Apr 29, 2020 - Health

Why the coronavirus feels so risky

Illustration of viruses under a magnifying glass that appear smaller and more blurry

Illustration: Sarah Grillo/Axios

With deaths from the novel coronavirus potentially cresting and some U.S. states taking early steps to reopen their economies, the COVID-19 pandemic is at a critical moment.

Why it matters: State and local leaders are trying to figure out what to open and when. Properly managing the pandemic on a social and personal level will require hard honesty about what we know and what we don't.

The big picture: "We still don't know how the coronavirus is killing us," David Wallace-Wells recently wrote in New York magazine.

  • While confirmed U.S deaths from COVID-19 have been largely declining from a peak in mid-April, new statistics from the Centers for Disease Control and Prevention released today indicate that thousands more Americans died from COVID-19 than had been reported once provisional deaths above the normal rate had been included in the count.
  • Estimates of COVID-19's fatality rate have ranged from 0.1 to 15%.
  • Initially thought to be primarily a respiratory disease, it now appears the virus can attack the heart, the circulatory system, the kidneys, the nervous system and more.
    • The Washington Post recently reported that some young COVID-19 patients — who aren't in a high-risk group — were unexpectedly dying from heart attacks and strokes caused by unexplained blood clots.
  • There's no way of knowing how many Americans have had COVID-19, in part because of lack of testing and in part because those tests can be inaccurate as often as 15–30% of the time.
  • Even the clinical presentation of COVID-19 is evolving — on Monday, months after the first U.S. cases, the CDC added six new symptoms for the disease.

The big question then is how can we accurately understand the risk COVID-19 poses to each of us — let alone make decisions about how to ease off the lockdown that has suffocated the U.S. economy?

One way, say risk experts, is for those in authority to be more honest about what we know and what we don't. "Many MDs have been talking in absolutes rather than communicating the uncertainties that may be involved here," says Charles Haas, a professor of environmental engineering at Drexel University.

  • That uncertainty is frustrating, but it's to be expected. As the name suggests, the novel coronavirus is a new pathogen, and it comes from a family of viruses that have been relatively understudied, meaning scientists are largely learning about its behavior on the fly.
  • The sheer number of cases means more statistical outliers — like seemingly young and healthy people dying from the disease — will inevitably emerge, and just as inevitably grab disproportionate attention from the media and the public.
  • Past pandemics, which largely involved influenza, may have little to teach us. "People keep referring to the 1918 flu pandemic, but the virus then was different, the infection was different and the economy was different," says Allison Schrager, a senior fellow at the Manhattan Institute.

The continued uncertainty around COVID-19 is what makes it feel so risky — and what makes it pointless to compare the pandemic to known dangers like the seasonal flu or automobile accidents. Not only do years of data give us reliable projections about risk from those threats, but we can take steps to reduce our personal risk — get a flu vaccine or drive more safely.

  • The risk posed by the coronavirus, though, is characterized by what is known in the field as "dreadfulness," both because it can lead to the very worst outcome and because as a new virus, it's still unfamiliar to us.
  • Right now it also feels as if there is very little we can do to control the risk we might face from COVID-19, other than to take the steps of extreme social distancing, which carries its own severe consequences.

Be smart: COVID-19 will be with us for months or longer, and we will need to shift out of a defensive crouch and find a way of living that balances the tradeoffs between the disease and the cure.

"A key message is that you can never get to zero for anything when it comes to risk."
— Charles Haas

The bottom line: The more time passes, the more we'll learn about COVID-19. But first, we'll need to learn to live with some degree of uncertainty — and some degree of risk.

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