Its time to learn to live with the virus

When the Coronavirus first emerged at the beginning of this year, it was poorly understood and there was justifiable fear about its potential deadliness. Fortunately, we now know exactly who is most affected and who has little to fear.

According to the Department of Health, as of 10th October 2020 Australia has identified 27,229 cases of coronavirus. Of this 27,229 identified cases we have had 897 deaths. This makes a death rate of 3.3%. However, given that most cases, especially in younger people either have mild symptoms or no symptoms at all, this is clearly an undercounting of the real infection rate. And hence a gross exaggeration of the real infection fatality rate.

In Australia the total known cases for people under 50 is 17,980. Total deaths is 5. This leads to a case fatality rate of 0.00028. Remember though, the case rate is much lower than the true infection rate so the true infection fatality rate may be as much as ten times less than even this tiny number. Given that many people under fifty are in poor health to start with, we can only assume that these 5 deaths were all people with serious comorbidities.

The one place in Australia where death rates have been substantial is nursing homes. Over 75% of the deaths from coronavirus in Australia are nursing home residents. Of the 2050 nursing home residents in Australia who are known to have been infected by this virus, 676 have died. This is a death rate of 33%. This sounds shocking until you realise the state of health of Australian nursing home residents.

According to this article, 91% of people admitted to nursing homes die there. 40% will die in their first 9 months. The average life expectancy of male residents is 2.1 years from admission and 3.2 years for female residents. Residents have on average over 8 comorbidities, including heart disease, stroke and dementia. The reality is that nursing home residents are not simply old people. They are both old and extremely sick. If they were old but in good health, they would still be living at home. As much as the 33% death rate is shocking, the flip side is that 67% of nursing home residents who contract it still survive, and this is despite being both old and very sick.

We can compare the nursing home fatality rates with those who are receiving at home aged care services. In Australia there have been 82 infections and 7 deaths in this group making a death rate of 8.5%. People receiving at home aged care services are also old and sick. Just not quite as old and sick as those in residential care. The kind of services they are receiving are assistance with showering, dressing, meal preparation and cleaning services as well as assistance with medication management, wound care etc. Despite their age and poor health status, 91.5% have survived this virus. The average age of death from coronavirus in Australia is 83 years old. This is slightly older than the average age of deathin 2018 of 81 years old.

Australia is not alone here. In the United States, the Centre for Disease Control best estimate for the true infection fatality rate given by age groups is as follows: 0-19 years: 0.00003, 20-49 years: 0.0002, 50-69 years: 0.005, 70+ years: 0.054. This means that for young people there is almost zero chance of dying from this disease. And by young, I mean under 70 years old.

What about hospitalisations?

According to the CDC, around 70% of hospitalisations are in people over 50 years old. This is despite the vast majority of infections being in people under 50 years old.

This chart from the CDC is fascinating where it compares hospitalisation and death rates for different age groups, using the 18-29 year old age group as the comparator.

People in the 75-84 years age group have an 8 times higher chance of hospitalisation and a 220 times higher chance of death than people in the 18-29 age group. People in the 85+ age group have a 136 times higher chance of hospitalisation and a 630 times higher chance of dying

This is why we are seeing large numbers of infections in the younger cohorts all over Europe, but only small increases in hospitalisation rates and only very small increases in deaths.

So what has been Australia’s approach to this virus that targets almost exclusively the very old and sick? We have shut our borders to international travellers, shut our internal borders as well, despite this being most likely unconstitutional. We have closed our schools where almost nobody is vulnerable to the disease. We have closed our pubs, restaurants and night clubs where healthy young people gather. We have cancelled our sporting events and closed our sports clubs. We have raided peoples homes who wish to protest about this response. We have prevented people having proper weddings and worse still proper funerals. We have destroyed entire industries and created an economic disaster not seen since the 1930’s. We have stopped shaking hands when we meet and at times view each other with suspicion or even fear.

