The number of COVID-19 deaths is horrible, but it's the number of cases that is devastating
As of Saturday morning, 285,000 Americans have died from COVID-19. Current projections are estimating more than half a million dead by spring, and that’s in a scenario in which there are both new restrictions and a rapid rollout of vaccine. Even these numbers undercount the genuine losses, as the CDC estimates that there are significantly more excess deaths that result from overcrowded hospitals and people afraid to seek care for other health issues.
But as sad as it to think about the number of Americans dying alone, and the number of families who will spend the upcoming holiday mourning a lost loved one, reducing COVID-19 to a death toll is significantly underplaying its impact. It’s that other number—the one that is likely to tip past 15 million over the weekend—that’s the real measure to watch. Because while the fatality rate for those who receive a positive result on a COVID-19 test is currently below 2%, the number of people who will suffer serious illness lasting weeks, months, or years is much higher.
The result of a COVID-19 infection can vary widely, and the effect can be enormous even on patients who are otherwise healthy. After months of puzzlement, scientists are just beginning to understand why.
There is little more frustrating about COVID-19 than the way it’s portrayed in the media, and especially by right wing media. Rather than talking about a death rate, the disease is often described on the right as having a “99% survival rate.” There’s a strong suggestion that only those people who are some way defective—bad health, bad habits, old age—have anything to worry about, and everyone else sails right through. After all, look at Donald Trump. He got it and came right back to scream at America in an almost unbroken chain of rallies.
But of course, Trump got a experimental monoclonal antibody treatment. In fact, he got four times the normal dose. And despite Trump repeatedly promising to make that treatment available to everyone for free, the truth is there are currently not enough doses available to deal with even one day’s worth of COVID-19 patients. The government has committed to eventually distributing 300,000 doses total, meaning not enough to deal with any two days of the past week. That’s all.
Meanwhile, millions of others are having a very different experience. As The Wall Street Journal reports, even people who skate through the first weeks of COVID-19 with little to no symptoms, are finding the disease has “a second act.”
Many are dealing with symptoms weeks or months after they were expected to recover, often with puzzling new complications that can affect the entire body—severe fatigue, cognitive issues and memory lapses, digestive problems, erratic heart rates, headaches, dizziness, fluctuating blood pressure, even hair loss.
Not only can these problems crop up in young patients who survived the initial infection with few symptoms, they also seem to be more likely in those patients than those who had a severe reaction to the disease in the first few weeks. Based on surveys, about 10% of COVID-19 patients between 18 and 49 were still experiencing symptoms more than four weeks after first becoming ill. A quarter of those patients were still sick two months later. A second study produced results that were even more intimidating, with 25% of all patients saying they were still seeing symptoms three months after infection. And that’s still not as bad as one European study which found that a third of all patients were “dependent on a caregiver” months after symptoms began.
There’s a huge difference between having a cold for a couple of weeks, and being in dependent care for at least three months.
If a third of all Americans infected with COVID-19 have long-term health effects, that’s 5 million people. Even if it’s “only” 10%, that’s already 1.5 million people. In addition to a boatload of misery and disappointments for those affected, those are the kind of numbers that both remove billions from the economy and place a burden of billions on the healthcare system.
It was already obvious that nearly anything could be a symptom of COVID-19 infection, but how can a single disease cause so many lasting effects? A lot of the blame seems to fall back on an effect that causes everything from muscle aches to devastating injury to the lungs and heart—inflammation.
The inflammation resulting from infection by the SARS-CoV-2 virus appears to linger even after the immune system has dealt with the virus itself. Studies have shown that even college athletes who have been through COVID-19 experience heart damage that persists after illness. Another study showed that 78% percent of COVID-19 patients had signs of heart damage two months later, with 60% still showing indications of inflamed heart tissue. Both of those studies were conducted with patients who were not hospitalized, and had little to no initial symptoms.
“Even those who had no symptoms and were young and fit…even in those patients we saw abnormalities,” said Eike Nagel, one of the lead authors and director of the Institute for Experimental and Translational Cardiovascular Imaging at the University Hospital Frankfurt in Germany.
The same inflammation could be be behind long-lasting digestive issues, especially as it seems that the coronavirus can linger in the gut even after patients receive negative test results from nasal swabs. And inflammation could be behind nervous system damage that results in both persistent “brain fog,” as well as changes to the autonomic nervous system that can cause racing or irregular heartbeats along with rapidly changing blood pressure.
It’s not clear how long these symptoms will last, but the fact that some of the earliest COVID-19 patients are still among the “long haulers” who are afflicted with persistent symptoms indicates … too long. All of this points up the importance of not just finding treatments that prevent death from COVID-19, but simply preventing COVID-19.
Back on that IHME model of potential outcomes, there are no good numbers. However, there is one “best” number. That doesn’t come from a faster rollout of vaccines. It comes from universal use of masks.