COVID-19 Updates

COVID-19 Science Update for March 30th: The Planet’s Deadly Viral Baseline

This article constitutes the March 30th, 2020 entry in the daily Quillette series COVID-19 UPDATES. Please report needed corrections or suggestions to jon@quillette.com.

According to statistics compiled by Our World in Data (OWD), the number of newly confirmed COVID-19 deaths decreased yesterday.

The data, as reported by the European Centre for Disease Prevention and Control (ECDC), indicated 3,128 new confirmed COVID-19 fatalities globally, down 10 percent from Sunday’s newly reported deaths, of which there were 3,461. This is only the second time in the last two weeks that the daily death rate has decreased.

The rate of new deaths fell in France, the UK, Italy, Iran, and the United States. In Spain and Germany, the rate remained virtually unchanged. These seven countries have collectively accounted for over 80 percent of COVID-19 deaths in late March. So this is good news.

While previous updates in this series have focused closely on short-term developments in the fight against COVID-19, today’s entry will examine some of the important background issues that are commonly referenced in public discussion about best practices—such as the early suggestion that COVID-19 could be compared to seasonal influenza, aka the “common flu.”


As discussed below, common forms of influenza are indeed a deadly phenomenon. But COVID-19 represents a more acute threat, as illustrated by the sight of military trucks taking away corpses in Italy, and an ice rink in Spain being pressed into service as a morgue. The threat from a disease is measured not just in sheer body count, but in its potential to overwhelm and disable health networks through rapid localized transmission.

That said, many people are shocked to learn just how deadly seasonal flu really is. According to the World Health Organization (WHO), every year, “there are an estimated 1-billion cases, 3-5 million severe cases, and 290,000 to 650,000 influenza-related respiratory deaths worldwide.” Of those, a 2011 Lancet meta-study concluded, “there were 28,000-111,500 deaths in children younger than 5 years.”

The numbers here may seem shockingly high. But it should be noted that these are global statistics. Every year, about 60 million people die worldwide, so even the high-end estimate accounts for only about one percent of total deaths. However, the sheer uncertainty over how many victims are killed by the various influenza viruses is also somewhat surprising. Like many people, I have spent the last few weeks looking at COVID-19 fatality data that purports to measure deaths down to each deceased individual. Yet when it comes to seasonal influenza, which strikes every year, the global death toll remains statistically vague into five or even six digits.

By way of a national example, consider Italy, which has suffered more deaths from COVID-19 than any other country. In a 2019 paper in the International Journal of Infectious Diseases, researchers estimated that a combined total of more than 68,000 Italian deaths were attributable to flu epidemics during the winter seasons ending in 2014, 2015, 2016, and 2017. The variation was enormous, ranging from an estimate of about 7,000 in 2014 to about 25,000 in 2017.

This compares to about 11,000 deaths thus far in Italy from COVID-19. But, to reiterate, the two threats are hardly comparable. Being a novel coronavirus, COVID-19 is spreading within a population that has no baseline herd immunity and, absent public interventions such as social isolation, could kill many tens or even hundreds of thousands of Italians within several months.

But there is one sense in which the two phenomena may be connected. To read the Lancet paper is to understand the weak, scattershot nature of existing public-health defences against any viral epidemic. It is notable, for instance, that the researchers had to rely on broad forms of statistical extrapolation based on fairly small data samples. (The country’s national sentinel influenza surveillance system, for instance, relies on the throat swabs and “ILI” reports—observed symptoms of “influenza-like illness”—from a voluntary group of about 1,000 general practitioners, who collectively treat about two percent of the Italian population.) Because the country apparently maintains no comprehensive statistical database of influenza-related deaths, the researchers had to work from general mortality data—from which they had to statistically disaggregate weather effects and other presumed contributing factors.