This raises serious questions about the media who have done nothing but fear monger about this virus from the very beginning, reporting asymptomatic cases as though this was the Black Plague. Describing the deaths of 90 year old nursing home residents as “tragic”. The reality is that when a 90+ year old nursing home resident dies, that is simply the natural course that we will all take at the end of our lives. Sad for the loved ones but hardly tragic. Why is this style of reporting continuing? Are these journalists unable to read simple graphs? Have they lacked the curiosity to really look at who is dying? Is it that hyperventilating fear mongering sells newspapers and attracts viewers? Why are the rare and exceptional deaths of younger people broadcast so loudly with so little curiosity about their underlying state of health?

Why are our politicians still beating the drums of fear? Well they seem to be enjoying unprecedented popularity due to their actions. Maybe they simply feel unable to back track, having done so much damage already. How do they admit it was all for nothing? Perhaps they simply become hooked on the power they have been wielding.

So what is to be done?

Firstly we need to correct the public view of this virus as being deadly. It may well make you very sick, (just as the seasonal flu does) but unless you are in a highly vulnerable group, you are at almost zero risk of dying. Once the public know the truth, they will be less willing to accept the destructive restrictions our political overlords have imposed. This will eventually force either a change of approach or a change of government. In a democracy you cannot govern against the will of the people. Or at least not for very long.

Secondly, provided we protect the vulnerable population there is little chance of our hospitals becoming overwhelmed. The vulnerable are easy to identify. They are people who are both old and sick. Most of them live in nursing homes. Few of them have jobs to go to, so protecting them from exposure is relatively easy. It is certainly much more practical than trying to prevent the entire population catching this highly contagious virus.

One thing is for sure, you cannot keep coronavirus patients in nursing homes and not expect it to spread to the other residents. For those unfamiliar with nursing home care, this is the most intimate care that can be given. The carer assists the resident to get out of bed, dresses them, showers them, toilets them, brushes their teeth and hair, feeds them and then moves on to the next resident and repeats the process. Residents, many with dementia, wander about the home and into each others rooms. No amount of PPE can prevent spread of infection in such an environment.

As such, staff and residents need to be monitored constantly for any signs of coronavirus and immediately removed from the home if they test positive. This could be achieved through having an infection control nurse stationed in every home, taking temperatures of any person entering the facility and questioning them about potential exposure. Testing staff either daily or every second day and assessing every resident daily for signs of infection. Although this sounds expensive and intrusive, it is far less expensive and intrusive than the current system of trying to prevent the entire population from catching it.

Thirdly, we need to do proper cost benefit analysis on any policy approaches to this pandemic. We need to ensure value for money in any intervention we make. When the public truly understand the costs of lockdowns, they will be far less willing to accept them.

Fourthly, our journalists need to start doing their job. Reporting that a man in his thirties has died of coronavirus is not good enough. If the government is unwilling to tell them the full story about what other illnesses the person had, then they need to do some journalism and find out from the family or friends.

The information takes on a very different hue if it comes to light that the individual was actually in the end stage of cancer, or had just undergone a liver transplant. Additionally, the media needs to be encouraging debate about the true nature of the pandemic, and most importantly the policy response. This means printing contrary opinions from experts in a variety of fields, not just medical experts who lack any understanding of the wider ramifications of their suggested policies. The Australian newspaper has been excellent in this regard, with powerful, well researched articles both supporting current policy and opposing current policy. However, they seem to be the exception rather than the rule.

Fifthly, we need to understand that there is nothing to suggest that dying of coronavirus is worse than say dying of influenza, or dying of a stroke. Except of course if you are consigned to die alone in an isolation ward in order to protect your children and grandchildren from catching a virus that is unlikely to harm them. We have always accepted the fact that people get old and die. For many people nearing the end of life, death can be a welcome release from the suffering of the world. Pneumonia was traditionally known as “the old man’s friend”. Coronavirus need not be viewed any differently.

This madness needs to end. It’s time to stop worrying and learn to live (and to die) with the virus.