What Causes Differences in Severity in COVID Cases?

This one is a weird one, right? Whereas a lot of people get it and they're asymptomatic. I've had several friends that got it and literally experienced no symptoms. They were around people that had it, they got it, they tested positive and got as little as a mild headache or a slight cough for a day. Jamie had it and he thought he had a sinus infection. He has allergies and he thought it was just his allergies kicking in. Turns out he was positive but he was very fortunate. It was a very mild case. Do we know why when some people get it it's devastating, including young people? I have a young friend, he's 28, he got it and he was really ill for two weeks. Whereas some people get it and it's nothing. Yes, so we have some sense of some of the reasons it varies but not a huge understanding yet of the interpersonal variation. But I would like to go on a tangent based on that that highlights the ways in which these kind of protean manifestations of this disease. The fact that with this condition you can go from everything from having no symptoms to mild symptoms like Jamie to more serious symptoms like your 28 year old friend to really severe symptoms to being hospitalized to dying. There's this incredible range of diseases that this particular virus can cause and in a way this is very unfortunate for us because it makes it so much harder as a society to take the virus seriously and to combat it. Let me give you an analogy. So I want listeners to imagine that there are two worlds. I'm about to describe two different worlds. In world A there are a thousand people and a virus infects 10 people in this world, makes them seriously ill and one person dies. So we would say that in this world 10% of the people that got sick died of the virus. That's world A. In world B there are a thousand people, the virus infects 100 people, 90 of them get mild illness, 10 of them once again get serious illness like in world A and one of them dies. Again like in world A. So in this world, in world B, 100 people got sick and one died. So we might say 1% of them died. In world A, 10% of the people that got sick died. In world B, 1% of the people that got sick died. Now many people hearing about this might think that it's better to be in world B because it seems like the virus is less deadly. But that's a delusion. If you stop and you think about it a little bit more clearly, world B is the same as world A plus an extra 90 people got mild illness. In other words, nobody, no right thinking person should prefer to be in world B than to be in world A. In world A, 10 out of a thousand people got seriously ill and one died. And in world B that happened plus another 90 people got mildly sick. So it's clearly worse. The overall situation is worse than world B. And that is in fact the situation that we are facing. We are in like a world B situation with this virus. And the reason it's hard is that all these extra people, those 90 people who got mild illness make people take the disease more casually. Whereas in world A, people might say, well not many people are getting sick but when they get sick, 10% of them die. Wow, we should take this disease seriously. Do you see what I'm saying? Yeah, I do see what you're saying. So this virus is very sneaky in that way. It's really like if you wanted to engineer a virus that's going to spread the most, that's kind of how you would do it. How it affects so many people where they're like, it was nothing. And then some people where they're dead within a few days. Yes. And also, as you pointed out earlier, it also has this property of being transmissible when it's asymptomatic. So just to remind people, HIV is like that. You can have HIV for years and not know it. You're spreading it to your sexual partners and then it kills you much later. Versus smallpox, which you can't really spread smallpox before you have symptoms. The pustules erupt on your body and that's when you become infectious. So there's no asymptomatic transmission in smallpox and there is an HIV. And SARS-1 from 2003 was more like smallpox. In other words, people didn't begin to transmit the virus until they actually had symptoms from it, which is one of the reasons it was easier to control because when people got symptoms, we could isolate them. Whereas with the SARS that we're facing now, the SARS-CoV-2, COVID-19, people can transmit it when they're not symptomatic. And in fact, there's a lot of analyses that have been done that show about 75% of the infections have been acquired from people who are asymptomatic. There's another issue as well that we can compare to smallpox in that you can develop a vaccine for smallpox that actually works for your whole life. We can't really do that with COVID. We don't know for sure. We don't know that for sure. I don't know that for sure. I'm hopeful that we'll be able to have a vaccine that confers long-term immunity, but I don't think we know that either way for sure. Episodes of the Joe Rogan Experience are now free on Spotify. That's right. They're free from September 1st to December 1st. They're going to be available everywhere, but after December 1st, they will only be available on Spotify, but they will be free. That includes the video. The video will also be there. It'll also be free. That's all we're asking. Just go download Spotify. Much love. Bye-bye. Me. Bye. Bye. Bye.