image credit: © angelinachirkova
04/06/2020: Edited to add an additional data source with extensive testing (South Korea). Updated references from CFR to IFR. Added reference to new study posted in The Lancet.
Before I launch into a plan to restore access to the Sacraments, I want to dive into something even more controversial – COVID-19. “NOOOO!” you might say. But, in the midst of so much (mis)information that has been politicized to hell, I thought I’d offer what I think is a balanced, reasonably accurate assessment of the COVID-19 pandemic. And I think this context will help illustrate why this forthcoming plan is appropriate.
I’ll start by saying COVID-19 is not the end of the world unfolding before our eyes – at least not by way of the virus’s pathology. And most likely you’ll be ok if you contract the illness. However, COVID-19 is also not “just a flu” and represents a more serious threat than your average disease that is able to circulate this quickly. Since the flu is the most similar disease, I think it serves as a good point of comparison.
I think the best data we have to truly understand the risk of COVID-19 are the data collected from the quarantined Diamond Princess cruise ship and the data collected in South Korea. These data are representative of populations that have been extensively tested. This is important because one of the issues at hand is how the WHO reported fatality rate is inflated because they are not counting all infections in the denominator – this is due to lack of testing, AND due a group of people who do not become ill enough, or maybe remain entirely asymptomatic, and never even think to get tested. In other words, the percentage of deaths can change substantially if the total number of infected is undercounted.
So what does the data show? When you include the asymptomatic people (which need to be included), it shows that the infected fatality rate (IFR) is actually closer to 0.6% – 0.7%. How does that stack up against the flu? It’s about 6 – 7X the fatality rate of the flu. At scale, that is a substantial increase, though not apocalyptic. Keep in mind that COVID-19’s IFR could increase substantially if top notch medical services are not available – more on that below.
Some other factors at play are how fast it can spread, and what percentage need hospitalization.
Let’s talk about the spread first. It has an R0 of around 2 (double that of the flu) which means for every infected person, 2 additional people will be infected. This is in part because unlike the flu, no one has immunity. So, it spreads more quickly and readily through communities.
Another very important measure is the hospitalization rate, which is hovering somewhere between 10% and 15%. The reason hospitalization rate is important, is that the somewhat comfortable IFR (Infected Fatality Rate) of 0.6% is dependent on those who need care actually receiving care (supplemental oxygen, fluids, a respirator in some cases, etc.). The whole “flatten the curve” mantra is an effort to make sure everyone can access the care they need so we can keep the IFR as low as possible.
Let’s say the IFR is 6X that of the flu. That is FAR less than what the WHO number. But it is still serious. Especially when you start to look at the distribution of fatalities across age groups, and people with underlying conditions in other recently reported data. There is broad consensus that the fatality rate scales up with age. The Diamond Princess study suggests the IFR for 70+ is 9% (again, this would include asymptomatic cases). This is not surprising, because the older you are generally the more adversely affected by disease you are. Another very recent study posted in The Lancet suggests the IFR is in the same ballpark.
So what should we do?
My own most humble of opinions is that we should be trying to mitigate risk, and do our part to slow the spread for two reasons: 1.) keep our brethren in the health care system from being overwhelmed and 2.) reduce the likelihood that we become an infection vector for someone in a higher risk category. We need to make sure we’re protecting the vulnerable within our community. This should also include immunocompromised people, or those with underlying health conditions of any age.
As an aside, the very fact that we are all in quarantine has and will change the impact to the healthcare system. So if you catch yourself saying, “what’s the big deal, our hospitals are not that busy”, you can’t discount the impact of our isolation. For more information on how that works I recommend studying the measures taken during the 1918 flu pandemic.
I am not saying that means we continue to shutter the doors of churches, and deprive Catholics of the Sacraments – what I am saying is that we need to work the problem. This is a battlefield – a battlefield of public opinion, a battlefield of risks, a battlefield for our liberties. So let’s work the problem and come up with solutions.