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COVID-19 Medical Review
May 22, 2020

Analysis by Medical Doctor:

Several studies conducted at the beginning of the world’s knowledge of COVID-19 operated under medical based assumptions to create models that predicted staggering death rates, overwhelmed hospitals and medical suppliers, and modes of transmission. Those conclusions created a fear of COVID-19 and the capabilities of the world’s healthcare systems, or lack thereof.

The response to these models wasn’t inappropriate, given that there were so many unknown factors at the advent of the disease. However, as more research has been completed, and the coronavirus increasingly understood, the continued shutdowns may not be the only path forward.

In fact, other medically based methods of mitigation could have saved livelihoods, as well as lives, if they were considered at the beginning of the discovery of COVID-19, rather than implementing country-wide shutdowns.

Assumption 1: IFR (Infection Fatality Rates)

The Infection Fatality Rates (IFRs) were estimated at .9% in some studies, and up to 3% and higher in others. Additionally, some studies and media outlets utilized Case Fatality Rates (CFR), which were based off of only confirmed cases, and ignored what we now know is a large hoard of asymptomatic carriers. Using the CFR leads to higher fatality assumptions and larger death tolls. In reality, the IFR may be as low as .5%, or lower. This difference, while seemingly only marginal, makes a vast change in large scale projections.

The IFR will become more accurate as more testing is done, and more studies show how many asymptomatic individuals there are. A study on pregnant women in NYC showed that almost 90% of the patients who tested positive for COVID-19 had no symptoms. The antibody study conducted throughout the rest of the state showed that one-fifth of NYC inhabitants are infected, or about 3.6 million people, and in some areas of the city, nearly a third of participants had antibodies. Estimates from China also show an IFR around 0.5%. Iceland, which has tested the highest proportion of its citizens, has an estimated IFR of 0.3% and many believe this low number is due to their efforts in shielding their elderly. This new data suggests that the IFR is not the 3% or even .9% used to create many early predictive models.

Another important note about the IFR is how variable it is for different ages and medical histories, information that would have been useful in the creation of more targeted and less disruptive mitigation alternatives. A study in Italy determined that 17% of all COVID-related deaths are from those 90 or older. The spread of virus within the controlled setting of the Diamond Princess cruise ship gave data which provided an IFR estimate of 0.5%, with no passengers dying under the age of 70.

In NYC, less than 5% of deaths occurred in patients under the age of 65 who did not have an underlying medical condition. Some of those people may have had underlying medical conditions researchers were not aware of. Nearly 90% of patients hospitalized had one, or more, underlying medical conditions.

This is not saying to disregard the needs of the elderly and medically compromised. Instead, use resources to prioritize their health and disease prevention, instead of requiring shutdowns of all of society. Studies have also shown that in over 50% of all cases in the world—and more than 80% in parts of the world—has been in nursing homes and other congregated living communities. If we had spent more time, money, and resources shielding the vulnerable, the death rates and economic losses could have been lowered.

Assumption 2: Healthcare Management

The need for shutdowns and social distancing cited the importance of lowering the rates of transmission so as not to “overwhelm” hospitals; states and countries were going to run out of beds and ventilators, and this would only make the death toll worse.

However, the world’s coronavirus epicenter, NYC, has been operating with a surplus of ventilators, which some studies have found may not even be as useful in the fight against COVID as was originally purported. While this surplus may be partly a result of the extreme suppression strategies implemented, it raises some doubt as to whether alternative mitigation strategies could have accomplished a similar, or better, feat.

While it is true that the NYC hospital beds got close to their capacity during the COVID peak, the vast majority of hospitals in less populated areas around New York state barely saw an uptick in admissions, let alone coming close to reaching their capacity. NYC shipped patients out to some of these hospitals, like Albany Medical Center, and hospitals such as Upstate Medical University lent some of their doctors and nursing staff to NYC. Healthcare workers have done a remarkable job in playing their part to treat infected patients, and while many hospitals were burdened and resource reallocation was utilized, the healthcare system in its entirety didn’t seem to be at threat of being overwhelmed, and that doesn’t look to be a threat in the near future.

