There can be no argument that it is better to be safe than sorry, but in devising any strategy available data must not be ignored. It is increasingly evident empirically that the savage path of COVID-19, both in terms of confirmed cases and reported fatalities, is not identical for all population cohorts. If anything, there appears to be marked differences emerging in the disease’s pathway in different countries.
Let us below examine two separate COVID-19 cohort of countries, with median age for each country is stated in brackets:
I. High incidence & high fatality –
China (38), France (41), Germany (46) Iran (31), Italy (45), Korea (42), Spain (45), UK (41), US (38).
II. Incidence & low fatality –
Bangladesh (27), Brazil (31), Egypt (25), India (27), Malaysia (30), Mexico (28), Nigeria (18), Pakistan (23), South Africa (28)
Cohort I comprises approximately 30% of global population of 7.5bn (or approximately 2200mn people); and the average median age is approximately 40. However, of the 800,000 or so (March 30) confirmed COVID-19 cases 80% fall in this group, as well as, 95% of global 35,000 recorded fatalities.
My latest piece in @brecordernews: "While there can be several factors that might be impact transmission and morbidity……one clear difference between the two cohorts that's immediately visible is average median age….https://t.co/2qSJBYmyA7— Javed Hassan (@javedhassan) April 2, 2020
Cohort II comprise approximately 36% of global population (or approximately 2700mn people); and the average median age is well below 30. Less than 2.5% of all 800,000 (March 30) confirmed COVID-19 cases fall belong to this cohort. More importantly less than 3% (or less than 1000) of global 35,000 fatalities fall in this cohort.
"..Cohort I comprise approximately 30% of global population of 7.5bn (or approx 2200mn people); & the average median age is approximately 40. However, of the 800,000 (March 30) confirmed COVID-19 cases 80% fall in this group, as well as, 95% of global 35,000 recorded fatalities." pic.twitter.com/qJ2NW3G9y8— Javed Hassan (@javedhassan) April 2, 2020
COVID-19: Isolated testing, fewer cases?
Even if it is accepted that lower number of confirmed cases in the second group is due to lower level of testing, the respiratory track related deaths would have spiked up dramatically in these countries. It is difficult to imagine that all ten countries in Cohort II would be conspiring to hide COVID-19 related fatalities. If the level of fatalities in cohort II were replicating that in I, it is highly likely that it would by now be exposed.
It’s worth pointing that with the exception of South Korea and Germany, there’s been no universal testing in most countries including UK and US. Even in Cohort I, highly developed and organized nations, only those individuals who exhibit clear symptoms of the virus are tested. In UK there are several instances were persons have been told to self-isolate when they have reported precisely COVID-19 related symptoms. If there is limited number of tests confirmation in Cohort II, and therefore vast underreporting of the true extent of coronavirus spread, the same to may be true in the group of more developed countries.
While there can be several factors that might be impact transmission and morbidity – including temperature/humidity, mask wearing, hygiene, genetic predisposition, etc. – one clear difference between the two cohorts that’s immediately visible is average median age. With the exception of Iran, which sits at the edge, the average of median age of Cohort II population is significantly lower than that of Cohort I. It’s too early to conclude that this particular factor is the driving variable for morbidity or fatality, but the preponderance of data cannot be ignored. The linkage between age and fatality was reported by analysis carried by researchers at Imperial College London.
As can be seen from table above those under 40 years are at extremely low risk. This obviously does not mean those under 40 years have zero fatality risk from COVID-19, but societies do not function on a basis that activities are riskless. There are already reported instances of young people and infants being affected adversely by COVID-19, but policies have to be devised to mitigate general population risks, not specific or exceptional cases.
Basics of devising a mitigation strategy
In devising any mitigation strategy, the impact on the vast majority of the population of measures taken against what is the objective has to be evaluated. If most of those that at risk are above 60 years, then it could be argued that government policies should be devised to assist such group self-isolate, rather than a forcing a lockdown in an attempt isolate the relatively young working population. It may easy for those with sufficient means to endure the loss of income during a lockdown, but near impossible for vast majority of poor people in Pakistan.
It is tortuously difficult to devise a mitigation strategy that balances the competing necessity to protect the elderly, while not disrupting the lives and dignity of the majority who are less ar risk from COVID-19. It is therefore imperative that all stakeholders avoid semantic disputes about herd immunity versus complete lockdown, and rather seek to implement a strategy that ensures essential protection for the most vulnerable, while allowing the vast majority (of relatively younger people) to go about their normal working lives.
Javed Hassan is a graduate of Imperial College London and an MBA from London Business School. He is an investment banker who has worked in London, Hong Kong, and Karachi. He tweets as @javedhassan. This article was published in Business Recorder and is being published with the permission of the writer .
The views expressed in this article are author’s own and do not necessarily reflect the editorial policy of Global Village Space.