OPINION: Why Number of Coronavirus Cases is More Important Than Mortality Rate
- Published on
- 14 Mar 2020, 12:00 AM
By Sophia Rodrigues
In the past few days, I have read several articles about how the mortality rate for coronavirus may be overstated, and therefore it is more important to focus on the accurate* mortality rate than the number of infected to get a true perspective on whether it is any worse than previous pandemic episodes.
I disagree, for several reasons including the fact that COVID-19 has the potential to spread rapidly, if not contained.
The number of infections and the rate of spread in cases is important because of one major reason: No country in the world, howsoever good their healthcare system, is equipped to deal with large spike in cases. The focus is therefore on containing the spread because failing to do so could eventually lead to a rise in mortality rate if your healthcare systems is not able to cope.
This is the main reason why in more recent days we have seen countries taking unprecedented steps to contain the outbreak.
SUPPLIES, HEALTHCARE PROFESSIONALS ARE LIMITED
Recently an overseas friend of mine told me how they are running short of medical supplies, and some hospitals are already using from their pandemic stock because of difficulty getting new supplies. Their regular suppliers from China aren’t fulfilling the orders. Indonesia is their next option but it would cost them more than double the amount and at least one month of wait time.
And this is when the number of cases in that country is less than a handful.
If the number of cases grow, their healthcare system will have a tough problem dealing with it especially when they are so reliant on overseas supply and have limited number of health care professionals.
I am not sure it is any different for Australia, and many other countries.
LESSONS FROM ITALY
Countries are taking lessons from Italy and going into panic mode, but they are doing so for the right reasons.
The number of cases in Italy have spiralled to over 17,000 and it has put a significant burden on their healthcare system. Remember Italy’s healthcare system is good, if not among the best.
I read a story a couple of days ago about the situation in Italy and the one thing that struck me the most was the extraordinary decisions that doctors there are having to make.
The guidelines issued by the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care said that the intensity of care required by coronavirus patients can be high, and based on data for the first two weeks in Italy, about one-tenth of infected patients could require an intensive treatment with assisted ventilation – invasive or non-invasive.
The guidelines have been issued to relieve clinicians from the responsibility of making choices because it can be emotionally burdensome, and to make allocation criteria explicit amid extraordinary scarcity.
But that doesn’t make the job of a doctor any easier. They can use the guidelines to prioritize treatment but making a choice between patient A and B is still a moral decision. The last thing you want to do is put that moral burden on someone who is already under a lot of pressure.
The following lines from the guidelines left me speechless.
“It is not a question of making choices merely of value but to reserve resources that could be very scarce for those who are primarily more likely to survive and secondarily to those who have more years of life saved, with a view to maximising benefits for most people.
In a scenario of total saturation of intensive resources, deciding to keep a criterion of “First come, first served” would still amount to choosing not to treat any subsequent patients that would be excluded from intensive care.”
DON’T WANT TO TEST HEALTHCARE
No, we can’t focus on the mortality rate because that would make us complacent and ultimately put to test our healthcare system.
I want us to focus on the number of cases because that would mean more emphasis on containment. I simply do not want our situation to escalate to a point where our authorities have put out guidelines like Italy has had to do.
* accurate mortality rate would be number of dead to number of infections (diagnosed and not diagnosed)