It’s also important to note that there are higher numbers of those hospitalized than those that are still stick. Many older adults who have recovered from the disease are healthy enough to be discharged from the hospitals, but cannot return to their senior communities for fear of transmission. They are held at the hospital until they test negative to COVID-19, unlike in earlier stages of our fight against COVID in which many New York State nursing homes were forced to accept COVID-positive patients, a move which could have contributed to large numbers of NYS deaths. The healthy patients waiting for hospital discharge are one reason that the current hospital rates aren’t even lower than what they are.   

Assumption 3: Method of Contraction

Shutdowns were implemented to reduce the transmission rate between individuals. Every non-essential business was closed, social distancing policies were implemented in “essential” businesses, and even parks and beaches were shut down.

Yet, it’s been found that 75% of outbreaks occur in the home, with those you’re in sustained close contact with. Cases occurring from outdoor contact were found to make up .08% of confirmed cases. And “sustained close contact” does not mean shopping, curbside pick-up, or various other methods that could have allowed businesses to stay open.

If one is wearing a mask, washing their hands, and not touching their face, in addition to practicing social distancing when in public, the transmission rate lowers. Especially in comparison to individuals interacting in the same home, a home that may now include family members from throughout the country all congregating together under one roof, in response to the current health policies.

Our understanding of when and how this virus spreads continues to expand. Even though the majority of COVID-19 cases are spread within the home, if you are locked in a house with someone with the virus, studies show you are more likely to not get coronavirus than to get it. is becoming increasingly clear that some individuals are simply more prone to spreading the disease than others. Some patients may have a higher viral load and shed more virus into their environment, and symptomatic patients who are actively coughing also shed more viral particles. One study has shown that 80% of transmissions come from only 10% of cases. As we continue to understand more how the virus is spread, it will be easier to implement more targeted mitigation strategies to protect individuals.

Other Factors

The benefits of certain treatments, as well as the speed at which they are being developed and approved, is an important factor to consider when continuing social distancing policies. Though we still need large scale trials, several studies have already found positive results.

Plasma

We still need large-scale trials for all treatments, but the positive outcomes of both convalescent plasma and medications are proving hopeful. Convalescent plasma (CP) has been found to improve clinical symptoms and paraclinical criteria rapidly, significantly increase or maintain the neutralizing antibodies at a high level, and help patients absorb lung lesions.

Vaccines

Dozens of companies worldwide are working on vaccines, and several have already started human trials. A vaccine is critical to managing COVID-19, and Moderna recently announced the vaccine they’ve been working on with the National Institute of Allergies and Infectious Diseases is safe and able to stimulate an immune response against the infection in a small sample.

Immunity

Individual immunity from the virus after recovery is likely, because the majority of patients will develop a rigorous antibody response. While vaccination is the goal, in the event that one is not obtained, herd immunity will eventually slow the continued spread. Reinfection with this same strand of virus should be rare.

Weather/Climate Effects

As we move into June, warm weather in the United States will also be able to help slow the transmission rate of the virus. This study found that with every 1*C increase in temperature, the transmission rate dropped by 13%.

Conclusion

Of course, none of this review is suggesting politicians and policy makers should have done nothing. But, making decisions that will impact this country for years ahead should not have been made rashly, without accurate data and varying opinions about COVID-19.

There are alternatives that could have led to the mitigation of disease without causing economic devastation and infringing on personal rights. Isolate high-risk individuals, such as older adults and the medically vulnerable, and protect these individuals with rigorous testing and monitoring.

Give the public accurate and unbiased information and make clear recommendations. As we see now, almost everyone is happy enough wearing masks and keeping appropriate distance, knowing it will help to protect them and those round them.

Perhaps keeping schools open with precautions, like they have done effectively in Sweden, would have allowed us to avoid depriving our next generation of their education while simultaneously keeping them away from their much more vulnerable parents for extended periods of time.

Give American people, each with their own unique circumstance, the ability to decide for themselves whether leaving their homes and going to work (with appropriate precautions) was the right decision of their health and well-being. And, perhaps most importantly, don’t create an environment of panic and fear.

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