Attrition: You Give Me Fever

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April 10, 2020: The worldwide coronavirus (covid19) has not had much impact on armed forces despite the fact that troops work, and often live, together in close proximity. The advantage the troops have is that they are generally young and in excellent health. This is especially true of troops in units deployed overseas and the crews of ships. Some 87 percent are between 18 and 39 years old while over 90 percent of ship crews are 18-39. The main covid19 danger in the military is to family members and civilian employees. These may be older or in poor health. These groups are more likely to die if infected. For example, the death rate of covid19 victims is 0.2 percent for younger (under 40) victims but that death rate gets much higher (over 20 percent) for people in poor health. Thus in the military, the most serious problem is troops getting infected and passing it on to more vulnerable civilian populations. Some 10-15 percent of the troops will suffer the effects of covid19 but few will die. Nevertheless, the impact of covid on troops is a problem for morale and overall readiness. In combat zones around the world, the impact of covid19 is already a reality. Most of these wars are disorganized affairs involving lots of irregulars, part-timers and militias. These wars tend to take place in areas that never had much in the way of modern health care or high standards of living. Since covid19 is less lethal than many of the existing diseases, like malaria in many parts of Africa, the new flu-type disease would come and go without much notice were it not for all the publicity.

There are some situations where the military impact pf covid19 can be more disruptive. This would be the case in special operations and air force units as well as the crews of ships at sea. There have already been cases of sailors coming down with covid19 while at sea. How could this happen? We already have examples of the impact. The cruise ship Diamond Princess had 3,700 passengers and crew on board and all were exposed to covid19 because there were enough infected passengers to begin with and the ship was quarantined long enough (two weeks) under conditions that allowed everyone on board to be exposed. Nearly all were tested and 19.6 percent tested positive but 47 percent of the infected showed no symptoms. Some of these did later exhibit symptoms (were asymptomatic) but none died. The danger of the asymptomatic infected is that they can spread the virus until their immune system eliminates it. It is unclear exactly how long that takes but it appears to be up to several weeks. It is known that 80 percent of those exposed to the virus do not become infected. This is typical of such diseases as influenza.

Even with flu, some of those whose immune systems reject the diseases, but some people do so while the virus has already infected them. These people probably spread these diseases more than the minority (10-15 percent) of the population that actually develops the uncomfortable symptoms of the flu. This gave rise, in the 19th century, to “Typhoid Mary” (Mary Mallon) a woman who carried the typhoid virus but never suffered the ill effects. This was not unique but it was the first time the relatively new mass media got a chance to handle this sort of thing. Unfortunately, Mary Mallon worked as a cook and refused to change professions and was found to have infected 51 people with typhoid, of whom three died. This led to her arrest in 1907 and she eventually spent 26 years confined to a cottage on an island dedicated to the care of those with contagious diseases. There were other such asymptomatic carriers of typhoid and similar diseases, but these were never noticed because they always believed as if they were vulnerable and took the precautions everyone else took to avoid infection or passing on the disease during outbreaks of these diseases. Historically, people have been dying of unidentified “fevers” for as long as humans, and animals in general, have been around. While modern medicine can’t cure all diseases, it can identify anything new that comes along and a fast-spreading “fever” that kills a few people per million is news, especially in countries were modern medicine and sanitation have enabled large segments of the population to live to old age they have less resistance to “fevers”.

The Diamond Princess provided other insights that were also historical truths. While 0.2 percent of the passengers and crew died, most of those were and older and all were in poor health. Adjusting this data for more common age distribution (based on global populations exposed to Influenza) shows an overall death rate of 0.3 percent. The average death rate for Influenza is 0.1 percent. Higher death rates in some countries are not based on universal testing and mainly counted only those who showed symptoms. That accounts for the early estimates of a much higher death rate for covid19. Rarely is an entire population tested for the presence of a virus. Thus the Diamond Princess is the only example we have of a large group of people on a ship with at least one infected passenger to begin with and that was enough to expose the entire population of the ship to the virus.

Meanwhile, there has been no universal standard for measuring the impact of covid19. For example, some nations only count a covid19 death if covid19 was the major cause of death. In other nations anyone who died while infected is counted as a covid19 victim. It is already being noticed that a lot of victims are dying in the traditional fashion, at home or work, who had not appeared in need of hospitalization. They had a fever then they suddenly died.

Some navies are providing other examples as ships at sea where this an outbreak of covid19 that the entire crew can be exposed to. A recent example was the American aircraft carrier USS Theodore Roosevelt which, while in the Pacific recently, found several of the crew had the virus. Given the days or week an asymptomatic victim may have been on the ship, it explains how a seemingly healthy sailor boarded the Roosevelt and infected others, some of whom did show symptoms and become visibly ill. Ultimately all 5,000 sailors on the Roosevelt were tested and seven percent were found to be infected. So far a few have been hospitalized and no one has died.

Based on the Diamond Princess experience if the carrier did not isolate those known to be infected, the entire crew would be exposed and hundreds of those would be sick for days or weeks and a few might even die. When cases of covid19 were discovered on the carrier it headed to the nearest port (the Pacific island of Guam) and docked so the entire crew could be more quickly tested and those who had the virus would be isolated and treated. The navy moved 4,000 of them off the ship so the carrier can be disinfected. A thousand sailors had to stay on the ship to operate the nuclear power system and watch over many electronic systems and large quantities of ammo and fuel carried. The popular captain of the carrier was relieved of command because a memo he sent to his superiors about the covid19 outbreak was also sent to the media. The carrier was out of action for weeks because the ship had made a port call in Vietnam even though it was known that covid19 had spread to nations, like Vietnam, that were neighbors. So far Vietnam has only identified 244 cases and most of those have recovered.

There are war zones where the threat of covid19 has led to ceasefires and some other strange discoveries. For example, in Libya, a ceasefire was implemented to avoid the spread of covid19 throughout the country. Up to that point (March 2020), no one in Libya has been tested and found to have covid19. All Libyans agree that it is important to keep it that way. A month later 24 cases have been identified in Libya and one person has died. There may be others but no one knows.

South of Libya and North Africa there are a lot Chinese doing business in rural areas where there is also a lot of fighting by rebels or other armed groups. Chinese are a growing presence in Africa where they are making large investments in mining and other enterprises. As a result, there is a lot of travel between China and Africa and covid19 showed up in Africa but has not become an epidemic. The public health systems in Africa are far less capable as those in the rest of the world like China.Chinese researchers discovered that Africans are less likely to catch covid19 because they have one fifth as many cellular receptors in their lungs than Chinese. That difference enables covid19 to cause breathing problems more, or less, readily. Other researchers found that this genetic difference was most helpful for Africans and most harmful for East Asians. People in other parts of the world have less resistance to covid19 than Africans.

Lung damage is the most frequent cause of death among covid19 victims. So far Africa, with 18 percent of the world population, has only suffered about 0.3 percent of the covid19 infections. Africans are not immune, just less likely to get infected or suffer the breathing problems that cause most covid10 related deaths. Such genetic differences are common and account for some ethnic groups having different health problems, or advantages. For example, Africans are more prone to have sickle cell anemia. This genetic mutation helps those with it resist the deadly effects of malaria but also brings with it a high risk of blood disorders. Many of these genetic differences are useful with no bad side effects. That would include the unique eyelid structure of East Asians, which provides more protection from fine sand driven by high winds. Those sand storms still regularly blow into China from the Gobi Desert.

 


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