What's the Chance Coronavirus Will Kill You (or Me)?
A Prominent Pathologist's Perspective
By Samuel Fistel, MD
I'm a male pushing 70, and I would prefer that the Coronavirus not kill
me (God will take care of that soon enough).
So what do we know about the pathogenesis of Coronavirus and its lethality?
Coronavirus is a family of constantly changing viruses that can cause a
variety of illnesses ranging from the common cold to a very severe
flu-like disease. Although it is not itself an influenza virus, the
disease it causes cannot be distinguished from influenza without testing
in the lab ( a case of parallel evolution?).
Like most viruses, it is constantly mutating and trying out new
variations. If the new mutation only results in a common cold-like
illness, no one will notice it. But if it causes a fatal illness, then
it will rapidly come to people's attention. Since the first victims we
learn about are those who are severely ill (including many deaths), it
initially appears that the virus is catastrophically lethal. Almost
always, though, that is not the case, and as more is learned, the
initial severely ill victims are seen to be the visible tip of the
iceberg, with most cases actually being of only mild to moderate severity.
What makes this particular virus severe, and how does it kill you?
1) The virus has to get inside your cells in order to do its work.
Covid-19 has a mutation that allows it to attach to a cell easily and
firmly, so that is highly infectious, from cell to cell, and person to
2) Once inside the cell, it is highly efficient at replicating itself by
suppressing the cell's own processes, and redirecting them towards viral
3) At this point, a race begins between how much damage the virus can
continue to cause, versus the capacity of the body to tolerate the
damage and fight the virus off.
4) Since the virus is in the process of destroying your lung tissue, and
thereby diminishing the amount of oxygen that gets into your body, your
ultimate survival is affected by your "pulmonary reserve" (a
combination of how much damage your lungs can tolerate, and how well
your body can handle a decrease in oxygen).
5) In the end, it is up to your immune system to fight off the virus.
Conditions that have weakened your immune system (including simple old
age), will increase your vulnerability. In some cases, your immune
system is "normal", but still unable to mount an adequate response in
time (due to the individual variability of our immune systems). And
sometimes, your immune system will overreact, and go on to cause even
more damage rather than limiting it.
In the end, there are too many unknown factors to predict who will die
in any given case. But general predictions can be made: you are more
likely to die if you are elderly, (?male), have diminished lung capacity
(smoking), are out of shape, and have underlying conditions that have
already weakened some of your organs (especially your heart) and/or your
If, as is looking more and more to be the case (at least at this time),
Covid-19 will end up acting like a very severe flu-like illness, then
after a (unfortunate but bearable) wave of deaths (mostly of the
elderly), normal life will resume.
Sameul Fistel, MD is a retired physician (pathologist) and scientist.