Very, very mild: Covid-19 symptoms and illness classification
May 9, 2020 9:19 AM   Subscribe

What does 'mild' mean in the context of Covid-19? Geographer Felicity Callard details the multifarious meanings of mildness in this pandemic; how the term is used by different actors and what it comes to mean to those experiencing 'mild' cases. The mild, Callard argues,
will likely continue to be used for multiple Covid-19 purposes – whether adjudicating clinical symptoms, assessing the virus’s impact on the body, determining the need for formal healthcare services, or judging the likely time of return to functional normality, whether inside and outside the labour market. I therefore predict on-going epistemological, ontological and political contestation over the scope and definition of the mild.
posted by 3zra (20 comments total) 28 users marked this as a favorite


 
Yep. I like to think of it like professional illiteracy.

For instance, the number of people who say "the theory of evolution is just a theory" when they don't have the same definition of "theory" as scientists. Established theories are the best explanation we have for something happening. They reach this status by being tested repeatedly and generate predictable results. It's not a hierarchy. There will be no law of evolution because laws describe what things do (absent action by another force an object will remain in motion) and not how they work.
posted by Your Childhood Pet Rock at 10:08 AM on May 9 [6 favorites]


So 'mild' is anything prior to intubation in the ER?
posted by sammyo at 10:59 AM on May 9 [3 favorites]


So 'mild' is anything prior to intubation in the ER?

Supplemental oxygen is where the general threshold between mild/moderate and severe lies. You can feel like death with mild cases but that's because your body is doing its job. A lot of the stuff your body is doing that makes you feel like shit (fever, chills, diarrhea) is basically virus fighting. The problem is real death happens when your body does its job too little, or, in a lot of COVID-19 cases, too well. That's when you get severe cases.
posted by Your Childhood Pet Rock at 11:10 AM on May 9 [18 favorites]


One of the people defining "mild" in this piece is Patrick Vallance, who is a proponent of UK seeking to establish "herd immunity", a policy which makes the trade of allowing a certain number of deaths, in order for enough people to get infected, so as to establish some as-of-yet not understood adaptive immunity in enough people to perhaps limit further infection — even if we don't yet really know to what extent infected survivors gain adaptive immunity, or even for how long, which leaves open the effects of future waves of reinfection, as the virus spreads, respreads, and mutates along the way.

Notably, this approach received short shrift from the leadership in New Zealand, which seeks to limit avoidable death.

This is the strategy that Sweden is employing in all but name, whilst also failing to protect old and immunocompromised, at the same time. Both Vallance and Sweden's functional equivalent Anders Tegnell propose protecting those more vulnerable to the disease as a key element of their policy, but the governments of their respective countries are not doing much about that, while still pursuing a reopening of their societies (and economies). So those sectors of the population are dying at much higher rates than background.

Generally, one can look at the UK, Sweden, and the US, as effective "controls" for a mostly hands-off policy at the top-most level. And then one can take into consideration the resulting death rates and thus what their health officials would call a "mild" infection, given their governments' respective health policies, goals, and how the actual implementation has lead to death outcomes.
posted by They sucked his brains out! at 12:23 PM on May 9 [16 favorites]


There is also the potential for the mild to be wrapped in moralizing (and again racializing) discourses and injunctions, whereby those who are seen to have looked after their own health might be expected to experience no more than mild Covid-19. (‘Because he lives a healthy lifestyle and gets plenty of exercise’, one journalist wrote in relation to a white doctor’s recovery from Covid-19, ‘his immune system had no real trouble defeating the virus’ (Blech, 2020).) ... Cases of mild Covid-19 might well be used in efforts to firm up a stoic nation, recalibrate citizens’ understanding of suffering, and moralize further over the healthy and unhealthy body.

This is so interesting. Part of why I'm being so careful, beyond my partner's family's risk factors (and the fact that they're of color and might not be prioritized for health care in the same way white folks might be if they do get it), is that for me, a cold is absolutely not mild, or rather does not feel like my subjective experience of something that is "mild." So if this is worse than a cold, it's going to hit me like a ton of bricks—another metaphor, I guess. I had the actual flu last spring and felt like death. I had a sinus infection this past fall that dragged on for a month and kept me feeling like I had no energy to do much of anything. I can't know how the virus would hit me, so I feel like I should avoid it if I can. My working theory is that my immune system easily goes into overdrive with many infections and allergens, given how respiratory illnesses tend to go for me and how overblown some skin conditions and rashes I've had have gotten, some of which are autoimmune.

