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Terms 

The Bug

  • Coronavirus were thought to be innocuous until 4 able to cause severe illnesses popped over the past 20 years.

    Coronaviruses – a group of viruses distinguished by spike-like projections which give the appearance of a solar corona. Of the seven known to infect humans, four can produce severe respiratory infections. Primarily transmitted via droplets produced when sneezing and coughing.

  • SARS-CoV – The name of the coronavirus which appeared in late 2002 in China and spread to 26 countries before it was almost completely stamped out by July 2003. No known transmission of the virus has occurred since 2004. Infected approximately 8,000 and killed approximately 10% of them. The mortality rate above 60 years of age was approximately 50%. Ian Lipkin hand-carried 10,000 test kits to Beijing and trained clinical microbiologists on their proper usage at the height of the SARS epidemic.
  • SARS – Severe acute respiratory syndrome – the name of respiratory illness caused by the SARS-CoV coronavirus. Able to produce both upper and lower respiratory infections.
  • MERS-CoV – another highly dangerous coronavirus which first showed up in Jordan in April 2012. Causes MERS. Infected 2,500 people and killed approximately 35% of them. Only very rarely found now. Ian Lipkin was the first outside investigator invited by the Saudi Arabian government to investigate the MERS outbreak.
  • MERS – Middle-east respiratory syndrome – the name of the respiratory illness caused by the MERS-CoV coronoavirus. Biggest outbreak outside of the Middle East, which occurred in The Republic of Korea in 2015, was started by one traveller returning from the Middle East.
  • SARS-CoV-2 – the present coronavirus. Closely related to the first SARS-CoV virus, but more transmissible and less deadly. Causes COVID-19. Mortality rate still to be determined but most experts seem to think it will be around 1% – making it ten times more dangerous than the common flu. Most dangerous for older people and those with underlying conditions.
  • COVID-19 – the name of the respiratory illness caused by SARS-CoV-2.

The Illness

  • Incubation time – time between exposure and the first development of symptoms (cough, fever, etc.).
  • Latency period – time between first exposure and when someone becomes able to pass a virus on.
  • Communicable period – time during which an infected person can pass on a virus.
  • Serial Interval or period – the average time between which an infection is acquired and then passed onto another.
  • R0 – the average number of people an infected person then infects (pronounced R-naught). If the average infected person infects three other people, the average R0 is 3. the R0 needs to be below 1 for the infection to stop spreading. The most recent figures suggest the R0 for COVID-19 is about 2.0 – which would make it considerably more contagious than most flus.  Much more study is needed, though, to determine the actual R0.

A New Virus in Town

It had such humble beginnings – an outdoor live animal/food market somewhere in Wuhan, the capital of Hubei province in China. Who would have guessed that one bat (probably) could have unleashed such havoc.

Yet here we are. Thousands of people have died. Whole countries have isolated themselves.  Economies are tanking. Recession fears have erupted. All because somebody brought the wrong animal – stressed out of its gourd, no doubt, and spewing virus particles like Pig Pen spews dust – to a market.  One of those viruses – a coronavirus – jumped to a human and here we are. (Ian Lipkin has said those live animal markets are going away, and China has now banned them.)

The COVID-19 producing coronavirus.

Coronaviruses didn’t use to be so alarming. Twenty years ago, they were thought to be harmless producers of the common cold. Not so anymore. Of the seven known to infect humans, at least three can kill.

The first coronavirus to jump to humans called SARS (severe acute respiratory disease), creating an epidemic which authorities throttled to death with quarantines, isolations, etc. in 2003, killed almost 10% of those infected, and almost 50% of people 60 years or older.

SARS-CoV bug which caused it was nasty, but it was nothing compared to the next coronavirus to appear – the MERS-CoV (Middle East respiratory syndrome) virus that popped up in Saudia Arabia in 2013 and spread to several countries. MERS didn’t infect many people but it was astoundingly deadly, killing about a third of them.

So when health authorities had nightmares of a major flu epidemic to match the killer in 1918, it’s no surprise it’s the coronaviruses they turn to first. Hence the alarm when a brand new coronavirus called SARS-CoV jumped to humans in the animal markets in the Hubei province of China in December 2019. It only took until January 30th for the outbreak to be declared a public health emergency of international concern.

