How serious is Covid-19?


Readers will be aware that in December 2019 an epidemic, caused by a previously unknown coronavirus, started in Wuhang, China, and that this has since created a pandemic involving almost the entire world. Although the developments of the pandemic receive daily news coverage and many figures are shared, there are still people who remain sceptical about the severity of Covid-19 and do not want to adhere to preventive measures. They consider it as just another flu. The question I would like to address in this article is: is Covid-19 really a dangerous disease or is it all an overreaction? Related to that is the question: how seriously should you take the importance of vaccination?

  1. What is the extent of the Covid-19 problem?

Covid disease illustration. Bing image

After a pandemic of more than one year, around 130 million infections have been officially registered worldwide (as of beginning of April 2021) and around 3 million deaths have been attributed to the virus. In countries with a large population, such as Brazil and India, the mortality rate is still increasing. What do these figures mean? We cannot take them at face value, because there is a significant underreporting of both the number of corona positive tests and the number of deaths. The reliability of reporting also differs from country to country. In the Netherlands, the number of deaths in the year 2020 was initially set by Covid-19 at 13,000. Meanwhile, the Central Bureau of Statistics puts the probable number for 2020 at 20,000.  After all, not everyone was tested. There are also countries that, especially in the early days, reported low mortality rates, for political and other reasons, which in reality were much higher.

If we compare the worldwide mortality rate in the first 12 months of the Covid pandemic (approx. 2,750,000) with that of the annual real ‘flu’, Influenza A (worldwide varying over the years between approx. 290,000-650,000), the Covid mortality rate appears to be a factor 5-10x higher. It should also be borne in mind that during the Covid pandemic, very strict measures were taken in many countries to slow down the spread and mortality. This is not the case in annual influenza epidemics.

In the Netherlands, during the first wave of the Covid epidemic, the mortality rate was above 6000. By taking very drastic lockdown measures, the epidemic could be somewhat reduced. If you extrapolate what would have happened in the absence of the restrictive measures, we would probably have had more than 50 000 deaths within one year. Now this is limited to about 20,000.

Based on the official figures, the mortality rate among infected persons (also called the case-fatality rate) varies between 1% and 3% per country.  This percentage only remains an estimate of the reality due to the underreporting mentioned above.  There are those who argue that with a mortality rate of less than 1%, not much is going on, but this percentage – if it is true at all – does not say much about the extent and severity of the disease. In the case of a highly infectious disease, the number of seriously ill people (and deaths) can be much higher than for a less infectious disease with a higher mortality rate. For example, infection by the related virus SARS-1 in 2002 had a much higher mortality rate (9.6%) than Covid, but because it was much less contagious, the spread was limited and there were only 800 deaths in total.

There is another consequence of the Covid epidemic. Because many seriously ill Covid patients require hospitalisation, with some requiring intensive care treatment, there has been a shortage of beds and staff to care for patients with other serious illnesses. This has a negative impact on them and contributes to the severity of the Covid epidemic. Even now, more than one year on, there are still many Covid patients in the hospitals and the Intensive Care Units are at their maximum. Even when part of the population has already been vaccinated, regular care for non-Covid conditions is still partly scaled down, albeit to a lesser extent than at the beginning of the epidemic.

  1. How serious is the picture of Covid-19 disease?

It is estimated that 70% of infected people show symptoms of the disease. Those who do not develop the disease after infection may still contribute to the spread of the virus. The severity of the disease varies enormously and depends on a large number of risk factors. Age is a very important factor. For example, a large international study estimated the mortality rate after infection for ages 0-17 at 0.002%, for ages 18-49 at 0.05%, for ages 50-64 at 0.6% and for ages 65+ at 9.0%.  Other risk factors affecting the severity of the disease include obesity, diabetes mellitus, cardiovascular disease, hypertension, pulmonary disease and immune disorders.

About 80% of those who become ill develop only mild symptoms within 5 days of infection. These are mainly upper respiratory complaints, such as nasal congestion or runny nose, sore throat and coughing. In addition, there may be fever, fatigue, headache, muscle aches and sometimes diarrhoea. A characteristic complaint is loss and change of taste and smell.  During this initial phase, there is a peak in the number of virus particles that can be spread.  After recovery from the disease, some patients may continue to experience symptoms of fatigue, psychological complaints and loss of taste for many months.

Of the patients who become ill, the rest (20%) develop a severe clinical picture 7-8 days after the onset with shortness of breath. The cause is bilateral pneumonia with a shortage of oxygen in the blood. This is partly due to a massive inflammatory reaction of the body against the virus. There is then a need to administer oxygen.

Some of these patients (5%) even require artificial respiration. The inflammatory reaction can also damage other organs.  A special phenomenon is the formation of blood clots with embolisms. Many of these very seriously ill patients die. Timely administration of dexamethasone has a favourable effect, reducing mortality in these patients to about 25%.

  1. Isn’t Covid-19 just comparable to Influenza (‘flu)?

To answer this question properly, an extensive study was conducted in France, which was recently published.  It compared 89,530 patients admitted to hospital because of Covid with 45,819 patients admitted because of influenza. Underlying diseases were different for the two groups. Overweight, diabetes, hypertension and blood lipid abnormalities were more common in Covid.  The duration of stay in the intensive care unit for Covid patients was twice as long.  

A significantly higher proportion of hospitalised Covid patients died (16.9%) compared to hospitalised patients with influenza (5.8%).

In short, the pathologies are not comparable. The clinical picture of Covid is clearly more severe than that of influenza.

  1. Can Covid-19 not be treated with medication?

At this moment there is no medication that can completely cure someone of Covid. However, in the course of time a number of drugs have been tried out with varying success. For example, the anti-malarial drug Hydroxychloroquine received a lot of attention in relation to this. However, two comparative studies have failed to demonstrate the benefit of this drug for hospitalised patients.

The virus inhibitor Remdesivir can shorten the hospitalisation period, but it does not improve survival. The benefit of administering blood serum containing antibodies, taken from patients who had Covid, has yet to be demonstrated. Dexamethasone is effective for severely ill patients who require ventilation. There is no benefit in less severely ill patients.

Recently, treatment with Baricitinib, an anti-rheumatic drug, was researched and its administration to patients who need oxygen, but are not being ventilated, had a favourable effect in a study.

In short, some drugs can improve one’s condition in relation to the disease, but a drug that quickly gets rid of the disease does not exist at the moment.

  1. Consequences.

Because the coronavirus spreads easily, the disease is potentially serious, and there is no effective medicinal cure available. Preventive measures remain necessary. These include vaccinations.

We must understand our responsibility in this regard—responsibility with regard to our own lives and those of our neighbour in submission to, and dependence on, the Lord our God, who knows what is good for us. If we live close to the Lord, we may not and need not be (over)concerned in relation to Covid. But neither should we be careless and reckless.

Apart from the implications for economic and social life, it is very important to understand our personal task for the functioning of church life.

What a blessing it would be if we could once again simply serve the Lord as a whole congregation in His house, and visit each other in the fellowship of the saints, without the restrictions brought about by this disease.


From 1988-2005 the author was a specialist doctor in internal medicine and infectious diseases at the Erasmus Medical Centre in Rotterdam and head of the Infectious Diseases Section there. He obtained his doctorate from the University of Amsterdam in 1985 with a thesis on the epidemiology of meningococcal disease in the Netherlands. This article is translated from 17-04-2021.