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As First US Coronavirus Deaths Hit Near BC, Four New Realities

COVID-19 targets the old and the vulnerable. Are we ready?

Crawford Kilian 2 Mar 2020TheTyee.ca

Crawford Kilian is a contributing editor of The Tyee. He blogs about COVID-19 at his blog, H5N1.

What lessons to take from the first U.S. deaths from the new coronavirus, two men, one age 50 and the other 70, living in a Seattle suburb less than two hours’ drive south of the B.C. border?

The following four new realities add up to one big takeaway: It’s time for Canadians to take COVID-19 very seriously because the new coronavirus is a special threat to seniors and the immunocompromised, and they, in turn, pose something of a threat to the public health-care system.

First, the last two months from the virus’s point of view have been an overnight success.

The virus now known as SARS-CoV-2 was one of billions of viruses that had never taken notice of humans, at least until November or December of last year. It had been contentedly living in some animal reservoir (bats? pangolins?) until somehow it found itself in a human being in Wuhan, a central Chinese city of 11 million.

COVID-19 has gone from obscurity to a world tour that marches triumphantly from one country to the next. At the beginning of March, Antarctica is the only continent free of it.

If the virus had broken loose in the China of the 1950s or ‘60s, it would have been largely confined there. In those days, the only way to get out of China was to swim to Hong Kong. Now, the U.S. alone gets 3 million Chinese tourists a year, each of whom spends US$6,700 per trip. And that’s not counting the tourists who’ve visited everywhere from Thailand to the Canadian Rockies.

The loss of revenues like those helps to explain the fall of world stock markets in the last week of February, with the Dow Jones losing over 3,000 points and oil prices falling more than 10 per cent in the same period.

While these consequences have dominated the business news, medical research has acquired a hard-won understanding of this new enemy. In the blur of the first few weeks, we got a confused picture of a disease something like influenza but maybe less lethal, except that it was killing hundreds of health-care workers as well as a lot of ordinary Chinese — and spreading far beyond China.

Second, while the fatality rate of COVID-19 is just over two in 100, it is far worse for the old, the ill, and those with compromised immune systems, like cancer patients.

This weekend’s reports that the men in Kirkland, Washington had died of COVID-19 in a local health facility included the key fact that they had underlying medical conditions. Over the same weekend, a nursing home in the same community reported a staff member and a resident had both tested positive for the virus. More than 50 persons associated with the nursing home were reported ill with respiratory problems or even hospitalized with pneumonia. On March 1, the nursing home went on lockdown.

On Feb. 24, an article in the Journal of the American Medical Association provides some key context for that news. Based on a study of 72,314 cases, it showed a disease with a “spectrum” of effects. Reassuringly, 81 per cent of all cases were mild. Only two per cent of infants, children and adolescents contracted it, and only eight per cent of 20-somethings. COVID-19 seems to be a disease of the middle-aged and old.

But for those it targets, COVID-19 is a very dangerous adversary. The JAMA report found that one in five cases is “severe” or “critical,” when pneumonia is complicated by outright organ failure and sepsis. Such cases are often vulnerable owing to other medical conditions like diabetes or chronic obstructive pulmonary disease. In patients over 80, COVID-19 kills 15 per cent, and eight per cent of those in their 70s. Most alarmingly, the death rate in critical cases is 49 per cent.

These numbers may change from country to country, depending on the preparedness of health-care systems and their logistical resources. But British Columbians should expect a heavy blow.

According to the 2016 census, almost 850,000 of us were over age 65, and 109,000 were 85 and older. Our immune systems have weakened with age, and any number of infectious and chronic diseases oblige the health-care system to spend more time and money on us than on younger Canadians.

So if and when COVID-19 becomes widespread in B.C., it will hit seniors hard, especially those crowded into assisted-living centres and nursing homes and adult daycares.

Third, the heightened threat to seniors and the vulnerable creates a risk for everyone.

As COVID-19 takes hold in assisted-living centres, nursing homes and adult daycares, it will also seek out those who enjoy active social contacts in community centres and volunteer activities.

Families that bring their elders to GPs, walk-in clinics, and emergency departments will also put others at risk, from young families to health-care staff. The whole health system will focus on COVID-19, pulling resources from maternal care, hip and knee replacement and routine vaccinations.

Health-care workers and first responders will also suffer casualties: firefighters and paramedics may revive overdose cases only to bring COVID-19 home to their families, while nursing-home staff fall ill while caring for dementia patients.

Fourth, the virus thrives on secrecy and inaction.

China’s totalitarian political system helped launch this outbreak by terrifying local political bosses into suppressing news until COVID-19 was out of control. But the same system enabled Beijing to impose astounding quarantines on scores of millions of people, and, at a heavy cost, their lockdowns of megacities seem to be working: the rest of the world is now seeing more cases than is China.

Could Canada do something similar, by locking down Vancouver or Toronto to suppress the spread of COVID-19? It seems unlikely; we can’t even get a grip on fossil fuels and climate change. Imposing draconian health measures amid an economic collapse seems even less possible.

Health-care systems around the world are bungling the outbreak of COVID-19. We could well bungle it ourselves, but it would be the old and infirm who pay the price.  [Tyee]

Read more: Health, Coronavirus

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