It turns that new coronavirus, SARS-CoV-2, shares some striking similarities to the first SARS (SARS-CoV) virus. Its genome has an 86% similarity with SARS-CoV; both likely jumped from bats to humans; both attach to the same receptor (angiotensin-converting enzyme 2 (ACE2) in the lungs; both appear to be mostly spread through the air via respiration; both have a similar mean incubation time (the time between exposure and the development of symptoms); and both appear to have about the similar “serial interval” time.

People who get severely ill do so in the same general way. In both the first SARS and the present SARS, the respiratory illness which can ensue – called COVID-19 this time – takes approximately 8–20 days after the first onset of symptoms for the bug to get into the lungs and wreak havoc.

SARS virus

The SARS virus had a higher mortality rate but COVID-19 has already killed more people.

That’s where the difference ends, however. The first SARS was far more deadly but also far easier to control than the present one. By the time the first SARS epidemic was squashed out, approximately 8 months after it had begun in July 2003, it had spread to 26 countries, but was concentrated in five (and in Canada was found in only one city (Toronto)). It had infected a total of 8,098 people, 774 of whom died.

COVID-19 blew through that number quickly. In COVID-19’s short life – just 4 months at this point – over 100,000 people have come down with it.

SARS was defeated the way epidemics generally are – by identifying who was ill as quickly as possible, and then using social distancing (refraining from as much contact with other humans as possible), isolation and and quarantining individuals. As it’s done repeatedly with COVID-19, China quickly built a hospital (10-days!) that was devoted solely to treating SARS cases.

SARS had some vulnerabilities that made it easier to put down, however.  Most people infected with SARS quickly became quite ill – making them easy to spot and isolate.  The virus was not particularly easily transmitted, and people didn’t transmit it until they showed symptoms (and thus were able to isolate themselves and stop the transmission of the virus).

COVID-19 is less deadly, but because it often produces a mild – or at times no – illness at all, it can easily be spread unknowingly. By the time the first COVID-19 case showed up in Seattle, the virus had had enough time to genetically mutate, and six or seven generations of transmission had probably already occurred.  As we’ll see with Italy, infection rates can ramp up astonishingly fast in some cases.

COVID-19’s ability to be transmitted before a person shows symptoms may make it more difficult to catch. Some evidence suggests, though, that transmission rates are very low before symptoms appear and that asymptomatic transmission may not be a big concern. Finally, COVID-19 appears to be more easily transmitted than the first SARS virus was.

The goal in stopping an epidemic is to stop what’s called the R0 – the spread of the infection from one person to another. The 1918 flu epidemic was so deadly for a couple of reasons. First, governments hid what was going on – allowing it to spread. Plus, we were in the middle of a war with large troop movements occurring from coast to coast, which spread the virus. Plus, the HINI virus (which caused the 1918 flu) was deadly and contagious, killing from 20-50 million people. Plus, we had many fewer tools to treat the virus back then.

SARS was deadly but probably not as contagious as HINI or COVID-19.  It became clear with SARS that the ability to identify and isolate SARS patients within 4 days of their becoming symptomatic played a key role in bringing the infection under control.

Those infected were quickly isolated (either at home or in the hospital) and anyone who came in contact with a case underwent some sort of quarantine. For instance, Toronto Public Health identified 2,132 potential cases of SARS and then 23,103 contacts who came in contact with them. Both groups were required to quarantine themselves and were given health checks from the Public Health Department. In-home isolation was so effective that SARS was only transmitted to other house members 6-10% of the time. The vast majority of transmissions, in fact, occurred in the hospitals.

The Ro for COVID-19 right now is believed to be around 2.2 but that number will probably fall as the virus gets better contained.

Update: 3/13 – In a shocking and troubling finding, the Institute for Disease Modeling calculated that the new coronavirus is roughly as equally transmissible as the 1918 flu, and just slightly less severe. Their data also suggests that it is more transmissible and severe than all other flu viruses encountered over the past 100 years.

Trying Not to Be Italy 

Every country right now is praying they will not to be the next Italy. Italy provides a classic example of how a viral epidemic can, from very small origins, quickly spin out of control.

Italy’s first two cases (from two Chinese tourists) were reported on January 31st. A week later, the third case (from a person who had been to China) was reported. A couple of weeks later, 16 cases were reported in Lombardy in northern Italy.

