There are four fundamental states of matter - solids, liquids, gases...and plasma.
The corona is a halo of plasma that surrounds many stars, including our own sun. However, although the sun's corona extends millions of kilometers into outer space, we virtually never see it due to the intense light radiated by the sun. The sun's light is a brilliant distraction. To see the corona, we need a coronograph, a telescopic attachment designed to block out the direct light from the sun...only then is the corona plainly visible, for all to see.
In an analogous fashion, the coronavirus surrounds humanity. However, although it has spread to nearly 200 countries, we still do not perceive the true facts of this virus due to the intense debate that surrounds it, one that is propagated by mainstream and social media. This debate is a brilliant distraction. To see the coronavirus, we need something akin to a coronagraph, we need the facts...only then will we be able to see the coronavirus in its proper light.
On one hand of the debate are media sources which instill an irrational fear of the coronavirus. Mainstream media articles abound with titles such as "Coronavirus burial pits so vast they're visible from space" (1), "World struggles to stop spread of coronavirus" (2), and "Wake up call: Yes, young people can also get seriously ill from coronavirus" (3). While all these articles convey an element of truth, they grossly obscure the context, implying a level of disease severity that does not exist.
The sun's corona extends millions of kilometers into space, but we can only see it using a coronagraph (6).
We need a coronagraph to see the true corona of this virus; we need to unearth facts, particularly those pertaining to coronavirus mortality. Only then can we accurately ascertain the risks imposed by the virus, and only then can we devise a strategy to deal with it. There is always a way to deal with any problem, let us seek it.
Calculating Coronavirus Mortality
The simplest way to calculate coronavirus mortality is to divide the total number of coronavirus deaths in the world by the total number of cases, which at the time of writing this article yields a mortality rate of 4.7% (7). Yet for many reasons, this approach is incorrect and leads to a false mortality rate.
First, this approach ignores time. The entire world is still in the midst of the coronavirus pandemic, with most of the diagnosed cases still active. We do not yet know the outcome of these active cases - whether they will recover, or die, and we will not know that outcome until all of these active cases have either fully recovered, or died.
Second, this approach ignores under-reported cases. Due to shortages in testing availability, incomplete reporting, and lightly symptomatic or asymptomatic individuals, the number of actual coronavirus cases in the world is almost certainly under-calculated, meaning that coronavirus mortality is almost certainly over-estimated.
Third, this approach ignores the effects of age; young people are much less susceptible to the coronavirus. In China, which was one of the earliest countries affected, people up to age 39 years have a mortality of 0.2%, whereas those aged over 80 years have a mortality of 14.8% (8). The age of the population has a huge impact on mortality.
Fourth, this approach ignores the effects of coexisting chronic health conditions, each of which increases an individual's vulnerability to the coronavirus. Using the China data again, people with cardiovascular disease have a mortality of 10.5%, those with diabetes 7.3%, those with chronic respiratory disease 7.3%, those with hypertension 6.0%, and those with cancer 5.6% (8). In contrast, those without any chronic health condition have a mortality of only 0.9%.
Calculating coronavirus mortality...it's complicated (10).
Fifth, this approach ignores treatment effects. People who receive breathing support via high-flow oxygen and mechanical ventilation do better than those who do not, with mortality varying from 0.25% where treatment was received, to 3.0% where treatment was constrained (9).
Thus, calculating coronavirus mortality is complicated. To do so with any degree of accuracy, we would need a population in which the pandemic is completely over, in which all the people were tested, in which both age and chronic health conditions are specified, and in which we knew the treatment implemented. For the world, this data is not yet available. However, this data is available for one particular situation - the Diamond Princess.
Projecting Coronavirus Mortality
The Diamond Princess, a Grand-class cruise ship, was afflicted by the coronavirus back in January 2020. The ship contained 3,711 passengers, constituting a closed-system, well-defined population in which we have available most of the data that we need to make an accurate calculation on coronavirus mortality:
(1) Since the ship was infected early in the pandemic, we know the final outcome for nearly all (97.3%) of the passengers; only 99 (2.7%) cases remain active (7), so we can virtually ignore time effects.
