Dr. Magryta: Coronavirus update
Preamble note continues to not change significantly: 98-99.34% of us are not at risk for a bad outcome, which I define as death, if we follow the CDC guidelines. Take solace in that notion, however, the sand continues to change under our feet as the healthcare system gets stressed, this could change. Please do not use any of the following information as a license to be cavalier with other people’s health as we do not know enough yet to make counter decisions. Continue to follow the CDC guidelines and the stay-at-home directive as it will help those at risk. Section 2 is a very deep dive into why nutrition can be a life-saving decision for the foreseeable future.
Today, I would like to take a dispassionate analysis of the data as this is the best that we can ask for as the pandemic progresses. We continue to see dysfunctional projected death rates without a true denominator to assess true risk which is both inflaming people’s fears and worsening overall health through unneeded stress. I do not say this lightly as SARS2 has turned out to be a nasty player for between 0.66% of humans and 1.5% depending on the country and healthcare system that you find yourself in. Where does this number come from?
The Chinese data set has proven to be just so as a recent article in the Lancet Infectious Diseases has demonstrated. They have boiled the Chinese data set down to a case fatality rate (CFR) of 0.66% for all infected individuals which is significantly higher than the seasonal influenza outbreaks but way lower than original estimates of 3%. (Verity et. al. 2020) The case fatality rate is a complete unknown in the United States as we have no true denominator. We are still flying completely blind as to our risk or CFR. However, that being said, South Korea has a CFR of between 0.6% and 1.6% which is likely to be the true COVID-19 risk globally. Germany has a CFR of 0.9% according to the latest data and they are effectively progressing through this pandemic. Remember that these countries tested and quarantined broadly which had a significant effect on the CFR. Perceived CFR rates are much worse for Italy and Spain as their healthcare systems have been overwhelmed.
As of noon on March 31, the CFR in the U.S. is 1.7% based on CDC data and only on the tested individuals which is a tiny number as we are predominantly only testing those people that are seriously ill and requiring admission to a hospital.
The key to preventing a significantly worse CFR in the U.S. is predicated on Americans following the current guidelines. Please stay home. Please wash your hands frequently. Consider wearing a mask if you have one primarily to prevent you from touching your nose or mouth which is the portal of entry for SARS2. Do not touch any mucous membranes unless your hands are thoroughly washed. Following the Integrative Medicine guidelines as presented last week could also lower your risk even more as the data coming out of NYC is tilting heavily towards obesity and metabolic syndrome, food- and lifestyle-driven inflammation, as driving worsening disease in the younger populations from 20 to 50 years old.
Why am I belaboring this point? The problem with poor data analysis and release is that it has the effect of fear mongering and stress induced disease in those 98+% of people that survive. I see it everywhere as people are stating things that are not rooted in truth. We need truth and data to make reality real. We need non-emotional data. We all need to understand that this virus is nasty and we all need to practice safe activity based on the excellent recommendations of the CDC and infectious disease specialists but not live in abject fear for our lives for our risk is truly low but clearly not zero and increasing in frequency with advancing age and metabolic disease risk.
For point of comparison again, more than 650,000 Americans will die this year in a car wreck or from heart disease combined. This is three times the current CDC projected COVID-19 deaths which may be low if 60% of Americans get infected and 1+% die. Again, this is to help people gain perspective to reduce fear and anxiety while maintaining a healthy and robust understanding of the seriousness of this issue and therefore following the directives to the letter.
Here is the rub. There is a very strong probability based on past viral outbreaks that this outbreak may take six months to peak. No one knows but the likely six-month point is early summer 2020. What is likely to be true from a historical and epidemiological perspective is that we need a large part of America to become infected and immune before we see this disease and its risks dissipate. Again, this is a guess not a known.
According to a new podcast on March 31, Dr. Peter Attia and Dr. Michael Osterholm discussed SARS2 and note that we see information coming out of New York City that individuals between the ages of 20 and 50 who are obese are at significantly higher risk for a death outcome. This is a new wrinkle in the global risk data and could significantly skew the CFR in the wrong direction. Dr. Osterholm believes that the final CFR will be in the 1-2% range because of our poor lifestyle choices and an overwhelmed healthcare system. That is a bit scary and I hope that he is wrong because that number is between 3.27 and 6.54 million Americans if 100% get infected or if 60% get infected that number is to 1.96 to 3.92 million. Either way those are ugly numbers.
Other interesting points of knowledge from the conversation are that we have huge supply chain issues in this country as the materials needed to test, useful drugs and PPE materials are mostly not produced in the United States and therefore are being competed for globally. We are behind the eight ball in procuring the reagents for tests, masks and gowns, analyzer machines and ventilators all of which are critical to this fight. We are going to war without vests, helmets or guns in many cases. Again. this is a political and business problem for the future and will not be fixed today or tomorrow likely.
The take-home point today is this: we need to maintain our robust safety actions while trying very hard to be positive within the storm. Try not to obsess about the numbers, the risks or the news as they are ever-changing and should not affect your behavior as there are much brighter people than I making these safety decisions. Rather, practice daily gratitude for our beautiful world, eat amazingly healthy food, meditate daily, and follow the great guidelines presenting last week by the Integrative Medicine Department of the University of Arizona.
Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at firstname.lastname@example.org