The Gist

  • COVID-19 follows on two other deadly coronaviruses (SARS, MERS) which have appeared in the last 20 years.
  • The virus apparently jumped from an animal – probably a bat – to a human in a live animal market in Hubei province in China.
  • The present virus appears to be much more contagious but less deadly than SARS or MERS. Although it’s substantially less deadly, its faster spread has lead it to already cause more deaths than either virus.
  • China’s extensive mobilization – building over a dozen temporary hospitals and many more isolation centers, its quarantines, rapid diagnostic procedures, and authoritarian measures – have helped bring the infection, at least for now, under control.
  • Despite quickly shutting down air travel from China, the infection in Italy – which began with just two tourists – has exploded. In just a matter of weeks over 15,000 people have been infected and over 1,000 people have died. The high death rate – the highest reported yet – may reflect Italy’s aging population.
  • South Korea presents a success story. Rapid government action and a strong plan (they had a plan) including rapid and extensive testing, clear communications, rapid isolation, etc. appears to have dramatically blunted the outbreak there.
  • The U.S.’s anemic and muddled approach including the failure to rapidly develop test kits, President Trump’s overly optimistic statements, his contradictions of his advisors, etc. has left the U.S. in catch-up mode. It has tested far fewer individuals than some other countries, leaving the extent of the viral spread unclear.
  • Other than the fact that it’s likely to be much higher than the flu, the mortality rate is unclear. Experts generally expect it to settle in somewhere between 0.5% and 2.0%. It is clear, though, that the young are largely untouched and the elderly and infirm, particularly those with comorbid illnesses like hypertension, heart disease and diabetes, are most at risk. People with ME/CFS are assumed to be at increased risk.
  • The chances of catching the coronavirus in the U.S. right now are probably quite low but most epidemiologists appear to believe that the virus will eventually sweep the U.S. and other countries.
  • As the test kits finally role out in large numbers over the next while, we should learn much about the extent of viral spread in the U.S.
  • The big goal now is to “flatten the curve”; i.e. keep the infections to a minimum for as long as possible to allow our medical system to free up as many resources currently being devoted to caring for people with the present flu. The U.S. does not have enough intensive care units or ventilators to care for two major flu outbreaks at the same time.
  • Since there is no vaccine for the coronavirus, more people will likely catch it than catch the flu. Most will experience mild or no symptoms but a significant number of people will require hospitalization.
  • Hand washing, social distancing (keeping 6 ft away from other people, avoiding crowds), cleaning surfaces, not touching one’s face, isolating oneself, etc. are the primary means of avoiding the virus.
  • Some suggestions from alternative health doctors on ways to bulk up the immune system are given in the blog.
  • Opinions differ as to whether summer will halt the spread of the virus. Some believe it will become endemic; i.e. be present in some form from here on in.
  • A vaccine will hopefully be present within a year.

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The virus then exploded into action. Just two weeks later,15,000 confirmed infections and over 1,000 deaths have occurred, leaving Italy – perhaps because of its older population – with an astoundingly high death rate (@ 5%) . This is despite the fact that Italy, like the U.S., stopped airline traffic from China early in the outbreak. Italy moved to close down the northern half of the country – quarantining its 15 northern provinces.  That hasn’t worked either. Italy recently closed schools and today announced the closure of all businesses across the country. The entire country has effectively been isolated from the rest of the world.

Trying to Be South Korea

South Korea presents an entirely different picture. It was one of the earliest countries affected, and as of today, 7,700 confirmed cases have been reported – far less than in Italy. The number of new infections, however, has been falling steadily, and it’s hoped that South Korea is turning a corner.

Why does South Korea appear to be on the mend while Italy wilts? Justin Fendos, a PhD in cell biology working in South Korea, reported that after the SARS and MERS outbreaks, South Korea invested heavily in infectious disease control. When the COVID-19 outbreak occurred, the South Korean government followed their infectious disease protocols to the letter. Those included “an aggressive and transparent information campaign, high volume testing, quarantine of infected individuals, treatment of those in need, and disinfection of contaminated environments”.

The South Korean government’s attempts have been remarkable.  The information campaign staged by the government has provided an impetus to S. Korea’s citizens to act responsibly during the outbreak and they’ve bought in.  Text messages regarding the state of the outbreak are provided continuously. Rapid, accurate, high volume testing has been a mainstay of the government’s approach. Korea has already tested over 200,000 people, and has the capacity to test 10,000 people a day. Every day the Korean government communicates the recent locations – the restaurants, shop, churches, etc. –  infected people have visited to warn people to stay away from them.