Also, though, this dovetails with a few things I've been discussing with folks regarding the supposedly healthy and their reactions to the virus. One thing I subjectively feel like I've seen a fair bit of are reports of people dying who were, for instance, triathletes or similar. I don't actually think there's much that's protective about being an athlete right now, and in fact, one theory I have is that it's possible that joggers and runners are getting more exposed right now to a virus no one has immunity to, by dint of their insistence on running around others without masks. Ultimately, everyone has to weigh their own risk factors, and I don't say this to blame victims. But anecdotally, many of the people I see and hear about doing this are white folks. It starts to feel like a possible pattern—of privilege and hubris followed by consternation and grief at the results. It's really unfortunate that writers' biases and assumptions about what makes one "healthy" could contribute to "healthy" runners feeling like they have nothing to worry about (even beyond the usual privilege white runners don't realize they have), and thus endangering themselves and others.

I'm also thinking about an early tweet I read out of Seattle that was talking about the triage conditions for rationing ventilators. I cried when I read them because they would mean a hospital would likely make the choice to let my ex die, were he to get the virus and require ventilation, simply because he's over age 40, obese, and affected by a few preexisting conditions. Similarly, someone I mentioned in another comment earlier who had died was a larger woman. I've been wondering how that influenced the course of her illness and care. My current calculations are a terrible catch-22: Go outside, try to exercise to treat my own chronic condition that leads to my being overweight, but possibly catch the virus from a runner swooping by without a mask, or stay inside, don't exercise effectively, gain weight, and still possibly get it from a delivery from a contaminated Queens Amazon facility (with perhaps worse effects due to reduced cardiovascular conditioning).

Personally, I guess I have to figure out a way to start doing more indoors. I don't have a ton of motivation to do it (or anything right now), but I'm starting to look into it. But yeah, I wish more people understood the nuances of how the discourse and wording we use can affect people's real behavior, and took pains to assume less about individuals' health on the basis of visual factors such as being of color or being overweight.
posted by limeonaire at 12:33 PM on May 9 [13 favorites]


One thing I subjectively feel like I've seen a fair bit of are reports of people dying who were, for instance, triathletes or similar. I don't actually think there's much that's protective about being an athlete right now, and in fact, one theory I have is that it's possible that joggers and runners are getting more exposed right now to a virus no one has immunity to, by dint of their insistence on running around others without masks.

I have, too, but I have interpreted those reports as refuting some of the just-world theorizing happening in the brains of a lot of Americans right now--highlighting the fact that Covid is not something a "healthy," youngish, well-situated white person can or should brush off as being a disease that affects "other people." Like, among my white conservative family members, there is a real sense that we don't need to worry about it, because this is something that gets people who are incarcerated or living in assisted care, or who made "bad choices" that led to pre-existing conditions.

Basically, those reports of triathletes dying from complications of Covid I don't think are because of a statistical feature where they're more susceptible; I think it's because news editors recognize the need to remind us that we all need to look out and take precautions, and stop kidding ourselves that if we get enough exercise we'll definitely be okay and anyway the symptoms will be mild, so who cares?
posted by witchen at 12:48 PM on May 9 [19 favorites]


Yeah, I do think it's meant to counter just-world theorizing, for sure. I just have seen those videos showing how the virus disperses when people breathe heavily, and it makes me wonder if even beyond messaging to folks to take this seriously, we should be cautioning people more about their running practices around others, both for their health and for others'. This was a pretty good article about the ethics of this.

Also, I was about to say, this article makes me ruminate on various notions of what's "healthy" and what's "unhealthy": All other factors aside, am I more healthy if I have an immune system that responds in a robust manner, or less healthy? I may be more healthy, because my body is responding to a viral threat, while feeling less healthy, or even, in extreme cases, being somewhat endangered by how strongly my body is responding. So what does healthy even mean? Not a lot, I feel like, and use of the word "healthy" can, as the original article notes, obscure a lot of assumptions.

Counter to common moralizing about being overweight, for instance, some have found that being overweight can correlate with better health outcomes and longer lifespan among older women (in general; not sure about this virus specifically). Many people find themselves above (or below!) normatively defined weight classes while still being healthy on every other measure. My mother and I, for instance, both are overweight or obese by typical definitions, and we both have invisible and chronic reproductive, autoimmune, and mental health conditions. But we are by most physical measures in good standing and within the normal range of human experience, with normal to low blood pressure, nicely low resting pulse rate, the ability to gain and maintain muscle through sustained physical activity, good cognitive function, etc. We just happen to store fat in certain ways, probably because of some combination of our Ashkenazi Jewish ancestry, our particular family's epigenetics, and reproductive health conditions that influence our hormones (the likes of which are statistically more common among women where I grew up, likely due to the spread of inadequately remediated radioactive waste in the local environment). Ultimately, we're just human and deserving of as much care and consideration as others.

