COVID back in the day
a meta analysis of infection fatality rates; revisiting East Asia exceptionalism
Angelo Maria Pezzullo and others, including John P.A. Ioannidis, write
Across 31 systematically identified national seroprevalence studies in the pre-vaccination era, the median infection fatality rate of COVID-19 was estimated to be 0.035% for people aged 0-59 years people and 0.095% for those aged 0-69 years.
*The median IFR was 0.0003% at 0-19 years, 0.003% at 20-29 years, 0.011% at 30-39 years, 0.035% at 40-49 years, 0.129% at 50-59 years, and 0.501% at 60-69 years.
*At a global level, pre-vaccination IFR may have been as low as 0.03% and 0.07% for 0-59 and 0-69 year old people, respectively.
Pointer from Don Boudreaux. My emphasis.
Suppose that the infection fatality rate for age 60-69 is the median of 0.5 percent, or 5 in one thousand. There are about 35 million Americans in that age range when COVID hit. If all had become infected, then 175,000 would have died. That is a lot of folks.
My next door neighbor, who was my age, died from COVID early in the pandemic. That made it quite real for me. We each had three daughters. When my daughters were married, I was present (so was he, for that matter). But he was no longer alive for his two youngest daughters’ weddings.
It seems plausible to me that social distancing and then the vaccine saved thousands of lives in my age bracket. So you can argue that anti-COVID measures had costs that exceeded the benefits, but the benefits were not zero. There was a lot of stupidity: outdoor masking; vaccinating children; closing schools. But the idea that the optimal policy regarding COVID was to blow it off will not get my endorsement.
Separately, Boudreaux points to a paper by Jay Bhattacharya, Phillip Magness, and Martin Kulldorff, which says
The relatively low COVID-19 prevalence in East Asia in 2020 is a genuine puzzle needing an explanation. Of the explanations we have considered, lockdowns, genetics, seasonality, and climate are less likely to solve the puzzle. The relatively older demographic composition of some East Asian countries deepens the mystery since COVID-19 is more likely to cause severe disease in older patients. On the other hand, a differential presence of pre-existing protection against SARS-CoV-2 infection – perhaps from prior human coronavirus or SARS 1 infection – is the most likely answer, but questions remain regarding the specific mechanism. Whatever the mechanism turns out to be, it will need to explain the rapid spread of COVID-19 through East Asia, including China, with the arrival of the Omicron variant in 2022.
They admit that their analysis is speculative. They have no direct evidence for the hypothesis that East Asians enjoyed pre-existing immunity that protected them from the early variants of COVID-19 (but not the Omicron variant). They find studies in the literature that provide evidence against alternative hypotheses, leaving pre-existing immunity as the most plausible story. (Read the paper before you make comments promoting mask-wearing or other explanations.)
I would note that I can come up with reasons to be skeptical about the ability of exposure to SARS 1 to be protective against SARS 2. Would the immunity acquired from an exposure in 2003 not have worn off by 2019? Could enough East Asians have acquired immunity to create herd immunity for the population as a whole?
Still, I agree that the East Asian mystery is one that invites investigation. But scientific curiosity is not our health bureaucracy’s strong suit.
My father recently passed away. Ironically, despite being extremely at risk for COVID, when he finally got it the whole thing was a total non event. Didn't even feel very sick. He later died of the same health problems we knew would inevitably kill him.
There were two paths my fathers last two years could have taken.
One was to stay in that old folks home that my parents moved into for like a year beforehand. They had decided to leave and move in with us just before COVID as they hadn't really liked the old folks home before COVID. After COVID, the few things they did like went away. People were essentially locked in their apartments with food delivered every meal. All social events and activities were cancelled. People had to wear masks all the time whenever they rarely left their room. Visitors were either not allowed or highly restricted, and leaving to go outside was the same. Life consisted entirely of sitting in a room alone and watching TV all day.
This was in fact very safe, I imagine he wouldn't have caught COVID at all.
He still would have died at the same time, in fact probably sooner would be my guess.
Instead, he came to live with us. He played with his grandchildren every day. He made friends and engaged in activities. After vaccines he got to sing twice a week in his chorus. He was Santa Claus one year. His life was a joy, not a prison.
When it became obvious that having them watch the kids full time was a lot on them and that our kids were becoming shy and missing out of key social development of being around other kids, we discussed with him about sending them to daycare. We had found one that didn't do masks or social distancing or the rest despite threats from the state. It seemed best for the girls. My father said that if they brought home COVID and he died that was a risk he would take if it was best for the girls. This was just before vaccines came out when we didn't know if there would every be an effective vaccine.
When the end finally came he was in kidney failure at the hospital. He could do dialysis to try and stay alive, but he was having heart attacks every other time he did dialysis. They had revived him so many times that his ribs were cracked and bloody. I won't go into it all.
Instead of trying to drag things out a slight bit longer doing dialysis, he decided to come home. He got to spend a week with his family. He saw his grandkids. He sang with his signing groups when they came to the house. He sat on the porch on a beautiful day and talked to the neighbors. Members of the family visited. Friends called. He got to eat home cooking around a table with all of us. It was a great last week after a miserable time in the hospital.
I don't think my father would have traded the end of his life for any other. I honestly can't understand people whose idea of the correct way to live is to sit alone in a room watching TV and trying whatever they have to in order to exist on the earth slightly longer. The mindset it so foreign to me.
When that way of life was forced on the rest of us in the name of protecting such "life" it was evil.
I think you are misunderstanding something when you write 'Would the immunity acquired from an exposure in 2003 not have worn off by 2019'? Immunity, in the general case, does not wear off at all. But the immunity is specific for a particular variant of a particular pathogen. And the pathogens mutate. If the current thing that is going around is sufficiently like what you have immunity to, then bingo you are immune. If it is sufficiently different, then your body may not mount any immune response at all based on the old thing you were infected with. From your immune system's point of view this is a whole new disease and it has to go about creating a new immune response to this one.
The interesting question is 'what happens when a new pathogen is different, but not a whole lot different from something that you have before'. Your body starts trying the thing that worked before. If it works, great. If it doesn't work, then it switches to making a new thing. But this is seriously age dependent. Young children, with robust immune systems, very quickly move to 'make a new thing'. Very old people don't, and rely entirely on making things they have seen before. If you look at their antibody production for flu in flu season you will find they are busy making antibodies for 'flu I caught in 1968' and 'flu I caught in 1983' and so on and so forth. When making antibodies, at whatever age, 'things you caught in childhood', and 'last year' seem to be preferred. It's quite expensive to find the antibodies and then test them against past pathogens, (so this is not something we can expect to do at home) but people who study aging immune systems have done so. Sometimes the old ones are effective, too -- it is not as if flu viruses are 'progressing' in a particular direction with an end goal.