MILWAUKEE – A dangerous fiction has made its way through social media and American politics, the idea that COVID-19 is really only a danger to the elderly or those with a severe, chronic illness.
“Those who are in terrific shape, are young and have no prior illness can, indeed, become critically ill from COVID,” said Nina Shapiro, a professor at the David Geffen School of Medicine at UCLA and author of the book, “HYPE: A Doctor’s Guide to Medical Myths, Exaggerated Claims and Bad Advice.”
“Many have died and many will die. In addition, healthy people are continuing to unknowingly spread COVID to the elderly, who, in turn, become quite ill and are at higher risk for death.”
To those young adults who doubt their vulnerability to the pandemic, “I would invite them to visit our ICU and see the multiple tragedies of younger people who are infected with COVID,” said Daniel S. Talmor, chairman of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center in Boston.
“I think people are willing themselves to believe that they are not at risk because they are young and healthy, but that’s a very dangerous and mistaken belief.”
The persistent dismissal of the pandemic as an overhyped virus that kills mainly the elderly and those already severely ill has undermined the public health message that “we’re all in this together.”
Moreover, when the young and healthy underestimate the danger, it provides new opportunities for the virus to spread, especially at a time when many Americans have grown weary from months of wearing masks, canceling birthday parties and downsizing weddings and funerals.
The result has been all-too-predictable: reckless behavior and skyrocketing cases, with Wisconsin ranking among the highest rates of COVID cases in the nation.
College parties are believed to have triggered outbreaks at Notre Dame, the University of New Hampshire and the University of North Carolina at Chapel Hill. Riskier yet was the 10-day motorcycle rally in Sturgis, South Dakota, which drew almost half a million people in August. The rally has been linked to COVID outbreaks in South Dakota and Minnesota, and cases across a dozen states.
Now, Americans face a moment of peril, but also promise. Public health leaders worry that at a time when the first vaccines appear to be just a few weeks away from emergency use, people will disregard warnings and gather for the holidays.
“The tragic thing is that now we’re very close to having a solution available, if people would just hold on for a few more months,” said Nasia Safdar, medical director of infection control at UW Health in Madison. “We don’t have to see the devastation in health care systems, and the people who are dying from it.”
Safdar and others say that while age definitely increases the likelihood that a patient will experience more severe illness from COVID-19, there is no ironclad protection for the young.
“That concept that young people do not get extremely ill and die from COVID-19 is simply not true,” said Jakob I. McSparron, associate director of critical care medicine at Michigan Medicine in Ann Arbor.
“The majority of patients in our intensive care unit currently are below 60. There are three patients in their 20s.”
McSparron said the myth that the young have little to fear from COVID has also led to people unknowingly infecting friends and loved ones, who have then died. An infected person may not show symptoms of the disease, but they can still pass it to others, a phenomenon doctors call “asymptomatic spread.”
“We had a very young man with chronic disease who was very fearful of acquiring COVID,” McSparron said. “Unfortunately, someone visited him at home who did not know they had COVID. The young man did end up getting COVID and dying of COVID.”
A grim toll
The death toll of Americans under the age of 40 from COVID-19 — 3,571 — has now surpassed the total death toll from the 9/11 terrorist attacks.
The idea that COVID-19 was mostly a disease of the elderly took hold early in the pandemic when testing capacity was limited and directed largely toward residents of nursing homes and people who showed symptoms.
By the summer, the U.S. had broadened its testing for the new coronavirus.
“We found younger and younger people being infected,” said Frank Esper, a pediatric infectious disease expert at Cleveland Clinic Children’s hospital.
Esper said the median age for hospitalized COVID-19 patients across the nation is now hovering around 40.
“I’ve seen plenty of children without any underlying health conditions have problems with COVID and get very sick and require oxygen,” Esper said.
McSparron said health care workers are “exasperated” by the way many Americans have let down their guard on mask-wearing and social distancing, failing to take the pandemic seriously.
“I think there’s a sense out there that we have a better way to treat this,” McSparron said. “We have gotten better and the outcomes are better than they were months ago. However, we do not have a magic bullet.”
Remdesivir, plasma, steroids and placing patients in a prone position to increase their oxygen intake have all helped save the lives of COVID-19 patients. But there remain many cases when none of these treatments work.
Millions have extra risk factors
Another fact often downplayed is just how many Americans suffer from conditions that put them at higher risk for severe disease from COVID-19. While some adults no doubt suffer from more than one risk factor, the total number with at least one is likely to be 100 million or more.
Obesity alone — listed in multiple recent studies as a risk factor for severe COVID-19 — afflicts an estimated 85 million adult Americans.
Other risk factors listed by the Centers for Disease Control and Prevention include: chronic kidney disease (37 million Americans); smoking (34 million Americans); Type 2 diabetes mellitus (30 million Americans) and chronic obstructive pulmonary disease (16.4 million Americans).
That doesn’t include the number of people with weakened immune systems from cancer treatments or organ transplants.
At present, the highest number of COVID-19 cases is in the 18- to 29-year-old age group.
“It’s really quite striking,” said Lew Kaplan, president of the Society of Critical Care Medicine, a nonprofit medical organization. “What’s worse is that they’re young enough to have parents and grandparents. The rate of asymptomatic spread is very dangerous for everyone around them.”
Kaplan said the high rate of spread by younger Americans “belies the social contract that we have in which we care for and about one another.”
Like all experts interviewed for this story, Kaplan stressed that in order to bring the pandemic under control Americans must practice mask-wearing and social distancing and embrace the idea that “we are in this together.”
“It is absolutely essential,” he said. “Buy-in makes it all work. Lack of buy-in puts everybody at jeopardy.”
Follow Milwaukee reporter Mark Johnson on Twitter: @majohnso.