Framing is a glass half full/half empty concept that can have an effect on your emotions and what you focus on. Which oncologist would you rather have? The one that gives you a 20% chance of dying, or the one that gives you an 80% chance of living? This might seem a little bit ridiculous but patients do better/feel better under the second one.
Viral emotions (no pun intended) is a Robert Greene concept that he talks about in his bestselling book Human Nature which is well worth the read. His premise is that we humans remain highly susceptible to the moods and emotions of those around us. This compels all kinds of behavior on our part – unconsciously imitating others, wanting what they have, getting swept up in viral feelings of fear, anger, or outrage (social media anyone?). We imagine we’re acting of our own free will, unaware of how deeply our susceptibility to the emotions of others in the group is affecting what we do and how we respond. For example, one person starts to panic and then other people start to panic because they’re panicking and before you know it there is no toilet paper or paper towels anywhere even though paper products have little to do with the threat we are facing. We are all very susceptible to the feelings of others around us, especially negative feelings because evolutionarily it would have helped us survive. So, when everyone around us is freaking out about a hurricane or a global pandemic it is going to affect us by driving up our stress levels and negative feelings.
I am feeling a lot of stress and pressure right now.
In an attempt to lessen that pressure I have spent a lot of time learning about COVID-19 and other pandemics to learn about the situation so I can accurately assess the risk. Once I understand the risk I can then better decide what actions to take. For example, the risk of dying in a car accident is roughly one in 86 million per mile you travel. Not a big risk per mile and traveling in a car is really convenient (I do not walk anywhere). However, that small risk adds up over time. The average American travels 13K miles a year in a car. So, that small 1 in 86 million per mile risk adds up to a pretty significant lifetime risk of 1 in 77. Yes 1 in 77 Americans will die from injuries sustained in a car accident. That is really high and is a major cause of death, roughly 100 people die everyday in car accidents in America.
I never thought about the consequences of a car accident until I started working with a lot of patients who had been injured in car accidents. Growing up on Long Island I was an aggressive borderline reckless NY driver. Now I’m a defensive driver who gets made fun of by his friends for being too laid back. Defensive driving does lower my risk, it does not eliminate it. But it is something I can control and is easy enough to implement.
COVID-19 is a real threat and is being taken seriously.
There is a lot of uncertainty. I do not know what is going to happen. The experts do not even know what is going to happen. FiveThirtyEight is doing this really interesting weekly survey with 15+ infectious disease experts and then plotting their predictions to come up with a blended expert forecast for what the most likely outcome will be. Their blended expert prediction is roughly 260K deaths in America being the most likely outcome. Dr Fauci’s model as of the last week in March 2020 has the death total at 100K to 200K.
For our risk assessment purposes let’s say there are going to be 330K deaths from COVID-19 in America over the next 12 months (which is higher than what is currently predicted). That would put the average American’s risk of dying from COVID-19 in the next 12 months at 1 in a 1000. Or a 99.9% chance at not dying from COVID-19. But wait, that is too optimistic and does not tell you where the real risk is, because COVID-19 is not an equal opportunity killer. Three factors age, sex, and pre existing conditions determine your risk. The average fatality from COVID-19 is an 80 year old man with at least one pre-existing condition.
For the next set of risk numbers I am only going to focus on age and sex as that is relatively easy to calculate but not pre existing conditions. World wide we know 94% of fatalities are over the age of 60 and males are twice as likely to die than females. So here is a clearer but incomplete risk profile for Americans when you account for sex and age but not pre exiting conditions (which does affect your risk significantly).
- Females under 60 have roughly a 1 out 18,000 chance of dying
- Males under 60 have a roughly a 1 out 9,000 chance of dying
- Females over 60 have roughly 1 in 550 chance of dying
- Males over 60 have roughly a 1 in 275 chance of dying
Am I going to bet my or anyone else’s life on this information? No, I’m mixing expert predictions and my assumptions with rough data. I’m still going to wash my hands before touching my face and follow all expert recommended guidelines. I’m still worried about my dad and brother (he is 38 but undergoing treatment for cancer). The more I learn about COVID-19 the more I respect it. But I do think these are fair assumptions at this moment (4/5/20 5pm) and there is some good news in the rough data points I used.
Good news #1: at the current forecast level no matter how old you are there is better than a 99% chance you are not going to die from COVID-19 in the next 12 months.
Good news #2: if you are under 60 with no pre-existing conditions you have better than a 99.98% chance of not dying from COVID-19 in the next 12 months.
Big bad news: we have more than 110 million Americans who are really at risk for serious consequences from COVID-19 and that is why we are making this sacrifice as a nation.
Here is a front line doctor from Manhattan who has treated many COVID-19 patients who is no longer scared and wants to share his knowledge to help you:
- Do not touch your face without washing your hands first
- If you have COVID-19 only go to the Hospital if you feel short of breath after getting up to go to the bathroom
- A small % of COVID-19 patients will end up in the ICU and most of his patients are getting better. He feels they know what to do to treat it now.
Check out this interesting video about what Taiwan has been doing to contain COVID-19 (which they have done a great job at) and something that we will probably need to do when we open up schools again. https://www.youtube.com/watch?v=71rxlWJcLSE
FYI as of Friday April 3rd some Labs in Charleston were lagging 7 to 14 days for Test results. A friend of mine got her negative test results 12 days after taking the Test.
Weird scary times but I think we are going to be okay sooner rather than later
Thank you for reading this
Dr Chris Steidinger
Here is my source material and work if you want to double check my math or see what assumptions I made. I welcome any feedback. This really was a thought exercise for me to help me get my head on straight. If I made a mistake it was an honest one.
Odds of Death per mile data:https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year
I averaged out the last 5 published years of fatalities per 100 million miles driven and used the average of 1.16 fatalities per 100 million miles driven to calculate the odds per mile driven fatality risk.
I got the lifetime risk of dying in a car accident from this cars.com article https://www.cars.com/articles/are-the-odds-ever-in-your-favor-car-crashes-versus-other-fatalities-1420682154567/
The FiveThirtyEight article summarizing expert opinions: https://fivethirtyeight.com/features/best-case-and-worst-case-coronavirus-forecasts-are-very-far-apart/
Article talking about demographics of coronavirus deaths: https://www.timesofisrael.com/israeli-coronavirus-fatalities-mostly-elderly-men-average-age-79-8/
My assumptions about the demographics of America:
(There are lots of websites out there all slightly different)
- I went with ⅓ of the population of America being over 60 and the population being evenly split 50/50 between the sexes. So 330 million americans split 50/50 male/female with 110 million being over 60
- And if the age and demographic projection held for a projection of 300K deaths from CoVid 19 in the next 12 months.
- 6,000 female deaths under 60 or 6,000 deaths per 110 million females under 60
- 94,000 female deaths over 60 or 94,000 deaths per 55 million females over 60
- 12,000 male deaths under 60 or 12,000 deaths per 110 millions males under 60
- 188,000 male deaths over 60 or 188,000 deaths per 55 million males over 60