I've written about some of this stuff before. But I do find it all very interesting, and speaking from my own experience, I know that my weight was a confounding factor and sparked bias that kept me from being diagnosed with at least one of my chronic conditions for way longer than should have been the case. So I'm glad someone is talking about the nuances of language regarding what is "mild" or "healthy."
posted by limeonaire at 1:07 PM on May 9 [10 favorites]


I think the disconnect between medical terminology and what laymen know isn't a new issue. It's just at the forefront because in this global pandemic, lots of people but especially those who don't read beyond the headline are politicizing everything for their own ends.

There's the classic faces pain scale where apparently anything lower than an eight isn't medically relevant. I've had stomach pain so bad that I considered death to be preferable, except that the pain was so bad I couldn't move out of the fetal position. Even so I'm not sure I would classify that as an eight.
posted by meowzilla at 2:40 PM on May 9 [1 favorite]


> I'm also thinking about an early tweet I read out of Seattle that was talking about the triage conditions for rationing ventilators. I cried when I read them...

Hopefully it will make you feel a bit better to know that that tweet was a hoax and not based on any reality in Seattle.
posted by gingerbeer at 4:06 PM on May 9 [4 favorites]


The author appears to be railing against the overuse of the loaded word "mild" in much the same way I tell people to f-off whenever they use the word "glitch" (unless followed immediately by "art"), so I appreciate the position, but I can't help but feel that they've been driven to this point not because of a lack of tight definition, as that is common throughout the English language, but for the lack of supporting structure to help with an appropriate reaction.

When this virus first hit the headlines, I honestly believed this would be an exercise in testing and disclosure. The right kind of symptoms would result in a test, that you would need to disclose to your professional relationships (and friends), who would then warn their network of potential exposure where appropriate, then the results would be positive or negative, which would result in either more tests down the line, or life returning to normal until the next potential infection.

This structured response appears to be almost absent.

Instead we have panicked lock-downs, travel restrictions and hundreds of thousands to tens of millions of newly unemployed, depending on where you live. Given that "mild" still means "leper", regardless of if it's a discoloured toe or just shy of reaching for the oxygen tank, you can't help but feel managed rather than informed whenever the word is used.
posted by krisjohn at 4:45 PM on May 9 [6 favorites]


> I'm also thinking about an early tweet I read out of Seattle that was talking about the triage conditions for rationing ventilators. I cried when I read them...

Hopefully it will make you feel a bit better to know that that tweet was a hoax and not based on any reality in Seattle.


Hmm, I don't know that it was a hoax. There were actual care-rationing guidelines discussed at one point, at least, that provoked a federal civil-rights complaint. I believe a health-care professional was privy to the early discussions of this and spoke up about it online. Thankfully, it sounds like an investigation and vocal response was issued to this. I'm so thankful to all the people who have bravely spoken up and blown the whistle on stuff like this.
posted by limeonaire at 7:07 PM on May 9 [4 favorites]


[A few deleted. This thread is sort of zooming off the track all over the place. Let's try to stick to discussion about the posted article here, and post general thoughts in this more general Covid thread, or one of the many other threads on various aspects of the disease / situation.]
posted by taz (staff) at 6:25 AM on May 10


tldr: It is stupid to use a single value-inflected word to describe the experience of an illness that has a broad range of outcomes.

Proposed alternative: Instead of "mild", use "non-intubated"
posted by storybored at 11:06 AM on May 10 [1 favorite]


I found this article baffling until I remembered I'm a great big nerd and not everyone works with clinical trial data every day. I confess to not finishing it, but the following is relevant to this discussion. (I did search for some of the terms below in the article but didn't find any; apologies if any of this is redundant.)

Medical researchers deal daily with describing the severity of illness, injury, and any unfortunate thing that can happen to a patient ("adverse events", or AEs) and have developed criteria which help keep these assessments consistent across studies. Criteria differ depending on the patients and the condition; for example, different FDA subgroups release AE severity grading criteria for studies involving cancer patients and healthy volunteers in vaccine clinical trials.

For healthy volunteers, grades boil down to...
1) Mild: asmptomatic or mild symptoms, and patient can go about their daily routine without changes. If present, symptoms are easily tolerated without intervention.
2) Moderate: symptoms are present and uncomfortable, and interfere with daily activities to some degree.
3) Severe: AE prevents normal daily activities entirely.
4) Life-threatening: Urgent intervention required. Hospitalization automatically goes to this grade.
5) Fatal.

