Coronavirus Ponderings
It’s been quite awhile since I posted on the blog as I’ve done many more short posts on social media. This topic requires a bit more space so I thought I’d just fire up the blog and link to it
As I’m sure you are aware there has been an absolute sense of panic over this new strain of Coronavirus and as with all infections, caution is always warranted. The situation scientifically is still rather fluid as we gain more information and I think it will be for the rest of the year. Several questions remain unanswered , such as , Where did it originate ?. Was it a typical species jump from close human / avian / bat/ “ pangolin” contact ( most likely... contact that is ,not the pangolin) or was it accidentally released from the lab in Wuhan .Note- labs in China have been cited for lower level employees selling lab animals to local “ wet markets” in the past to make some significant $$$ on the side. The lab in Wuhan is a BL4 lab tasked with working on novel viruses like SARS and MERS ( both corona viruses ) . Why are kids less than 13-15 not showing up on the fatality reports? Is it because they are constantly exposed to Coronavirus on a regular basis ( the typical daycare / elementary school snotty nose) or is it the opposite and their more naive immune system is preventing the Acute Respiratory Syndrome as the immune system response can cause significant damage. Why did the CDC botch the roll out of diagnostic tests? In the US the FDA wants to make sure testing has appropriate sensitivity and specificity ( In medical diagnosis, test sensitivity is the ability of a test to correctly identify those with the disease (true positive rate), whereas test specificity is the ability of the test to correctly identify those without the disease (true negative rate). Over the years I’ve seen tons of tests come and go and clinicians frequently rely on a “ paper” diagnosis as 100% true only to find out later that the test just sucked. I’ve heard reports that the CDC funding was cut and the head of infectious disease was fired.... I looked it up on www.cdc.org and the funding remains unchanged but a cut has been proposed ( probably not a great idea either way ) . China is testing thousand of cases and perhaps the test is good but as with many things manufactured in China... I’m skeptical . So take the data for what it is.....information filtered through a government that doesn’t want you to know what’s happening and one that is now trying to deflect blame on the United States saying it came from here so their people are placated.
This leaves us with what to do and how bad can it be. Most likely it will be a very severe seasonal flu that becomes endemic( always around) in society with severity decreasing over time as natural immunity increases. Note-20,000 people have died in the US alone this year from flu . If fatality rate is 3x that of flu then we are potentially looking at 60,000 people. But keep in mind , we don’t quarantine for flu, we just accept it. It could also cause an incredible loss of life as it moves around the globe and really shake our society as the global supply chain gets disrupted. Many are unaware of just how much of the worlds manufacturing has shifted to Asia and that now 90% of the raw materials for pharmaceuticals comes from Asia. Note- one positive from the so called trade war with China might be that many companies have been forced to find alternative manufacturing . Either way it’s something our Government needs to address and perhaps this will at least wake some of them up. I read a great piece on how the influenza epidemic of 1918-19 was handled and what measures were most useful. It remains one of the largest data sets for an epidemic that we have . It’s over at marginal revolution if you want to read the entire article here’s the link. The main points are that 40 million people died worldwide and 550,000 in the US. This was at a time when we had marginal intensive care, no antivirals and no antibiotics . Just think about that for a moment . All that they had was basic public health concept of infectious disease and a rudimentary understanding of the germ theory . With that said they were somewhat effective in slowing down the spread of the epidemic. What they found out was that those cities that were proactive in three areas were the most successful .[1] Isolation of ill persons and quarantine of those suspected of having contact with ill persons refers only to mandatory orders as opposed to voluntary quarantines being discussed in our present era. [2] School closure was considered activated when the city officials closed public schools (grade school through high school); in most, but not all cases, private and parochial schools followed suit. [3] Public gathering bans typically meant the closure of saloons, public entertainment venues, sporting events, and indoor gatherings were banned or moved outdoors; outdoor gatherings were not always canceled during this period (eg, Liberty bond parades); there were no recorded bans on shopping in grocery and drug stores.This makes us question , when or if these measures need to be put in place ? What if it’s like really severe season flu? ( “ only flu” shouldn't minimize the fact that ~35,000 people will die on average from flu this year) What will the social, political and economic costs of these measures be? I don’t know. What are the current costs of the current media induced panic ? ( look at airline and cruise line losses this month) and I suspect it will only get worse as this is an election year and this will be used as a campaign message from now until November. Imagine all sports events being cancelled and the effects on beer sales alone. We are now talking the great apocalypse for sure. Hhhhmmmm , What is the shelf life of beer? Need to make sure I have a amply supply and all 4 seasons of Doomsday preppers on DVD. But... back to the science, The authors define “public health response time” as the number of days from the day the excess death rate was double baseline to the day that at least one of their three key public health measures was implemented. The longer the public health response time the greater the total excess deaths ( you gotta love the term “ excess deaths”) . When we look at how China, Italy and Viet Nam have used quarantines of entire cities and how the US instituted flight restrictions and local quarantines it seems draconian but it is exactly what was done in 1918. The authors point out how important early adoption of these measures can be so the question becomes , if we are eventually going to close schools and stop large public gatherings ...... should we do it now , next month?“Although these urban communities had neither effective vaccines nor antivirals, cities that were able to organize and execute a suite of classic public health interventions before the pandemic swept fully through the city appeared to have an associated mitigated epidemic experience. Our study suggests that nonpharmaceutical interventions can play a critical role in mitigating the consequences of future severe influenza pandemics (category 4 and 5) and should be considered for inclusion in contemporary planning efforts as companion measures to developing effective vaccines and medications for prophylaxis and treatment. The history of US epidemics also cautions that the public’s acceptance of these health measures is enhanced when guided by ethical and humane principles.”
And there’s this from Liz Specht PhD who has ran some numbers on hospital beds in the US.
The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).
- Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients).
- By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)
The 2018-19 Influenza season had 35 million cases with 16 million doctor visits but only 490,000 hospitalizations , that’s only 1.3% . With this being the first time our bodies have seen this virus we can expect it to be a REALLY bad case of flu. Maybe 3 times as bad. This could mean a significant strain on our medical system. A recent presentation by the WHO director general stated the following “ This virus is not SARS, it’s not MERS, and it’s not influenza. It is a unique virus with unique characteristics. However, there are some important differences between COVID-19 and influenza.
First, COVID-19 does not transmit as efficiently as influenza, from the data we have so far.
( note- there is a possibility of prolonged airborne infection)
With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19.
Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days.”
This is different from previous reports that said patients could spread the virus for 10-12 days before being truly sick enough to stay home. Additionally he said
“ The second major difference is that COVID-19 causes more severe disease than seasonal influenza. While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection, and some will suffer severe disease.Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected.”
The good news is that most Coronavirus doesn’t survive long on contaminated surfaces and outbreaks frequently die out during the summer and summer is coming. If your non-symptomatic you’re likely not transmitting disease ( unlike flu) We can also hope that our hospitals don’t become overwhelmed . From my small Corner of the world here on the east coast of Florida where we has seen few cases , I can say this . 1- We should consider closing schools several weeks early. 2- we should continue to test and quarantine 3- Postpone international travel ( my trip to Vietnam has been cancelled, going out west instead. 4- practice smart personal protection , wash hand frequently , avoid crowds , if you are at risk ( smoker, asthma, heart disease, on immunosuppressants or use steroid inhalers , cancer patient , over 70 years of age, ) consider a semi- self quarantine until this burns out. 5- don’t go out as much for the next few months 6- read “some “news to stay up to date but avoid watching TV news ..... that’s always a good idea anyway.
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