What Young, Healthy People Have to Fear From COVID-19

The White House’s new science adviser says: nothing. The science disagrees.

Updated at 11:03 a.m. ET on September 8, 2020.

A new philosophy of COVID-19 is circulating through the Republican Party and conservative media. If you look closely, you might notice that it resembles an early philosophy of COVID-19 that circulated through the Republican Party and conservative media: If young people get this disease, it won’t be so bad—and it might even be good.

Scott Atlas, the new White House science adviser and Trump-whisperer, seems to be the ringleader of this emergent corona-stoicism. A neuroradiologist and senior fellow at Stanford University’s conservative Hoover Institution, Atlas is not an expert in epidemiology or infectious diseases. As a Fox News regular, his relevant credentials seem to be more televisual than scientific.

“It doesn’t matter if younger, healthier people get infected,” Atlas said in a July interview with San Diego’s KUSI news station. “I don’t know how often that has to be said. They have nearly zero risk of a problem from this … When younger, healthier people get infected, that’s a good thing.”

The reality is that, so far, COVID-19 has killed fewer children and teenagers than seasonal flu in a normal year, according to data compiled by the Centers for Disease Control and Prevention. (COVID-19’s fatality rate is much higher than influenza, but school closures and lockdowns have reduced teenage exposure to all sorts of infectious diseases.) A 25-year-old who contracts this disease is approximately 250 times less likely to die than an infected 85-year-old, according to the most sophisticated estimates of infection-fatality rates. For every 1,000 people infected with COVID-19 under the age of 35, the average expected death count is less than one.* These facts might give you the impression that, as Atlas said, “it doesn’t matter if younger, healthier people get infected.”

But it does. It really does. Here’s why.

Many young people navigating this pandemic are asking themselves a two-part health question: What are the odds that I get infected? And if I do get infected, is that really a big deal?

Much of my reporting has focused on the first question. To summarize that work in a sentence: People are at highest risk of infection in communities with a sizable outbreak, when they spend long amounts of time in closed, unventilated spaces where other people close by are talking or otherwise emitting virus-laden globs of spit, and everything is worse when people aren’t wearing masks. This advice is easy to give, because the best practices hold across the board, for everybody.

“What’s the big deal?” is a harder question, because the person-to-person outcomes of this disease are so maddeningly variable. The most universal answer must begin with the observation that death is not a synonym for risk.

COVID-19 presents an array of health challenges that are serious, if not imminently fatal. The disease occasionally sends people’s immune system into a frenzy, wreaking havoc on their internal organs. Several studies of asymptomatic patients revealed that more than half of them had lung abnormalities. A March study published in the Journal of the American Heart Association found that 7 to 20 percent of sick patients showed heart damage associated with COVID-19.

As my colleague Ed Yong explained, many COVID-19 patients experience protracted illness. These “long-haulers” suffer from a diabolical grab bag of symptoms, including chronic fatigue, shortness of breath, unrelenting fevers, gastrointestinal problems, lost sense of smell, hallucinations, short-term-memory loss, bulging veins, bruising, gynecological problems, and an erratic heartbeat. And according to the neuroscientist David Putrino, chronic patients are typically young (the average age in his survey is 44), female, and formerly healthy.

We don’t know how many long-haulers are out there. But by combining the conclusion of several well-regarded studies, we can arrive at a decent estimate.

For men in their 30s, like me, about 1.2 percent of COVID-19 infections result in hospitalization, according to a July study published in Science. Once the disease has progressed to this point, the risk of chronic illness soars. Research from Italy found that roughly nine in 10 hospitalized patients said they still had symptoms after two months. A British study reported a similar risk of long-term illness.

Now the math: When you multiply the hospitalization rate for 30-something men (about 1.2 percent) by the chronic-illness rate of hospitalized patients (almost 90 percent), you get about 1 percent. That means a guy my age has one-in-100 chance of developing a long-term illness after contracting COVID-19. For context, the estimated infection-fatality rate for a 60-something is 0.7 percent, according to the same study in Science.

You might be used to thinking of 30-somethings as safe and seniors as at risk in this pandemic. But if a man in his 30s and a man in his 60s both contract COVID-19, it is more likely that the 30-something will develop a months-long illness than that the 60-something will die, according to this research. (The calculation above doesn’t even include the countless long-haulers who never went to the hospital.)

More frightening than what we’re learning now is what we cannot yet know: the truly long-term—as in, decades-long—implications of this disease for the body. “We know that hepatitis C leads to liver cancer, we know that human papillomavirus leads to cervical cancer, we know that HIV leads to certain cancers,” Howard Forman, a health-policy professor at Yale, told James Hamblin and Katherine Wells of The Atlantic. “We have no idea whether having had this infection means that, 10 years from now, you have an elevated risk of lymphoma.”‪

Why would Scott Atlas, the White House, or anybody for that matter dismiss the threat to young people? One answer is that they want to convince Americans that if a bunch of teens and 20-somethings get infected, the U.S. will move closer to the ultimate goal of achieving “herd immunity.” Briefly, that means the point at which a disease, like COVID-19, can no longer trigger an epidemic outbreak, because enough of the population has already developed immunity. Atlas has argued that, if herd immunity is an inevitable destination, we should perhaps put our foot on the accelerator.

But the case for herd immunity rests on two dubious assumptions. The first is that the disease isn’t risky to the people it doesn’t kill—which we know to be false.

“If you’re signing up for herd immunity, you’re also signing up for a huge number of hospitalizations, and a substantial fraction of those people will be sick for months,” says Marm Kilpatrick, an infectious-disease researcher at  UC Santa Cruz. “Do the symptoms last three months? Six months? Three years? Nobody knows, but I wouldn’t want my pandemic plan to be Let’s have hundreds of thousands of young people with lifelong illnesses. I wouldn’t want to tell 30-to-50-year-olds that we’ve signed them up for a high risk of heart disease and chronic organ damage.”

The second dubious assumption is that it’s easy to distinguish between the high-risk group and the low-risk group.

“The most simplistic way to protect the vulnerable is to divide the population by age, but you can’t choose an arbitrary cutoff and say ‘Let’s protect everybody under age 65,’ because nothing magic happens at age 65,” says Andrew Levin, an economist at Dartmouth. “The average person who is 64.9 years old has the exact same health risks as somebody who is 65. So it’s very difficult to divide populations into safe and not-safe categories.”

Besides, the U.S. is not, for the most part, spatially segregated by age. Restaurants and stores serve old and young patrons, and there are tens of millions of multigenerational households. Evidence that young and old people mingle constantly can be seen in the recent COVID-19 death data: A southern surge that started among young people spread to older populations, who died in disproportionate numbers. “There is the assumption that we can start cocooning the elderly, but we have no new innovation here,” says Natalie Dean, an assistant biostatistics professor at the University of Florida. “Are they saying we should try harder to protect old people? What does ‘trying harder’ even look like, compared to now? I just don’t understand the argument.”

Herd immunity is an inoperable plan, teetering on a false assumption of elderly-cocooning, which encourages young people to play craps with the long-term health of their internal organs. The choice is yours. You can listen to the scientists. Or you can roll the dice with your guts.

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* This article originally misstated the fatality rate for COVID-19 patients under 35.