Why we should be fundamentally more like South Korea and less like China
March 24, 2020: This content was originally published 3/22/20 on Medium. Medium pulled it down because they claimed that it violates their terms of service against “Health claims or advice which, if acted on, are likely to have detrimental health effects on persons or public safety.” On the contrary, this article is an attempt to point out serious detrimental health effects on persons and public safety resulting from public policies not based on scientific evidence. Even after editing to make the headline less attention-grabbing and the final paragraph less rabble-rousing, Medium censored it a second time. Read it and judge for yourself.
The coronavirus known as SARS-CoV-2 exploded out of China to circle the globe.
At every level of society and government, responses have been rapid and dramatic. Borders are being slammed closed, businesses shuttered, gatherings, shows, and events canceled, projects put on hold, and schools shut down. Governments make promises to “make people whole,” but we all know there’s no way to make up for the 1.1 trillion in lost business income, or the 20% of people predicted to file for unemployment (according to the US Secretary of the Treasury as quoted in US News and World Report), especially since the employers being directed to pay lost wages have no customers coming through the doors, and the governments that are promising payouts are facing massive drops in tax receipts as buying and selling and earning come to a screeching slowdown.
What the Hell Are We Doing?
Thousands of new viruses every year emerge, move from person to person, and spread around the planet unnoticed. But this one was different. We all know the grim litany of facts by now: it has a case fatality rate somewhere between an estimated .3% (per The Lancet) of all infected and 3.4% (per early reports cited in The New York Times) for people ill enough to be tested, a much higher rate than most respiratory viruses. It can be transmitted by well-seeming people for an unknown amount of time, with the average infected person infecting two to three others, per The Scientist (or maybe more, per a biophysicist publishing out of Los Alamos National Laboratory ). It’s believed that 80% of people with COVID-19 have mild or asymptomatic disease, 14% have severe disease, and 6% are critically ill (link to The Lancet ).
Scientists such as Neil Ferguson, an infectious-disease epidemiologist at Imperial College London, acknowledged as early as January that it’s impossible to contain the virus from spreading everywhere; everything being done is with the stated goal of “flattening the curve” (website link) so that more of the minority who get extremely sick from the virus will be able to get Intensive Care when they need it.
So, now, the luckiest few people are working from home. These are those fortunate enough to have skills and occupations that are easily transferred into an online work environment. They’re overrepresented among journalists, editors, and content moderators, so curated media platforms are full of eerily identical “Ten Things That You Need to do When You’re Working From Home” articles like those in the link.
The rest—the vast majority— are not working, according to scientists at the MRC Centre for Global Infectious Disease Analysis at the Imperial College of London. Everyone’s trying to homeschool children (despite expert opinion that school closings will be ineffective, as published in The Lancet), using an internet that, due to unprecedented use, periodically slows to a crawl. We’re talking here about waitresses, paralegals, receptionists, retail clerks, salespeople, ushers, janitors, gig musicians, sex workers, taxi drivers, mechanics…the list goes on. All those unglamorous people working in occupations you don’t like to think about.
At the same time, they’re trying not to think about what they’ll do when next month’s rent is due. Their landlords, forbidden to file evictions, are trying not to think about what they’ll do when next month’s mortgage and next year’s property tax come due. But they know it won’t be pretty, since they haven’t collected rent from laid-off workers. All these people know that Texaco and Delta will get billion-dollar bailouts, but they’ll be lucky to get one paycheck’s worth of assistance, weeks or months too late to do any good in the crisis.
So many people have poignant stories about the personal, heart-wrenching effects of these measures. Here are some that I’ve learned about first-hand:
- The high school senior whose senior trips, senior proms, and graduation walks are canceled.
- The hairdresser who’s finally saved enough money to open her own one-chair hair salon, only to have customers too afraid to come in the door. She’s watching her life savings go up in smoke.
- The mother whose daughter who lives in a foreign country is pregnant, with her first grandchild, and who learns that borders are shut to unnecessary travel and flights are canceled. (Full disclosure: I’m talking about me.)
- The retiree who was planning to become a “snowbird”, spending summers in the north and winters in a milder climate, whose Spring flight home was canceled and who has to face blistering Summer heat, far from family and friends.
- The adult child whose mother is dying, far away, and cannot go to be by her side, and would not be allowed as a visitor in the hospital anyway.
