‘Mild’ May Not Mean What You Think It Means

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A common refrain throughout the ongoing COVID-19 pandemic has been something along the lines of this: 80 percent of people who become infected will suffer mild symptoms, or be asymptomatic. Obviously, getting sick without symptoms is the ideal (if one must get sick at all — and chances are alarmingly high that one will), but many youngish, healthy people, including me, have reassured ourselves with that “mild.” (Older people, and people with chronic health conditions, never had that privilege.) We’ve all had colds and the flu before, we told ourselves — while the experience certainly isn’t fun, it is familiar.

But there may have been some misunderstanding of the term “mild” as applied to coronavirus, according to Bruce Aylward, who led the World Health Organization team that visited China amid the outbreak in Wuhan. Aylward, who has, per the Times, “30 years experience in fighting polio, Ebola and other global health emergencies,” says cases classified as “mild” by doctors in China include those that develop into pneumonia, and “severe” means needing machine-assisted breathing. Cases deemed “critical,” he says, involve respiratory failure or multi-organ failure.

There may, of course, be cases with even milder symptoms, for which patients don’t seek care and/or aren’t tested. Another Times story reported that COVID-19 “could be virtually indistinguishable from the common cold or seasonal flu.” According to Sean Morrison, the leading expert in geriatrics at Mount Sinai Hospital, “mild” refers to symptoms mild enough that patients don’t feel the need to call their doctors or go in for a visit. That can include people with pneumonia, though he sees it as less likely.

“Most people with pneumonia — any type of pneumonia — feel sick enough that they call their doctor, and come in and get treated,” says Morrison. “There are a small group of people who may develop pneumonia who don’t feel that sick, stay home and recover. Particularly with a viral pneumonia, for which antibiotic medications aren’t effective.”

Pneumonia is generally a miserable experience, and can cause other health complications — and in patients with COVID-19, says Morrison, it’s one of three apparent causes of death. “Deaths from COVID-19 occur for one of three reasons: lung failure because of pneumonia (which means an infection in the lung); an infection overwhelming the body and resulting in sepsis; and kidney failure, again due to the load of the infection on the body.”

This is all to say that yes, there are some cases of coronavirus which may feel like a cold or a flu, or not much at all. But it could also be much worse than you’re imagining, and there is a lot we still don’t know about the range of coronavirus experiences. “This is changing daily,” says Morrison. “If you call me back in a month, I’ll probably have a better answer for you.”

What we do know now is that walking around in public with mild symptoms (or no symptoms) contributes to community transmission, making other people sick — not all of whom will be so lucky as to have “mild” cases.

‘Mild’ May Not Mean What You Think It Means