NOTeD: COVID-19 Cases Are Much Higher than Reported

Tom Rifai, MD, FACP
Newspaper with headline,

IN TODAY’S MEDICAL NEWS: COVID-19 Cases Are Much Higher than Reported

ABC News just released a new article reporting that antibody test study results reveal COVID-19 cases are much higher than reported. The underlying emphasis of this article? COVID-19 is everywhere – fear factor should be high.

My take: asymptomatic infection of COVID-19 has been noted on multiple other occasions. This has led to estimates of actual true infections being at least 8 to 10 times higher than the total cases reported by virtue of those tested. Of course, we know why that is – our overall dearth of testing (hopefully being addressed soon) and lack of population sampling. This new data suggests that the actual COVID-19 infection rate in the USA might be 55 times higher than currently reported, due to lack of widespread testing.

We have seen evidence along these lines before: for instance, the Diamond Princess cruise ship, in which almost 20% of those found to be infected were totally asymptomatic (notably, that was a high risk, older, population). Iceland’s experience showed even higher numbers of asymptomatic experiences with SARS-CoV2 (the virus causing COVID-19) exposure.

The GOOD News that Comes with Asymptomatic COVID-19 Cases

Based on a study of primates as well as the promising data regarding the effectiveness of treating victims of severe COVID-19 with convalescent plasma from those who have recovered from it, antibodies to SARS-CoV2, including in those who have been asymptomatic, are meaningful and protective. Full disclosure: I believe I developed and recovered from a mild COVID-19 in early March after traveling to Santa Monica, California and I am currently on Red Cross’s list to be tested for antibodies. If positive, I will donate plasma.

BOTTOM LINE: Should We Worry if COVID-19 Cases Are Much Higher than Reported?

While it might seem eerie to not have a full grasp of how wide the virus has spread among us, we should also keep in mind the silver lining, which is that the ultra-mass majority of people exposed to this virus will survive. Most will have mild or no symptoms, particularly those who are healthy and robust (especially if young), based on our growing understanding of who is at high to low risk.

There seems to be little doubt that metabolic health issues that are potentially largely under our control like hypertension, type 2 diabetes and prediabetes, coronary artery disease and overweight can be either prevented, far better controlled or even potentially reversed, with dedicated therapeutic lifestyle. Do we have absolute proof that correcting or improving such metabolic health status will reduce our risk of severe morbidity mortality upon any second wave of COVID-19?

No. But why take the chance when there are so many other benefits that we have known for decades related to diseases like coronary artery disease and cancer that, combined, typically take the souls of approximately 4,000 Americans a day?

What Can We Do to Reduce Our Risk as Society Starts to Open Up?

As our society starts to inevitably, and carefully, open up, it is incumbent upon us to do everything we reasonably can to reduce risk, which of course includes hygiene measures. But let’s also consider “physical hygiene” in terms of our “feet, fork and fingers” (as my great colleague, Dr. David L. Katz, likes to say, referring to our levels of physical activity, food choices and smoking).

Of course, social determinants of health trouble me as far as how challenging such lifestyle changes can be for many. Nevertheless, that means for any and all of us who have the means we should advocate for what we can access to be accessible to all and start to truly address our food environment and lifestyle culture. I would even add that it is our patriotic duty to do so. If we do, I can imagine an alternative therapy, one prophylactic in nature, to mitigate COVID-19 impact will be Lifestyle (as) Medicine, as well as addressing our social determinants of health…stat.

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