The way public health officials and the media are presenting COVID-19 data is unhelpful and leaves the public more likely to panic. The goal of this information should be to allow people to make reasonable decisions about their health and activities. In order to do this, they need to be able to make accurate personal risk assessments for themselves and their loved ones.
Stop Posting Total Cases
No one should care about the total number of diagnosed cases since the pandemic began other than epidemiologists trying to accurately calculate mortality rates. As testing expands, more cases are going to be found. This will also be true when public health officials engage in surveillance testing, contact tracing, and testing.
Using total historical cases to present COVID-19 data is worthless to an individual trying to assess his or her own risk. It has been demonstrated in multiple studies of contained populations as well as in antibody studies that between 50% and 96% of positive tests result in mild or asymptomatic cases.
Instead, some measure of the number of patients ill enough to be hospitalized would be a better metric. The entire goal of “15 days to Slow the Spread” was to prevent the health care system from becoming overwhelmed. Providing insight into the fraction of patients who become very ill with COVID-19 is more useful to individuals in making personal decisions.
At a minimum, the number of total cases should be presented as hospitalized and non-hospitalized. The latter should be a rolling 14-day number. It does me absolutely no good to know that Cherokee County, Georgia, has had a total of 753 cases since the pandemic began. If I am going to make decisions about my activities today, I want to know how many active cases there are locally now.
Next, the public needs to see COVID-19 data in tranches. They need to understand the specific segments of society that are at risk by age, sex, and preexisting conditions. It could be the most important information to help an individual make a decision regarding his or her personal activity.
Age
Phil Kerpen has been doing some excellent work providing data about age-related disease and death. He has been compiling revealing data on nursing home deaths. His compiled data shows that approximately 52% of deaths nationwide have occurred among this population. This information is critical to public health and most certainly why Dr. Deborah Birx said these facilities would be prioritized for sentinel testing.
Kerpen went further compiling age-related statistics for particular states at this point in the pandemic. The point of his thread, complete with graphs, is clear. Kerpen points out that COVID-19 data at the state level for Pennsylvania shows more patients over 95 died with COVID-19 than patients under 60 did. There were more deaths among patients over 100 than among those under 45.
He goes on to note that in many states, the number of deaths under the age of 60 is less than 10% of the total. The average age of death among confirmed COVID-19 cases in Massachusetts is 82. He summarized with a chart from the CDC through May 9, 2020, which reinforces the trend he found in the states he presented.
Twitter screenshot of COVID-19 data from the CDC.
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Sex
However, age is just one factor. Males seem to suffer from severe illness with COVID-19 at a higher rate than females according to global data. One study in Germany suggested that low testosterone levels could be a factor. Testosterone levels are easily measured in older men and this condition has effective treatment options.
Preexisting Conditions
There are still some cases of severe disease and death under the age of 60. A partial explanation of those cases likely resides in an individual’s preexisting conditions. In an interview with Larry O’Connor, Dr. Drew Pinsky noted a cluster of conditions that were present in severe cases that he termed “brutal”:
- Central obesity
- High blood pressure
- High cholesterol
- Insulin resistance and Diabetes
- Antiphospholipid Syndrome, an autoimmune disorder where a person’s immune system mistakenly creates antibodies that make your blood much more likely to clot.
People under 60 can be evaluated for these conditions during a routine physical exam. Also important to note, central obesity makes someone more prone to the three conditions that follow it. Warning against obesity is not ‘fat-shaming’ in the age of COVID-19.
If you want to reduce your risk, put less in your mouth and move more, at any age. Being able to see your feet when standing up straight is a good rule of thumb. Nancy Pelosi was half right. If President Trump was morbidly obese, he is at higher risk. However, his risk is for severe disease from COVID-19, not from taking a prophylactic dose of hydroxychloroquine.
How You Catch COVID-19
Another interesting piece of COVID-19 data Dr. Pinsky shared was a study from China. Out of 5,000 cases studied, the virus was brought into the home where an additional 3-5 people became infected. This reinforces a study of over 1,000 patients admitted to the hospital with the virus in New York City. Over 90% came from sheltering at home or a contained living situation such as nursing homes and jails.
This indicates an individual is far more likely to contract the virus through prolonged close contact with an infected individual. Families with an at-risk member in the household should know this and take appropriate precautions. A young healthy individual should not be overly concerned about catching the virus in a retail outlet.
Change the Narrative
A responsible media would be putting this kind of information front and center often to help quell the public panic. Graphs, charts, and visuals would all be excellent ways to help the public approach reopening with common sense and confidence. However, when 42 percent of Americans agree that business owners who violate lockdown should be jailed and have their licenses removed, public common sense is clearly not the goal of many media outlets.
It is time for public health leaders and state websites to reconfigure data to educate the public. Using COVID-19 data to show the current situation in a state or county, not the full pandemic numbers, would be a start. Dividing cases, especially hospitalized ones, along the lines of age, sex, and preexisting condition is also very important.
Changing the way data is presented is one way to force the media to cover what truly matters to educate the public. Clearly, media outlets are not going to do it on their own. There is too much money in panic porn.
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