Map of life expectancy at birth from Global Education Project.

Monday, May 18, 2020

It's not just the dying

As I occasionally point out here (sorry to be a downer)  everybody dies. Therefore, in public health, when we measure problems or evaluate policies we don't just count deaths. Comparing one problem to another requires, first that we estimate the number of life years lost. As a person of oldness I am not actually offended, nor do I feel discriminated against, by the proposition that we ought to care more about a problem that will kill 1,000 people under 20 than one that will kill 1,000 people over age 80. Some people have tried to argue that because Covid is more deadly among old people, it isn't that big of a deal.

They aren't squinting at the data very hard, alas. While it is true that age is a risk factor for death, it cuts off a lot of life years from people who were previously healthy and enjoying life, including quite a few young people. But that brings up another issue, which is the healthy and enjoying life part. We aren't just concerned about how long people live, but how well they live. So while it is true that the death rate among young and middle aged people is lower than among older people, lots and lots of people get sick, and based on current estimates (without widespread testing we can't be sure exactly) maybe 20% of them get really sick. That's why when the epidemic rages uncontrolled within a population, the hospitals fill up and they can't take are of everybody.

As a result, some people die of other causes but that's not the only problem. This costs a whole lot of money, first of all, not just from providing health care but from people who can't work because they are sick. If you tried to ignore the whole thing and not impose any restrictions to try to contain it, people would be dying in the hospital parking lots, a lot of jobs would not be getting done, and lots of people would stop going to the restaurant or the ball game or the barbershop even if they were allowed to go because they would have seen relatives and neighbors get horribly sick or die.

But it turns out it's worse than we knew because many people take weeks or months to recover and some of them will be permanently disabled. Here's one previously health and highly productive person's story and at this point, after seven weeks, he doesn't know if he will ever fully recover. It turns out this is not even uncommon.

According to the latest research, about one in 20 Covid patients experience long-term on-off symptoms. It’s unclear whether long-term means two months, or three or longer. The best parallel is dengue fever, Garner suggests – a “ghastly” viral infection of the lymph nodes which he also contracted. “Dengue comes and goes. It’s like driving around with a handbrake on for six to nine months.” . . .

Scientific explanations for what is happening are still at an early stage. Lynne Turner-Stokes, professor of rehabilitation medicine at King’s College, says Covid is a “multi-system disease” which can potentially affect any organ. It causes microvascular problems and clots. Lungs, brain, skin, kidneys and the nervous system may be affected. Neurological symptoms can be mild (headache) or severe (confusion, delirium, coma).

So no. It's not the flu. Do what's right and protect yourself and others. Don't be an irresponsible moron.

2 comments:

Alexander Dumbass said...

A Tale of Two Cities (NY and SanFran)

https://www.propublica.org/article/two-coasts-one-virus-how-new-york-suffered-nearly-10-times-the-number-of-deaths-as-california

Cervantes said...

Yep, it's true, DeBlasio, and particularly Cuomo, were too complacent at first. It's off topic, so normally I would not allow it, but it's true. However, once they recognized the mistake they turned on a dime and took it very seriously. It's worth noting that the New York outbreak actually first surfaced in the wealthy suburbs of Westchester County.