March 8, 2020
Updated: Mar 18, 2020
Predictably there are people who feel that we are over-reacting to the potential impact of the pandemic. The argument is that influenza kills 10,000s of people each year and that this pandemic will turn out to be similar. This logic fails simply according to the much higher case fatality rate of SARS-CoV-2 & the pace at which SARS-CoV-2 is hitting our health care system. However, given the very steep price of social distancing measures, it is worth considering the alternative which is to let the epidemic run its course.
The data from China & anecdotes from front line providers in Italy suggest that this virus really poses the greatest threat to the elderly. (I also worry about the large populations of immunocompromised younger people for whom there is still no data, but experience with other respiratory viruses strongly suggests that COVID-19 poses a significant threat).
If we let the virus run its course & ~20-70% of people get infected with a 7% mortality rate in people aged 70-80 and 15% in people >80, we are talking about a huge number of deaths. Without social distancing, cases would surge dramatically. There is no way that all of the sickest people could be accommodated in acute care facilities so many would die at home, with or without skilled nursing to assist with comfort care.The take home points for me are that the extreme measures currently being imposed in Seattle, and likely to be imposed elsewhere, are designed mostly to protect the elderly and immuncompromised, and will hopefully ease the burden on the health care system. A rational argument against social distancing is that it imposes too great of a social and economic cost. There is lots of room in the middle and we will learn as we go. However, in my opinion, the idea that the SARS-CoV-2 threat is overblown is ludicrous. Whichever path we take, there will be very unpleasant sacrifices.Another side note from the emerging data is that smoking is a powerful risk factor for bad outcomes. The population of elderly smokers in Italy is high and I think this is in part why the health care systems in Lombardy are currently overwhelmed. The prognosis for COPD even without an acute illness is akin to a moderately bad cancer so this really is a vulnerable population. Incidentally, this same population accounts for a decent percentage of worldwide flu deaths each year:And finally some lighter news from Trader Joe’s: