An Open Letter to Your Family “Covidiot” – Part 1

Link to "Part 2"

During the summer of this pandemic, I received an email from an educated family friend that had quite a bit of information I disagreed with. I wrote a letter back as a response. The original letter provided no sources for the information it stated, and I have tried to remedy that in my response by linking all the sources throughout this article. I have tried to use as many primary research papers as possible but also dip into reputable news sources in some cases. In the following two months, I realized that perhaps this could be turned into a more generally useful refutation of some of the more dubious claims that people have commonly made about Covid-19, and so I have adapted my letter into this post.

“Young people’s (under 50) risk of dying from Covid-19 is similar to the flu.”

It is true that children under 18 have a very small chance of dying from this disease. There are multiple sources that look at the current data for chance of death, and they often break it down into different categories. Firstly, we have a vaccine for the flu, and while it may not be 100% effective in preventing it, it does lessen the severity of symptoms for those who do catch it anyway. The CDC states that in the USA between 34.2% and 68.7% of people get the flu vaccine every year (18-49 year-olds with the lowest number and those over 65 with the highest, other age categories in between). So, when we look at flu mortality rates, we are looking at the mortality rates with a vaccine. The flu is a huge killer of people every year, and until modern medicine was a leading cause of death around the world. In 2006, for example, influenza and pneumonia were the 8th leading cause of death in the USA.

One difficulty with comparing statistics is that normally mortality rates are presented as “number of deaths per 100,000 people” not as a percentage chance of dying. Influenza for example had a mortality rate of 10.2 deaths per 100,000 people in the early 1900s and declined to 0.56 per 100,000 in the 1990s. The most current statistics (linked in the first CDC link I mentioned) show a current death rate for the flu at between 2 and 2.8 per 100,000 people. Here is another source. Now, Covid-19 statistics are still very new as we only have worldwide data about this disease for about 7 months so far, and reporting of data and strategies have varied widely from country to country, but in the USA the case fatality rate currently stands at 2.8% or 65.03 per 100,000 people. This is roughly 23-32.5 times more deadly than the flu across all age categories. When you look at the case mortality rate data by age (and only looking at 18-49) it appears to vary from 0.11% to 0.4%, which is at best roughly equal to the flu mortality rate of 0.1%-0.2% and up to 4 times as deadly. What this doesn’t take into account looking only at the numbers, is that EVERYONE in the US is vulnerable to catching Covid-19; it is much more transmissible than the flu.

“Why do you live in fear of something that has a 97.2% survival rate?”

One thing that you fail to address, is that the mortality rate of Covid-19 is not the only matter of importance. Currently, it is completely unknown what the long-term effects of having been infected with Covid-19 are. There is quite a bit of evidence that this virus produces strong and varied long term effects, and whether they will be a permanent addition to those patients’ lives is unknown. At the very least it is currently known that symptoms can persist for months. We know that covid-19 can damage the lungs, heart, and brain, and we do not know yet if this damage is temporary, or will produce long term health problems. Covid-19 has been associated with blood clots and blood vessel problems, causing heart attacks and strokes in otherwise healthy people, up to a 6-fold increase in the risk of stroke in young people. This kind of organ damage has not been limited to patients with severe cases of Covid-19 either. The scariest part of this is that we don’t know how long these effects last, or if they are permanent.

One of the most dangerous aspects of encouraging people to take this disease more lightly is that we don’t yet know! In 10-15 years, we might start seeing massive amounts of early deaths due to heart attacks and other cardiovascular issues. Maybe 30 years after an asymptomatic case of Covid-19, patients develop COPD and lung disease. We’re studying this as much and as fast as can be done, but we won’t know the long-term effects until we get to that point. As scary as this sounds, there is evidence that some of it may be true. In a recent study, it was found that among recovered Covid-19 patients 78% had ongoing cardiac involvement and 60% had ongoing myocardial inflammation, independent of pre-existing conditions. And in this study, 67% of the patients had mild/asymptomatic cases and had recovered at home.

"Children are safe from Covid-19”

Children do (thankfully) have a much lower rate of serious Covid-19 cases. It is not true, however, that it is “essentially non-existent”. In an analysis from March 1st – July 25th of American children is was found that children were admitted to the hospital at a rate of 8 per 100,000 (compared to adults at 164.5 per 100,000), but that of those children, 1 in 3 was admitted to an intensive care unit. The American Academy of Pediatrics found that as of October 1st, 2020 (and using data from the states that reported it) children made up 5-16.4% of total state cases, between 0.2-7.9% of all child cases resulted in hospitalization, and 0-0.16% of all child cases resulted in death. Now, it may be worth remembering that this is a low mortality rate, but we also have no idea if these children will have lingering or permanent organ damage from their infections, but I’ll get into some of that later.

