I’m young and healthy — I don’t want my grandparents to die, but if I get it, I’ll be fine.” You may have heard friends and family members say this recently, based on reports that Covid-19 mostly kills the elderly and sick.
If you’re young and healthy, you are not without reason to shrug: If you get the coronavirus, your odds of dying are fairly small.
But there is more reason for concern than this line of thought suggests. Millions of young people may not be as healthy as they believe — they may have undiagnosed conditions that place them at higher risk. And aside from the risk of death, many young people with coronavirus are falling severely ill, with possible long-term consequences for their health and ability to work. Most troubling of all is the question of how patients will fare if hospitals become overwhelmed.
Let’s walk through these issues.
What does “healthy” mean here?
A number of conditions place you at higher risk of dying or being hospitalized with Covid-19: hypertension, diabetes, lung disease, atrial fibrillation, heart disease, kidney disease, among many others. A March report from Italy shows that among hospitalized patients who died with the coronavirus, 98.6 percent had pre-existing conditions.
When we look at serious illness — that is, people with Covid-19 who were hospitalized or admitted to an ICU — the rates are also higher for patients with prior conditions. But even healthy working-age adults are at significant risk. Yesterday, the CDC published a report on the prevalence of underlying health conditions among U.S. coronavirus patients. Among adults younger than 65, almost a third of those with a prior condition were hospitalized or admitted to intensive care. Among those without a prior condition, the rate was 9 percent.
You may not know that you have one of these conditions. An Australian study found that 14 percent of people under the age of 55 had asthma, and that close to a third of those cases are undiagnosed. The CDC estimates that 1.4 million American adults under the age of 45 have undiagnosed diabetes. A 2010 study estimated that among American adults with hypertension under the age of 40, about forty percent are undiagnosed. And 37 million adults have chronic kidney disease, mostly undiagnosed.
Also, there are other factors we don’t normally think of as risks: If you have blood group A, you may have a higher risk of acquiring Covid-19. And death rates from the virus have been higher among men.
What does it mean to have a “mild” case of Covid-19?
The World Health Organization describes mild symptoms as fever, fatigue, sore throat, cough, and shortness of breath. A large study of cases in China found that 81 percent of patients had “mild” symptoms, which included everything up to mild cases of pneumonia. There is also an ongoing debate about whether there may be a large number of undiscovered cases with mild or no symptoms.
If I get coronavirus, how likely am I to be hospitalized?
A CDC report from two weeks ago showed that, where data was available, one in five people aged 20 to 44 with Covid-19 required hospitalization. Hospitalization is typically recommended for symptoms such as difficulty breathing or rapid breathing, low oxygen levels in the blood, or pneumonia.
How likely am I to need an ICU?
According to CDC data, of American coronavirus patients aged 20 to 44, four percent were admitted to intensive care. Patients are typically admitted to an ICU for critical symptoms, which a report from China’s CDC describes as “respiratory failure, septic shock, and/or multiple organ dysfunction/failure.”
What is it like to be in intensive care for Covid-19?
A 39-year-old British woman suffering from Covid-19 in ICU described it as like having “glass in your lungs.” A New Orleans respiratory therapist explained that patients with ARDS, the respiratory failure caused by coronavirus for which patients are put on a ventilator, “are essentially drowning in their own blood and fluids because their lungs are so full. So we’re constantly having to suction out the secretions every time we go into their rooms.”
We spoke with Dr. Luke White, a pulmonologist in South Bend, Indiana, about the experience of patients in the ICU for respiratory conditions. Dr. White’s hospital has not yet had to deal with Covid-19 patients, but he described the experience of patients with pneumonia and acute respiratory distress who are placed in the ICU:
Any patient in that situation feels as if they are going to die. They are using every ounce of their energy to breathe, and to move oxygen through the body, and they are not succeeding. They have almost universally a sense of impending doom. Often their other organs are failing because they are not able to deliver oxygen effectively to them.
What are the odds that I will die?
The fatality rate for known Covid-19 patients aged 20 to 44 in the U.S. is 0.2 percent. This rate is ten times higher than the fatality rate for the last flu season, which the CDC estimates was 0.02 percent for people aged 18 to 49. (Note that there is considerable uncertainty in both of these fatality rates.)
The death rate for younger Americans diagnosed with Covid-19 works out to odds of one in 500. For comparison, an American’s odds of dying in a motor vehicle accident over the course of a year are one in 8,000, and of dying in a firearm assault are one in 22,000.
If I survive, will I fully recover?
Because the virus is so new, there are no patients who have been recovered for long, and available reporting on their outcomes is quite limited. However, there are some early warnings of possible long-term health problems, especially for patients who were seriously ill. A group of intensive care specialists in the UK has estimated that recovery from nerve damage and lung scarring could take 15 years.
Treatments can themselves be harmful. A ventilator is necessary in critical cases for providing oxygen, but as one New Orleans health care worker describes, “it can also do long-lasting damage to the lungs. They can get filled up with scar tissue. ARDS can lead to cognitive decline. Some people’s muscles waste away, and it takes them a long time to recover once they come off the ventilator.”
Dr. Luke White described a long recovery for patients treated in an ICU for respiratory failure:
Almost invariably, folks who get better are left with pretty severe debility, for a while. About half of folks who are in the ICU for any reason have post-traumatic stress disorder, and that’s even higher in folks with long ICU admits such as is the case when you have a viral pneumonia that requires intubation….
Some of these folks won’t be able to have the breathing tube out at all. They will be so weak that even as their lungs start to heal, the disease and medical care has left them so weak that they simply don’t have the strength to breathe on their own, even if their lungs have recovered. Those folks will often need a tracheostomy [surgically inserting a breathing tube into the windpipe], which is usually temporary, but it sets them back that much further, and folks will often have to have a tracheostomy for anywhere from a few months to over a year before we can take that out.
If I were hospitalized with Covid-19, how long would my stay be?
The CDC reports that the median length of hospitalization for Covid-19 survivors was 10 to 13 days.
Accounting for the cost of hospitalization in the United States is notoriously difficult. But one new report from FAIR Health estimates that the average cost of a hospital stay for Covid-19 will be about $73,000 for uninsured patients and $38,000 for insured patients. At least one insurance company, Aetna, has announced that it will waive copays and deductibles for Covid-19 hospitalizations.
What if hospitals are overwhelmed when I get sick?
The most worrisome scenario, and the most difficult to predict, is one in which so many Americans become sick at once that the health care system is unable to treat all of them. The relatively low fatality rate among young, healthy patients is based on areas where they have been able to receive adequate care.
There is no systematic data yet on how Covid-19 patient outcomes might change when the demand for care exceeds capacity. Triaging guidelines that are currently being issued to doctors in some areas suggest prioritizing treatment based on likelihood of recovery, which is correlated with age and pre-existing conditions. In some cases, doctors may decide whom to treat by drawing names from a hat.
All of the possible outcomes under a triage scenario are troubling. It is conceivable that the system could be so overwhelmed that, even though young and otherwise healthy, you may not be able to receive care. And if your illness is critical — such as respiratory failure or septic shock — your prognosis without care would be dire.
The best case under a triage scenario is that you do receive adequate treatment and recover — but deprive another, likely elderly or frail patient, of an ICU bed or a ventilator.
A final factor to consider: If health care facilities in your area become overwhelmed and you need treatment for a problem other than Covid-19, you may also have trouble getting care. In many areas, doctors are already postponing procedures, including surgeries to remove early-stage cancerous tumors and chemotherapy treatments.
Exhausted by science and tech debates that go nowhere?
