Saturday, April 25, 2020

COVID-19 Statistics and Questions

by Dr. Iva Lloyd, ND

The requirement to isolate is into it sixth week. This is putting many into a state of fear, uncertainty and confusion.  Speculation is making the situation worse. Although there are many unknowns, we do know quite a bit about COVID-19 including what groups are most susceptible to severe or fatal outcomes, how it is spread and how to protect ourselves.

Generally speaking, the more understanding you have about a stressful situation the easier it is to handle. Also, looking at a problem from many different perspectives often provides the best insight into not only why there is a problem, but how to handle it. The following analysis raises many questions, but hopefully it also shreds some light and alleviates some of your concerns.

World Wide Statistics

To get a better understanding of what is really going on I analyzed the statistics (as of April 21st) provided by the World Health Organization (WHO) a few different ways,  For the sake of this analysis the focus is primarily on what the fatality rate tells us. I have focused on fatality rates as the rationale for the extreme Public Health measures that have been taken are about preventing deaths, not about preventing mild symptoms. Of the 209 countries have reported confirmed cases for COVID-19, the following is what it currently indicates:


Chart 1: Death Rate by World Region
as of April 21st, 2020

Chart 1 looks at fatality rate by world region. All regions, other than Europe were tracking at a death rate between 4.3 and 4.8 percentage . In Europe the rate is tracking at 8.5%.  What's going on in Europe?
Although there is a high degree of consistency in most world region, when you break that down by countries within each world region, there is more variability.  For example, in the Western Pacific the fatality rate in China is reported at 5.5%, Korea at 2.2%, Japan at 1.6 and Australia at 1.1%.

Chart 2: Percentage of Countries by Death Rate
as of April 21st, 2020
Chart 2 illustrates that the fatality rate by country varies substantially.  55% of the countries currently have a rate of less than 2% with 21% reporting no fatalities at all based on the date of the analysis. 7% of the countries had a fatality rate of greater than 11% including the European countries of France (17%), Belgium (14%), United Kingdom and Italy (13%) and Netherlands (11%).

The tremendous variability in fatality rate by countries provides additional confirmation that there is something other than the virus itself that is a threat to health.  Why is the fatality rate in the majority of countries so low and in others so high?  What can we learn from those countries with such a low rate?

Of the 209 countries that reported confirmed cases we see that 35% of the countries have less than 100 cases and 28% have between 100 and 999 cases. Chart 4 also shows that only 3% or 6 countries have over 100,000.

What this indicates is that, generally speaking, the majority of countries have been able to control the spread of COVID-19 quite well.

Chart 3: Death Rate Based on Number of Confirmed Cases
Chart 3 indicates that the fatality rate is highest in those countries with the most number of cases.  In those countries with less than 10,000 cases the fatality rate is quite consistent at around 3.3%.

When we look closer that the numbers it is not that black and white. Of the countries that have more than 100,000 confirmed cases of COVID-19, the fatality rate ranges from 3% in Germany, 5% in the United States, 10% in Spain, 13% in Italy and the United Kingdom and 17% in France.

If it was simply, the higher the number of cases the higher the fatality rate, why is there such a range? Is this because of hospital capacity?  Is it associated with population density?  To what degree does the age of the population in those countries impact the outcome? What other health factors are impacting the outcome?  What else needs to be considered.

If we look a little closer at the numbers in Canada, as of April 25th there are 44,353 confirmed cases reported in Canada with a total fatality rate of 5.3%.  Nine provinces and territories have a fatality rate below 2.5%.  Quebec has the highest rate at 5.9%, followed by Ontario at 5.8% and British Columbia at 5.3%.

Just recently what has also come to light is that a large number of deaths (upwards to over 80%) are in the elderly and in those that are institutionalized.  On April 14th, a local paper reported that over 90% of the all fatality in Canada were in those over the age of 60.  What is also interesting about this fact is that those over 60 years of age represented only 38% of those that had COVID-19. The correlation with severity of symptoms and fatalities is not only related to age, but to a person's overall health status, especially as it relates to uncontrolled diabetes and heart disease. Similar facts have been echoed in other countries as well.

Why do I like all the numbers?  I like numbers and research because it brings reason and logic to any situation where emotion tends to drive outcomes and behaviour.  I rely on it because it confirms that the threat of COVID-19 is not based solely on the virulence factor of the virus.  It is a stark reminder that there are many factors to consider.  From a naturopathic perspective (or my perspective) there are three main things to consider:
  1. The virus itself.
  2. Environment
  3. Individual susceptibility, risk and resiliency

Protecting Yourself From the Virus


Yes, it is important to follow the guidelines from your local Public Health. Understanding how the virus is transmitted hasn't changed.  It is transmitted through respiratory droplets primarily when a person coughs or sneezes and then touches a surface that someone else comes in contact with and then touches their face.  The reason that the primary Public Health guideline is to wash your hands frequently and avoid touching your face after touching other surfaces is because this is the primary way that transmission happens.

