Coronavirus Death Toll is a Bad Metric

As of this writing, the novel coronavirus causing a global pandemic has killed over 200,000 people worldwide (probably more because of reporting issues) and over a quarter (~54,000) have been in America. That's an astounding and heartbreaking number. But, the coronavirus death toll is a terrible metric to use when thinking about your risk in this situation. Death is not the only bad outcome. There are very real and long-term health risks associated with this virus and other coronaviruses even if you recover, there are societal impacts to everyone getting sick at once, and, of course, there are financial considerations to any type of illness in America.


This strain of the coronavirus falls into the family of viruses that cause Sudden Acute Respiratory Syndrome otherwise known as SARS which is why it is called COV-SARS-2 in the scientific literature. This sudden onset severe pneumonia has been shown to permanently reduce lung function even if one fully recovers. So that's frightening but it at least tracks for an illness that supposedly targets the lungs. And yet there is an increasing number of reports that those that become critically ill from COVID-19 show signs of heart, liver, and kidney damage as well as damage to the vascular system. This damage to the vascular system can lead to blood clots which in turn can lead to lung damage or even stroke. And these complications are not limited to the elderly or high-risk population. According to Thomas Oxley, a neurosurgeon at Mount Sinai Hospital, some younger COVID-19 patients with mild or no symptoms have experienced large-vessel strokes.

"Our report shows a sevenfold increase in the incidence of a sudden stroke in young patients during the past two weeks. Most of these patients have no past medical history and were at home with either mild symptoms (or in two cases, no symptoms) of COVID-19," he told CNN on Thursday.

Societal Implications

The idea of social or physical distancing was never about stopping the spread of the virus. It was about slowing the spread and preventing everyone from getting sick at the same time. As we saw in Italy and then to a lesser degree in NYC, if more people require critical care resources at one time than the system is equipped to handle, things can get very ugly. Doctors may have to choose who gets to have a ventilator and who dies unassisted. Not only is that a nightmare situation for the doctors and nurses making these choices but it will invariably lead to vulnerable populations experiencing worse outcomes.

If our hospital systems get overwhelmed, everyone suffers. Medical care is a zero-sum issue. The resources we have to allocate are finite and as a greater proportion of those resources go to caring for coronavirus patients, there is less for literally everything else. Of course, more people would die from coronavirus but more people would also die from influenza and sepsis and renal failure. Others won't die but will see their quality of care decline because they can't get medical care in a timely fashion. Have you ever gone to the emergency room and had to wait several hours for care because the waiting area and department was already full of people with more serious issues? Imagine that amplified by a thousand and nationwide. So the questions to ask are how contagious is this virus and how likely are you to need critical care if you catch it.

  1. How contagious is COVID-19? Estimates vary and situations matter a great deal (think of the difference between an office and a sporting event) but it looks like each person infected will infect between 2 and 6 other people. That's pretty freaking contagious and left unmitigated leads to lots and lots of people sick at the same time. To boot, it is probable that the virus can be spread by infected people who have no symptoms at all and believe themselves to be healthy.

  2. How likely are you to need critical care? That question is much harder to answer because data is lacking and varies wildly based on population health. While it appears to be the case that most people will only experience mild symptoms that resolve without treatment, a not-insignificant number will develop respiratory distress so severe they will need hospitalization and need to be placed on a ventilator. This is not limited to the elderly. Early data from the CDC showed 38% of cases serious enough for hospitalization were in people under the age of 55.

Financial Implications

So let's say you catch coronavirus and get sick enough to need hospital services but recover. How much might that cost?

This one is actually beyond my analytical capabilities because it depends on your state, insurance, the speed of legislation if the hospital you go to does balance billing, if the physicians that treat you are employed by that hospital or contractors, and a bunch of other silly only-in-America factors. It could range from nothing to tens of thousands of dollars. For the acute treatment. Now let's say that you come away with reduced lung function or damaged to your heart or kidneys. That's hundreds of thousands of dollars over your lifetime and a seriously reduced quality of life.

These considerations taken together paint a really clear picture for me: Stay the eff home. Even if you're not likely to die if you catch COVID-19 you could get very sick and (or) have your organs seriously damaged, contribute to the collapse of our already mind bogglingly inefficient medical system, or be financially ruined. Stay home.

#covid #coronavirus #covid19 #stayathome

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