A demographic portrait of the pandemic

The chart above is an analysis of the mortality rates of COVID19 in Spain, demonstrating that mortality rates among those over 65 are much higher than for younger populations. These trends could be applied to any other country with the caveat that Spain has a high elderly population when compared to other countries (ranking third in Europe with regards to its elderly population, it is slightly below Italy and Greece) which is coupled with extensive intergeneration social contact. COVID19 fatalities are directly linked to the patient’s age and looking in detail at which age groups are most affected by the pandemic is imperative. 

The total deaths in Spain from COVID19 are 27K and can be found in the first row. Government figures quote around 21K deaths, yet I have also added excess mortalities, which account for about 6K more deaths (for excess mortalities see Informe Momo). The official death counts and the total number of deaths are probably the result of limited testing for the virus rather than intentional undercounting (see Imperial College’s report on the number of infections). My estimate is that between now and until the end of the year, the number of total fatalities will double, with a total of 54K. These projected figures are obviously questionable, yet I find value in including not only real figures, but also a projection of how the pandemic could evolve.

In the second row are the statistics regarding people under 65 with 5.4K deaths and a total of projected deaths of about 11K. This translates to 1 in 690 people who have died already from the virus or 1 in 3.4K by the end of the year. The total population for this age group is 37.64 million yet this age group represents only 8% of the total COVID19 deaths. 

In stark contrast, people over 65 years of age, make up 92% of the fatalities due to COVID19 and amount to a total of 9.4 million in Spain. This age group has disheartening rates: 1 in 435 have died by now and possibly 1 in 215 will die by the end of the year.  When you narrow it down to people over 80, it is possible to see how incredibly lethal this virus is: those over 80 represent 60.4% of the deaths. However, there are only 4.7 million people in this age category in Spain, meaning that already 1 in 271 have died from coronavirus and around 1 in 135 will probably die by the end of the year, unless of course a vaccine is developed or a treatment is found, thus herd immunity would not have to be reached.

In terms of the impact of COVID on those under 50, it is an almost non-lethal virus and the fatalities in this age group represent only 1.7% of the total deaths. To better assess this percentage and get a better idea of what this means we must take into consideration that a person who is 35 years old has a chance of dying of 1 in 500  due to any cause between the ages of 35 and 36. The likelihood of dying from coronavirus for this age group is 1 in 61K which is statistically insignificant. By the end of the year, those under 50 will have a chance of dying from coronavirus of 1 in 30.5K. Essentially, the pandemic is a non-factor for people under 50 who amount to 28 million in Spain.  

The age group comprised between the ages of 50 to 60 represent only 3.1% of the total COVID19 deaths, while for the age group between the ages of 60 to 70 the percentage of total deaths is 8.9%. The chances of dying from COVID19 for these age groups are insignificant when compared to the chances of dying from anything else. 

Assessing the likelihood of dying from coronavirus and highlighting the high lethality of COVID-19 for older people is essential in order to decide the future steps to follow with regards to the pandemic. 

Lessons from Covid in Europe for my friends in the USA

Policy recommendation:

Lockdown only for those over age 45, then slowly lift the lockdown for those aged 45 to 65. Keep those over 65 in lockdown until treatment or vaccine is developed or most of the population is immunised.

The reasoning:

The first and most relevant data on Covid that my friends in the USA seem to be unaware of is the age group with the highest death rate:  91% of those who died in Europe from Coronavirus were over the age of 65 and 87% were over 70. People under 40, on the other hand, have a mortality rate of less than 1% and are therefore much less likely to die from Coronavirus. In fact, people under 40 have the same chance of dying from Covid than they do of dying from the regular flu.

Secondly, Covid is extremely contagious and one would need to live a life of tremendous isolation in order not to get Covid. The official European data on how many people have been diagnosed with Covid are not accurate and the reality is probably 50 times greater. This would mean that Italy and Spain do not have a combined amount of 250k people who have been been infected with the virus, they actually have millions each. Imperial College estimates that in Spain, a country with as many people as California, 7 million people are infected.

Thirdly, Covid is nowhere near as lethal as people think. When people read published figures, namely that Spain has 125K infected and 12K dead, they conclude that around 10% of those infected die and thus panic over this high mortality rate. However, if the real numbers follow Imperial College predictions, then Covid actually kills 17 people in one thousand or as many people as a bad flu would. The difference being that bad flus kill children too, whereas Covid in Spain has killed just 2 people under the age of 20 and 10 under the age of 30.

