There’s was a article here- can’t find it now saying that COVID actually has a similar fatality rate to flu i.e. 0.1%. I don’t agree with it. Aside from NEJM not being the highest impact factor journal in the world (it’s Cancer journal, followed by about 5 branches of Nature, with NEJM pretty static over the last 20 years at 19); my experience in working in Intensive Care is the mortality is far higher and occurred in the last wave for a number of reasons. 1) It didn’t behave like a viral pneumonia- patients were easy to ventilate- i.e. they didn’t have stiff lungs mainly because it looks like the majority of the pathology is microvascular- i.e you can get oxygen into the lungs, but because the blood vessels are blocked, you can’t get it from the lungs into the bloodstream. This microvascular issue explained to some extent why other organs also failed. In addition, it generates a massive inflammatory reaction in a subgroup of people which is unpredictable- media are saying type 2 diabetics, the obese, certain ethnicities, but I saw all manner of demographic. 2) A lot of deaths sadly came from treating it like a viral pneumonia; this understandably is not highly reported- but either patients being over ventilated, ventilated when they didn’t need to be, or having intra-cerebral haemorrhages as a result of being put on anticoagulants for massive clots and pulmonary embolisms as a result of the virus, and reflects not negligence but the novel pathology we’re seeing. We had 1 influenza A admission during this period who survived. 3) COVID patients can occupy an ICU bed long after they’re no longer infectious as they’re often too weak to get off ventilators and have to be weaned off them slowly- this blocks a bed for a period of weeks, even months which given limited capacity is disastrous. We had 100% occupancy in our ICU within 2 weeks of the surge and only emptied out 4 weeks ago. 4) This is a novel virus- we don’t know the long term effects of infection. A significant number of asymptomatic people have scarred lungs from C19 (trial ongoing) which they aren’t aware of but may become symptomatic when lung function drops off with age- i.e. there may be a epidemic in 20 years of pulmonary fibrosis in the young becoming symptomatic when they hit their 50’s and 60’s. Both Epstein-Barr virus (glandular fever) and HIV (seroconversion) have acute phases which resemble flu and then have a later phase resulting in nasopharngeal carcinoma in Chinese, Burkitt’s lymphoma in Afro-Caribbeans and we know about HIV. I’m not trying scaremonger, I’m just saying it’s an unknown entity. 5) We aren’t at an advanced stage enough yet to create a viral pathogen de novo with predictable activity. You can weaponise one (e.g. smallpox) and indeed that’s what’s done with some vaccines (e.g. adenovirus where its altered to deliver gene therapy). 6) I have no drug company conflicts of interest. 😐
My advise is take it seriously and stay safe.
