I have a minor medical-related degree. During the time I earned it (and actually for years before) I cultivated a deep interest in epidemic disease. It has always fascinated me. Because of that I come at this current crisis with a bit of a different perspective, and I dare say with a bit more understanding than your average news consumer. The most frustrating thing to watch, for me, is intelligent, educated people downplaying the seriousness of the situation. Here is why.
First, I think we need to look at some real numbers that actually are relevant. One thing that is NOT relevant is to cite numbers of infection and death from flu every year. That isn't the same virus, and it has nothing at all to do with this one. Additionally, this one is far more virulent (it spreads faster and more easily) and has a higher fatality rate.
Here are real numbers. We can't rely on numbers out of China - that we know based on their behavior and false information to this point. We can know what is happening in Italy, which is currently the country next to China in terms of the spread of the virus. As of today, Italy reports 10,149 diagnosed cases (many more will remain non-diagnosed and unknown), and of those 631 have proven fatal. This means that the rate of death is a little above 6%. In other words, a little more than one in twenty people infected are dying. (Common logic suggests that of those non-diagnosed, about 1/20 could die as well.)
In contrast, in any given year the common flu virus kills about 0.1 % in a Western country, or about one person in one thousand.
Just yesterday, I heard an educated person declare - "Well, the flu killed at least 20,000 people in the U.S. this year, and COVID-19 only 26." But that is a ridiculous comparison! The CDC estimates about 34 million people in the U.S. have had flu this season; there were indeed about 20,000 deaths so far this season. That is a death rate of about 0.06%, or a little over one in 2,000. Now, let's say 34 million people got COVID-19 - which is within the realm of possibility. Given the current stats (they may change over time as the behavior of the virus changes and more information and data is gathered), about 2,040,000 would die. This is a different virus, and it behaves differently. It is many times more dangerous and infectious than is the common flu virus. This is a "known". A spokesman for the CDC this morning said in a press conference that COVID-19 is "ten times more" infectious. He was speaking in a generality. It's actually not only apparently more infectious but as I explained by the math, about 15-20 times more fatal than flu.
We know this one is bad. How bad, no one is certain yet. There are a lot of unknown factors that make its course difficult to predict or to prepare for. For me - and I'm sure epidemiologists would agree - the most alarming are these:
- We still aren't certain how it's transmitted, and it is spreading very quickly. Given other coronaviruses (the past 18 identified), we assume the germs linger on inanimate surfaces, and can be passed object to hand to face. We suspect it is also traveling through the air; when one person coughs or sneezes, another inhales that air and gets it.
- We don't understand much about "carriers" in relation to this virus. For example, are people who are simply carriers (show no symptoms) able to easily transmit the virus? And why are some people more immune - children, for example, don't seem to be acquiring the virus as easily as adults.
- This virus is believed to be able to mutate quickly and dramatically. That means that what may be true about it today, could change by next week, making it more deadly.
- It is spreading faster than we can contain it. Even in the U.S., where our president wisely halted airline flights from critical regions and closed the border, we were able to slow it but not stop it. It has gained hold here within a mere few weeks, and is set to explode.
- There is some evidence that it does not leave the sufferer immune to a second bout of illness.
- We don't know what the incubation period is - that is the time between when you are exposed to when you show symptoms. That's why the recommendations for self-quarantine vary from 2 days to 14. This is important because we don't know yet whether a person with no symptoms (yet) can transmit it. If that is probable, this will be a much different journey for all of us.
People ask what we can know for certain. I would offer the following.
- Our lives will be affected. Every life. Schools will close, events will be cancelled. Things we take for granted with be changed. This will be temporary, but no one knows how long it will be. People will see churches close, workplaces close - people will work from home. Non-essential services and businesses may close. Although these are temporary changes, they will leave permanent effects on the way we see our world and do business and live.
- The virus will spread, into nearly every corner of the Westernized world (so far, sub-Saharan Africa and much of South America has escaped, but that may change soon). One widely-respected epidemiologist predicted yesterday that about 80% of us will be infected in the U.S. About 50% of those will acquire pneumonia. And about 6-10% of those infected will die. Every family will be touched.
- We know that this virus targets the lower respiratory system, much like SARS did. In fact, once this virus becomes life-threatening, it is technically a sub-strain of SARS. Those most vulnerable are people prone to respiratory illness and have conditions like emphysema, asthma, COPD. The elderly will be especially hard-hit.
- It will affect the way we do business, the stock market, buying and selling. Goods we take for granted may become scarce temporarily as international and domestic transport suffers.
- Medical supplies will be an issue. Over 90% of our everyday supplies come from CHINA, and the Chinese govt. has already discussed denying the U.S. supplies as a political weapon. The equipment your doctor's office uses is largely manufactured and maintained from - elsewhere in the world. (President Trump has already expressed this problem and a desire to change it.)
- Treatment will become problematic in areas where the virus has taken hold; isolation beds are not common and will be filled quickly. (The average hospital has 10.) Clinics and hospitals will become over-burdened and available care scarce as resources and staff are stretched to the limit.