The authors note in passing that the vaccine coverage among elderly Italians—who, as with COVID-19, account for the vast majority of flu fatalities—was just 50 percent (the WHO recommends at least 75 percent coverage). They also note that this coverage rate had been on the decline since 2005 and, somewhat ominously in the COVID-19 context: “One study, reporting an excess of mortality in 2015 in the Italian city of Bologna, showed that elderly individuals unvaccinated against influenza had an increased risk of all-cause and cause-specific mortality compared to vaccinated individuals.”

Italy is just one country, of course. But the discussion section of the paper indicates that the situation is not greatly dissimilar in other developed countries. Overall, the authors lament, “scarce data is available on influenza-attributable mortality estimates for single countries in the study period considered.”

One outcome of the COVID-19 pandemic is that national health authorities all over the world—much like average citizens, I expect—will stop taking such a casual attitude to influenza reporting and prevention. Indeed, perhaps we will do more to fight all forms of respiratory viral infections—including the lower respiratory infections (LRIs) that, despite much progress, cause an estimated 2.74 million deaths every year, almost all of them in the developed world.

From an overall epidemiological perspective, this gets us into somewhat awkward territory. LRIs are the fifth leading cause of death in the world, and the leading infectious cause of death in children younger than five, with the two main risk factors being undernutrition and air pollution. And—this is where we get to the awkward bit—thanks to the public response to COVID-19, our air has never been cleaner in recent memory. People are driving much less. Air traffic is down. Around the world, whole office buildings are being temporarily shuttered as people work from home, thereby lowering traffic and avoiding road fatalities. Add in the fact that social distancing will serve to not only suppress COVID-19, but all forms of contagious disease, and this might be the first large pandemic in human history that, in the long term, actually causes global deaths to fall instead of rise.

Or maybe not. As has been widely reported, COVID-19 also is causing an enormous economic disruption that will negatively affect human health in all sorts of ways. In the United States, for instance, new jobless claims for the week ending March 21st were a staggering 3.3 million, an order of magnitude above the usual level. In Canada, nearly five percent of all workers lost their jobs in a single week. Poverty, unemployment and homelessness are all associated with negative health outcomes, and are also associated with substance abuse, addictions, and mental-health conditions that carry their own medical risks.

Ultimately, the health toll from COVID-19 is unknowable. When this is over, we will be living in a different kind of world. Healthier, I hope. But also poorer.

 

Jonathan Kay is Canadian Editor of Quillette. He tweets at @jonkay. If you believe this article contains information about COVID-19 that requires correction, or if you would like to suggest content for future updates, please email jon@quillette.com.

 

Comments

  1. I just made the mistake of countering complaints among a very left-wing group of friends that anyone would dare suggest that the economy matters right now. I pointed out that estimates of the American death toll from the Great Depression are all in the millions, at a time when the US population was ~125M, and that’s not including WWII, which was caused by the Depression. Ergo, magnitude matters when discussing whether we should worry about the economic toll.

    I left the conversation amid the following barrage of counterarguments:

    1. You’re a monster for valuing money over lives (WTF did I just say above?)
    2. Some people won’t care if they lose friends to the virus but not their jobs (why should one subjective view overrule the macro reality?)
    3. You’re pretending that COVID deaths wouldn’t hurt the economy (No I’m not)
    4. Economic measures are imprecise (So is the death toll from WWII. It’s bad regardless)
    5. It doesn’t matter because people would self-quarantine even if government did nothing, so businesses would still lose revenue (my argument is that economic harm is happening; the reason is orthogonal to that)

    This is why left-wing bubbles are so frustrating. The ability to say a thing is all that they feel they need to win, regardless of that thing making any sense. And I know, I know “durr, the Right does that too!” No, the Right’s arguments have no power if they can’t stand up to scrutiny, because of the Left’s institutional dominance. Left-wing absurdities have vastly more traction than right-wing ones ever could.


    This Quillette update includes this link, which needs more emphasis:

  2. As discussed below, common forms of influenza are indeed a deadly phenomenon.
    That said, many people are shocked to learn just how deadly seasonal flu really is.

    The word “deadly” - is likely to cause death. Is the coronavirus likely to cause death in any age cohort?


