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.

News Coverage Disappoints Me

This is what cnn.com is showing right now related to the current coronavirus outbreak.

CNN Headline

And I have to tell you it frustrates the hell out of me. Because pretty much any expert or frontline individual handling this in the U.S. would tell you that the headline should be “there are now 158 CONFIRMED cases of novel coronavirus in US”.

That distinction between actual number of cases and reported number of cases is vital for getting people to understand what is actually going on in the US right now with respect to this illness.

See, the thing is, if you don’t test for something you can’t find it, right? And that’s what’s happening in the US right now.

Last week there were news reports that the care facility in Kirkland, WA that has been the source of the majority of the fatalities reported in the US so far had another 50+ individuals showing potential symptoms and another 150 people that were patients or staff of that facility in addition to those fifty. And yet, those people have not been tested. As of 20 minutes ago, CNN is just now reporting on that fact.

So right there, in one small location, you very likely have at least 50 more cases.

On top of that are all the stories coming out of people with travel history and symptoms who’ve tried to get tested and were refused. One in New York was told to go home via the subway and go back to work if he wanted. Think about that from a disease transmission perspective. How many times has that happened in the last six weeks? How many cases are there that we simply don’t know about because no one is testing aggressively?

If you only look at the fatality number of 11 and use a 2% fatality rate, at a minimum there are 550 cases. But we’ve already seen that some fatalities that occurred previously were only retroactively identified as fatalities related to this virus. So how many more were there that were chalked up as pneumonia or the seasonal flu? And that fatality number is a lagging indicator. This infection takes weeks to reach the point where someone dies from it. (Per the WHO report on China.) So that’s 550 as of a month ago.

It really frustrates me that I get more accurate information on what’s going on from Twitter than I can from my local news or from CNN who I had previously considered a trusted source. (Their coverage of the stock market the other day when it dropped a 1,000+ points in a day was also almost non-existent as it was happening. I had to go to Yahoo Finance to track that.)

I understand the desire to not be sensational and to not cause a panic. Especially with respect to stock market trading which in the short term can be very emotion-driven. And I get that we have a bunch of stupid people in this country who will react to bad news in stupid ways. And that the news very often gets accused of an “it if bleeds it leads” mentality.

But I have a 90-year-old grandma with COPD and a mother who is almost seventy and has needed emergency treatment on multiple occasions for breathing issues. Based on what I’m seeing I think they should both be limiting their public activities for the next couple of weeks.

There are no REPORTED cases in my state right now, but to think that a virus could be circulating freely in Washington state and not have made it to Colorado is wishful thinking. (My last full-time job I traveled every single week from Colorado or DC to New York or Miami or the UK or Germany. There are people whose jobs routinely have them on planes traveling all over this country–and this world–on a weekly basis. And flu transmission on planes is incredibly high.)

I told both my mother and my grandmother this over the weekend, but they looked at the local news coverage which says, “Hey, no big deal, small numbers, small risk” and they ignored me. My mom went to a casino which is a germ breeding ground on the best of days, and my grandma went to church, the store, and the doctor this week.

Hopefully I’m being alarmist about the current situation and the people I love will be fine.

But there has to be a way to provide news in an objective fashion while still applying critical thinking. Not just, “Hey, we’re being told this” but “Hey, we’re being told this and here’s the context in which that information should be evaluated.” Because far too many people in this country just listen to the news that airs at four on the local television station or just read the headlines of their chosen news site without engaging with that content and applying outside knowledge to it.

Anyway. It’s frustrating.