"We are on the verge of ringing a giant bell that we don’t know how to un-ring." This was the sober warning delivered by Dr. Michael Osterholm regarding lockdowns in March. Dr. Osterholm spoke eloquently and at length in the article cited above about the economic costs of lockdowns. He does not mention much about health consequences. I am certain he was aware of what they might be. Despite this awareness, it seems unlikely that he--or anyone else--expected the results of these disastrous public "health" policies to arrive so swiftly, and with such lethal force. But arrive they have.
In the U.S. alone, the death toll from ringing this ominous bell is crushing--more than 100,000 additional people have died from non-COVID causes, compared to 240,000 who have died from COVID. The average age of these non-COVID deaths is fully 14 years younger than COVID deaths, 64 vs. 78. What this means, is that the actual loss in life years is at least 30% greater from non-COVID deaths, as COVID deaths--2.2 million life-years lost, vs. 1.7 million from COVID. The average age of death in the U.S. is 78, equal to the average age of death from COVID. However, the average 78-year-old has an an anticipated life expectancy of 88--10 more years. This is, however, heavily health-dependent. People dying with COVID have on average 2.6 serious co-morbidities, cutting their life expectancy to 1-2 years. Using a more conservative estimate of 5 years life expectancy yields 1.7 million life-years lost due to COVID fatalities.
The most staggering number though, is the 20% increase in deaths in people under 45. Of that increase, only a quarter are due to COVID. The other 20,000 deaths are due to causes other than COVID. Some will be tempted to say that of these 101,000 non-COVID deaths, many are actually COVID deaths that were missed. There are many reasons why this is almost certainly not the case. The under-45 non-COVID deaths provide the starkest proof of this. While COVID kills quickly, it is not a sudden death, particularly not in young patients. This means that we have the ability to test people before they die. There may be some elderly people who die, untested, at home from COVID. There are almost certainly no such fatalities in those under 45. Even if such a person were to somehow quickly die without going to a hospital and being tested, CDC guidelines allow any death that is suspected of being COVID to be classified as a COVID death--even if COVID is only a secondary cause. An additional provision allows someone who tested positive up to 60-days earlier, but who dies at a later date from suspected complications of COVID, to be counted as a COVID death. These, and many other policies in place make it almost certain that at least in the under-45 group, we can be confident that deaths associated with COVID are not being missed. Which means that these 20,000 deaths are due to some other cause than COVID.
It will take time before we have the data on the causes of these deaths. In the absence of that data, it is hard not to credit these deaths to the loneliness, anxiety and fear occasioned by our leaders' decision to ring the death knell ushering in an era of lockdowns.
The most galling aspect of these deaths is that had we followed the following science laid out by Dr. Osterholm in his March op-ed, not only would excess deaths in the under-45 population have been lower, the immunological shield that these younger, healthier people provided would have helped to protect the vulnerable from a disease which for them, is truly a killer. Quoting Dr. Osterholm:
"But the best alternative will probably entail letting those at low risk for serious disease continue to work, keep business and manufacturing operating, and “run” society, while at the same time advising higher-risk individuals to protect themselves through physical distancing and ramping up our health-care capacity as aggressively as possible. With this battle plan, we could gradually build up immunity without destroying the financial structure on which our lives are based."
The statement above will now read as apostasy to many. This statement, however, is reflective of decades of public health policy. It was also based on very good data--data which has now been proven out over and over again during the course of past nine months. To wit, the risk of death from COVID for those under-45 is lower than their risk of flu. In the case of children, fully ten times lower (Table 2 below). These estimates include the people in these age groups with co-morbidities. For those without serious co-morbidities, the risk drops by a factor of 10. These estimates are not heterodox, arcane, or controversial.
Nor are they new. We have known these risks roughly since March. Since that time, one study after another has borne them out, or lowered them.
In March, the Imperial College put out its now-notorious modeling which included age-stratified infection fatality estimates. This study was used to justify lockdowns, assuming uniform infection across ages (a ridiculous assumption). Given the highly stratified nature of the risk across age groups (4000:1), and the large portion of the population under 45, this study could just as easily have been used to advocate for adhering to past policy, with a shot of focused protection supported by the 50,000+ doctors and scientists who have now signed the Great Barrington Declaration.
Table 1: Age-Stratified Infection Fatality Rate for COVID-19, Imperial College, March 2020
Source: Imperial College NPI Modeling
If we compare these early estimates to the CDC's current estimates of age-based infection we see how accurate the Imperial College estimates proved to be -- particularly for younger cohorts. The risk to those between 30 and 50 was over by a factor of 10. The risk to the elderly, while still great, has turned out to be 2-3 times lower than anticipated--and to be heavily stratified within that group according to the amount and severity of co-morbid conditions.
Table 2: COVID-19 and Flu Estimated Infection Fatality & Hospitalization Rates for Symptomatic Illness
What this means is that 210 million people--fully 65% of our population are at higher risk of dying from the flu, than from dying from COVID. We have known since March that at least those under 30, 36% of our population, were at lower risk of death from COVID than flu.
More terrible yet, is that if literally every single one of these people under 50 had contracted COVID-19--65% of the population, and more than enough to provide the immunological shield to protect the vulnerable--fewer of these under 50's would have died than have died from our COVID-response alone. Based on these age-stratified fatality rates, if 100% of people under 45 (190 million) were to be infected, 20,620 people would have died from COVID, and 58% of the population would have the immunity that would protect the other 42%.
Instead, by trying to stop the virus, there have been 7,238 more deaths in the under-45 group than there would have been had the entire cohort gotten COVID. Because 3/4 of these deaths had nothing to do with COVID, these deaths provide no protection to the vulnerable--they are simply deaths.
