Apr 12, 2020
 in 
Global Health

A Covid-19 Easter Message of Hope From a Rising Attending Physician

I have resisted the urge to post about the covid-19 pandemic but I have fielded questions privately from many about my thoughts so I will share my perspective here just this once. I do not mean to disparage or belittle any other dissenting views and all are welcome. These views below are solely mine. I have adopted some ideas from one of my senior medical colleagues and mentor Dr. John Powell.

Today at my hospital in Bowling Green KY, there are about 19 documented cases and the number seems to be going up given that we are just now beginning to test for the disease. I have also mentioned to friends that COVID-19 mortality rates were likely overstated by the CDC and WHO because the majority of tests are performed on the most ill and those requiring hospitalization, and there was very little testing of those with limited or no symptoms. From the little I learned about epidemiology in medical school, I believe we do not know the actual prevalence of the disease in the general population and there is a clear selection and reporting bias in the testing process. There are likely other biases we are yet to note. This problem has been present from the onset and still remains. We have all been looking forward to antibody testing as a better measure of immunity in the community. These tests are now being rolled out but not as fast as we all had hoped.

So where are we now in regards to known COVID-19 statistics as of 4/11/2020. Here I have chosen some places that are of interest to me below.

Globally: 1,760,978 confirmed positives and 107,775 deaths
US: 519,453 confirmed positive and 20,071 deaths
Warren County, KY: 24 confirmed cases and 0 deaths
Bradley County, TN: 31 confirmed cases and 0 deaths
Douglas County, OR: 12 confirmed cases and 0 deaths
International (Nigeria):305 confirmed cases and 7 deaths

There is no need to attach the mortality rate as I have seen many do. Why? Because it is not a difficult calculation. The number of deaths is divided by the number who had the disease. Again the problem, like we all know by now, is that we do not know how many people really have or have had the disease. We only know how many people tested positive, so the mortality rate if calculated with these above numbers will not be accurate in my view. Just for illustration, the mortality rate is 6.1% globally and 3.9% for the US. Again I believe the actual percentage is much much lower for the aforementioned reasons. But I have found the South Korean data the most helpful since they tested people early and often. You can review the data here yourself https://www.cdc.go.kr/boa…/board.esmid=a30402000000&bid=0030

You will notice that as of today, South Korea has now tested 410,479 people. Let's analyze the mortality there by stratifying by age group. For age 30- 39, mortality rate is 0.09%, for age 40-49, that number is 0.2%, for age over 60, that number is 2.1%. Unfortunately for age over 70, mortality rate is 9.08% and for those over 80, it is 21.2%. Now these later numbers are tragic but not particularly shocking. Community-acquired pneumonia (CAP) is one of the main causes of morbidity and mortality worldwide. Globally, pneumonia, together with other lower respiratory tract infections are the leading cause of death from infectious disease causing 3 million deaths worldwide and being the fourth cause of death from all causes in 2016. Basically, in high income countries, it’s a higher cause of death than colon cancer, breast cancer and diabetes. In the US for example, mortality rate for those over age 65 was 15.2% and for those over 75, that number is over 25%. Unfortunately for those over 85, the mortality from CAP was over 30%. For patients with pneumococcal pneumonia and bacteremia (bacteria in the blood), the mortality rate has been measured to be around 35-40% in a 20-year study published in 2019. Now keep in mind that the average life expectancy of a U.S citizen is 78.6 years. You can view these sources yourself here:
https://www.who.int/…/fac…/detail/the-top-10-causes-of-death
https://www.ncbi.nlm.nih.gov/pubmed/20935033

The Italian and Spanish situation is unfortunate. In the EU, pneumonia remains the most frequent cause of death from infection and was responsible for nearly 140,000 deaths in 2015, accounting for over 30% of all respiratory disease mortality. In Europe, 25% of the population is already aged 60 years or over and that proportion is projected to reach 35% in 2050 and 36% in 2100. This scenario implies that CAP related outcomes may continue to have a high clinical and economic impact by an expected increase of hospital admissions, costs and potentially deaths. Again when you consider this, you can understand why these countries got hit hard.

The New York situation is also very unfortunate. According to an article in the Wall Street Journal published on March 25, it was noted that over twenty hospitals have closed in New York City alone over the last two decades, most of them located in low income communities. Over 20 hospitals? Yes, that is remarkable. It isn’t really surprising then that they were having significant capacity issues and severe medical equipment shortages. I am optimistic they will meet the challenge and that we can all learn from this.

Nigeria, the most populous nation in Africa, with over 300million citizens is also in a precarious place. With the average person living on $2/day, it has been quite a disaster instituting a lockdown. We recently lost a Child Scholar family member last week. We suspect she suffered starvation and could not reach the hospital in time due to the lockdown. So, I have doubled my efforts to support our kids and staff with meals and other resources during this time. It has been effective but I worry it’s still not enough. Unfortunately the government is unable to provide as robust a stimulus package to benefit the masses. I am hopeful.

Even as we celebrate Easter which has always been my favorite time of the year, let's keep things in perspective. I want to restore some hope. Let’s continue to use reasonable precautions as recommended by the experts. It is especially relevant if you are older or have significant chronic medical issues such as diabetes, asthma, COPD, or other immunosuppressed conditions. I am a bit stressed, even as a health care worker, so I can imagine the stress in my neighbors and friends and in the general community. It’s very likely that our routines will change both in the medium and long term, but let’s not allow the statistical distortions, propaganda, sensationalism, and alarm bells, to wear us down. We can take some time to connect with family and reach out to friends and neighbors who may be having a more difficult time.

I am particularly so thankful for the generosity and kindness of our communities. And even as I reflect on my medical training so far, I cannot help but admit that I have benefited from many people who have sacrificed so much for me. My family will be moving near Eugene Oregon this summer after I finish residency as a fully licensed physician (my full medical license got approved), and I am ever thankful for everyone who has helped me reach this point and achieve my dreams.

Stay well everyone.

Sincerely,
E

About the Author:

Dr Emmanuel Okenye is an Internal Medicine physician who practices near Eugene Oregon. He has completed externships at Harvard Medical School and is a recipient of several awards. He is the President and Founder of Child Scholars, a non profit that helps make education accessible to at-risk children in Nigeria and Kenya. He can be reached on www.childscholars.org