Furthermore, you assert without evidence that children produce a smaller viral load, as their immune system is fighting the virus, and are therefore less contagious and do not transmit the virus readily. In fact, recent studies have shown the exact opposite of this. Asymptomatic children, in fact, were found to have carried higher viral loads than severely ill adult patients. Another study found that while older children have similar levels of viral RNA to adults, those 5 years old and younger had significantly higher levels. The European Center for Disease Prevention and Control show earlier data from several studies that children have at least comparable viral loads to adults and that symptomatic children of all ages shed infectious virus. So, I would assert that keeping schools either closed or remote, is in fact, the safest way to contain a major source of disease transmission. And if anyone seriously thinks that the schools and underpaid teachers are equipped to invent procedures and control the children into behaving safely….well: A recent study found that early school closures this spring due to Covid-19 related concerns reduced the incidence of covid-19 diagnosis by 62% per week and reduced mortality by 58% per week. Furthermore, an increasing number of schools that have been reopening, are immediately shutting down again due to Covid-19 outbreaks.

“Why don’t we just get herd immunity?”

Now, to acquire Herd Immunity ~60-70% of the population needs to catch the disease and build immunity to it (and we are still unclear on whether covid-19 immunity lasts, at least two different cases of Covid-19 reinfection have been confirmed several months after initial infection). If Covid-19 runs rampant through the USA and is roughly on par with the flu, then 198 million Americans (~60% of 330 million citizens) will catch Covid-19 before herd immunity is acquired. At 0.1% mortality (that of the flu) this would equal 198,000 dead Americans or roughly 5.7 times as many deaths as caused by the flu on a yearly basis. This is assuming the same death rate as the flu, which, according to current data is not in fact the case. At the current rate of 2.8% mortality, those 198 million infected would result in 5,544,000 American deaths before herd immunity is acquired. Remember that currently, with the restrictions in place, the USA currently has 213,390 deaths and that is in only 7 months of this disease. Studies have also shown that less than 10% of the US population has formed antibodies so far, which means we would have, at a minimum, 6-7 times the current death rate to achieve natural herd immunity. And this natural herd immunity may not even linger long enough to provide real protection, depending on how common reinfection becomes.

“We should be more like Sweden. No lockdowns but they are already near herd immunity”

They may not be as badly off as some other countries (probably due to high living standards and excellent socialized medicine), but they still have the highest death tally for the first 6 months of the year in 150 years. Furthermore, it is very important to remember that Sweden didn’t have a lack of lockdown, they did. They just asked their populace to be individually responsible, rather than creating legal restrictions. The only restriction I know of was a ban on gatherings of more than 50 people… and a request for their citizens to be careful, prudent, and safe. And yet, they have had a more protracted outbreak with more deaths than their neighbors.

These voluntary restrictions did work nearly as well as the mandatory ones of their neighbors, but it availed Sweden in almost no way. The economy is still badly damaged: for example, Sweden’s economy fell by 25% compared to Denmark’s 29%. Despite this, Sweden has 9748 confirmed cases per million people, compared to 2807 per million in Norway, 5462 in Denmark, The UK has 8480, the USA has 23155. Additionally, their death rate has also been significantly higher at 57 per 100,000 vs Norway at 5 per 100,000, Denmark at 11 per 100,000, the UK at 64 per 100,000, and the USA at 65 per 100,000. This means that with a voluntary rather than compulsory lockdown, Sweden had 5-10 times as many deaths as its neighbors, while enjoying no real economic benefit from their strategy. If you think that they are at least closer to achieving herd immunity, a September 3rd study on antibodies from the Public Health Agency of Sweden found that the population with antibodies had a high of 11.4% in Stockholm and only 7.1% across Sweden. If you would like to read a longer article on the details of Sweden’s response to the pandemic, Time published a recent article that goes into much more detail.

We all have a Covidiot as a friend or in our family

There are many ways to deal with those who are misinformed about the data or have come to believe various conspiracy theories that are gaining in popularity. Research shows that a feeling of loss-of-control causes people to search for patterns that don’t exist. I cannot imagine a time where more people feel a loss-of-control than during a pandemic. I recently read an article that showed that both ridicule and rational arguments showed success at reducing conspiracy theories, while empathizing with the conspiracy theories had no effect. I have tried to avoid ridicule in this piece while providing as much rational argument as I can. While there will certainly be more arguments and more data emerging all the time, I hope that some of you are able to use this article and the data I have referenced to convince someone you know to look more closely at the science behind their beliefs.