Offline: COVID-19—bewilderment and candour

Richard Horton

Published: April 11, 2020


As deaths accumulate, the early message that severe acute respiratory syndrome coronavirus 2 causes mostly a mild illness has been shown to be dangerously false. One in five patients develop complications and are at grave risk. A further misunderstanding concerns age. An impression was given that only older people are at risk of serious illness. But the average age of non-survivors is under 70 years. Two-thirds of those admitted to hospital in China were younger than 60 years. The complexity of illness in these often quite young patients is challenging to comprehend. Patients are not commonly dying, for example, from hypoxaemia. The cause of death is often cardiovascular, with high-sensitivity cardiac troponin I being a more reliable marker for mortality. 

The number of patients admitted to intensive care units has been doubling every 2 days. Deaths are so frequent that hospitals have created emergency mortuary space, often in car parks, moving bodies at night to avoid media scrutiny. Intensive care teams are doing truly remarkable work. But it is a huge physical and mental struggle. 

The focus of the political debate about coronavirus disease 2019 (COVID-19) has so far been almost exclusively about the public health dimensions of this pandemic. But at the bedside there is another story, one that has so far been largely hidden—a story of terrible suffering, distress, and utter bewilderment.


The Lancet – DOI: