There has been a lot of talk about COVID 19. A lot. And while the POV is primarily a sports blog, when a pandemic or world events threatens sports, there is a lot of overlap, and that is why I am writing this article.
I have, for some time, been trying to figure out for myself if the hype around COVID-19 is real. The TV & Print media climate (on both sides I’ll point out) in the United States is not helping. Neither does social media. Certainly there are some basic facts that are real – 130,000+ deaths in the US vs ~35,000 for a standard flu season. But there is also a segment of the population (including some close personal friends of mine outside of this blog) that continue to drive the narrative that COVID 19 is not as bad as some folks would have us believe.
And so I decided to take the politics and media out of it and do my own research, which I am about about to share with you. Keep in mind, it is EXTREMELY important to take the politics out of this. In some cases I’ve forced myself to absorb a viewpoint from a media outlet that leans opposite of my own personal political leanings. This has been difficult, and yet educational. At the end of the day though, I have avoided quoting or using data from media outlets in, as so to not politicize my findings. I would ask that you do the same if you are posting and sharing links.
If someone chooses to post a link from a particular outlet, I need two rules to be followed: 1. The link needs to be fact based. And any “facts” quoted are fair game to be (civilly) debunked. And if they are debunked – with facts cited from a credible source – well then you get to suffer the ignominy of that in the eyes of your peers, and I may also choose to delete your comment. 2. You as a reader need to approach any link posted with an open mind, and comment on the content – and not the politics of the media outlet. I will be ruthless in striking down comments that stray from these guidelines, and I reserve the right to be the sole arbiter here. I don’t need to keep writing this blog, after all.
With that being said, lets get onto the original premise of the article. Just how bad is COVID? And should “they” really be considering cancelling the college football season because of it?
The first thing I wanted to do was understand how COVID fits into the global context of pandemics throughout history. If you take the news reports out of it, what is the actual scale of the so-called “pandemic” we are facing today?
If you are following along at home, you’ll see that COVID-19 has currently accounted for 570,000 deaths so far. And yes this is a college football blog so yea, the infographic above is a kind of very morbid top 20. COVID at 570k deaths is just cracking the top 15. If you throw out the HIV/AIDS “pandemic” (because it’s been spread over forty years which kind of puts it a different context) COVID’s current death toll checks in at #14 overall. This is not insignificant but there are also orders of magnitude that go up pretty fast once you get into the top 10, and COVID isn’t even close to say, the Spanish Flu or the Black Plague.
I want to stop here for a second to clarify something. I am by no means attempting to trivialize the Death Toll around COVID 19 by comparing it to a college football top 25 list. Some of you may have lost a loved one to COVID. Heck, one of our own readers and commentors is in the ICU as we speak. Were he to (God forbid) succumb to this disease, that would be terrible. Any death is terrible and my sincere condolences go out to anyone who has lost a friend or loved one to Coronavirus. That, however, should not prevent us from discussing the facts. Because if we know the facts you can make informed decisions, and informed decisions can help save future lives (in many different ways).
The fact is that on the surface, COVID is the 14th deadliest pandemic of all time. But of course, there is more to the story. For example, the numbers above do not adjust for world population. And when you do that, you start to get a sense for just how deadly some of the ancient pandemics were (I removed smallpox because it was spread over many years, and I also removed HIV/AIDS as noted earlier.)
In the table below, I’ve calculated the “death rate” based on estimated world population at the time of a given pandemic. It is simply the total number of deaths / world population. Interestingly enough, COVID still checks in at #14. (Population figures are from this website)
You’ll also see that in order to get a sense of scale, I’ve taken the death rate and applied it to the current 2020 world population. See the “How Many Would it have Killed in 2020” column. So for example if the Bubonic plague (Black Death) were to happen today in the same way it happened in the 1300’s, it would kill 4.5 BILLION people, and well that would be pretty bad. I think you can probably say the same about any of the top seven. If the 1918 Spanish Flu (#4 all time) showed up today and killed the same percentage of the world population that it did 100 years ago we’d be talking about close to 200 million dead. That is roughly equal 2/3 the population of the United States, and is about 3x more people than died in all of World War II. If the “Italian Plague” of 1629 – 1621 (#7 all time) showed up and did the same damage per capita that it did back in the 17th century, that would equate to nearly 15 million people in 2020. That is a lot. And it’s a lot more than the 570,000 COVID deaths that are grabbing headlines today.
Well shoot, then, lets turn off the TV, shut down the Twitter and open everything up right?
Ummm….not so fast my friend. I think we need to take a look at some other things first.
I’d like to start with Sweden.
In case you’ve been living under a rock these last four months, Sweden famously refused to lock down and instead kept businesses and elementary schools open, closed high-schools and colleges and told at-risk people to self isolate.
Predictably they had a lot more deaths then their neighboring Nordic countries (Denmark, Norway, Finland). A lot more.
Here are the Nordic country death rates per 100,000 population:
As you can see, Sweden’s death rate is 5x to 10x worse than its neighbors.
So how do we use this data? We extrapolate it into a world scenario.
IE, If the entire world did what Sweden did, used the same guidelines, and enacted it the same way (unlikely and we’ll get into that later), you can make an assumption that the global death rate per 100,000 people would be right around 54, just like Sweden. If that’s the case, then the total COVID death toll moves up to roughly 4.2 million people. 4.2 million deaths puts COVID into the top ten as far as worst pandemics of all time, actually moving it to the #6 spot as far as total deaths, and the #9 spot if you adjust for world population at the time of the pandemic.
I would like to think that is what has epidemiologists so concerned.
I think it’s also reasonable to assume that the overall death rate could be higher than 54 per 100,000 because much of the world probably doesn’t have a health system as advanced as Sweden’s. Also, there is also evidence that the Swedes made a conscious decision to turn certain patients (i.e. older patients) away from their ICU’s in favor of patients that had a higher chance of survival. While I do not care to speculate on the ethics of turning patients away from ICU’s, I have to ask myself if America would or could do something like this? What about the rest of the world?
Here is the quote about Sweeden’s ICU’s, which I’ve taken from this excellent and non-biased article:
“Analyzed by categorical age group, older Swedish patients with confirmed COVID-19 were more likely to die than to be admitted to the ICU, suggesting that predicted prognosis may have been a factor in ICU admission. This likely reduced ICU load at the cost of more high-risk patients dying outside the ICU,” the researchers observed.
Heavy stuff, but informative.
So…back to the original qeustion, “how bad is it?” My personal conclusion is this: Right now it’s somewhat bad, but left unchecked, it’s top 10 bad, and while we aren’t talking about 40 or 50 million deaths like 1918, or even 15 million deaths like a modern-day “Italian Plague” scenario, we could potentially be talking about four to six million deaths globally, and that I think is pretty serious and relevant.
But there is more here, especially in the context of a college football season and COVID education in general. And I think its important to dive deeper into the Sweden numbers to illustrate just how much risk there is to certain age groups, and how little there is to others.
I analyzed Sweden’s death rate by age group, and here is what I found:
Yes, you are reading this correctly. Out of a population of 10 million people, with zero lockdown, eight people below the age of 29 died from Coronavirus.
If you were to extrapolate that to the US population, it would look like this:
While this is just a simple calculation, you could estimate that there would be 262 deaths under 29 if the US were to switch to the Swedish Herd Model (keep in mind this includes turning those over 70+ away from the ICU)
Now this is where the slope gets slippery. I am not a doctor. I am not an epidemiologist. I am not advocating going to the Swedish model, and I am not writing this in an effort to convince anyone to go the Swedish model. I am merely presenting the facts.
The fact is that the Swedish model shows a very low death rate at younger ages. Still, it is likely that there will be more deaths at every age group under the Swedish model vs the German or Japanese or Korean models which included lockdowns (and a highly compliant and rule-following population, which the US seems to lack). So that is a decision I would leave to the people in charge, and that is the burden of leadership, hard as though it may be.
Sidebar: Here is a great article on the Japanese model Note how culture also plays into virus containment.
I’ve also got the US data, by the way. Note that the data isn’t fully up to date as we are now north of 130,000 deaths, but I think the percentages are pretty consistent:
In the context of college football, you should note there have been 14 total deaths between ages 15-24. It is likely that most if not all of them had underlying conditions. Still, one preventable death is probably too many in the eyes of universities and collegiate sanctioning bodies (and they’d be right, especially as it relates to the student-athlete’s parents and family) but these numbers have to make you ask yourself, where does society in general need to draw the line around risk? I’m not sure I can answer that question.
Here is some food for thought from the opposite perspective and also some context on underlying conditions and non-fatal COVID side effects. It’s an older article (i.e from May) but still relevant.
Separately, a new study of children with Covid-19 admitted to pediatric intensive care units in the United States and Canada concludes that while the overall severity of symptoms in the children was “far less than that documented in adults… Covid-19 can result in a significant disease burden in children.” According to the research, published in JAMA Pediatrics, 40 of the 48 children, ranging in age from four to 16, had underlying medical conditions. Two of them died, and three remain on ventilators.
