weaker virus. The lower death rate is more of a reason to continue the current measures since it is evidence that they are effective not less.

We must have herd immunity, otherwise the numbers would have increased by now

This is a common refrain in places in the Northeast that were hit hard early on and is used to justify not wearing masks or social distancing. My usually response is “I hope you’re right but I wouldn’t bet your mother’s life on it”.

The fact that there are low case rates in certain areas is not proof of herd immunity. It is quite possible that people are vulnerable but these areas have not been exposed to the right confluence of events that can lead to a new rise in cases. If this is the case people could be living on a powderkeg and there just hasn’t been the right spark. That spark could be visitors from a high prevalence area, kids going back to school, or people moving inside when the weather gets colder. Even if there was some level of herd immunity in hard hit areas that immunity may be short lived. It is far from certain how long immunity lasts and there have been reports of reinfection that may be caused by waning immunity. We can either look back and say, wow we overreacted or we can look back and say wow a lot of people died, why didn’t we do something? When New York was overrun in the spring people could justifiably say that they never had any idea it would get this bad. If it comes back in the fall, they will not have that excuse.

The lower death rate is more of a reason to continue the current measures since it is evidence that they are effective not less.

The bottom line is that there is no evidence that the virus is weakening or that herd immunity is present. To assume so is wishful thinking. Wishful thinking as a strategy has already proven to be foolish.

So now we have to change the kids’ sleeping and bathroom arrangements for 2 weeks. Have I mentioned that I really hate this virus?