Diary: Living with a pandemic 29 (Wednesday 15 April 2020)

Handling Covid-19…

There is a lot of chatter among people and in the media about what is the best way to handle the Covid-19 pandemic. Currently the advice from health and government officials is to maintain physical distancing. And it seems to be working well.

Avoiding contact with each other gives us at least a fighting chance to control the infection rates. In most jurisdictions that instituted restrictions of this type, the case numbers and deaths have been kept relatively low.

There are a few people who advocate the only way of overcoming diseases like Covid-19 is through “herd immunity.” In other words, let everyone go about their business while the disease makes its way through the community. Over time people will develop an immunity to the virus. The inescapable facts, though, are that many will die in the process and the health system that we all depend on will collapse under the great numbers of sick people in our hospitals. Perhaps even a large percentage of health care workers will also succumb. Will any of those people who think this is the best way volunteer to go for the good of the rest of us?

Mostly herd immunity means that it will be the oldest among us that will die as they are the least able to fight off the infection, especially if they have other ailments. Already in Canada, 61% of deaths (total 167) have been people over the age of 80 years; 93% of deaths are people over 60 (total 254). Of those over the age of 60, about 15% die. Our long-term care facilities have been hardest hit.

Without even the physical distancing we are practicing and using a modest 2% of population would be infected, the percentages would mean that the deaths could total several hundred thousand people over the age of 60, given Canada’s current population distribution.

Oh well, this (my) group is mostly past its best-before date anyway! Right?

Numbers of cases don’t mean a lot when looking at pandemics. No country has tested everyone. And no country has even tested those that show any symptoms. So, the total cases are only an indication of how the virus has spread. Most testing in our region is on people showing symptoms as well as on health care workers.

Testing does give us a very good idea of where infections are breaking out and how they are being spread. For example, a large group of cases in Calgary was tracked to a prayer meeting a few weeks ago. Another group came out of a curling bonspiel in February. Over time we expect testing to increase such that we can narrow down problem areas or groups as well as put people’s minds to rest as to whether they might have inadvertently contracted the virus.

What really matters, in terms of looking at the pandemic’s effects is how many die. And that is best measured and compared in terms of deaths per million population. We are lucky to be living where we do. Our population in the province of Alberta is 4.4 million. Current deaths from Covid-19 are 46 (10.4 deaths per million population). Canada is also one of the favourable countries where the outbreak has occurred with 903 deaths in 37.6 million people (24 per million).

Compare that to Sweden where physical distancing is not as widely practiced. They have 118 deaths per million population. The worst is Spain, at 395 per million and Italy which has 387 deaths per million population. It is difficult to obtain accurate death information. For example, in the United Kingdom, deaths in nursing homes and long-term care facilities are not reported in daily tallies. Their reported death rate is 180 per million population due to Covid-19. In reality, the death rate is probably significantly higher.

Here is a small comparison of reported deaths from Covid-19 by country:

Country	Population (million)	Covid-19 Deaths	Deaths per Million
Spain	46.94	18,579	395.8
Belgium	11.46	4,440	387.4
Italy	60.36	21,067	349.0
France	66.99	15,729	234.8
Netherlands	17.28	3,134	181.4
United Kingdom	66.65	12,107	181.7
Switzerland	8.57	1,183	138.0
United States	328.2	26,061	79.4
Iran	81.80	4,777	58.4
Germany	83.02	3,495	42.1
Canada	37.59	903	24.0
South Korea	51.64	225	4.4

Hospitalizations tell us more about the spread and seriousness of Covid-19 infections in a community. Equally important is the number of people that end up in ICU. In Canada, according to the most recent Epidemiology Report, as of 14 April 2020: those over the age of 60 represent 35% of all cases; of those, 65% have required hospitalization; 63% of ICU admissions are also people over 60. Those 80 years of age and over who have contracted the virus have been hospitalized at the highest rate (51%). Those 70-79 years of age have been admitted to the ICU at the highest rate (14%). Once intubated, few elderly people survive and those that do can have serious physical and mental impairment.

Some jurisdictions have reported a high death rate of patients who have had to be admitted to ICUs – over 50%. Any who had to be intubated were obviously very advanced in respiratory distress and the death rates of those exceeded 80%.

None of this is good news. And re-emphasizes the point that older people should stay home. Others should restrict their contact with even small groups and avoid any unnecessary travel or trips across town.