Coronaviru­s: Who is most at risk of dy­ing?

Kuwait Times - - Internatio­nal -

PARIS: As the num­ber of con­firmed coronaviru­s cases across 61 coun­tries hit 86,000 Satur­day with nearly 3,000 deaths to date, the pro­file of those most at risk of dy­ing is com­ing into fo­cus, ex­perts said. But the over­all mor­tal­ity rate re­mains un­cer­tain, they said. The World Health Or­ga­ni­za­tion raised its global risk as­sess­ment to its top level Fri­day, with the global health cri­sis edg­ing closer to a pan­demic. Among those in­fected with the virus, older adults with pre­ex­ist­ing heart con­di­tions or hy­per­ten­sion face a sharply higher risk, ac­cord­ing to pre­lim­i­nary statis­tics, in­clud­ing from a study cov­er­ing more than 72,000 pa­tients in China.

Among a sub­set of 44,700 in­fec­tions con­firmed through lab tests as of midFe­bru­ary, more than 80 per­cent were at least 60 years old, with half over 70, said the study, that was pub­lished in the of­fi­cial China CDC Weekly. Ini­tial re­ports from out­side China are sim­i­lar, with the first 12 vic­tims

re­ported in Italy mostly in their 80s, and none un­der 60. Sev­eral had known heart prob­lems. Men in the China study were more likely to die than women by a mar­gin of al­most 3-to-2. But whether that was due to be­hav­ior - no­tably that most men in China smoke, while few women do or bi­o­log­i­cal fac­tors, such as hor­monal dif­fer­ences, is still un­known. One strik­ing find­ing from the China study is the near ab­sence of cases among chil­dren. The 10-19 age bracket com­prised one per­cent of in­fec­tions, and a sin­gle death. Chil­dren un­der 10 made up less than one per­cent, with no deaths re­ported. “We are still try­ing to wrap our heads around the deficit of cases among those un­der 20,” Ce­cile Vi­boud, an epi­demi­ol­o­gist at the US Na­tional In­sti­tute of Health’s Fog­a­rty In­ter­na­tional Cen­tre, told AFP in an in­ter­view. “Is it be­cause young chil­dren are less sus­cep­ti­ble than adults, and thus sim­ply don’t get in­fected? Or if they do, that they have less dis­ease?” It is sur­pris­ing in­fec­tions of very young peo­ple are so low, she added, be­cause they tend to be among the hard­est hit by al­most all res­pi­ra­tory in­fec­tions - whether vi­ral or bac­te­rial.

Heroic health work­ers David Fis­man, an epi­demi­ol­o­gist at the

Univer­sity of Toronto, was also mys­ti­fied. “Where are the in­fected chil­dren?,” he wrote in an email. “This is crit­i­cal - per­haps kids are not be­ing tested be­cause they have mild symp­toms.” An­other pos­si­ble ex­pla­na­tion is that chil­dren in China were out of school for the lu­nar new year hol­i­day when the virus be­gan to spread widely in Jan­uary. “But young chil­dren still live in house­holds where they can be in­fected by their par­ents,” Vi­boud noted. A lower rate of in­fec­tion among the youngest age groups was also seen dur­ing the 2002-03 outbreak of SARS, but was less marked. SARS, which is also a coronaviru­s, broke out in Guang­dong Prov­ince and killed 774 peo­ple out of 8,096 in­fected.

The death of 34-year old Wuhan doc­tor Li Wen­liang in early Fe­bru­ary, along with sev­eral more health work­ers in their twenties sparked spec­u­la­tion they had died be­cause of re­peated ex­po­sure, or even sheer ex­haus­tion. Li’s death sparked out­rage in China be­cause he had been muz­zled by author­i­ties for call­ing at­ten­tion to the virus. Cell­phone video im­ages on so­cial net­works showed nurses and doc­tors, un­able to cope with the caseload, break­ing down in hys­ter­ics. “A more likely rea­son why young clin­i­cians are get­ting in­fected is

be­cause they were op­er­at­ing out­side their level of ex­per­tise and train­ing,” John Ni­chols, a pro­fes­sor in the depart­ment of pathol­ogy at the Univer­sity of Hong Kong said. “It is noble that the ju­nior doc­tors pony up valiantly to help, but they most likely would not have had the nec­es­sary train­ing in han­dling in­fec­tious pa­tients.” The larger ques­tion of just how lethal COVID19 is, re­mains unan­swered.

‘Some­where in the mid­dle’

The ra­tio of con­firmed cases to deaths sug­gests a mor­tal­ity rate of 3.4 per­cent, but sev­eral stud­ies have con­cluded that up to two-thirds of in­fec­tions in China and else­where have gone un­de­tected, which would make the virus far less deadly. “At the mo­ment, we don’t have a good un­der­stand­ing of the real mor­tal­ity rate,” Sharon Lewin, di­rec­tor of the Do­herty In­sti­tute for In­fec­tion and Im­mu­nity at the Univer­sity of Melbourne told Aus­tralian tele­vi­sion.

“It is es­ti­mated at about two per­cent.” With SARS - which killed nearly one in 10 pa­tients - early mor­tal­ity fig­ures turned out to be un­der­es­ti­mates, in part be­cause vic­tims of the virus did not die quickly. With the 2009 H1N1 in­fluenza pan­demic, how­ever, the op­po­site hap­pened, said Vi­boud. —AFP

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