- The young man who was just diagnosed with cancer, in a city where he moved for a new job, and now faces chemo and radiation with no friends or family to support him—in a hospital gripped by grim panic and smelling of fear.
- The foreign visitors, French and Hong-Kongese, exploring a small town in India, abruptly told they must leave the country, but refused boarding on trains, lodging in hotels, and seating in restaurants. Finally, taken in by a saintly good Samaritan, the four of them huddle in one room.
There are hundreds of millions of individual stories. But all those stories and circumstances don’t tell the story of the damage of a thousand cuts being inflicted on everyone, everywhere, by social distancing. Fewer “hellos” and “thank yous”. Fewer smiles. No lunches in the breakroom, no shirts versus skins games, no coffee with the girls. All the little bumps of oxytocin and dopamine that we take for granted as we go about our day: missing in action. Those social interactions are not trivial. They lower our blood pressure, reduce our cortisol levels, and strengthen our health in numerous ways.
This isn’t airy-fairy, lacy-spacy speculation. If you have even the slightest doubt that the effect of this stress is real and measurable and will be intense, have a careful read of this paper published at the US National Center For Biotechnology Information, as a special direct-access article, by the US Department of Health and Human Services:
TL;DR: the effect of stress on your risk of dying is real, quantifiable…and major. Bigger than smoking. Bigger than obesity.
Strokes and Heart Attacks
Strokes and heart attacks, grouped as cardiovascular disease, are the one of world’s biggest killers. To give you an idea of how lethal cardiovascular disease is: In 2018, the most recent complete year, CDC reports that there were 3,830,366 cardiovascular deaths in the USA alone. Check out this map at the CDC. And around the entire world, 14,996,617 deaths are due to cardiovascular conditions according to World Atlas.
Put that together with the research showing that job and financial stress increase the risk of an apparently healthy adult having a heart attack or stroke by 1.16 to 1.6 times that of an unstressed individual. (Nature Reviews: Cardiology; paywall)
Apply the midpoint, of 1.38 times, to everyone in the entire world, since everyplace on the entire planet is locking down due to COVID-19, do some simple arithmetic, and you come out with 5,698,714 excess deaths from cardiovascular disease alone, as a result of the lockdowns.
But it’s probably going to be even more than that. Remember? Because ICUs are going to be maxed out even if the lockdowns work as intended? (Also remember, WE DON’T KNOW if they will work as intended. None of this has been tried before, because there’s never been an identical situation). So a lot of non-fatal heart attacks are going to become fatal heart attacks—when the patient can’t get Intensive Care.
Cancer is not just one disease, it’s many, and so research on stress and cancer doesn’t focus on the blanket diagnosis of “cancer.” Like other studies, studies on stress and cancer focus on one individual type of cancer at a time. That research is pretty undeniable though. Peer-reviewed, indexed oncology journal articles are linked below. It’s found, among other things, that:
- Cervical cancer patients having stressful life events within the year before or after diagnosis have 1/3 greater risk of dying from the cancer.
- Men’s odds were more than twice as high of developing lung cancer if they had had any stressful life events in the past 5 years. This is a large effect, and it’s especially bad news because lung cancer is one of the most lethal; it kills 1,694,623 people worldwide every year.
- Stressful life events increased women’s risk of developing breast cancer by 11%.
9.6 million people, per year around, the world die from cancer, per Cancer Research UK. Multiply that by a conservative (based on the above) 33% increase, and you come out with 3,168,000 excess cancer deaths as a result of the major stressful life event of being un- or under-employed, financially strapped, isolated, and deprived of the things that give your day-to-day life meaning.
Each stressful event increases the risk of death from HIV in infected people by about 50%. (JAMA; Paywall) HIV is estimated by the World Health Organization to kill 770,000 people yearly. So, there’s an additional 385,000 deaths, a cherry on top of the gruesome sundae our well-meaning governments are preparing for us.
Deaths Among the Elderly
This isn’t really a separate category of death, so it’s not added into the total, because many of the deaths from cardiovascular disease, cancer, and HIV will be deaths of elderly people. But much of the fear around COVID-19 focuses on those over 65, who do have a much greater risk of being hospitalized and of dying if they become ill with the virus.