After a 61-year-old woman in Daegu refused testing twice (after coming into close contact with an infected person) ended up infecting almost 40 people, the government made violations of quarantine by infected patients an imprisonable offense.

U.S. Lagging Behind

“The United States is far less prepared than other democratic nations experiencing outbreaks of the novel coronavirus.” Former Dept of Homeland Security expert

Compare that to the U.S. response. President Trump acted quickly on January 31st to stop foreign nationals from traveling to the U.S. from China – a move that probably bought us some extra time – which the U.S. mostly squandered.  The U.S.’s response has been embarrassingly anemic.

It didn’t help that Trump’s National Security Advisor, John Bolton, removed the government’s entire pandemic response chain of command, including the White House management infrastructure – which had been created to ensure a rapid and efficient response to a pandemic.

The National Security Council’s entire global health security unit was shut down, the funding for the global health section of the CDC was hollowed out, the $30 million Complex Crises Fund was eliminated, and the administration attempted (but failed) to cut the U.S. Public Health Service Commissioned Corps by 40%.

In contrast to the clear and concerted response from the South Korea government, the U.S.’s response has been muddled. Two days after the CDC on February 24th warned that an outbreak in the U.S. was a near certainty, President Trump said he thought the number infected was “going to be down to close to zero”.  Two weeks later, despite the difficulties in getting test kits, 1,000 people were confirmed to have the virus in the U.S..

Comparing the coronavirus to an ordinary flu, former Chief of Staff Mick Mulvaney asserted the media was paying attention to it in order to bring President Trump down.  Likewise, Sean Hannity suggested that the media attention might be “a fraud” perpetuated by the deep state to spread panic in the populace, manipulate the economy and suppress dissent.”  On Tuesday, Anthony Fauci told Hannity to “make sure” that his viewers knew that the coronavirus “is 10 times more lethal than the seasonal flu“.

On March 11th, with over a thousand confirmed cases and the stock market tanking, President Trump changed course and called COVID-19 a “horrible infection”, and then announced a European travel ban.

Trump’s travel ban may not help.  The World Health Organization and epidemiologists assert that if the virus is present in a country – and it’s now in 125 countries – all available resources should be put to identifying patients, isolating them, treating them and tracing their contacts.

Professor Cowling, Head of the Division of Epidemiology and Biostatistics at Hong Kong University’s School of Public Health, stated that once the virus is present:

“Stopping travel will have no material impact on the trajectory of the pandemic’s developments from a public health point of view.” Instead, “the focus should be more on reducing community transmissions.”

U.S. stocks responded to Pres. Trump’s travel ban by registering their largest drop in almost 45 years.

Indeed, recent studies suggest that even the Wuhan province travel ban only set back the epidemic’s spread across China by three or four days because by the time it was enacted, the virus was loose in the country.

The ban did, however, introduce major economic stressors – as did the European travel ban – sending stock markets across the world crashed.  It was remarkable to see a Futures index tank as Trump was announcing the ban. The next day U.S. stocks registered their worst drop (9.5%) since Black Monday in 1987.

The CDC’s Epic Failure

The CDC’s epic failure to produce a correct testing kit was one thing, but the CDC, with its limited production facilities, was never intended to produce the volume of testing kits the U.S. needs. It was not until March 1st, though, that the FDA relaxed restrictions and allowed private companies to produce them.

Somehow, the CDC failed to quickly produce an accurate coronavirus test.

As of March 6th – long after it was clear that community spread of the virus (person-person) was occurring in the U.S. – the Atlantic reported that only 1,895 people had been tested in the U.S., putting it far behind South Korea (200,000), the U.K. (18,000) and others. A week ago, Vice President Pence said 1.5 million tests would be available this week.

This week, Anthony Fauci reported that 1 million tests would be ready to ship over the next couple of weeks.  Meanwhile, the CDC reported on March 11th that only about 8,000 people had been tested in the U.S. (Check out the number of tests run here.) Today the New York Times ran a story which relates the ‘Kafkaesque” quests sick people are going on in an attempt to get tested.

Right now we have little idea how much coronavirus is in the U.S., but as testing ramps up, the spread should become clear over the next month.  When the tests come, they will not be perfect. Positive results will be trustworthy but false negative results – in which someone with the virus tests negative – are a concern. False negative test results in China currently run about 30% – meaning that about 30% of the people who are told they don’t have the virus actually do have it. The CDC has not released the sensitivity of its test but Anthony Fauci has said that people with symptoms who test negative will likely require a second test.

