Q) Ontario is in a State of Emergency now. Is Covid-19 really that serious?
A) Infections in general do not treat everyone the same and Covid-19 is no different in this respect than influenza, SARS or any other virus that makes its way over here. It is prudent for everyone to take the necessary precautions such as frequent hand washing, not touching ones face, and everybody’s new favourite term: social distancing.
There are some among us who need to be extra cautious because they are both most likely to get sick from Covid-19 and more likely to become seriously ill. About 80% of us who do catch this virus will be only mildly to moderately ill and will thereafter likely have immunity from this bug.
A mild to moderate case usually starts with a fever and is followed by some mild breathing issues, a dry cough and some aches and pains. A moderate case will have a higher fever, chills and a feeling that you don’t want to get out of bed. Of the remaining 20%, 14% of those cases will develop into severe disease where patients may need supplemental oxygen while the remaining 6% will become critical and necessitate the use of intensive care beds equipped with ventilators (which, by the way, Canada is one of the least well prepared countries around as we have about half the number of these types of beds per person (10-12/ 100,000) as other modern countries).
The actual mortality rate is difficult to gauge and has been estimated at around 3.4% but that fails to take into account all the people who have Covid-19 but were never diagnosed with it because their symptoms were so mild nor does it take into account thousands of people who have been diagnosed and are alive but may soon pass on.
Perhaps the most accurate number comes from the cruise ship, the Princess Diamond, where all passengers were tested and has occurred far enough in the past to know the eventual outcomes. The death rate on the ship was about 1.2% which may be an accurate reflection of where Canada will fall as these patients were eventually treated within a modern healthcare system (Japan) and the population of a cruise ship tends to be older as is Canada’s population (although probably less so) relative to most of the world. However these numbers are just averages and do not reflect how are most vulnerable will likely fare.
A very recent paper released by the medical journal JAMA tried to come up with estimates based upon 72,314 coronavirus cases in mainland China. In their sample, the overall mortality rate was 2.3% which is roughly in line with global estimates that take into account those who have the disease but have not been tested. No deaths occurred in those aged 9 and younger which supports the assumption that this particular virus hits children less hard than others such as influenza.
In those aged 70 to 79, there was an 8% fatality rate which rose to 14.8% in those over the age of 80. As such, our elderly, defined by many as over the age of 60 (or 70 by others) are an easily identifiable “at risk” group. Another risk group are those who take medications that can compromise your immune system such as those undergoing chemotherapy, taking oral corticosteroids such as prednisone or on the sorts of medications we put recipients of transplants on.
There are also a lot of medical conditions that can affect your ability to fight off this virus. These conditions include, but are not limited to cardiovascular disease (coronary artery disease, heart rhythm disorder, heart failure and others; which in the same study showed a 10.5% mortality rate), diabetes (7.3% mortality rate), chronic respiratory disease (6.3% e.g. asthma, COPD..), high blood pressure (6%) and cancer (5.6%). Interestingly, women have lower fatality rates than men (2.8% vs 1.7%) which may reflect the prevailing belief that the female immune system is more active than its male counterpart. T
he reasons for these increased risks vary by the category but in the case of the elderly it is believed to be due to the fact their immune system undergoes “immunosenescence”. This means it very gradually loses its ability to mount a robust response to an invading bacteria or virus possibly due the thymus, an organ in our immune system that is thought to shrink as we age.
We should also spend a second and talk about one last at risk group who too frequently gets ignored. It is those who are least able to access the medical system or have the financial resources to be able to afford to self-quarantine. I’m talking about the homeless, people with disabilities, people who have difficulty washing their hands or those who have trouble communicating with others due to speech, hearing or language challenges. It is for the benefit of all of the groups above that we, the general public, need to take precautions right now. It is for their sake that we should pay particular heed to such habits as frequent hand washing and complying with the suggested guidelines for social distancing. For more information about this or any other health related questions, contact your pharmacist.