Most of us won’t die from COVID-19. But looking beyond the basic statistics can help us to better assess and mitigate the virus’ risks to our personal health.
We are constantly bombarded with the basic numbers of COVID-19: deaths, hospitalizations, and cases. These statistics are crucial to evaluating the virus’ spread, but they provide an incomplete picture of the numerous ways COVID-19 can influence our health even when our personal risk of mortality from an acute infection is low. Moving past these surface-level numbers and examining some of COVID-19’s broader health implications can help to inform our own risk assessments and behavior choices as we navigate daily life in the months to come.
We can’t just look at COVID-19 mortalities. We have to look at morbidities too — that is, the long-term consequences of the virus. Although researchers are just beginning to untangle COVID-19 morbidities, they loosely fall into two potentially overlapping camps. The first camp is COVID-19 cases that linger. While it’s not surprising that cases severe enough to land people in the ICU and on ventilators can involve long recoveries, one startling aspect of the virus is that even mild cases can drag on for quite some time. One study showed that more than a third of adults with mild cases — those not requiring hospitalization — had still not returned to their usual health two to three weeks after an initial positive test. For reference, more than 90 percent of outpatient influenza patients recover within that time period. Another study (in preprint) estimated that around one in seven symptomatic cases will last for at least four weeks, one in 20 will last for at least eight weeks, and about one in 45 will last for 12 weeks or more.
These long haulers, many of whom appear to be young and otherwise healthy and some of whom are children, continue to experience a range symptoms that can include debilitating fatigue, shortness of breath, cough, headaches, brain fog, gastrointestinal distress, and cardiac irregularities, including POTS. One study found that nearly 20 percent of COVID-19 patients were diagnosed with mental disorders, including anxiety, depression, or insomnia, within three months of their illness.
Another study followed more than 1600 patients with severe COVID-19 who had been hospitalized. The authors found that of the 75 percent of patients who had initially survived and been discharged from the hospital, 7 percent died and 15 percent were re-hospitalized within two months of discharge.
The second camp of COVID-19 morbidities includes organ damage with unknown long-term consequences. Again, the virus has surprised us by inflicting organ damage not only in individuals with severe cases but also in those with asymptomatic and mild cases. For example, one study of recently recovered COVID-19 patients, two-thirds of whom had asymptomatic or mild cases, found that 78 percent of the patients had experienced cardiac involvement and 60 percent continued to exhibit myocardial (heart) inflammation two to three months after diagnosis. Brain, lung, and kidney damage from COVID-19 have also been documented. This growing evidence has many experts concerned that the health repercussions of the virus could persist long after we control its spread.
We can’t just look at hospitalizations and bed capacity either. We’ve also got to look at what it actually means for COVID-19 patients and everyone else when hospitals become overwhelmed. ICU bed capacity is often used to judge how much trouble a region is in, but the real limitation of ICU capacity is ICU-trained staff, not bed space. (Many rural hospitals don’t have ICUs or ICU specialists at all.) ICUs typically care for patients with a large range of needs and operate at 70 to 80 percent capacity to allow some flexibility in case of a short-term increase in patients or in the proportion of patients who require the highest levels of resources. But patients with severe COVID-19 are among the sickest in the ICU. They require about twice as much care and stay three times as long as the average ICU patient, which means they can quickly overwhelm staff capacity before the beds are full.
When ICUs become overwhelmed, they’re forced to pull in non-ICU staff to help cover the surplus of patients. We saw this all-hands-on-deck crisis care occurring in New York and Houston earlier this year. Now it’s happening in hospitals around the country. North Dakota hospitals are so short staffed, the governor recently announced that healthcare workers who test positive for COVID-19 but are asymptomatic can keep working. As crisis care increases during a pandemic, so can the mortality rate.
Moving hospital staff from other units into the ICU as cases surge also impacts the care of non-COVID-19 patients. As we saw in March and April and are beginning to see again, hospitals are forced to halt elective procedures when overwhelmed. While it doesn’t sound like a big deal to stop performing nose jobs and facelifts for a while, people often don’t realize that many procedures that can be quite urgent — but not technically emergent — are also considered elective: cancer surgeries, joint replacements, cardiac ablations to correct rhythm problems.
The delay of urgent procedures — both because hospitals don’t have the capacity to offer them and because fewer people than usual are seeking care for serious conditions that require medical attention, such as heart attacks — can result in poor health outcomes and avoidable deaths. Some of these cases are likely reflected in the 100,000 excess deaths the CDC has reported through early October in addition to the country’s official pandemic death toll of nearly 250,000 people.
We can’t just look at skyrocketing cases either. We have to look at how the circumstances in which people are becoming infected are changing too. During the early months of the pandemic, many cases were linked to long-term care settings, large crowds, and tightly packed indoor spaces, such as bars. Hot spots emerged, like in New York, where community transmission became widespread. But in other parts of the country, especially in rural regions, the chance of encountering the virus if you avoided crowded locations remained small.
We’ve seen a massive shift in transmission in recent weeks, however; most of the country is now considered a hot spot. Because the virus has become so ubiquitous, a lot of transmission is also now occurring in places previously thought to be a safer alternative to large crowds: small, in-home gatherings. In some counties in the Midwest, for example, you’re now very likely to encounter an infected individual in a gathering as small as 10 people and almost certain to encounter one in a gathering of 15 people, according to a model created by researchers at Georgia Tech.
Infections spread within immediate households too. One study showed that among people living together in a single household, the rate of secondary infection — that is, the chance of another person within the household becoming infected from the first detected case — was about 53 percent. Studies in other countries have placed the rate between 20 and 40 percent. That means it’s not a lost cause if a family member becomes ill. Immediately isolating the sick person in a separate bedroom and bathroom, masking, opening windows, running air filters, washing hands, and sanitizing surfaces can reduce the risk of secondary infections within the home. (The entire family also needs to stay home to prevent spreading the virus to those outside the household.)
Despite the fact that the basic COVID-19 statistics are growing grimmer by the day, we have reason to hope that next year will be brighter: early data indicate that both the Pfizer and Moderna COVID-19 vaccines may be around 95 percent effective. And we’re not helpless in steering our way out of the depths of the pandemic even before vaccine approval and widespread distribution. Digging a bit deeper than the ever-present death, hospitalization, and case numbers flashing across every screen can give us a broader picture of our personal health risks from COVID-19, as well as those of our loved ones. This knowledge can help us to make more informed choices to reduce risk as we negotiate daily living. By masking, distancing, washing hands, and interacting outdoors rather than indoors as much as possible, we can still avoid many preventable morbidities and deaths.