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Gambling at the COVID Casino

It’s like playing Russian Roulette, but harder to calculate the odds. If you’re playing Russian Roulette with a 6-shooter and one live bullet in the chamber, then chances are 1 out of 6 you’ll “lose.” With COVID, here’s a way to put your risk into perspective.

(A). Your chances of getting infected depend a lot on your behavior and level of concern regarding COVID infection. So proceed through the following steps, and then adjust accordingly.

(B). If you get COVID your chances of severe illness depend on your age and health, possibly the dose of virus you were exposed to, and whether or not you can access emerging therapies like monoclonal antibodies (mAb). There is a limited supply out there, but if health systems are overwhelmed the rate limiting factor will be availability of staff to administer the treatment. Overall risk for severe illness, using hospitalization data: runs from about 4% in our “best case” younger adults (20-29, not addressing pediatric COVID here) and then increases along a sliding scale with age: 9% among 40-49, and >33% of cases above age 70.

(C). If you develop severe illness, your chances of survival depend on your age and your underlying health. And whether your community has overwhelmed health care systems to the extent that sufficient staff and supplies are not available to provide you with oxygen, therapeutic positioning (called proning, to help with breathing), and the basic care you need to get well and get out of the hospital. Going back to our young people, with 4% hospitalized among 20-29 year olds: 4% is not a small number. It’s 1 in 25 people, and with thousands of people in this age group acquiring COVID -- there are a lot of hospitalizations. And even this younger group, once they’re in the hospital about 7% need mechanical ventilation and about 1% die.

(D). Even if you avoid severe illness, only 65% of people are fully recovered within about 2-3 weeks. Among younger, healthy adults (18-34 years old and no underlying health conditions), 80% are fully recovered within 2-3 weeks. A little better, but it’s still a really disconcerting figure: a one-in-five chance that you, in one of the lowest risk profiles for severe disease among adults, will still be fighting symptoms like shortness of breath and fatigue weeks later.

(E). Beyond prolonged recovery there is the spectre of post-acute COVID-19 (also called “Long COVID” or “Long Haul”). For some people it can be debilitating for weeks, months, or possibly (we don’t know yet) years. This can happen after even a mild case of COVID, but we don’t know all the risk factors nor how many people suffer, or for how long. The preliminary information we do have, however, is again disconcerting: Around 10% of COVID patients remain unwell beyond three weeks, and symptoms can include fatigue, headached, and difficulty concentrating.


So, there is a calculation you can try to do incorporating all these factors (and there are online calculators you can find to estimate risk for some, but not all, of these elements) -- but the take-home message here is not a specific figure, which could be artificially reassuring or concerning due to some of the uncertainty we still have in our understanding of COVID.


Here’s the take-home: if you get COVID, regardless of your age and underlying health, you are at measurable risk for a life-changing (and perhaps life-ending) event. If you consider your risk of a bad outcome to be a small-ish seeming number, say, 2%: would you play Russian Roulette if there was only one live bullet out of 50 in the chamber?

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