About younger adults (though I’ll admit that lumping ages 20-44 is a pretty bad look):
Meanwhile, more data is revealing how other age groups are affected. People ages 20 to 44 account for 20% of Covid-19 hospitalizations and 12% of ICU admissions, according to Paul G. Auwaerter, MD, at Johns Hopkins Medicine.
About risk factors that don’t necessarily include death:
But lately he’s seeing more people under age 40 developing severe breathing problems and blood clots related to Covid-19.
“We are really shocked to see younger age groups have similar complications” as older people, Salata tells me, adding, “We’ve seen it in some younger people who had no risk factors.”
One does not have to die from Covid-19 to be severely affected. In Italy, where the outbreak hit hard before it did in the United States, some people who recovered from Covid-19 have been “unable to shake sickness and fatigue” weeks later. It’s too soon to know whether the disease might leave some people with enduring debilitations.
U.S. Centers for Disease Control and Prevention found that 71% Covid-19 patients requiring hospitalization had at least one underlying health condition or risk factor, as did 78% of those requiring intensive care. If those figures hold up on further analysis, however, that means 29% of Covid-19 hospitalizations involve otherwise relatively healthy individuals.
About the US being a generally unhealthy society:
“We estimated that 45.4% of U.S. adults are at increased risk for complications from coronavirus disease because of cardiovascular disease, diabetes, respiratory disease, hypertension, or cancer,” according to a new analysis from the CDC. Those at elevated risk include 19.8% of people age 18 to 29 and 80.7% for people over age 80.
So again, these stats in a vacuum are concerning. But if you take a step back and look at the big picture…(per the CDC):
Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative COVID-19 hospitalization rate is 107.2 per 100,000, with the highest rates in people aged 65 years and older (316.9 per 100,000) and 50-64 years (161.7 per 100,000).
Overall you’ve got a 0.11% change of being hospitalized for COVID today. That’s roughly one out of every 1000 people. If we all continue wearing masks and distancing that probably drops. If we don’t it probably goes up to two out of every thousand, maybe three. Still not a lot in the grand scheme of things right? Oh but if you are one of those two or three…
Lets extrapolate the numbers to college football: Assuming there are 125 scholarship + walk on players and student managers and support staff per team x 130 teams, you get a total population of 16,125. If they all get infected (not likely), 16 of them would need to be hospitalized. Of the 16 that get hospitalized…well.
But that’s if they all get infected. Early data shows top end infection rates (Clemson and UNC) at about 35%. That reduces your COVID infections to about 5700 and puts only six people in the hospital. Do they all make it? One would hope (but can’t guarantee)
Taking it one step further, if you screen for at-risk student athletes you could conceivably reduce the risk to close to zero. In theory…
At that point you start getting into the world of informed consent (i.e. student athletes signing waivers). In my mind that would have to be a decision made by both the parent and the student, and of course the facts have to be presented in a non-biased manner. Would there need to be indemnity insurance to go along with all this? How much does THAT cost?
An additional consideration: The numbers above do not include coaching staffs. And that’s a wildcard. Randy Bates just beat cancer, which means he has a comprised immune system. Are you as a Pitt fan ready to deal with the fact that Randy Bates could die from COVID? I’m not sure I am. On same side of the coin, how many coaches have heart conditions? Urban Meyer is one. (Hold the jokes please, we are talking about a man’s life here.) What does Nick Saban’s health look like? Ed Oregon’s? Which coaches are diabetic? Which have lung conditions? They probably ALL have hypertension.
Again, based on the numbers, you probably see low double digit hospitalization among football coaches, and maybe 1-2 deaths. And believe me, I’m not trying to trivialize this. That feels like a high human cost to pay for entertainment – although the financial side of CFB maybe forces coaching into a more “high risk” job category now that COVID is around. (And the truth is that it’s got to be tough for colleges to ignore the financials)
And that’s kind of the wrap up. Unless (or until) we get a vaccine – COVID is here to stay. It’s increased the risk in the world by a degree. People at all levels will have to get their heads around that and learn to manage or accept the risk. Which sucks, but it’s reality. We are in the foundling stages of learning about both the risk management and acceptance as a society. It’s a personal choice on so many levels, and it’s probably both fair and rational to say that it’s going to take more time to figure it all out. Colleges pushing seasons out or cancelling is an offshoot of that.
Here’s to hoping it all gets figured out, with a minimum of loss of life and in the shortest amount of time possible.
Hail to Pitt