Time will tell if mistakes, bad luck, bureaucratic blunders and off-messaging let the coronavirus out of the bag in the U.S., allowing the virus to spread without notice, and resulting in far more cases than would otherwise have occurred – or not.  We clearly weren’t as prepared as Johns Hopkins – which rated the U.S. #1 in epidemic preparedness (but near the bottom in access to health care) – thought.

A collective sigh of relief was surely let out when Anthony Fauci, today, simply stated what was obvious:

“The system is not really geared to what we need right now… That is a failing. Let’s admit it. The idea of anybody getting it easily the way people in other countries are doing it, we are not set up for that. Do I think we should be? Yes. But we are not.”

Update: on 3/13, the Trump administration announced new efforts to dramatically increase the production of test kits, including restructuring its present team, an emergency hotline for private companies, and a goal of developing a test that can determine if the virus is present within an hour.

Mortality Rate

Just over a week ago, the World Health Organization reported the mortality rate to be 3.4%, a preliminary number that most believe time will show is too high. One epidemiologist said he expects it to between 0.5 – 2.0%. (Note that the Spanish flu of 2018 is believed to have had a mortality rate of 2-3%, but that was before treatments were available.)  The truth is we don’t know what the mortality rate in the U.S. will be. It could be considerably lower than expected or it could be high. We won’t know until we have the stats.

Young person mortality is expected to be almost nil, while mortality rates in the elderly and infirm are expected to be much higher. I was struck looking at the individual deaths in Italy how many of them were in people in their 80’s or older. Because of their weakened immune systems, anyone older than 60 is expected to be at higher risk.

A Chinese study of coronavirus mortality in two hospitals found that the odds of dying were higher in patients with diabetes or coronary heart disease. Age, lymphopenia (low white blood cells), leucocytosis (increased white blood cells), and elevated ALT, lactate dehydrogenase, high-sensitivity cardiac troponin I (an indicator of heart damage), creatine kinase, d-dimer, serum ferritin, IL-6, prothrombin time, creatinine, and procalcitonin were also associated with death. Age was the most significant factor – the older one was, the greater the chance of dying.

Age – plus a comorbid illness such as diabetes – appears to produce a kind of one-two punch. Another study found that patients who ended up in intensive care tended to be older (median age, 66 years vs 51 years),  and were more likely to have serious underlying comorbid illnesses (n=26 [72.2%] vs n= 38 [37.3%]).

Green = released from hospital; Beige = death.

A retrospective study of deaths vs discharged patients in two hospitals in Hubei province, China found that age made a striking difference in mortality rates. Below the age of 50, very few deaths occurred. As people aged, though, the mortality rates shot up dramatically.

Again, comorbid diseases took their toll, with the presence of a cardiovascular disease, in particular, increasing the chance of death.  Chinese studies indicate that when in a severe state, coronavirus infections can greatly exacerbate heart conditions. The very high rate of smoking in older Chinese men could be elevating mortality rates greatly. (One infectious disease expert believes the increased rates of obesity in the U.S. may do the same here.)

That doesn’t mean that younger adults are off the hook. Dr. Li Wenliang of China was a healthy male in his thirties when he died. The New York Times presented a fascinating story of a fifty year old, otherwise healthy lawyer, who ended up in critical care with what his doctors thought was pneumonia but was actually the coronavirus. 

One Flu at a Time, Please

While the mortality rate of COVID-19 seems almost certainly to be higher than that of the common flu, even a low mortality rate is of concern. This is because of the strain even a moderate flu season puts on hospital resources and doctors.

Thankfully, this year’s flu season, which began early in the year and has been pretty bad, is beginning to ease. The volume of flu cases – which required between 300,000 and 500,000 people to become hospitalized and caused between 20,000 and 40,000 deaths – is still, however, quite high – and if the coronavirus does hit with a vengeance, there’s a good chance that hospitals will be overwhelmed; i.e. they won’t have enough beds, ventilators, etc. needed to keep people alive.

That’s already happened in China and in northern Italy, where doctors reported that about 10% of all people testing positive for the virus ended up intensive care units, causing them to have to triage patients; i.e. decide which ones will get treatment and which ones will not.

A Chinese study attributed the much higher mortality rates in Hubei province than in other provinces to the lack of medical resources as hospitals in Hubei were overwhelmed by sick patients.

