When I was in my 40s and quite healthy, I got viral pneumonia. I caught it from my son and husband, who were likewise young and healthy. Fortunately, we all recovered uneventfully, but it still knocked us all out for a while and made an impression.
I’d already been impressed by pneumonia’s power, however. Twenty years earlier, a favorite relative had come within a hair of dying from pneumonia. He was in his twenties and healthy as a horse, but for reasons no one could understand, pneumonia swiftly overtook him, landed him in the hospital and the ICU, and it was touch-and-go for quite some time.
In more recent years I’ve seen pneumonia – and septic shock from pneumonia – kill another relative dear to me. One day she was suffering from a slight cold, and within twenty-four hours she was hospitalized and in a coma on what turned out to be her deathbed. She wasn’t young (60s) and had some pre-existing conditions, but it was nevertheless astounding and dismal to see how swiftly she was felled.
I saw something similar a decade ago with another friend, a woman who was healthy and in her early 50s and nearly died from H1N1. The difference is that she lived.
Why am I going into all of this? Because in all the talk about COVID-19 I don’t think most people appreciate that when it kills, it’s through the same basic mechanism as pneumonia, and this phenomenon is with us anyway. The only real question is whether COVID-19 is likely to cause a truly significant uptick in the number of people to whom this happens. But what is lost in all this is that pneumonia is always a killer, is always with us, and waxes and wanes with some better years and some worse ones. Somehow the world has managed to deal with this year after year without undue panic or canceling public get-togethers. And yet the risk is always there, as the cases I have described anecdotally illustrate.
This description of how COVID-19 can be fatal is no different from what often happens when flu kills through pneumonia or when the other various forms of pneumonia kill. The article says “The progression from mild or moderate to severe can occur ‘very, very quickly,’ said Bruce Aylward, a WHO assistant director-general.” Of course it can. That is not just a characteristic of COVID-19. It is a characteristic of pneumonia in general, which tends to ordinarily strike the same population most vulnerable to COVID-19: the elderly and those already weakened by serious illness.
To give you more of an epidemiological look at pneumonia, see this article, which focuses on cases in the UK in 2012, but has some worldwide data as well. In the UK, around 220,000 people are diagnosed with pneumonia a year. There was a spike in 2009 because of H1N1, from around 355 diagnosed per 100,000 people to 409 diagnosed per 100,000 people.
Pneumonia is much more common in the elderly, but there are a significant number of cases in all age groups, and the disease is generally characterized as “common.” The death toll from pneumonia in the UK in 2012 was 28,952. That means that if we assume the average 220,000 of diagnoses, the death rate for diagnosed cases (not hospitalized cases; diagnosed cases) in 2012 was 13%. That’s an extraordinarily high baseline toll that pneumonia takes of its many victims in a relatively ordinary year in the UK.
US statistics are different and significantly better, but still troubling: “About 1 million adults in the US seek care in a hospital due to pneumonia every year, and 50,000 die from this disease.” That’s a death rate of 5% in the hospitalized, significantly less than the rate in the UK but still high (and apples to oranges, because that high death rate in the UK was of the diagnosed rather than just the hospitalized, which makes that UK death rate even worse in comparison).
How many people in the US get pneumonia every year? Apparently, about 5.6 million, of which about 1 in 5 end up hospitalized with five percent of the hospitalized dying of the disease. Putting all those numbers together, the death rate in the US among those diagnosed would be 1%, and that represents a lot of people because a lot of people get the disease every year.
These UK and US statistics serve to point out how different death rates can be from the same illness even in supposedly developed countries in the West, depending on all sorts of factors including the state of the health care system. Similar country-to-country differentials can be expected with COVID-19, and similar differentials have already been found.
So, why don’t we close the schools and theaters and cancel parades because of all our pneumonia deaths? More to the point, why doesn’t the UK? Because we’re used to it; it’s a phenomenon that’s familiar to us and we don’t see any reason to change our lives because of it. If someone is particularly susceptible, that person would be more inclined to avoid crowds and to wash his or her hands very often, and those who are relatively healthy should also wash hands often and stay away from those with active illness, too, if possible. That’s just common sense.
But we can’t completely avoid the risk. And novel diseases such as H1N1 and COVID-19 have come along, and will continue to come along, with some frequency. Meanwhile, the old diseases march on.