This is going to be bad Ep. 06

If you are over 65 and male, you should put your affairs in order

Covid-19 is coming for you

If you are like me, every once a in awhile you have one of those “oh fuck” moments when something that should have been obvious smacks you in the face. I had one of those moments this morning when I was writing a friend about “how risky” Covid-19 was for her (she is 67) and if she should keep isolating as much as possible. There is no doubt Covid-19 is going to seriously impact the Over-65 population anywhere the virus can spread unchecked or it becomes uncontrolled. As I told her:

Unfortunately, the evidence is also accumulating that the burden of this disease falls unevenly on different age cohorts. One percent Infection Mortality does not mean that everyone has the same 1 in a 100 chance if dying.

For those under 45, the rate of mortality seems to be about 1 in a 1,000 (which explains the “half-truth” WH estimate, Covid-19 is “only” as deadly as the flu, IF YOU ARE UNDER 45).

For those 45–65, the mortality rate is shaping up as 1 in 50 (about 2%)

For those over 65, the mortality rate is about 1 in 25 (about 4%) (70% of all US deaths have been from this age cohort, which makes up only 16% of the population, which is reflected in what has been observed in nursing homes and senior communities)

As you can see, a 1% Infection Mortality Rate over the total population does not mean that your personal risk is only 1%. Your age is a huge influence on your risk, as is your overall health (diabetes and asthma sufferers are at greater risk), gender (men die twice as often than women), race (minorities are at greater risk), and income level (poor people are dying more often than middle class and wealthy people).

What really stands out to me is how heavily this is going to hit the over 65 population. In the US they are 16% of the population but they have been 70% of the Covid-19 fatalities. Roughly 7 people over 65 die for each person under 45 who dies. If this pattern holds, and assuming complete 1% population mortality, of the 3 million people who are likely to die from Covid-19 infection, 2.1 million will be people over 65. About 1 out of every 25 in that age group.

That’s when it hit me, “men die twice as much as women” from Covid-19 (In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age. (Front. Public Health, 29 April 2020 | Gender Differences in Patients With COVID-19: Focus on Severity and Mortality). There are already fewer men than women in the over 65 age cohort. Covid-19 has the potential to kill about 1 out of every 16 men over the age of 65 in the next 18–36 months. Including me.

I guess it’s time to get my affairs in order.

My entire life can be described in one sentence: Things didn’t go as planned, and I’m OK with that.