    The fatality rate is so low that they’re representing by blocks (each block is 1% (link)), The maximum is for 90+ where it is <22%. Again Italy deems any death with COVID-19 positive status as COVID-19 death.

    Or maybe not. As has been widely reported, COVID-19 also is causing an enormous economic disruption that will negatively affect human health in all sorts of ways.

    It is our response which is causing it. We forget the swine influenza pandemic. 199 countries infected, disputed death rates from ~18K lab confirmed deaths to the ~350,000 death estimate. All the criticism of WHO then.

    LRIs are the fifth leading cause of death in the world, and the leading infectious cause of death in children younger than five, with the two main risk factors being undernutrition and air pollution. And—this is where we get to the awkward bit—thanks to the public response to COVID-19, our air has never been cleaner in recent memory. People are driving much less. Air traffic is down. Around the world, whole office buildings are being temporarily shuttered as people work from home, thereby lowering traffic and avoiding road fatalities. Add in the fact that social distancing will serve to not only suppress COVID-19, but all forms of contagious disease, and this might be the first large pandemic in human history that, in the long term, actually causes global deaths to fall instead of rise.

    If the WHO, national governments cannot be trusted on masks, how does anyone trust them on the more complex system that is the environment itself? Epidemiological data.

    I really wish these updates were factual, and presented better.

  3. Death counts sell much better than recovery counts, or even progress counts on creating test kits, masks, ventilators, etc.

    2 people die every second (along with 4 births). That sounds bad, that 151,600 people die each day, but without the media covering all those deaths like a sports score, we seem to not even notice.

  4. “By way of a national example, consider Italy, which has suffered more deaths from COVID-19 than any other country.”

    There are a number of reasons for the greater suffering in Italy. The Lombardy region where much of this is happening is a very dense population, the densest in Italy with approximately 1200 individuals per square kilometre; there are many elder people there in the region.

    It serves as a place of retirement for Italians. Lombardy has been the destination of large numbers of international migrants. 25% of foreign-born residents of Italy live in Lombardy, it makes up 11.4% of the population. Mainly Syria and the countries of northern Africa are where migrants have come from… Where MERS is more predominant, and many carry that virus, which infects close to 1.4 million camels in northern Africa. The region of Lombardy is highly industrial, it is part of the Four Motors of Europe economic organization, a highly productive organization which brings many many travellers coming from all over the world. Lombardy accounts for some 21% of the total GDP in Italy, so they are quite busy and industrial. It has higher wages per capita that the rest of Italy and so attracts greater numbers of people.

    The winters in northern Italy are very damp and cold, and they get thick fogs that hold down pollution in Lombardy between Oct-Feb. Much of the country’s nitrogen oxides are here because of heavy industry and agricultural fertilizers. Oxides cause inflammations in the lungs, the lower regions of the lungs.

    Lombardy has an established – particularly Bergamo and Brescia of highly industrialized land, and rich agriculture on the plains where there is a consistent agricultural activity using modern farming chemicals. Productivity is enhanced by the well-developed use of fertilizers and irrigation systems. Fodder crops are mowed as much as eight times a year; cereals crops (rice, wheat and maize), fruit trees and olives. The areas produce fruits and wine, and all this adds to the pollinated and highly industrially polluted air. Creating both allergies and respiratory problems.

    The highest density of cattle, pigs and sheep are in the north of Italy and Lombardy.

    There are a greater number of smokers in Italy in general, the numbers are again higher in northern Italy. And lastly, the Italians dropped the ball, and could not deal with the overwhelming numbers of cases.

    “They also note that this coverage rate had been on the decline since 2005 and, somewhat ominously in the COVID-19 context: “One study, reporting an excess of mortality in 2015 in the Italian city of Bologna, showed that elderly individuals unvaccinated against influenza had an increased risk of all-cause and cause-specific mortality compared to vaccinated individuals.””

