Beyond the death rate, Part I: You may not die, but what other risks does Covid-19 pose?

Are we thinking about the health risks that Covid poses to us correctly?

I had the chance to catch up with a friend of mine the other day. His wife is a nurse at a nearby hospital that is being overwhelmed by a flood of new Covid patients for a second time. The picture she paints is grim. ICU beds are full, and new patients are being put on the floor in the hospital wherever there’s room for them. And unlike in April and May, this wave has a much higher percentage of younger people. She estimated that maybe 25% of patients admitted to her hospital are between the age of 20–40, and that many of these young people are walking away from their hospitalizations with what appears to be permanent damage to their pulmonary systems, cardiovascular systems. Some are even developing what appear to be long-term cognitive impairment.

This conversation startled me. How could 25% of Covid hospitalizations be young adults? After all, at this point, we have a decent (but still developing) idea of what the Case Fatality Rate (CFR) is for people in different age groups, and young people are fairly unlikely to die from Covid (~ 0.1% for 20–29 year olds, and 0.3% for 30–39 year olds). What accounts for this seeming discrepancy? Is her single experience representative of hospitalization trends across the country?

As it turns out, the is yes: this experience is typical of hospitalization rates around the country. Let’s take a look at the numbers to discover why.

What is the profile of people being hospitalized for Covid?

Understanding demographics — or how many people there are in each group — helps answer the first of these questions. There are more people who are 20–40 in the US than there are people above the age of 65. If 1% of all 20–40 year olds got Covid, that would represent 880,000 people, whereas if 1% of 65–85 year olds caught Covid, it’d be about half that, or 470,000 people.

Put simply — there are more young adults than there are seniors. 128 million Americans are between the ages of 20–40 and only 53 million are over the age of 65. This means that, even if younger people need to be hospitalized less often than older people, a lot of young adults are still being hospitalized to survive their bout with Covid.

As it turns out, my nurse friend’s rough estimate of 25% was pretty damn close. To date, approximately 20% of all Covid hospitalizations have been for adults between ages 20–39:

How can this be? Everything we’ve heard about this virus is that the elderly suffer its most severe consequences. By now most of us have learned what a Case Fatality Rate (CFR) is, and what that number is for your own age group. If people between the ages of 20 and 39 have something between a 0.1%-0.3% CFR, which is comparable to the CFR of the flu, how can one out of every five hospitalization be from this age group?

This is sort of a “when you have a hammer everything looks like a nail” sort of problem. If the only thing you’re looking for is who’s dying, you’ll use statistics that measure death. And while CFR is a critical statistic for both health experts and the public, it is only one way to measure the risk that Covid poses to us all. There are plenty of other risks that Covid poses besides death.

Hospitalization risk

For starters, having to be hospitalized and potentially put on a ventilator is a traumatizing experience. Having to live through that on your own, without any family support (since you will be quarantined and alone), surrounded only be overworked, stressed medical professionals desperately trying to save lives and other covid patients struggling to hold on to theirs. That’s is a terrifying experience that we all want to avoid and want to prevent our family members from having to endure.

And it turns out that young adults are far, far more likely to end up in a hospital and live through this hell than they are to die from Covid. 30–39 year holds have about a 5% chance to end up in the hospital if they catch Covid, compared to a 0.3% death rate. Statistically speaking, there is a vast chasm between 5% and 0.3% in terms of how risky an activity is. It’s the difference between 3 people in a thousand and 1 person in 20. In other words, if you’re 30–39, you’re about 17 times more likely to be hospitalized than to die from Covid, and be forced to live through this experience that, at its best, will be traumatic but result in no permanent health consequences.

Risk of long term symptoms

However, as we now know, there do appear to be long-term, and possibly permanent, health effects, from Covid. Clearly, we’re somewhat limited here, since long-term studies can only be conduct if a lot of time has passed, and Covid is only about 9 months old. But young adults have already begun telling stories about long-term Covid symptoms that persist for weeks or months after they test negative.

Two months after getting Covid, one 32-year old said she still struggles to muster the strength it takes to stand while taking a shower, and is extremely fatigued after the effort. Another patient, who claimed to have previously contracted dengue fever and malaria earlier in life, said that Covid “has been like nothing else on Earth.” At one point, the long-term symptoms were so severe that he thought he was going to die, and so waited a long time to get a second test. When he did get his results (from the viral test) it was negative. A 28 year old, who used to run in competitive races, has had symptoms for over three months after getting Covid that included shortness of breath so serious he twice had to call 111 (911 in Scotland). He’s been unable to think clearly, a Covid symptom that people have started calling “brain fog”. Thousands of people who suffer from these long-term consequences have begun online support groups to help get through it the radical changes in their quality of life.

Permanent heart and lung damage

Medical research, too, is increasingly suggestive of long-term consequences to Covid that we haven’t been as aware of yet since enough time has not passed. These includes higher risk of blood clotting, stroke, embolisms, and the risk of heart and lung damage that could perhaps turn out to be permanent. One study found that 20% of hospitalized patients suffer heart damage. Another Chinese study found lung scarring in 77% of all Covid patients. Lung scarring is usually irreparable, and makes it “more difficult for oxygen to pass into your bloodstream” ( Mayo Clinic). In other words, this means that you might feel like you’re struggling to breathe for the rest of your life, and your case is counted as a mild one. Heart damage is also often permanent and irreparable. Studies of SARS and MERS, two other types of corona viruses that have been around for longer and studied for longer, show that it “ can take people years to recover. “

Neurological disorders

Yet another study found neurological symptoms in 57% of all patients. Some patients have even developed serious and at times fatal brain diseases after having Covid. The sheer variety of brain disorders that have developed following Covid is, frankly, pretty scary. On the “mild” end, a number of patients develop psychosis or delirium while hospitalized, including vivid hallucinations. Apparently, ICU delirium is a real thing, and it affects “80% of people who go on ventilators, and persist after patients go home” ( Atlantic). If you end up in a hospital for Covid, there’s a 1 in 5 chance that you’ll need this sort of critical care.

If you’ve ever known someone who’s had a psychotic breakdown, you’ll know that delirium isn’t “mild” at all, especially if it persists. However, there are even more frightening neurological complications arising from Covid. One, called Acute Disseminated Encephalomyelitis (ADEM), comes on rapidly and can often cause permanent brain damage that can lead to visual loss and paralysis. And, apparently, the chances of developing ADEM only depended upon whether they contracted Covid at all, and was “not related to the severity of the respiratory COVID-19 disease” ( Journal of Neurology). Still other patients developed Guillain-Barré syndrome, a neurological disorder that causes paralysis and that some equate, experientially, to living through muscular distrophy.

What’s my own risk?

Despite all of these other fairly serious risks from Covid, most people (and most media) remain focused on the CFR. However, as we’ve seen, the CFR is a slightly misleading statistic because it only measures your chance of dying, not your chance of incurring permanent or physical damage, or living through a traumatic hospitalization experience. How, then, should we measure the other risks associated with Covid?

To be fully aware of the risks that Covid poses to us we need go beyond the CFR. We need metrics that offer a more comprehensive assessment of the different types of risk that Covid poses.

These other metrics are what I’ll explore in Part II, and will be accompanied with an infographic that is designed to intuitively show the non-death related risks you face from Covid based on our age group. I promise, it’ll take the “ic” out of “statistics”.

Originally published at https://reconsidermedia.com on July 20, 2020.