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COVID Crisis Post 51: Life, Obesity, & The Pursuit of a 2nd Strain.

I had an interesting conversation with a colleague of mine today regarding the economic impact of COVID-19.

He is someone I respect a great deal, and though his political views at time challenge mine, I learn a great deal from my discussions with him because he is very open-minded and offers INTELLIGENT points and counterpoints, but values discussion and consideration of alternate viewpoints without resorting to insults like so many.

He is an anesthesiologist. In no way does he advocate death, and he realizes many would refuse to put themselves in harm's way for the sake of saving the economy. But he brought up the argument regarding the infection fatality rate (IFR) of COVID-19.

If it is low, say in the 0.2-0.5% range many cite as more realistic for the infection but NOT proven, would those number of deaths have been worth saving the economy? He said 30 million people are unemployed. His stance was during the 1918 flu pandemic, where ~0.5% of the population died, it did not impact our ability to recover or have long-lasting devastating effects... besides all of those who lost loved ones as a result. But that is a moral/ethics debate vs a discussion on economic viability as a nation.

We did not get to finish our discussion, but it got me thinking about this topic and how I wish this topic could be put to rest.

For me, I cannot put a monetary value on some peoples lives, others can. Perhaps those of us financially sound can be true to our ethics, whereas others do not have that luxury. Fair enough. But again, I am also not an opponent of the economy opening, I am only advocating it open SLOWLY.

But many people want this to be rushed because they believe COVID-19 has been overblown and as a result do not care if they, or anyone else for that matter, gets sick. Not only do these individuals want to keep all of their freedoms, but they want the additional freedom to risk my health for their convenience.

Well, fuck that.

The dumbest counter to the above is the "solution" to isolate those at highest risk and allow the rest of the workforce to go back to work. We know there are multiple risk factors associated with getting significantly ill, the biggest one being age.

But do you know what is likely the 2nd biggest risk factor? Obesity. And if you did not remember, this is a BIG problem in the US.

There is strong evidence that after age, obesity could be the 2nd biggest factor for risk of severe disease (ahead of heart disease, diabetes, smoking, etc). In China and other countries hit hard with COVID-19, the rate of obesity is lower, and in many cases MUCH lower, than the obesity rate here in the US. So when initially describing risk factors, this was not as large of a consideration for many countries when evaluating risk as it is with our population.

So while we talk a great deal about this pandemic, we never talk about how dramatically our obesity epidemic could be impacting our current situation.

So back to the "solution" at hand. There are so many issues with this. The most obvious one is it would be impossible to 100% isolate at-risk individuals, even if you only included those at risk as anyone above 65 years old. But second, I want to fully put into perspective the staggering data regarding obesity in the US.

Using percentages found in the statistics of 2018 as an estimate for obesity in our population, 42% of the entire US adult population, or about 107 million people, is considered obese (BMI 30 or above), with 9%, or 23 million, considered severely obese (BMI 40 or above).

And what we are seeing in our ICUs, and is being corroborated across the country, are younger patients being admitted to the ICU are MUCH more likely to be obese than non-obese. And many of the older patients are obese as well.

Obesity is associated with increased risk of inflammation, heart disease, immune suppression, amongst many other things. That sounds pretty high-risk to me. So should we now isolate the 107 million adults who are obese? Or the 18 million who are working age who are severely obese (with the highest rate found in people aged 40-59)? Every race besides Asians (who only have an obesity rate of 17%) have obesity rates >40%: non-Hispanic whites (42%), non-Hispanic blacks (50%), and Hispanics (45%). That is staggering.

And this further underscores why using the possible IFR as an argument against COVID-19 and as a reason to reopen the economy is so flawed.

We are NOT a homogenous population.

Remember: when looking at IFR, this is the percentage of the ENTIRE population who dies from infection ASSUMING HOMOGENEITY.

The IFR for COVID-19 differs GREATLY between groups, and this is true of many diseases. For example, the IFR is essentially 0% for the 74 MILLION children in the US (anyone less than 18 years old) - but this is still going to figure into the overall IFR. And our kids are not contributing to the workforce.

If you then recalculate the IFR for those >18, the IFR will be higher, which is the population that is truly at risk. And when you start separating it into age groups, the IFR will vary. When you start separating IFR due to disease, the IFR will also vary. Same with BMI.

We know certain groups are at higher risk. But do you know how high YOUR risk could be? Because I sure do not know mine.

If you do not fall into any of the high-risk categories, it is easy to support reopening the economy because your IFR may also be tiny. But a HUGE percentage of our population is NOT healthy, and many people seem to gloss over that fact. And many of the protesters who think this pandemic is a hoax fall into these high-risk categories, whether they want to acknowledge it or not.

If you could know the IFR for your risk group, what IFR would be acceptable for yourself? For your family? If a loved one's IFR was much higher than yours, would that then give you pause?

And something else no one seems to be talking about: getting sick is not benign for the economy either.

If a significant number of workers get sick, and some for weeks, this is not going to help businesses; businesses lose staggering amounts of money due to loss of productivity every year due to illness. Even if the number of deaths were overblown (spoiler: they are not), it still does not mean the number of those ill would not be significant.

So we cannot rush to reopen. And the shutdown WAS necessary. Precautions must be taken and reopening slowly is a must to ensure the risk of getting sick is mitigated as much as possible.

One last quick note: reports have come out regarding a possible second strain of SARS-CoV-2 that is more contagious than the original strain. This is a surprise to many, but not to those in the scientific community.

Mutations are inevitable because viruses, especially RNA viruses like SARS-CoV-2, are ALWAYS mutating. Every replication of the virus, even within the body, has the possibility to cause mutations, which could be good, bad, or no big deal. Many times it is the latter. But the good thing is SARS-CoV-2 is mutating at the rate expected by scientists, and relatively speaking, it is mutating slowly.

Plus, the differences between these two strains seem to be minimal in regards to virulence, meaning the symptoms and severity of disease do not seem to differ between the two. The original strain was likely the initial virus which jumped from bat to human, and the newer strain one that mutated when spreading from human to human.

A recent study, NOT peer-reviewed, did demonstrate changes in the spike protein, and this immediately caused consternation amongst many in regards to vaccine development. But since the second strain is now the predominant strain affecting the world, vaccines are being developed primarily against this strain so this should not affect vaccination trials currently going on.

So again, relax. It is going to be okay. Do your part. And a BIG part of that is your health. And your loved ones health.

This is MUCH more complex a problem than people give it credit for. But thankfully, most of you realize that. And I thank you so much for caring about my health.

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