These well-established and widely-used criteria (at least in the medical research and regulatory arenas) allow for greater nuance in describing the impact of COVID-19. Someone who has a fever and cough, and has to stay in bed, would have a severe case, not "mild"!
posted by esoterrica at 12:08 PM on May 10 [11 favorites]


There's the classic faces pain scale where apparently anything lower than an eight isn't medically relevant. I've had stomach pain so bad that I considered death to be preferable, except that the pain was so bad I couldn't move out of the fetal position. Even so I'm not sure I would classify that as an eight.

Just for future reference, that would definitely have been a 10. If you are so much pain that you cannot move, that is definitely a 10.
posted by LizBoBiz at 2:51 AM on May 11 [1 favorite]


That’s why the pain scale has always been crap. I can imagine pain being much worse, so there have been times where the top end of the scale is just garbage.

And, I’ve had relatively minor injuries cause disproportionately bad pain, which then confuses things more- I have had cystic acne that can be nearly as bad as the worst toothache.

And I think to myself “but if I were in a car accident and a limb crushed, it would be so bad so this can’t be that high.”
posted by [insert clever name here] at 8:38 AM on May 11


I agree that phrasing it as "worst pain you can imagine =10" is nonsensical. I just think of a 10 as pain bad enough that it wipes away conscious thought and cannot be ignored. It doesn't matter that being drawn and quartered would be worse pain.
posted by benzenedream at 9:04 AM on May 11 [2 favorites]


I highly prefer the functional pain scale, because I very frequently rate pain as 3 or 4 and then am like, "Yeah so I lost the entire day because I couldn't do anything, even watch TV. But like, it really doesn't hurt much."

It does make me wonder about the severity of the symptoms people are experiencing from COVID-19. This columnist, for example--are those experiences worse than my migraines? Or is it affected by the experience of someone who's never felt something like that before? I was flabbergasted when I got to the point where he said he was writing this column while in the middle of those symptoms. I was like, what? If it's that bad how are you writing? I couldn't write anything that bad during the worst of my migraines. But then people are talking about not being able to survive anything worse, so it must be really bad, much worse than anything I've ever experienced. But is it? Or is your perception influenced by the pain and other symptoms you've actually experienced before? Are healthy people basically experiencing the equivalent of migraines and because they've never had to deal with that before it's "worse than surgery or childbirth"? Idk.

I dunno. Maybe I'm just trying to reassure myself that if I get it I won't end up completely bed-bound for weeks straight, which is what I'm worried about given that managing my chronic illness is difficult enough, adding COVID on top sounds like it might kill me just out of the sheer force of this malaise people are experiencing.
posted by brook horse at 11:02 AM on May 11 [3 favorites]


My parents have both had COVID-19 and recovered, back in March. They're in their 60s, both in decent health but my mom's family has rampant heart disease and diabetes.

My dad is a podiatrist; he had a patient the first week of March with a severe cough, visibly sweating, who insisted "it's just allergies, not that bad" and ignored my dad's stern warning that he needed to go home and call his GP immediately. 10 days later, my dad had a low fever and mild aches for 3 days; once he was fever-free for 24 hours, he went back to work. My mom got sick around the same time but took about 3 weeks to fully recover -- she had bad congestion, fever, no energy, and eventually a sinus infection; she also lost her sense of smell and taste which was the tipoff that it was COVID.

My dad's patient, who never did see his GP as far as my dad knows, turned up at the ER with shortness of breath in the last week of March, and was dead by the end of the month.
posted by nonasuch at 11:11 AM on May 13


On a related, worrying note, there's an article out here in Italy today which puts "mild" Covid cases in a whole other light.

This is the ADNKronos agency piece (here's a Googletranslation), and here's a second article (Googtransl) that adds considerations from a virologist at University of Milan, who also references a paper published in Radiology, where there's some clinical details.

Basically the head of Italy's emergency service organisation outlines a growing number of what he calls Covid-like cases, in which patients display next to no typical symptoms and test negative with naso-faringal swabs, but whose radial artery blood test show severe oxygen depletion, and whose x-rays then show the interstitial pneumonia typical of Covid-19. In some cases, the virus is subsequently found only in alveolar liquid.

I'm not seeing this reported outside of Italy yet, so... probably good to wait for more on this from other sources. But seeing how there's consensus forming around a correlation of Kawasaki cases in kids exposed to Covid-19... it struck me as somewhat ominous. (Yeah, Italy's basically doing a major relaxation of lockdown measures tomorrow, so...)
posted by progosk at 3:59 PM on May 17 [3 favorites]


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