In over-65s, major stressors like serious financial problems and natural disasters increase mortality by a quarter to 2/3. This study described in the journal Psychoneuroendocrinology found that one of the strongest effects came from having a seriously ill family member, and the effect increased with multiple stressors. In other words, just when elderly people are likely to experience a wife, husband, lover, or best friend becoming seriously ill with COVID-19, they are being subjected to social isolation, financial uncertainty, and the loss of contact with those their networks of support. Figuring this out takes a even more back-of-the-envelope calculation than the others: Consider the World Health Organization’s findings that 63% of the 54,500,000 deaths every year are those of people over 65. That comes to 34,335,000 deaths a year. An increase of roughly half would mean 17,165,500 people dying worldwide due to the stress of COVID-19 lockdowns.
There’s very little evidence or information about the outcome of pregnancies among women who are ill with the virus.
But there is data, published in the journal Early Human Development, from populations who’ve been subject to catastrophes and natural disasters, showing consistently that miscarriages increase, resulting in more male fetuses being lost, causing an decrease in the ratio of males to females in the birth cohort.
Exercise and Mortality
Another factor that will cause added deaths that result from Covid-19 lockdowns is the fact that gymnasiums are being compelled to close by many municipalities, states, and national governments. At the same time, people are being advised to stay at least 6 feet away from other people, which means in many of the world’s more crowded cities, which kind of by definition contain a majority of the population of the countries they’re in, people will need to simply stay inside at all times in order to comply. It’s well-established that the risk of mortality is reduced by a wide variety of physical sports and exercise activities. According to a study in the British Journal of Sports Medicine, that reduction varies according to the sport or activity, but it appears to average to about 25%. That’s all-cause mortality, meaning that if you do activities like swimming, racquet sports, cycling, and aerobics, you are much less likely to die in the next year than if you don’t do those activities. Some of that mortality is accounted for in the cardiovascular deaths listed above, but not all of it.
So, how many additional people will die due to withdrawal from exercise and sport? We don’t know, because that depends on how many people are exercising currently, and how much of that exercise is dependent on gyms, courts, and other forbidden settings.
But: there also are probably many people who are getting life-saving exercise from jobs at businesses which are now closed. This effect of employment-associated exercise would naturally be greater for poorer people and for more people in poorer countries.
So, How Many Will Die of Coronavirus?
To determine if the cure (lockdowns) is worse than the disease (the pandemic), you have to know the damage done by both.
As of this writing on March 24, 2020, worldwide, COVID-19 has reportedly killed 16,591 people, according to the Coronavirus Dashboard website. If everyone, everywhere, all of the world’s 7.8 billion people, became ill enough with coronavirus to visit a doctor and be tested, at a mortality rate of 1.4%, 109,200,000 would die.
That won’t happen. Again, according to The Lancet, most people who are ill with suspected coronavirus are not ill enough to be tested, by governments’ designation of eligibility. Washington State, site of one of the US’s earliest outbreaks, found that of those people with respiratory symptoms who do get tested, 93% of those tests are negative. And Washington directs health care providers to test only symptomatic individuals, and recommends against testing younger people with mild illness. (Both links to the Washington Department of Health official website). Nobody knows for sure how many people are exposed to the virus, have no symptoms (or maybe they think their hay fever is acting up for a few days), and go on with life. But with colds, that number can be more than half of those exposed. The Lancet article linked/cited above estimates that, in the very worst-case scenario, 60% of those exposed will get sick. China’s Wuhan outbreak is now declining, according to a WHO epidemiologist quoted in the Times of India. And yes, China’s totalitarian state did lock down drastically, but South Korea’s is declining too per the CDC, and they were far less stringent (as described in a South Korean English-language news site, EN24) in the restrictions they imposed; they focused on near-universal testing and tracing of infected people’s contacts. (It’s worth noting here that the USA’s failure to test widely for the virus was due to the CDC’s strict constraints on which tests were permissible to use, and its refusal to authorize private labs, as described in an Associated Press article, to use their own, validated tests). Korea predicts a .3% decline in GDP growth due to this pandemic, to a 2% growth rate, as reflected on Statista, as opposed to other countries which are predicting a major recession, as reported in Forbes.