    But the case is being shown worldwide as we speak of an unvaccinated public, dealing naturally with the COVID-19 virus and the numbers are not even standing up to a vaccinated seasonal flu virus. Seasonal flu, if the numbers are to be believed from the CDC are telling people more about Covid than data ever will…so the case for vaccinated people is what? Much worse?

    “[…] showed that elderly individuals unvaccinated against influenza had an increased risk of all-cause and cause-specific mortality compared to vaccinated individuals.”

    Which again points to herd immunity.

    "LRIs are the fifth leading cause of death in the world, and the leading infectious cause of death in children younger than five, with the two main risk factors being undernutrition and air pollution ."

    Also one might look to a form of what could be called ‘kennel cough’ that young pre-schoolers or part-time schoolers are contacting within North American daycares. Low grades infection that never really clear up and because of lowering physical activity by small children, breathing inside air, does not allow for more consistent deeper breathing and clearing of the lower part of the lungs through physical activity. And simply being outdoors. Children are more sedentary than previous generations – pre-technology. This is an accident waiting to happen I would suspect. Children are consistent with putting their fingers in/on places on their bodies and then touching everything in a daycare. Toys and things are generally picked up and tossed in a box, in lower quality daycares. Daycares are famous for hamsters and bunnies, snakes and salamanders…

    […] actually causes global deaths to fall instead of rise.

    But then again being locked up as a population, I am sure deaths from crimes of the household are rising, but you do make a point.

    Has anyone notice the journalistic pieces about the economy falling to ashes are being pushed to the back burner, IGNORED while we find out the “Seven best ways experts know on how to wash your hands and kill COVID, and the twelve easy steps to accomplishing that.”

    TURN THE ECONOMY BACK ON!

  5. Do you mean lol…"Not publically…I’m afraid!

  6. “Either children are less likely to become infected, which would have important epidemiologic implications, or their symptoms were so mild that their infection escaped detection, which has implications for the size of the denominator of total community infections.”

    "On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal , Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively" – Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D .

    https://www.nejm.org/doi/full/10.1056/NEJMe2002387

  7. As far as I’m concerned this is the first clickbait health crisis. Billions of people have had basic human rights (article 9, 12, 23, 24, 26, 27 and most critically 20 of the UN Universal Declaration of Human Rights) removed from them because of scaremongering in the media. There have been very few news articles that have given any sort of context for the number of deaths due to the Coronavirus and pointed out that the measures imposed on us will also have a significant negative impact on our health.

    I believe that severe reporting restrictions need to be brought in now and punishments given to journalists and publications for inflating the crisis. If our human rights are being removed then they should be held accountable for their actions and be forced to report responsibly

  8. No; think about the unintended consequences that invariably follow.

    If you have media that you trust, then support them, for example with donations and subscriptions, or at least by clicking on, or buying through, ads that appear on their sites. Post links to their articles, or quote them in conversation.

  9. " But COVID-19 represents a more acute threat, as illustrated by the sight of military trucks taking away corpses in Italy, and an ice rink in Spain being pressed into service as a MORGUE"

    Well Jonathan you have excelled yourself this time. I feel great comfort that people like you have no authority or management in the current times. Like all journalists you just want to see your name in lights and I wonder once this panic dies down if they will consider crimes created by journalist? So long Quillette (account closed) I can almost tolerate CNN after your decline into garbage reporting.

  10. Well nobody cares (at least no one with power, anyway) that “as far as you’re concerned” this is just a “clickbait health crisis”, moron. And I’d believe that severe punishments should be given to journalists and publications who downplayed the severity and claimed it was a just a hoax with the goal to impeach President Trump. Except I don’t, because I actually believe in the human right of freedom of the press.

  11. Scream in the dark all you like, but at least don’t massively misrepresent what I said.

    If you do happen to be right in your very premature declaration of victory, there won’t be any winners.

  12. We’re currently about to enter the unintended consequences of large sections of the population in home confinement. Those Journalists in their ivory tower stoking up the fear and panic need to be punished for it.

  13. Just remember, everyone, we are two weeks away from flattening the curve, and always will be.

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