- Numbers of those infected will double about every 5 to 10 days. It will explode, in other words. There is no shot, no drug, that will stop a virus once it takes hold. Again, our best defense is to avoid crowds, keep hands off face, avoid people who are ill or who have traveled recently.
Americans need to reconsider their view of disease. Too many Americans casually go to work sick or send sick children out, and infect others. It's selfish and it needs to stop. We need to start thinking about how we infect others and take care of each other better.
It's interesting to me, from a scientific standpoint, that this virus is avoiding the very young - although children are assumed to be carriers and may spread it. The Spanish flu - 1916-18 - killed millions worldwide; it was also a virus (rather than a bacterial disease). It also targeted people from 25 to 35 years of age. In the medical world, this is known as a "W Pattern": where most viruses target very young and very old, these viruses have a peak in the middle as well - and kill young, healthy adults. To this day, scientists don't understand why Spanish flu did that - and COVID-19 seems to adopt the same pattern.
Spanish flu shared something else in common with COVID-19: it mutated unexpectedly, quickly and unpredictably. Its initial trip around the world looked much like this virus. A few vulnerable people died here and there. People had a world war to contend with and paid it not much attention. But just as it seemed to be waning, it turned on its heels and came back stronger, more virulent, and started the real killing. In the end there had been 3 distinct waves of it, over two years.
As a teen, I first began reading about the Black Death - the plague of 1347-51. Although most scientists agree it was some form of Bubonic plague (from a simple bacterium) or a combo of two or three types of plague, we still don't know exactly what happened. Seven-hundred year old bones from mass graves tell us that the bacterium causing plague was present, but what part it played isn't apparent. What fascinated me was what the plague did to the social fabric and course of history. No one was spared - no social class. It changed the economy, the class structure, the religion, and even the way Europeans viewed the world. Some changes were not for the better. It came also from the Far East, and traveled the world. Before it was over, from one quarter to as much as two thirds of Europe was dead. In our age of modern medicines, we won't see that. But we may see some big changes and shifts in attitudes and social fabric.
Interestingly, the plague of 1347 did not wax and wane with the seasons as do most epidemics. Thus, it didn't die out for years. The Spanish flu - a virus - didn't either. There is early evidence that COVID-19 may be oblivious to weather changes. I think all are hoping that is wrong and that, like the more predictable common flu virus, it will die out in summer months (remember the seasons are reversed in the southern hemisphere).
During my education, I came to understand that within my lifetime we would see a devastating pandemic. But everyone thought it would be bacterial. As we abuse antibiotics (and we do just that when we don't take them as directed, when we take a family member's and not one specific to our illness, when we take the wrong antibiotic, when we demand a doctor give them to us for a virus for which they are worthless) we weaken our resistance to disease and render antibiotics useless. One day, a bacterium will pop up that we can't stop (things like MRSA - "flesh-eating bacteria" are the early warning signs of that day coming), and we will be introduced to a world before antibiotics where our ancestors lived in constant fear, and seeing a child or a family member die an early death was commonplace. This viral threat is a bit unexpected.
Our scientists are working not only to find a vaccine (which will protect those uninfected, not cure those who have it), but to decrease the time it takes to develop it - in the U.S. (the world leader with France) - that means about two years. They are trying to do it in one year to eighteen months. However, in a country thrown into chaos, manufacturing enough to go around and then to vaccinate everyone who wants it, is another question entirely. Our president and his administration is not being "paranoid". Yes, the Democrats are politicizing the tragedy - did you expect anything else? They may sing a different tune when their family members fall seriously ill, or heaven forbid their colleagues die of it. The administration and the CDC is walking a tightrope between trying to inform us and also trying to prevent a catastrophe born of poor preparation. It is believed that many of the deaths due to the flu epidemic of 1916-18 could have been prevented, had the president taken more decisive action around isolation, funding, containment, and public education.
I still think the worst will be a bacterial disease. But the behavior of COVID-19 is alarming. The number of unknowns means that we have good reason to be on the alert. While things like hoarding toilet paper is a bit silly, we need to stop joking about it. I suffer from chronic asthma. My best friend has COPD. My mom and dad are elderly - my dad 87. When this virus hits our little city in the next few weeks, I will be very fearful for the people I love. It's really no laughing matter to me. Two years ago, I nearly died from the flu. It jolted my reality a bit.
Meanwhile, when I see people insist it's all a big hoax, I sigh and assume they will very soon understand just how ignorant they were. It is a certainty that their views on disease will be altered. They aren't wrong to scold people who are in a panic about it. We need to be calm and learn as we go. But to assume there is no danger is equally ignorant. Equally as stupid. I wonder how much wiser we will all feel about six months from now as we look back on the pending disaster we once scoffed at.
For me, understanding the reality and preparing well for the worst case scenario, is the wisest thing that any of us can do.
For me, understanding the reality and preparing well for the worst case scenario, is the wisest thing that any of us can do.