The table below models expected fatalities in the under-45 cohort, should every U.S. person under 45 have a symptomatic infection.
Table 3: Estimated U.S. COVID-19 Fatalities based on 100% infection under 45, and Estimated Total Infections, based on age-based IFRs
There are several things to point out in Table 3. First, it has been repeatedly demonstrated that a significant portion of the population, as much as 50%, has a kind of immune cell called a T-Cells that neutralize SARS-CoV-2, even without having been exposed to the disease. This so-called "cross reactivity" comes from exposure to prior coronaviruses, those that we are exposed to from the common cold. The level of cross-reactivity appears to be greater, the younger a person is. Thus, the expected number of infections in children, and even the 25-44 group would likely be far less than 100% in order to have a fully immune population.
Second, by allowing the young and healthy to create an immunological shield protecting the elderly, we also would have been able to reduce our total excess deaths from COVID and non-COVID causes significantly. Theoretically by up to 321,000--down from the 340,000 that we have suffered. Of course it is not possible to hermetically seal off portions of the population to that degree. The vulnerable are forced to rely more heavily on others, meaning that there would, of course, have been some spread within these groups. It is unlikely though that the toll would have been as severe as it has been. In addition to the 237,000 COVID deaths (as of this data extraction) in the over-45 cohort, there have been 75,000 non-COVID deaths. Were we to focus on protecting the vulnerable, it is hard to imagine we could have failed on this scale, either with COVID or non-COVID deaths.
The third aspect of Table 3 worth drawing attention to are the estimated infections to date. Based on the infection fatality rates by age, we can estimate the total number of infections, based on the fatalities to date. Using these age-stratified IFRs, we get an estimated 50 million infections in just this 190 million people--or 26% of this group. While this may seem high, given what is reported in the lay press, the CDC recently released an estimate of infections through September 30th 2020. They estimated at that point there had been 52 million infections across all age groups--36 million of them in the under-50 group. At the time, we had logged just 7.5 million PCR-confirmed infections. As of 11/21, when this data was extracted, there were 12.5 million PCR-confirmed infections--66% more, which would translate to 48 million in this cohort. During that period we nearly doubled our daily testing, so we are certain to be identifying more than the 1 in 7 new cases reported in the article above, but based on the other data such as the number of deaths, it is unlikely that we are identifying more than 25%, and likely closer to 20%. Thus, the estimate above seems to hold up quite well.
In trying to protect everyone, we have done worse than protecting no one. We have, in a very real way, sacrificed the lives of more than 100,000 people--people with decades left to live--to no purpose. The virus still rages. In some states, like Oregon and Washington, where the virus has been pushed into abeyance by the near total lockdowns Dr. Osterholm said would be needed to achieve that end, the reaper comes all the same. But instead of cutting down those with only a few years to live, he doubles or trebles his quota with younger, healthier people, leaving the most vulnerable for next year's harvest.
Though we do not know how to un-ring this bell, we must try. That starts by acknowledging the direct costs in in lives due to pursuing the dangerously quixotic goal of "stopping the spread." If one COVID death is too much, one non-COVID death is also too much. We can no longer continue to ignore the costs of trying to stop an unstoppable virus. These 100,000 lives are only the first and most visible of the costs of this myopic approach to public health. Other costs, likely greater in magnitude will be felt over the next generation. We must act now to limit these costs to the damage already done.
As states have opened, excess deaths due to non-COVID causes have returned to baseline. Yet, as COVID cases surge, many states are beginning to re-instate the lethal lockdowns that appear to have contributed to so many excess non-COVID deaths. That weekly deaths remain below peak levels of the 2017-18 flu season (a very good proxy of hospital utilization), tells us that this is not necessary. That hospitalizations stand at 100,000 today, just 13% of our 750,000 bed capacity further underscores how unnecessary this is.
Figure 2: Weekly U.S. Deaths, COVID and All Other Causes
As unnecessary as these lockdowns are, they are even more ineffective. That is clear comparing two states that have taken very different approaches. Massachusetts, which has not been above baseline deaths of any kind since July, has still maintained strict lockdowns, one of the highest rates of virtual learning in the country, strict restrictions on gatherings, and as of November 6th, a universal, outdoor mask mandate. At the same time, Florida removed all restrictions in mid-September. Since mid-September when Florida removed restrictions, daily deaths/million have decreased by 40%, while Massachusetts increased by 40% (though both are still very low relative to earlier levels, and significantly below weekly deaths that would be experienced in a standard flu season).
Figure 3: Daily COVID-19 Deaths/Million, MA v. FL
Source: The COVID tracking project
Both states have seen significant increases in cases, rising almost in lock-step, despite such widely divergent approaches to "managing" the pandemic. That two such different approaches are having the exact same results, is a powerful argument for adopting the one that does the least additional harm, i.e. the one that does not restrict other aspects of peoples lives, such as schooling, social interaction and the ability to earn a living. That is, it argues strongly for the focused protection approach of The Great Barrington Declaration.
Figure 4: Daily COVID-19 Cases/Million, MA v. FL
We must cease talking in utopian absolutes. It is no longer intellectually honest to say "One COVID death is too many," when we know that more than 100,000 have died in the attempt to stop this one COVID death. Trying to stop COVID is killing people. We must use reason and data to face our fear of the virus, and those of us who are at low risk--and who chose to--need to be able to make the decision to go about our lives. In so doing, we will absorb the remainder of the disease such that the high risk in our communities and our families can once again live without fear. We need to redefine what is altruistic in the age of COVID. Our current definition is sacrificing the lives of younger people for older people, prioritizing the lives and livelihoods of the wealthy above the middle and lower classes, and the elevating the education of the top 50% above the education of the bottom 50%. This is not what altruism looks like. This is what aristocracy looks like.