In this blog I am focusing on the guidelines for the public. Understandably, the guidelines for healthcare workers and those in close contact with individuals that have severe symptoms, for any illness, are very different than the guidelines for the general public.

I am concerned that without an understanding of the rationale for Public Health guidelines many people are taking things too far. So let's look at the rational for the main protective guidelines.

  • Physical Distancing protects an individual from entering the path of an unexpected cough or sneeze from someone that they encounter, based on the off chance that one of the individuals is infected.  Physical distancing is about transmission of respiratory droplets which is why it is possible for your doctor or health-care provider to be closer than 6 feet when providing care while wearing masks and gloves. You can not catch the virus simply by being next to someone.
  • Masks - On or Off? Masks act as a symbol of protection, yet according to the Center for Evidence Based Research there is reason to suspect that they may actually make the situation worse for some people. Masks can exacerbate or worsen other health issues as they can impede breathing and can make it more difficult.  Face masks may also negatively impact the natural way that the respiratory system and the skin regulate the body's core temperate. When walking outside, driving in your own vehicle or in places where you are not interacting with others it is seldom necessary or advisable to wear a mask.  The research, and Public Health, recommend that individuals wear masks under the following three conditions:
    • An individual is demonstrating symptoms of COVID-19 (and should be self-isolating other than going to doctor appointments)
    • An individual is providing care to another individual that is demonstrating symptoms or that is at high risk.
    • When an individual is in a situation where it is not possible to maintain physical distancing.
  • Gloves are a barrier between you and another surface.  It is important to keep in mind that gloves, disinfectant wipes or even tissues are only effective when we use them for a specific task and then discard them.  It makes sense to have a physical barrier - gloves, paper towel, disinfectant wipe, etc when pumping gas, opening doors that are frequently used by others and when doctors and health care workers are interacting with you. Keep in mind, a virus may last longer on gloves than it would on your hands. It is all about not touching a surface that may be contaminated and then touching your face shortly after. Wearing gloves throughout the day or while driving in your car does not make any sense. If you choose to wear gloves, wear them for a specific task and then discard them. 
Following Public Health Guidelines is still the primary focus for decreasing exposure to COVID-19.

Environment

With the high number of fatalities in individuals that have been institutionalized and in larger cities, the environmental factor will likely receive a lot of attention. There will be many questions raised such as:
  • How best to keep busy traffic areas (subways, elevators, large gatherings) safer during an outbreak.
  • The necessity to have windows and air flow in buildings where people work and sleep
  • Why are there more fatalities in cities? How much of it is about population density?  To what degree does the level of electromagnetic radiation exposure play a role?  What has to be done to make cities, large events and shopping safer?
  • Isolation standards in institutions, especially when someone is sick
  • What do our hospitals have to do to prepare for situations like this in the future.
  • The importance of spending time outside not only for the opportunity to breath in clean air, but impact of nature versus buildings on health.
We will likely be faced with other threats to health in the future. The question now is what have we learned and how do we prepare moving forward.  There are many environmental factors that a play in health and disease. Looking at environment from the perspective of health will help us make better decisions moving forward.

Individual Susceptibility

It is important for individuals to recognize that over time most of us are likely going to come in contact with COVID-19.  The current stats indicate that over 80% of people will experience mild symptoms or no symptoms at all. 

The two main factors that are associated with increased risk of severe symptoms or fatality from COVID-19 are those that are older AND that have other health issues such as diabetes, hypertension and other cardiovascular diseases.

Expect that over the next few months there will be many speculations as to why the fatality rate is so high in the elderly population, especially those in institutions. No one can say that they have all the answers, but what we do know at this time is that nutrient deficiencies are a world-wide problem, especially in the elderly. Also, with any respiratory infection, those individuals that are not sedentary and not engaging in physical activity may be more susceptible.

Part of the conversation will and needs to shift to the comorbidities (diabetes, cardiovascular disease, hypertension and obesity) that are associated with increased risk of fatality and severe symptoms of COVID-19.

What does all this mean for most people?  This situation has highlighted the need and the importance of lifestyle as a means of supporting overall health -- through all stages of life.

Looking at the statistics, both in Canada and around the world, have highlighted that this pandemic and future health crises can only be solved and prevented by looking at the problem from as many perspectives as possible. To-date the virus has been the focus. Over the next coming weeks and months we can expect that environment and lifestyle will explored in a lot more detail.

For more information on how to support your health, review my previous blogs:
For more information on staying healthy, check out our website at www.naturopathicfoundations.ca