A co-morbid condition is any medical condition in addition to the primary one. Most older adults have more than one medical condition. Diabetes in a patient who becomes ill with Covid-19 is such a co-morbidity. Covid-19 does not cause diabetes, but diabetes can alter the course of Covid-19, making that person more likely to become seriously ill or die from the virus. Other co-morbidities include obesity, heart disease, chronic respiratory diseases, and disorders that weaken the immune system, such as cancer, autoimmune conditions, and such. A sequelae, in contrast to a co-morbidity, is a consequence which arises due to the primary condition. For example, Covid-19 does not just kill people; it doesn’t work that way. There has to be some mechanism of death. Because it is a respiratory virus, it affects our lungs. The behavior of SARS-CoV-2, the virus that causes Covid-19 in using our cells to replicate, and our body’s immune response to this virus, result in changes in the lungs that we lump under the non-specific term “pneumonia”. Pneumonia can lead to respiratory failure and acute respiratory distress syndrome. All of these are listed as contributing causes of death from Covid-19. The report does not list cytokine or bradykinin storm as a contributing cause of death. The first is a well-recognized phenomenon seen with many viruses, including seasonal flu, in which an extreme overreaction of the body’s immune system leads to failure of multiple organs and death. The second is a newly recognized phenomenon that may explain Covid-19’s sometimes more unusual presentations and complications. We really have no clue what percent of seriously ill people or deaths are due to these reactions rather than the virus itself. In the CDC statistics, respiratory related conditions contributed to death in some way in over 167,000 cases. Basically, everyone died from or with a respiratory condition. If you break down the data further, 13,780 of those deaths were in people with chronic respiratory conditions, i.e. they had lung problems before getting Covid-19. In the remainder the conditions listed could have been due to Covid-19 or preceded Covid-19. Again, no context is given.
It is critical to understanding this 6% number to know the context. The main stream media and social media posts/tweets do a grave disservice in trying to oversimplify the data. The CDC chart from which the 6% number is derived is labeled “Conditions contributing to deaths involving coronavirus disease 2019.” The title is misleading in that some of these conditions could have been the result of Covid-19, e.g. respiratory failure, and some were unrelated but contributed to death, e.g. obesity. This is the problem with reporting of Covid-19. The numbers can be used in different ways to support or refute a particular position. This capacity for misrepresentation has led to the ability to politicize or weaponize Covid-19 statistics to fit a particular narrative or serve a specific agenda, such as continued lockdown of society and businesses, social distancing, etc. or, conversely, to justify opening the economy and society back up.
The conflicting information, misinformation, and outright fabrications regarding Covid-19 have made it next to impossible to truly understand it and formulate a reasoned, effective response rather than either abject fear or outright dismissal. In the final analysis, it is just as bad to overplay the seriousness of Covid-19 as to underplay it and I feel that both are being done right now.
SARS-CoV-2 is a bad bug, but so is seasonal flu. It is not, however, some superbug and Covid-19 is not the end of civilization as we know it. We have survived pandemics in the past and we will survive this one. All of the available information, and there is a lot of it, tells us that children have nothing to fear from this virus and that healthy adults have little to fear as well. We can protect the elderly and chronically ill with more measured means. There will be those who will focus on the outliers and exceptional cases to promote fear and continued social distancing, and closure or unsustainable restrictions on the economy, and they are more the enemy than this virus.
The question remains: will our response to this virus cause more human misery and cost more lives than the virus alone would have? I think the verdict is still out on that one but I suspect the answer, once the dust settles, and we look back on this sad chapter in our nation’s history, will be, yes.
Richard T. Bosshardt, MD, FACS