Why the true case-fatality rate of Covid does not matter

Summary

The article discusses why the exact case-fatality rate of Covid-19 is less significant than the pandemic's broader impacts on society and healthcare systems, emphasizing that even a relatively low fatality rate can have devastating effects and that the virus can cause severe complications in individuals without risk factors.

Abstract

The article "Why the true case-fatality rate of Covid does not matter" argues that the scientific debate over the exact mortality rate of Covid-19 is secondary to the pandemic's profound impact on daily life and healthcare systems. It highlights that even a fatality rate of 1 in 200 is significant when considering the number of preventable deaths and the virus's ability to affect individuals who would typically not be at high risk during a flu season. The author illustrates this point with personal anecdotes from medical practice and statistics showing the virus's impact on healthcare workers, children, and young adults without pre-existing conditions. The article also points out the unprecedented strain on healthcare systems, as evidenced by PPE shortages, the need for decontamination protocols, and the emotional toll on medical staff. Furthermore, it mentions the potential of Remdesivir to reduce the duration of illness, drawing a contrast with the flu by noting that even small improvements in treatment can be significant when dealing with a novel and unpredictable virus like Covid-19.

Opinions

The author believes that focusing on the case-fatality rate alone is misleading and overlooks the broader societal and healthcare implications of the Covid-19 pandemic.
The article suggests that comparisons to the flu are inappropriate, given the unique challenges posed by Covid-19, such as the disproportionate impact on ethnic minorities, the high mortality rate in certain age groups, and the occurrence of severe complications in otherwise healthy individuals.
The author emphasizes the unpredictability of Covid-19, using the term "Russian roulette" to describe the risk of severe illness or death, even among those without traditional risk factors.
The piece acknowledges the emotional and physical toll on healthcare workers, including the tragic deaths of some, as a testament to the severity of the pandemic.
The author expresses cautious optimism about the potential of Remdesivir, drawing parallels to the modest benefits of Tamiflu for the flu, and suggests that any effective treatment, even if marginally beneficial, is valuable in the context of a global health crisis.

Why the true case-fatality rate of Covid does not matter

Why scientists crossing swords over the “true” case-fatality rate won’t change anything about our daily lives. The new Remdesevir study findings might, though.

Clear as a snowstorm. ©TH Wong

In the midst of scientists crossing swords over the “true” case-fatality rate (depending on how you look at it, better than expected, or worse than expected… “only” about 1 in 200 people who get Covid die), these numbers don’t change why the Covid pandemic is different. It is not important if the final case-fatality rate is “only” 1 in 200. Many of the people who have died of Covid, would not have died if it were the flu.

I worked with a breast cancer surgeon, a long time ago. I was young and inexperienced, my patient was younger and scared. Somehow, through her tears of the terrible diagnosis, and my inept attempts to console her, I managed to get enough information from her to realize, she had zero textbook risk factors for cancer of any kind. When I told the surgeon, he nodded at my perplexed look, and went on to have a lengthy conversation with the young lady on the treatment to expect.

Finally, when we had all shaken hands and wiped tears, he turned to me: we can read all the scientific papers we want, but when the outlier with the disease is you, the risk for you has just become 100%.

There are many examples as to why we should throw out any comparisons with the flu, with or without the “real” case-fatality rate.

Healthcare workers don’t strike over lack of PPE (personal protective equipment) every flu season. We don’t have a protocol to decontaminate ourselves when we come home to our families every flu season.

Ambulance paramedics don’t make a comparison to a daily mass-casualty akin to 9/11. The flu has not, in the modern era, ever triggered an official inquiry as to why a disproportionate number of UK healthcare workers dying of Covid were from ethnic minorities.

The “modern era” flu does not kill young healthy people. New York City showed for patients requiring intensive care, almost 9 out of 10 died; as for those admitted to hospital, overall 1 in 5 died. Of the patients aged below 50 and who had no significant comorbidities, 1 in 6 died. Almost one-third of patients who died in China had no medical problems.

Away from the large numbers: at least a few children have been sick with Covid encephalitis, one died. Many healthcare workers have died. Young patients are getting heart attack and stroke (again, “without risk factors”), attributed to blood abnormally thickened due to Covid infection. And that is without counting the “mysterious” “unaccounted” excess deaths during the epidemic in many countries, in people not tested for Covid.

One epidemiologist explains this as “variance” (or, in the title of his piece, “Russian roulette”), another article highlights the “tails” in epidemiological modeling: it does not matter if most people don’t die after Covid. It’s the minority who do die, without reason, without risk factors. Someone you would never imagine dying from the flu, could die from Covid.

Covid-19 can be like the flu, can be very unlike the flu, and we have no way of knowing in advance which one it’ll be if we get it ourselves.

Maybe this is depressing, but there is hope: one drug appears to reduce how long people feel ill from Covid (by 4 days). Four days may not seem like much, but Tamiflu for flu is still given even though it reduces how rotten we feel by only 1–2 days. It seemed to reduce deaths in this study, but the difference was not big enough for the researchers to be sure it was not by “chance”.

Remdesivir was originally developed to treat Ebola, a disease that kills almost everyone it infects (case-fatality ranging between 25% i.e. one in 4, and 90%, or almost everyone). The last major Ebola epidemic lasted almost 3 years, and also took the lives of many healthcare workers.

If it makes us feel any better, Covid is not Ebola.