William Stoddart of Melio Health explains the link between Covid and our health.
We’re entering a new phase of disease management where it is challenging to balance the ongoing need to have some restrictions with the impacts of drastic restrictions on public freedoms. We think people feel pulled in multiple directions, and there’s a real danger of nuanced discussion being replaced by people shouting on either side of an unnecessary argument.
In Spain, the current risk for any particular individual is very low, so there is no need to panic. However, deaths do happen. As with many illnesses, a healthy lifestyle and precautions (e.g., hygiene and managing exposure) are likely to help you reduce your individual risk. The greatest risk, by far, is societal, and basic public health measures remain the best means of limiting the impact of the illness. The reason for this is that individual risk consists of the risk of catching Covid-19 multiplied by the individual risk of death if you do get Covid-19. This means that the simplest way to reduce risk overall is to reduce the spread of the virus.
The US Centers for Disease Control and Prevention (CDC) have, like most national health bodies, been tracking Covid-19 illness for some time. Pretty early on, they analysed data on hospitalisations and deaths to understand the effect of comorbidity (i.e., other illnesses) on the risk of death. In April, they observed that approximately 1 in 5 people in intensive care with Covid-19 had no underlying health condition (based on a specified list of risk conditions). Of those who died, 6% had no underlying condition.
Healthy people can die from Covid-19. However, knowing that some healthy people could die is not the same as understanding real risk. I could be hit on the head by an asteroid, but it’s not something I worry about. I also don’t worry a lot about my personal risk of Covid-19 because I know my personal risk is low. I worry that people I care about will die, and I worry about the pandemic’s impact and the control measures on everyday life because those are real, tangible, risks, and quite big.
Telling people with serious illness to isolate themselves is challenging, particularly if they already have a limited life expectancy. While the general risk of infection is low, we all have a low risk of death. Therefore, it is in the interests of society as a whole to reduce infection risk.
I haven’t talked about the long-term health effects of illness in healthy people because we don’t know what they look like yet, and, if you protect yourself from death, you also protect yourself from long-term health impacts, which is a good thing.
Broadly speaking, if a disease is seen more frequently in more severe patients, it’s probably indicating that the disease is a risk for more severe illness. This isn’t totally reliable because illnesses tend to cluster (i.e., one person may have multiple conditions). Other hidden variables
Based on this, if you are in a position where you can improve your general health, you should. This is very different from claiming that only people with pre-existing conditions die.
According to the latest NHS Health Survey, in England, 43% of adults have at least one long-standing medical condition, and 56% were at increased risk of chronic disease because of their BMI and waist circumference. These are not people we would expect to die any time soon; they are just people. They are us. If you dismiss Covid-19 as being unimportant because it only affects ill people, you are very wrong. About half the population has a pre-existing health condition, and most of us would not expect them to die any time soon.
If you thought, ‘Wow, 6% is quite high’, please remember that your absolute risk is still very small if you are healthy. 50% to 60% of the population have no underlying condition, so you’d expect more. The fact that the percentage is down to 6% by the time we’re looking at deaths shows that good health is a potent protective factor.
If you are the perfect weight with no other health conditions, you exercise daily and eat nutritious and healthy food; you may be at a very low risk of dying from Covid-19 if you get it. At each stage of illness, the more healthy you are, the better your chances, so you should keep yourself healthy. Being seriously ill is a physical challenge. The fitter you are, the better your chance of handling that challenge. The fewer the number of cases in your area, the lower your chance of catching it in the first place, and the lower the chance of other vulnerable people catching it, so keep fit and protect your community. It’s that simple.
As we get better and handling this pandemic, we should expect to see the number of cases identified through opportunistic testing increase, hopefully with the ONS estimates from population sampling remaining steady or declining. This would indicate population identification and management improving and identifying a more significant proportion of those with illness. If we’re doing this, we should be capturing more of the infected people with relatively mild illness. This means that the death rate from illness will appear to decline. A greater proportion of the positive tests will be among the young and healthy because we are capturing minor illness better. This is a good thing because it indicates that we are getting on top of local clusters of illness. It does not necessarily mean that young people are careless.
Photo Credit: Anani Kolleshi