“Why are we closing things down, when the mortality rate is only 1%? “ “Lots of people die from the flu- what’s the big deal?” “Death rates are going down.”
As an emergency physician, I’ve heard similar comments about COVID morbidity and mortality since the start of the pandemic. My concern is that comments like these demonstrate a lack of understanding not only about statistics but also about the difference between the terms MORTALITY (death) and MORBIDITY (illness).
I know many of you have read articles and seen memes about how COVID deaths are counted and some of you feel they are being overcounted. One false explanation for hospitals supposedly overcounting COVID deaths is explained in the following COVID death misinformation meme:
As a physician who has filled out more death certificates than I care to recall, I will tell you that it is clear that COVID deaths are being drastically undercounted, not overcounted.
According to Johns Hopkins Coronavirus resource and tracking, the mortality rate in the US is currently 2.7% although we don’t know the true number of cases of coronavirus so that number needs to be viewed as a guess rather than an absolute percentage. Most educated guesses in the US place the fatality rate between 1-3%. Still, that’s a small number right? Is it worth closing down our economy and altering our education system? Is it worth putting the mental health of so many on the line for? I mean really, what’s 2.7% (or even 1%)?
To some degree, the answer depends on who that % is to you. If it is a random stranger, maybe you would argue that all of our COVID precautions aren’t worth it. But if it’s your partner, your child, your mother or father or sibling, or yourself, maybe you care more.
Following the mortality percentage, there are usually specific risk factors that cause people to be in a much higher risk group for death or severe disease. You all know about age, immune compromise, diabetes, high blood pressure, but did you know that OBESITY is one of the leading risk factors for death from COVID? In America in 2019, 40% of our population is considered obese. 18% are considered morbidly obese. Obesity is an independent risk factor for severe complications or death from COVID-19.
But enough about death- let’s talk about the metric I am really interested in, which is COVID-related morbidity. Morbidity means being sick from an illness.
Morbidity encompasses short term and long term issues related to the illnesses that DID NOT LEAD TO DEATH. The percentage of people suffering from aftereffects of COVID infection is MUCH HIGHER than the percentage of people who die of COVID, in the range of 20% of cases. It bears repeating: about 20% of people infected with COVID will have short and long-term problems. In addition to this, we don’t know the long term consequences of COVID infection because this virus has not been around long enough for us to see these. Even in the short 8 months of worldwide COVID, we are recognizing more and more long term symptoms that persist long after the acute infection is over.
These range from heart damage (found in up to 75% of symptomatic COVID survivors), blood clotting disorders like stroke, and embolisms, neurologic problems including stroke, vision problems, long term psychiatric problems including depression, anxiety, PTSD, suicide, long term lung damage, chronic fatigue, chronic dizziness, and likely many more yet to be discovered.
These morbidities can strike anyone. You don’t have to have had a severe case of COVID or be hospitalized to have complications. Less severe disease resulting in chronic problems has been termed “COVID long haulers syndrome” and is being seen widely in populations all around the world.
Additionally, if you are young and healthy and get REALLY sick from COVID, you can end up intubated in intensive care for weeks to months on end, but because you started young and healthy, you don’t die. These people, who are profoundly impacted by severe disease but live, are not counted in the mortality numbers. This is not an uncommon scenario for young healthy people. It is not uncommon, and it is a highly impactful, very expensive scenario that none of us would want ourselves or our loved ones to be in.
The known mortality risk factors do not predict morbidity risk factors, or who will get severe COVID disease. They predict who will die. While it is essential to count deaths, we need to also be concerned about all the morbidity and be tracking those numbers, as we make personal and policy decisions surrounding socializing, mask-wearing, education, and opening states.