Most people who are ill with suspected coronavirus are not ill enough to be tested, according to government restrictions, in other countries. Again, consulting Washington’s Department of Health website, Washington State, site of one of the US’s earliest outbreaks, found that of those people with respiratory symptoms who do get tested, 93% of those tests are negative. And Washington directs health care providers to test only symptomatic individuals, and recommends against testing younger people with mild illness. Nobody knows for sure how many people are exposed to the virus, have no symptoms (or maybe they think their hay fever is acting up for a few days), and go on with life. But with colds, that number can be more than half of those exposed. The Lancet article linked/cited above estimates that, in the very worst-case scenario, 60% of those exposed will get sick.
Yes, it is Really That stressful
But is the COVID-19 lockdown a significantly stressful life event? US’s Department of Health and Human Services lists the following four ways of designating an occurrence as a major or stressful life event:
- The amount of adaptation or change it requires of the individual. Stressful events are cumulative, with each additional event adding to the overall burden of change.
- Imminence of harm, intensity, duration, and the extent to which an event is objectively uncontrollable are all factors that contribute to the potential magnitude of consensual threat
- Psychological distress and strain when resources are inadequate and the individual has little control over the situation.
- Stressful events include interruptions of major goals, (Link to download textbook from Google Scholar) including goals to maintain one’s physical integrity and one’s psychological well-being
The lockdowns may even increase the number of people who become ill with COVID-19. While no large-scale studies have been done, Sheldon Cohen and others have performed studies that compared stressed people with non-stressed people when given a dose of cold viruses. (Link to text on Google Books) After a month of stress, 49% of people developed a cold, as compared to 36% of people who weren’t stressed. Un- or underemployment lasting at least 1 month was the strongest predictor of developing illness among those exposed to a cold virus
Remember, it is expected that this coronavirus will eventually be everywhere. By flattening the curve, we’re supposedly reducing the number of very ill people who die because they don’t get intensive care. But what if these governmental lockdown measures are really creating a greater number of Covid-19 deaths, due to people being immunologically weakened by chronic stress of income loss, separation from friends and family, and constant fear of death of themselves and loved ones resulting from the endless drumbeat of COVID-19 news and incessant reminders in the form of disrupted routines, empty streets, and absence of friends and loved ones?
Just the absence of friends and loved ones may increase risk of mortality. People who are isolated from other people are more likely to die and more likely to get sick than people with an abundant daily network of social interactions. All the listicles and infographics about how to avoid feeling lonely during coronavirus cannot change that fact.
Non-Fatal Effects on Public Health
As reported in the Journal of the American Medical Association, people who’ve experienced a stressful life event have a 20-25% chance risk of developing depression. Other conditions that may be worsened are asthma, autoimmune diseases, and wound healing. Social isolation is in itself a stressor. More suicides, serious asthma attacks, and wound-infections will inevitably ensue. But how many?
And using social media is not the answer. Social media is not a substitute for face-to-face socializing. In fact, as described by journalists at NPR, social media makes people feel more lonely.
The World’s Poor
This article doesn’t even begin to address the fact that almost all of the countries affected by the pandemic so far have been among the wealthiest (whose residents can afford to fly internationally). Throughout most of the planet, people depend on jobs or micro-trade to support themselves and their families. They have no sick leave, no unemployment coverage (their governments are too poor), and no hope of ever getting Intensive Care if they do get sick. And almost all their income goes to food and shelter. If these lower-income nations mimic the actions of the globe’s wealthy nations, strangling their economies, the suffering will be measured, not just in heart attacks, cancers, and suicides (though all those will happen too), but also in starvation.
We Have Time to Turn This Around
Yes, wash your hands.
By all means, wipe down every surface people touch.
If you’re at risk, stay home.
Fist bump instead of hugging.
If you’re sick with any fever or respiratory illness, you have an obligation to quarantine! That’s what “quarantine” means by the way. It’s a word that’s being widely misused in this pandemic. It actually means: the sick person and their family stay home and separate from the surrounding community.
But recognize that the disaster being wrought by your Federal, State, and local governments is based on the politics of fear. There’s no proof that any of these measures will do any good.
And I just gave you plenty of evidence that they will do a lot of harm.
You don’t have to passively cower in your home and submit to senseless limitations.
You can let your voice be heard.
Address your voice to the policymakers and enforcers who are participating in this dreadful mistake: beg them to stop. Demand that they ease up on the restrictions.
Tell them: you’re wreaking havoc on your fellow human beings with no ultimate benefit to anyone.
Originally published 3/22/20; Updated 3/24/20