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Title : A Swiss Doctor on Covid-19
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A Swiss Doctor on Covid-19

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Published: March 14, 2020; upd. March 18, 2020; Languages: EN, DE

A Swiss medical doctor provided the following information on the current situation in order to enable our readers to make a realistic risk assessment.
According to the latest data of the Italian National Health Institute ISS, the average age of the positively-tested deceased in Italy is currently about 81 years. 10% of the deceased are over 90 years old. 90% of the deceased are over 70 years old.
80% of the deceased had suffered from two or more chronic diseases. 50% of the deceased had suffered from three or more chronic diseases. The chronic diseases include in particular cardiovascular problems, diabetes, respiratory problems and cancer.
Less than 1% of the deceased were healthy persons, i.e. persons without pre-existing chronic diseases. Only about 30% of the deceased are women.

The Italian Institute of Health moreover distinguishes between those who died from the coronavirus and those who died with the coronavirus. In many cases it is not yet clear whether the persons died from the virus or from their pre-existing chronic diseases or from a combination of both.

The two Italians deceased under 40 years of age (both 39 years old) were a cancer patient and a diabetes patient with additional complications. In these cases, too, the exact cause of death was not yet clear (i.e. if from the virus or from their pre-existing diseases).

The partial overloading of the hospitals is due to the general rush of patients and the increased number of patients requiring special or intensive care. In particular, the aim is to stabilize respiratory function and, in severe cases, to provide anti-viral therapies.
(Update: The Italian National Institute of Health published a statistical report on test-positive patients and deceased, confirming the above data.)

The doctor also points out the following aspects:

Northern Italy has one of the oldest populations and the worst air quality in Europe, which has already led to an increased number of respiratory diseases and deaths in the past and is likely an additional risk factor in the current epidemic.

South Korea, for instance, has experienced a much milder course than Italy and has already passed the peak of the epidemic. In South Korea, only about 70 deaths with a positive test result have been reported so far. As in Italy, those affected were mostly high-risk patients.

The approximately twelve test-positive Swiss deaths so far were also high-risk patients with chronic diseases, an average age of 80 years and a maximum age of 90 years, whose exact cause of death, i.e. from the virus or from their pre-existing diseases, is not yet known.

Furthermore, according to a first Chinese study, the internationally used virus test kits may give a false positive result in some cases. In these cases, the persons may not have contracted the new coronavirus, but presumably one of the many existing human coronaviruses that are part of the annual (and currently ongoing) cold and flu epidemics. (1)

Thus the most important indicator for judging the danger of the disease is not the frequently reported number of positively-tested persons and deaths, but the number of persons actually and unexpectedly developing or dying from pneumonia (so-called excess mortality).

According to all current data, for the healthy general population of school and working age, a mild to moderate course of the Covid-19 disease can be expected. Senior citizens and persons with existing chronic diseases should be protected. The medical capacities should be optimally prepared.

Medical literature

(1) Zhuang et al., Potential false-positive rate among the ‚asymptomatic infected individuals‘ in close contacts of COVID-19 patients, Chinese Medical Association Publishing House, March 2020.
(2) Grasselli et al., Critical Care Utilization for the COVID-19 Outbreak in Lombardy, JAMA, March 2020.
(3) WHO, Report of the WHO-China Joint Mission on Coronavirus Disease 2019, February 2020.

Reference values

Important reference values include the number of annual flu deaths, which is up to 8,000 in Italy and up to 60,000 in the US; normal overall mortality, which in Italy is up to 2,000 people per day; and the average number of pneumonia cases per year, which in Italy is over 120,000.
Current all-cause mortality in Europe and in Italy is still normal or even below-average. Any excess mortality due to Covid-19 should become visible in the European monitoring charts.

Updates

March 16, 2020

• A German lung specialist confirmed that the virus test has not yet been clinically validated, i.e. it may indeed respond positive to other, more common coronaviruses, too.

March 17, 2020

• According to press reports, some Swiss emergency units are already overloaded simply because of the large number of people who want to be tested. This points to an additional psychological and logistical component of the current situation.
• The mortality profile remains puzzling from a virological point of view because, in contrast to influenza viruses, children are spared and men are affected about twice as often as women. On the other hand, this profile corresponds to natural mortality, which is close to zero for children and almost twice as high for 75-year-old men as for women of the same age. 

• The younger test-positive deceased almost always had severe pre-existing conditions. For example, a 21-year-old Spanish soccer coach had died test-positive. However, the doctors diagnosed an unrecognized leukemia, whose typical complications include severe pneumonia. 

• The decisive factor in assessing the danger of the disease is therefore not the number of test-positive persons and deceased, which is often mentioned in the media, but the number of people actually and unexpectedly developing or dying from pneumonia (so-called excess mortality). So far, this value is still very low in most countries. 

• According to official figures, there are currently about 1850 test-positive patients in intensive care in Italy, most of them in northern Italy. There is no official data on the age and disease profile of these patients. The occupancy rate of the North Italian ICUs in the winter months is typically already 85 to 90%. Some or many of these existing patients could also be test-positive by now. However, the number of additional unexpected pneumonia cases is not yet known.

March 17, 2020 (II)

• In a study on 3000 persons, the Italian immunology professor Sergio Romagnani of the University of Florence comes to the conclusion that 50 to 75% of the test-positive persons of all age groups remain completely free of symptoms – significantly more than previously assumed.
•  A hospital doctor in the Spanish city of Malaga writes on Twitter that people are currently more likely to die from panic and systemic collapse than from the virus. The hospital is being overrun by people with colds, flu and possibly Covid19 and doctors have lost control.

March 18, 2020

• A new epidemiological study (preprint) concludes that the mortality of Covid19 even in the Chinese city of Wuhan was only 0.04% to 0.12% and thus rather lower than that of seasonal flu, which has a mortality rate of about 0.1%. As a reason for the apparently highly overestimated mortality of Covid19, the researchers suspect that only a small number of cases were originally recorded in Wuhan, as the disease was probably asymptomatic or mild in many people.
• Chinese researchers argue that extreme winter smog in the city of Wuhan may have played a causal role in the outbreak of pneumonia. In the summer of 2019, public protests were already taking place in Wuhan because of the poor air quality. 

• New satellite images show how Northern Italy has the highest levels of air pollution in Europe, and how this air pollution has been greatly reduced by the quarantine. 

• A manufacturer of the Covid19 test kit states that it should only be used for research purposes and not for diagnostic applications, as it has not yet been clinically validated 

• Stanford professor John P.A. Ioannidis asks: „A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data.“

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