So what should the USA do to fight Covid? It should gradually lift the lockdown according to age groups. First, lift the lockdown for those under 45 years of age (without any pre-existing medical conditions). Though those under 45 do get infected, it is extremely rare that someone without pre-existing conditions die from Covid. Especially with the caveat that the very few under 45 who might develop severe cases of Covid would have access to medical care. In order for the health system to be able to provide medical care to this age group not in lockdown, a complete lockdown with food and medical deliveries to all other age groups over 45 (who represent 99% of the fatalities) must be ensured. Younger people who live with people over 45 will have to be homeschooled for another month until the lockdown for those aged 45 to 65 is lifted.

Achieving herd immunity for those under 45 makes sense because of the incredibly low death rates in that group. Next, the question would be, what to do with those aged 45 to 65? These individuals are a key engine to the economy and an age group that does die more frequently from Covid than from the regular flu. In my view, they would have to wait for those younger than them to obtain herd immunity. This 45 to 65 age group would continue lockdown for another month after those under 45 have become immunised. Once this group’s lockdown is lifted, they will find themselves among two groups of people: older ones, who are still in total lockdown, and unable to infect others, and young ones who have become immunised. This 45 to 65 age group will also find an unburdened health care system as those over 65 have not required it for Covid and those under 45 have already been through the worst.

And what should be done with people over 65? This is an unresolved issue. In Spain, the average age of mortal victims is 80. Therefore, a month after those under 65 have been exposed to coronavirus, the lockdown of those between 65 and 75 should also be lifted. Having said this, I don’t see a way for those over 65 to safely leave lockdown until we have a vaccine or effective treatment. In Europe, it is very rare for Covid to kill a healthy, young person. Even though it has happened, it is extremely rare. We don’t know why this occurs: some speculate it is because of certain genetic predispositions, or because of viral load. What we do know is that once infected with Covid, the chance of dying for this age group is the same as your chance of dying in the next 2 years. So for example, if you are 30, the chances of dying from Covid are the same in the weeks after the exposure as the probability of dying between the ages of 30 and 32 for any medical reasons. And that probability is very low. However, if you are 80, the chances of you dying between the ages of 80 and 82 are quite high, and are similar to the ones that Covid patients of that age have. Therefore, there is no safe way to recommend that a 75 year old come into contact with the rest of society openly. Though this same 75 year old could lead a life where an App based system puts her in contact with those who are already immunised. If my recommendation is followed, there will be plenty of immunised people by the time 75 year olds leave lockdown.

Given the lethality of Covid, if our objective is to save the most lives, why not just keep everyone on lockdown indefinitely? Because the economic devastation of staying indefinitely in lockdown will kill many more people than Covid. Health does not only mean not getting Covid, it is also means not dying from everything else that could occur during lockdown: cancer, heart disease, suicides, murders. The only reason to keep everyone in lockdown would be if we believe that a vaccine is around the corner. But that is not the case. We don’t have a vaccine nor do we have an effective treatment for Covid.

I would like to end with some data on the Covid mortality rate, mixing Imperial College estimates of those infected of Covid with data obtained from the Spanish national Health system, Sanidad, regarding Covid deaths by age group. Imperial College estimates that in a country like Spain for every diagnosed case, there are 50 undiagnosed cases of people who have are asymptomatic or whose symptoms were not severe  enough to get tested. This is reasonable because in Spain or Italy your symptom have to be very severe to be tested. In Germany testing is more common and that is why the mortality rate is much lower. Around 10 times more people are diagnosed in Germany than in Italy and Spain, hence the mortality rate of these Southern neighbours is 10%  that of Germany. We can therefore estimate that the mortality of Covid in Spain is insignificant for people under 45 (with a total of 47 dead of that age group which is much less mortality rate than a regular flu). It is also very low for those under 65 (a total of 800 deaths for 7 million infected). And it is quite lethal for those 65 or over (a total of 11,200 deaths out of 7 million).

I imagine that when you read that the USA should now consider a lockdown only of those over 45 and the rest should lead mostly normal lives treating Covid as a normal flu (staying home if they are sick, going to the hospital if needed but otherwise taking their children to schools and going to work) you will think that I am exposing that younger population subgroup to tremendous danger. I do hope that after you read this data, you will agree with me.…/do…/Actualizacion_65_COVID-19.pdf
Martin Varsavsky

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