The Department of Health and Human Services reported that a 5% rate of ICU admissions from coronaviruses would still require about twice the number of intensive care units (200,000) than are now available in the U.S.. Similarly, the U.S. simply doesn’t have enough ventilators to help both flu and coronavirus patients at the same time.

Flattening The Curve

“Flattening the curve”, from the New York Times.

That’s why a big goal is to “flatten the curve” of the epidemic dramatically – something the U.S. has probably, with its weird and dysfunctional response to the epidemic, failed at miserably thus far.

Flattening the curve means lowering the rate of infection for long enough to give the U.S. medical system a better chance of dealing with it effectively.

We do that in the U.S. with the flu by providing vaccines which, even if they’re not completely effective, still slow the spread of the disease. Because no vaccine for the coronavirus exists, more people may be vulnerable to it than with the flu.

Flattening the curve now means engaging in social distancing, widespread testing, isolation, and doing simple things like avoiding crowds, washing your hands properly, not touching your face, etc. as well as putting off elective surgeries and doctor visits.

Update: 3/13 A model projected that social distancing — limiting contacts with others — could reduce deaths caused by infections acquired in the next month in the Seattle region (one of the hardest hit regions) by 75 percent (from 400 to 30).

The New York Times reported how effective social distancing can be. During the 1918 flu epidemic, the City of St. Louis closed “theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions” for several weeks “until further notice.” Its death rate stayed flat. Philadelphia didn’t close anything and its death rate soared. 

The Chinese Lesson

Perhaps the best news about this virus is what’s happened in China. The rate of new infections has been dropping dramatically. China’s extraordinary efforts – a total mobilization of its resources to fight the virus – appears to have worked.

That mobilization included the wholesale quarantine of some provinces, the temporary hospitals built to reduce the spread of the virus within the health care system and improve treatment, the rapid identification of clusters and the shut down of restaurants, schools, etc. near them, the traffic stops to check fever rates, etc. Sometimes, quite authoritarian measures were taken including locking people inside their apartment building. Physical barriers were even built to impede movement in and out of complexes.

Suspected cases were given PCR tests and told to wait at the facility for 4 hours to get the results. People with positive test results and mild symptoms (fever, cough) were often sent to large 1,000 bed isolation centers that looked like large military field hospitals. People over 65 with the infection were sent straight to regular hospitals.

China shifted as much of its medical care possible online to free up resources to treat the virus.  All elective surgeries were postponed. All COVID-19 treatment was free, as well. No worries about breaking the bank through a hospital visit as occurs in the U.S.

Government employees of all types were reassigned to assist with the effort.  Some delivered food. Others worked in hospitals. Online orders for groceries skyrocketed, but the system apparently worked. Restaurants required patrons to sit some distance from each other.

The last of China’s 16 temporary hospitals recently shut down. More new cases are being found outside China than inside it. A staggered restart of its economy is underway.

It was a remarkable effort which certainly won’t occur in the U.S. Instead, the U.S. is expected to do things like suspend public transport, limit public gatherings, test as many people as possible and get the health care system as ready as possible. One specialist said transparency – radical transparency – will be needed to win the public’s trust.

“It means our leaders being as truthful and honest as possible, including admitting mistakes and things we simply don’t know.”  Wilbur Chen, an infectious-disease physician at the University of Maryland.”

Time will tell.

It’s Coming!

“I think the likely outcome is that it will ultimately not be containable.” Harvard epidemiologist Marc Lipsitch 

 

“On balance it is reasonable to believe that COVID-19 will infect as many Americans over the next year as influenza does in a typical winter – somewhere between 25 million and 115 million.” Maciej Boni – epidemiologist

 

“One model from the Harvard School of Public Medicine … estimates that, at a minimum, 20% of the world’s population will get infected.”  Michael Osterholm

Let’s not delude ourselves. Right now, the chances of catching the coronavirus in the U.S. and Canada are probably very, very low, but this virus is coming and probably, as Emergency Preparation Specialist Linda Milne, speaking on a Bateman Horne Center video, said, to a neighborhood near you.

Maciej Boni is an epidemiologist whose concerns have gotten worse over time, not better.  He’s had his eye on something called the “infection mortality rate” (IFR), which refers to the percentage of people who get infected (but not all of whom  necessarily get ill) who then die.  He reported that the London School of Hygiene and Tropical Medicine researchers modeling the IFR believe that it’s from 0.5% to 0.94%. That number may seem low, but if they’re right, COVID-19 is 10-20 times as deadly as the average flu.

