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Another Angle: Neither Life Nor Death

Like most of you, I see figures every day summarizing the number of folks infected with COVID-19 and the ones who’ve died from it. It’s grade-school easy to calculate mortality: 1%–3% in most of the cities, towns, and counties I’ve sampled.

That’s 1–3 deaths per 100 infections—more than with almost any other new-onset, organic disease commonly encountered by EMS. Yet expressing that same ratio as 97%–99% survival seems to make some of the EMTs and paramedics I know—the younger ones, especially—feel pretty safe.

I hope y’all are, but I’m worried you’re not.

According to the CDC, 40% of COVID-19 patients hospitalized as of March 16 were in the 20–54 age group. Among those requiring intensive care, 12% were 20–44 years old, while 36% were 45–64. Those statistics reveal “a very important critical issue that we’re looking very closely at,” said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. “If they don’t have underlying conditions, that will be something we will really have to examine.”

One possible explanation for disproportionate serious illness secondary to COVID-19 among young people is a “cytokine storm,” described by emergency physician and author Bryan Bledsoe, DO, as “a severe immune reaction in which the body releases too many cytokines into the blood too quickly, causing inflammation, multiple organ failure, and ARDS.”

Even calling ARDS by its full name, adult respiratory distress syndrome, does little to convey what sufferers face. Consider this account, published by ProPublica, from an anonymous New Orleans respiratory technician:

“[ARDS] is notable for the way the x-ray looks: The entire lung is basically whited out from fluid. Patients with ARDS are extremely difficult to oxygenate. It has a really high mortality rate, about 40%.

“Normally ARDS is something that happens over time as the lungs get more and more inflamed. But with this virus it seems like it happens overnight… With our coronavirus patients, once they’re on ventilators, most need about the highest settings we can do.

“I’ve never seen a microorganism or an infectious process cause such acute damage to the lungs so rapidly.”

Even without considering the possibility of other major organs failing due to overactive immune systems, acute damage to the lungs is reason enough to highlight disability, perhaps permanent, as a much less publicized COVID-19 consequence than life or death. Avoiding disability seems to me like a pretty compelling reason for people of all ages to comply with CDC-recommended precautions. EMS providers can help get that message to friends and family, the public we serve, and each other.

Don’t give in to wishful thinking—this crisis is a long way from over. Without vaccines or definitive therapeutics, unbiased risk assessment may be our most valuable service.

Mike Rubin is a paramedic in Nashville and a member of EMS World’s editorial advisory board. Contact him at

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