The more you learn, the less you know, might be applicable to this epidemic. Here is my list of what we have learned and what we know with any confidence.
- The common infection tests aren’t necessarily accurate and don’t tell us if someone is infectious. Ohio’s governor is only the most recent example of the potential inaccuracy of infection tests. And PCR tests, supposedly highly accurate, only tell us if viral genome fragments are present, those can linger for a long time and are not indicative of active infection. So they don’t identify people who are contagious and can infect others. Right now, apparently only culturing a sample can do that with a high degree of certainty, although the combination of positive PCR test and several active symptoms would strongly suggest infectiousness.
- The vast majority of illnesses continue to be asymptomatic or mild, that is a fact. This is likely due to pre-existing immune responses in a majority of those exposed to the virus. The percent of cases requiring hospitalization or resulting in death appears to be going down, but this is almost certainly an artifact of much greater testing, although treatment has improved, with less use of ventilators and some drugs having benefit. It is also the result of the virus infecting those most susceptible to serious illness disproportionately at the start of the epidemic.
- We have no idea how many people have actually been infected, especially if you define infection as meaning the virus actually entered a person’s cells and began replicating. If you included the people who were exposed but disposed of the virus prior to that level of infection, due to immune response, we really don’t know. The current antibody assays used in prevalence surveys are inadequate, either not picking up all relevant antibodies, or having too high a threshold to identify people who were infected. In addition, T cell memory appears as important as B cell and antibody response, and there are no widespread surveys being done to identify the presence of T cell reactivity. So we are guessing on “infection” rates and we are guessing on case fatality rates or any other metric. My guess is that less than one-tenth of one percent of those “infected” are dying.
- The incredible bifurcation of the epidemic by age continues to be evident, this is known. While some pre-existing illnesses may contribute to vulnerability, the greatest risk factor for serious illness and death by far is age. I will give these statistics again to demonstrate. Nationally there are 104 million people aged 24 and under. Out of that entire group, 270 people have died. That is .00026%, and on average the people in this age group dying had two to three comorbidities. At the other end, just looking at the 75 and older cohort, over 83,000 have died out of a population of 22 million. That is a rate of .37%. If you are 75 or over you have a 1400 times greater risk of dying from, or with, coronavirus. You do not see that extreme bifurcation with influenza or other common respiratory viruses.
- On an apples to apples basis, this epidemic is not worse than influenza. It appears that some individual illnesses maybe worse, but we don’t hear all the detailed case reports on influenza, since people haven’t freaked out about that disease like we have with coronavirus. If we tested as widely for influenza as we do for coronavirus, it would be as or more prevalent, and if there were no vaccines for influenza, as there aren’t for coronavirus, influenza would be much more lethal, especially to younger persons, than coronavirus is. So, in fact, influenza is a far larger public health threat than is coronavirus.
- Significant slowing of transmission of the virus, if measured by actual “infection”, is likely to occur at relatively low levels of prevalence. This “population immunity” will be caused by a combination of actual infection and pre-existing immune defenses and may exist in several areas of our country and around the world. Slowing transmission does not mean that people will not still be getting infected; they will, just not in large numbers.
- The virus likely is transmitted in droplet form but also can survive in aerosols. It has a very high binding affinity to receptors on human cells and the infectious dose, or amount of virus it takes to start an active infection may be quite low in susceptible people. I believe the virus has a resilience that allows it to persist for some time in certain environmental niches.
- We do not have a good understanding of the weather or other factors that facilitate an active outbreak. The virus appears to surge or wane in geographies with no clear relationship to those factors.
- Because of the apparent ease of transmission, most measures to suppress spread are inadequate, if not futile. Masks almost certainly won’t cause a significant reduction in transmission. Social distancing may have a benefit, but unless you are going to lock yourself up forever, sooner or later you are likely to be exposed. When the conditions are beneficial for the virus to run, it is going to run, almost no matter what.
- Our social and political response to the virus has been unbalanced, irrational, driven by hysteria and delusion, and has caused damage far beyond what the coronavirus has or will cause, especially in regard to health. In the United States alone, millions of jobs have been lost, tens of thousands of businesses destroyed, public finances ravaged, and recovery is uncertain. The health and social consequences are even worse. People have literally been terrorized. Children have been deprived of school and normal social activities. Name a health harm and it has likely increased–child and domestic abuse, alcohol abuse, drug abuse, suicide, deaths and worsening health from failure to seek treatment, unvaccinated children and adults, and on and on; the research is just beginning to pour in, and most of these losses are to younger people than those affected by coronavirus. The response to the epidemic will kill many more people in the long run and cause far greater loss of years of life than will the virus. It is literally suicidal and insane for those harms not to be considered when devising public policy responses to the epidemic.
- Our obsession with disinfection and suppression may pressure the virus in ways that result in more lethal mutations. And we are almost certainly weakening our immune systems, especially those of children, with the result that we will be more susceptible to many infectious agents, including the flu.
- Good information is frustratingly and inexcusably unavailable. We are given inadequate information on actual dates of test positivity or case identification, dates and lengths of hospitalizations, whether a person was admitted for coronavirus or happened to have it on admission or acquired it in the hospital, dates of death versus date reported, the results of contact tracing efforts, which might reveal patterns of age and other transmission characteristics, and results of good prevalence surveys. We also hear nothing from politicians about all the harms our lockdowns and other suppression efforts have inflicted on the public.
In many ways, a more optimistic picture than is typically portrayed. The epidemic is a public health threat, but is not that deadly. Our responses on the other hand, have been a massive self-inflicted societal wound.