Just a brief note about a conversation I had yesterday with a medical doctor in the correctional system yesterday about the recent outbreak of Covid-19 in the 1,000 inmate Terminal Island facility in San Pedro, California.
You can read about in in yesterday’s article about it from the LA Times here.
The physician told me that in Terminal Island prison, 70% or 700 of 1000 inmates tested positive for Coronavirus although at times, the same sample had to be tested two or three times. Ignoring the false positives and false negatives for a moment, this is still very impressive because it demonstrates how rapidly the infection can spread among a closely confined population.
The decision was made to perform “reverse quarantine” because of logistics. In other words, those WITHOUT infection were separated rather than the usual isolation of cases.
Although the situation is evolving, he stated that 30 of 1000 (3%) were hospitalized and as you can read in the article above, 6 have unfortunately died. I was told that all the decedents had serious underlying medical problems.
Of course, we cannot definitely state that 3% of any population in which effectively the entire “herd” is infected will be hospitalized or that 0.6 percent will die because all that depends on mitigating health care measures such as use of medicines, aggressiveness with intubation, and how effective controlling inflammation and oxygenation are.
Of note, the presentation with GI problems such as diarrhea were very common versus only respiratory symptoms. It should also be noted that the vast majority of people were asymptomatic although that definition is subjective as people might minimize the sniffles, a tickle in the throat, or bouts of painless loose stools..
The conclusion from the Boston Homeless shelter (roughly 50% infected) and from the Lombardy blood donors (67% positive for antibodies) is that the infection spreads very efficiently and that it is usually without significant symptoms. If we believe the Terminal Island numbers, the 50% in Boston may have just been an artifact of testing a bit too early in the exponential growth phase.
I am pointing out that all the existing data suggests the same thing: <1% mortality among a typical population, greater, susceptibility among patients with preexisting conditions, and high infectiousness owing to the low virulence. When you have a more lethal strain like SARS or MERS, the host is isolated or succumbs too soon to effectively spread the disease.
I am not saying this is not a serious or potentially deadly condition. I am not saying that measures to avoid overwhelming of the hospital system are not worth it. Such prudent measures include contact tracing, isolation of cases, and testing of people in high social contact positions. But it is undeniable that people will also suffer because the majority of our health systems are not doing surveillance and mitigation of other diseases; hospitals are furloughing staff as people do not engage with the system. My friend told me that a mutual friend, who is an oncologist, states that he is seeing no new referrals so we can infer that “routine” cancer screening is simply not being done. The health care system is complex and not designed to spend all day chewing one flavor of gum; it needs to walk as well.
There is risk everywhere and that is why clinicians need to be flexible, creative, and adaptive. Administrators have certainly been flexible and creative when it comes to harvesting CARES act revenues and although the CDC recently revised Covid-19 caused deaths from 67,000 to 37,000 a few days ago, it doesn’t mean that hospitals will be asked to refund the money or prosecuted for accident victims coded as Covid-19 related.
Discernment and moral decisions are everywhere and the simple solutions are not always the best. If 70% of an isolated population can be infected so efficiently and largely without symptoms, then perhaps this is not the “airborne AIDS” that we were fearing? In fact, the odd thing about epidemiology is that you were being sentenced in a month and were afraid of Covid-19, you would do well to request Terminal Island because it would be safer than any other institution owing to the active immunity in most of the people there.
Before you say “so you want 0.6%” of all Americans to die?” I will state that you need to consider the risks from a furloughed health care system, large scale poverty and hopeless leading to social instability, and the fact that vulnerable members can succumb to many kinds of infections, just as they always have. The truth is that we are constantly negotiating with infections of all kinds and that life is a dance with our own internal immune regulation and countless infectious diseases. To be frank, the very notion of “immunity” is a cognitively-dissonant misnomer. If I pump you full of virus then you will get infected but your immune response will probably overwhelm it and suppress clinical symptoms. Similarly, even if 100% of the herd is “immune”, individuals will still need active viral infection to remember and mount a specific antibody response leading to a positive test result but no clinical symptoms. Immunity is not an impenetrable shield after several months; it is a program that requires another infection to work. That is why 80% of people with coronavirus infections already had evidence of previous infections and why waiting for a vaccine to restart the world is not logical.
To learn more, read this blog I wrote about the link between aging and acquired immune deficiency in three great souls who passed in their mid 90s: Jack LaLanne, Pete Seeger, and Nelson Mandela.
To learn more about Coronaviruses and epidemics, read my previous eight blogs:
- Public health context of reducing spread: hand washing, fomites, and quarantine
- The emergence of an apocalyptic death cult. People harbor religious beliefs about COVID-19
- The greater scale of aging as a threat and how it contributes to all-cause mortality
- Coronavirus biology: origins, testing, and therapeutics
- How inflammation produces ARDS, the final common pathway for death from flu-like illnesses.
- Epidemic modeling.
- Cognitive dissonance and cognitive bias in understanding mortality statistics and disease reporting
- Update on the Covid-19 situation