Its time to learn to live with the virus

When the Coronavirus first emerged at the beginning of this year, it was poorly understood and there was justifiable fear about its potential deadliness. Fortunately, we now know exactly who is most affected and who has little to fear.

According to the Department of Health, as of 10th October 2020 Australia has identified 27,229 cases of coronavirus. Of this 27,229 identified cases we have had 897 deaths. This makes a death rate of 3.3%. However, given that most cases, especially in younger people either have mild symptoms or no symptoms at all, this is clearly an undercounting of the real infection rate. And hence a gross exaggeration of the real infection fatality rate.

In Australia the total known cases for people under 50 is 17,980. Total deaths is 5. This leads to a case fatality rate of 0.00028. Remember though, the case rate is much lower than the true infection rate so the true infection fatality rate may be as much as ten times less than even this tiny number. Given that many people under fifty are in poor health to start with, we can only assume that these 5 deaths were all people with serious comorbidities.

The one place in Australia where death rates have been substantial is nursing homes. Over 75% of the deaths from coronavirus in Australia are nursing home residents. Of the 2050 nursing home residents in Australia who are known to have been infected by this virus, 676 have died. This is a death rate of 33%. This sounds shocking until you realise the state of health of Australian nursing home residents.

According to this article, 91% of people admitted to nursing homes die there. 40% will die in their first 9 months. The average life expectancy of male residents is 2.1 years from admission and 3.2 years for female residents. Residents have on average over 8 comorbidities, including heart disease, stroke and dementia. The reality is that nursing home residents are not simply old people. They are both old and extremely sick. If they were old but in good health, they would still be living at home. As much as the 33% death rate is shocking, the flip side is that 67% of nursing home residents who contract it still survive, and this is despite being both old and very sick.

We can compare the nursing home fatality rates with those who are receiving at home aged care services. In Australia there have been 82 infections and 7 deaths in this group making a death rate of 8.5%. People receiving at home aged care services are also old and sick. Just not quite as old and sick as those in residential care. The kind of services they are receiving are assistance with showering, dressing, meal preparation and cleaning services as well as assistance with medication management, wound care etc. Despite their age and poor health status, 91.5% have survived this virus. The average age of death from coronavirus in Australia is 83 years old. This is slightly older than the average age of deathin 2018 of 81 years old.

Australia is not alone here. In the United States, the Centre for Disease Control best estimate for the true infection fatality rate given by age groups is as follows: 0-19 years: 0.00003, 20-49 years: 0.0002, 50-69 years: 0.005, 70+ years: 0.054. This means that for young people there is almost zero chance of dying from this disease. And by young, I mean under 70 years old.

What about hospitalisations?

According to the CDC, around 70% of hospitalisations are in people over 50 years old. This is despite the vast majority of infections being in people under 50 years old.

This chart from the CDC is fascinating where it compares hospitalisation and death rates for different age groups, using the 18-29 year old age group as the comparator.

People in the 75-84 years age group have an 8 times higher chance of hospitalisation and a 220 times higher chance of death than people in the 18-29 age group. People in the 85+ age group have a 136 times higher chance of hospitalisation and a 630 times higher chance of dying

This is why we are seeing large numbers of infections in the younger cohorts all over Europe, but only small increases in hospitalisation rates and only very small increases in deaths.