If that’s true, then over time – perhaps a year or two – between 25 and 115 million people in the U.S. could contract the virus and approximately 350,000 – 650,000 people will die of it.

Update: – On 3/13 – the New York Times reported on the CDC’s modeling efforts – which have not been released. The Times appeared to be citing worst case scenarios when they reported that hospitals could be utterly overwhelmed by sick patients.  One infectious disease expert, Dr. Lawlor, reported that based on what we’ve seen thus far, the coronavirus is likely to cause 5 to 10 times the burden of disease as the seasonal flu, and 10 times the number of deaths. 

A Summer Savior? 

Will COVID-19 act be a good influenza bug and simply disappear into the heat of summer like the SARS virus did in 2003? Opinions differ greatly. Higher temperatures and more humid air definitely dampen virus travel through the air, and Ian Lipkin pointed out that viruses wilt in the direct sunlight.

Some epidemiologists think, though, that COVID-19 will persist through the summer and become an endemic problem – something we just have to deal with. Lipkin believes it’s probably here to stay, but that a vaccine will be developed – over the next year or so – which will be able to knock it down.

Even if COVID-19 disappears over summer, it may, like other severe influenza viruses, reappear in the fall.  If you do get infected and recover, you should have immunity from the virus should it appear again.

Who Is at Risk From the Coronavirus?

“The immune dysfunction that underpins these diseases mean that patients may be at increased risk of severe infection if exposed to COVID-19. While we wait for the development of antivirals and a vaccine, ME/CFS and FM patients should be prepared and minimize your exposure.” Suzanne Vernon – The Bateman Horne Center

According to the World Health Organization and the CDC, the highest risk groups include:

  • People caring for someone who is ill with coronavirus
  • People over age 60
  • People with chronic medical conditions such as:
    • High blood pressure
    • Heart disease
    • Diabetes
    • Asthma

This information appears to be based on limited studies coming out of China and is probably preliminary.  One study suggested that COVID-19 does not exacerbate asthma.  We will know more at time goes on. Since ME/CFS involves immune issues, it should clearly be included as well.

Coping and Avoidance and Supplements

Everyone probably already knows the basics – 20-second hand washes, regularly cleaning and disinfecting surfaces, isolation, keeping your distance from others (6 ft.), keeping well hydrated and as stress-free as possible. The CDC recommends wearing a face mask if you are sick, but not if you are not sick. Other coping possibilities include laying in longer stores of food in case in-home deliveries get affected (how could they not?), and stocking up on prescription drugs.

Isolating Yourself if You Get Ill or Are Exposed to Someone Who is Ill

  • Dean Echenberg, a former Director of Disease Control notes how important it is for everyone, that if you get start having symptoms (cough, fever) to isolate yourself, report your symptoms to your doctor and take it from there.
  • If you’ve been exposed to someone who is infected you should quarantine yourself from your date of exposure for 14 days. If no symptoms show up by then you don’t have the virus. if they do, then contact your doctor.
  • If you are infected you should isolate yourself until you are symptom-free and test negative for the virus.

Isolating yourself means occupying the same environment as other people as little as possible: only leave the house for doctor’s visits, stay in your room, and do not share bathrooms, if possible. Take no visitors, wear a face mask if you have to be around other people, immediately wash your hands for twenty seconds after you sneeze, avoid sharing household items, clean hard surfaces frequently. Your housemates should wear facemasks and disposable gloves when they interact with you and throw the gloves away afterwards.

If you have trouble breathing call your health care provider. Take note – you’re probably going to be pretty miserable – this is the flu after all.

Note that the virus appears able to stay present in the air for up to three hours, and on plastic and steel surfaces for at least several days and possibly longer.

Bulking Up Your Immune System

Different practitioners have suggested different ways to bulk up your immune system:

Try to get as much good sleep as you can. The New York Times just reported that studies indicate that people who get less than 6 hours of sleep a night are far more likely to catch a cold.

Resources

Ian Lipkin, not surprisingly, has been everywhere. He’s on my Google Alerts list and he pops up just about every day. He gives a good explanation of the coronavirus here.

Trackers

Linda Milne – Emergency Preparedness Specialist (and person with ME/CFS) on the outbreak – From the Bateman Horne Center

The Coronavirus Series From Health Rising

 

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