(2) We also know that all passengers were tested for the coronavirus (11), so under-reporting is not in any way a factor.
(3) We possess accurate age data on the passengers - 42% were under 60 years of age, 58% were over 60 years of age (11).
(4) We do not have comorbidity data, but since over half the passengers were over 60 years of age, many or most of the passengers likely had at least one chronic health condition.
(5) Finally, maximal treatment measures were available to all passengers, including mechanical ventilation.
Overall, coronavirus mortality on the Diamond Princess was 1.4%. The accuracy of this number is not perfect, as 2.7% of the passengers still remain as active cases, and we lack data on coexisting chronic health conditions, but it's pretty darn good and the best available to us. It is also important to note that the Diamond Princess passengers were more vulnerable to a higher mortality rate compared to most other populations - they lived in a constrained environment with repeated exposure to the virus, the majority were elderly, and they likely had a relatively high number of chronic health conditions.
Currently, the Diamond Princess provides us with our best available data on coronavirus mortality.
Despite being much lower than our initial simplistic (and incorrect) projection of 4.7%, the 1.4% coronavirus mortality rate shown by the passengers of the Diamond Princess is still reasonably high. However, the Diamond Princess represents the worst-case scenario given that there is no country in the world in which the demographics are so skewed towards the elderly, with 58% of that population over 60 years of age; by way of comparison, only 16% of the population is over 65 years of age in New Zealand (12).
Given the above known facts, we can confidently - not absolutely or arrogantly, but confidently - project that once the dust has settled, the actual coronavirus mortality in most countries will be less than 1.0%.
Coronavirus: The Ideal Strategy
To deal with problems, we need facts. We should not react to a problem with irrational fear or dismissal. We should analyze the known facts, then create a strategy based on those facts.
Let's look at some factual success stories, which at this point consists of countries in Asia such as South Korea, Taiwan, and Singapore. South Korea is an example of a country hit early and hard by the coronavirus; their strategy for dealing with the problem consisted of expanded diagnostic testing, comprehensive contact tracing, and supervised self-isolation programs (13). Moreover, although the government advised people to wear masks, wash their hands, and avoid crowds, none of this was enforced with a lockdown. In fact, none of South Korea, Taiwan, or Singapore have resorted to a lockdown.
Now let's look at some more tragic stories, which right now consists of countries in Europe such as Italy and Spain. Italy may be the most extreme example of a country having difficulties reacting to the coronavirus problem. There are likely many reasons Italy has been hit so hard by the coronavirus, including under-reporting of cases, an older population with more chronic health conditions, and a woefully inadequate stock of only 3,000 mechanical ventilators for the entire country prior to the pandemic (14). Whatever the reasons, their strategy right now is based on an enforced nation-wide lockdown combined with attempts to increase the number of available mechanical ventilators.
It would therefore be reasonable to ask, "Why the lockdown in Europe and other western countries?" At the very least, the facts suggest that those countries opting for a targeted testing, tracing, and isolation-based strategy aimed at the most vulnerable people are handling the coronavirus pandemic much better than those using a lockdown strategy imposed on everyone. At the very least, this simple fact ought to raise questions in any considered analysis.
It could be argued that lockdowns are necessary in those countries in which it may be too late to implement a more targeted strategy. This is potentially a valid argument. Yet even in these scenarios, context must be considered. For example, flu viruses kill 290,000 to 600,000 people per year (15); by way of comparison, the coronavirus as of today has killed 37,000 people (7). The coronavirus is still having its run and we should not take it lightly, continuing to acquire facts as they arrive, but it clearly has a very long way to go before it comes close to matching the flu for overall mortality (despite the fact that we possess a semi-effective vaccine for the flu).
The coronavirus has resulted in 11,000 flu deaths in Italy so far, so maybe lockdown is necessary...but why no lockdown for Italy's 23,000 flu deaths per year (16)?