It’s Not All About the Deaths

Sometime today the United States will “officially” cross the line to over 200,000 deaths from COVID-19. It’s sort of an arbitrary milestone because I’m pretty certain that we’re not really capturing all of the excess deaths that have happened this year as a result of the impact of this illness. But it’s going to happen and there’s going to be lots of discussion about all of the people who are dead who didn’t need to die this year.

I’ve written about this before and I will continue to write about this: it’s not all about the deaths. Those are bad and my heart goes out to each and every person who lost someone this year that they didn’t have to lose. Absolutely horrible.

But this country is in for a much bigger reckoning and that’s around the long-term health consequences for those who get COVID19 and survive.

Craig Spencer has an excellent Twitter thread about this very issue here. It was also turned into a Washington Post article here but that’s behind a paywall.

As horrible as it is to say, we will likely adjust fairly easily to the lost lives. It’s what humans do. Losing my father when I was 18 was devastating to me but I’ve managed to live a life for 25+ years without him.

Is it as good a life as it would’ve been? No. But humans are largely resilient and so we carry on and move forward.

But the societal impacts from those who survive but have lasting health consequences are going to be significant. I already mentioned this one before, but I’ll mention it again because it’s one I know well: kidney failure.

There are definite impacts on kidney function from this illness. And there are hints that the type of impact this illness has on kidney function could, long-term, lead to kidney failure. It may not be immediate. The gap between impact and outcome with kidney failure can be a decade or more. My dad got sick around the age of six but didn’t lose his kidneys until his early twenties, for example.

When I was young and my dad was dialyzing (which is what you do when you don’t have kidneys, you spend four hours three days a week having a machine filter your blood for you, see more here) there weren’t widespread dialysis options.

When we lived in the mountains of Colorado my mom had to dialyze my dad at home. And when we lived in the Denver Metro area my dad had to drive thirty minutes each way to reach Denver Presbyterian hospital which I believe was the only dialysis center available at the time.

Planning any vacation was contingent upon there being available dialysis wherever we were going. We had one memorable vacation where we got to our destination and my dad had to take all our spending money to fly home because the dialysis center he’d scheduled with couldn’t dialyze him after all.

That’s changed in the 20+ years since he passed away. There’s now a dialysis center that would’ve been five minutes from the last home we lived in. I don’t know this for a fact but I would assume the increased availability corresponds to the increased levels of diabetes in this country which can cause kidneys to fail.

So dialysis is more readily accessible now as demand for it has grown, but as that demand increases even more due to the fallout from COVID19 this country will need to increase the supply of dialysis centers and nurses again. And there’s a huge cost to dialysis.

My dad grew up believing he would die when he lost his kidneys because there was no way that he would be able to afford those treatments. Fortunately for him there were changes made (to Medicare I think it was) that made it possible for him to dialyze without needing to pay the full expense of doing so. According to the link I provided above, 80% of the cost of dialysis is subsidized by the government.

Which means a reckoning is coming because increased demand for dialysis means increased governmental costs to provide that care.

That’s just one of the long-term health consequences of getting this illness. Add in heart problems, chronic fatigue, and reduced mental capacity that impact individual productivity and you have a society-level crisis coming.

The more people who get this illness, the more people who are going to need a higher level of long-term medical care, many of whom will not be able to hold the types of jobs that can provide that care through private insurance.

Which means we as a society will have to make a decision.

Either we decide we’re heartless bastards and that those who got sick due to a failure of government are on their own to suffer and die. Or we finally bite the frickin’ bullet and start talking about real baseline universal medical care and social services.

(You can tell from my wording there which I believe in. I’m alive only because our government provided enough support for my dad to dialyze and I grew up with one of the best fathers in the world because of that continued government assistance. I like to think that between my dad’s contribution to society as a business owner and father as well as my brother’s and my contributions we’ve more than made up for that.)

It would be nice if we were the type of country that believes in stepping up and helping our fellow man out, especially when we have the wealth in this country to do so.

But I expect that we’re not. I expect that we’d rather see images of someone with a fifty-room mansion and a million dollar Maserati and pretend that’s possible for everyone than agree that maybe taxes should be raised on that Maserati owner so that children aren’t orphaned because their parents can’t afford adequate healthcare.

But whatever way we go with this, I expect COVID will be the final push that means people can’t politely ignore that choice we keep making. We won’t be able to keep pretending that people deserve what they get and that society has no role in creating that outcome.

So, yes, 200,000 or more people have died in the United States this year than needed to. And that is a disgusting travesty.

But it’s important to also think about the 7 million* or more who’ve likely already been infected and will have long-term health consequences from this.

(*Right now the stats show just under 7 million reported cases in the U.S. but there’s pretty widespread agreement that we’ve drastically undertested and that the number of actual cases is anywhere from 6-20 times that number. Factor in the fact that perhaps 30% of patients are going to see life-impacting long-term health consequences and 7 million becomes a conservative estimate.)

Bottom line: Stay safe. Take this seriously. And if you’re American perhaps consider who you want in power if it turns out you’re one of the ones who gets this and needs dialysis or heart surgery or can’t work the way you once could.

Author: M.L. Humphrey

M.L. Humphrey is a former securities regulator, registered stockbroker (although only briefly), and consultant on regulatory and risk-related matters for large financial institutions with expertise in the areas of anti-money laundering regulation, mutual funds, and credit rating agencies. Since 2013 M.L. has also been a published author under a variety of pen names and across a variety of subjects and genres.

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