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You have liver disease, what next under COVID

We are reaching the end of the beginning of the COVID pandemic. As society tries to return to some kind of normal the challenge is how, as an individual, to manage being a part of society if you have a medical issue.

If we look at some recent data from New York the issue is very clear.

Clearly, about 96% of the deaths are people older than 45. We have to remember that anyone can get it, but while it is hazardous for mature adults, most younger people will be OK. What that actually means is that it takes about 40 years for a typical person to develop some kind of chronic illness which puts them at risk.

That is all very interesting, but as part of the "at risk" population how do we think about the near term future? There aren't many good models but it is probably wise to keep a perspective even in the face of horrific news every day.


We have about 2.6 million deaths in the US each year. We have about 550,000 of those due to heart failure. Clearly, even if the COVID event produces 200,000 deaths, the death rate will hardly change at all. The categories will shift around some but as genuinely terrible as this disease is on a personal level it doesn't change the death statistics of the nation very much.

That is the purely pragmatic view of the population, but even in the midst of what is personally terrifying, I think this will lead to a host of amazingly good things. It is sad that we will pay for future good with the lives of our older generation but tragedy is often the fertilizer of rebirth and growth.

I was a child of the computer revolution. Looking back at the last 50 years it is nearly impossible to wrap your mind around how much knowledge has been gained in all fields and how the pace of change is accelerating. Broadly we speak of the growth of knowledge as its "doubling time". How long does it take for our total knowledge to double. It is estimated that in 1950 it was 50 years. By 1980 it was 7 years and it was only 3.5 years in 2010. By the end of 2020 it is projected that total human knowledge will double in only 73 days.

We are so very fortunate to be at risk of dying from COVID in this time of amazing expansion of knowledge. These viruses have been a known threat for decades but no one really chose to combat them. The threat of dying badly has a way of focusing the mind and societies everywhere have focused on the corona virus. We don't know what the outcome will be, but the vast resources of medical research have become engaged in managing this threat.

The research that will ultimately save our lives is riding on a wave of progress in all fields of medicine and the doubling time of knowledge about this virus is days to weeks. Compare that to the doubling time for HIV which was decades or smallpox which was centuries and understand why I am optimistic about our future as patients. We don't know what the details are, but it is a safe money bet that those who look backward for guidance about what is possible will not see the vast progress before us.

I'm reminded of the smartphone. In one generation society worldwide has fundamentally changed as a result of that invention but few predicted that. Medicine, medical care, and public health will never be the same after we pass through this crucible of the corona virus pandemic.

From a personal perspective, the goal must be to avoid infection until help arrives. Good hygiene habits, caution with relationships, and a bit of luck are the elements but it is helpful to understand that help is on the way.