The Coronavirus pandemic is certainly turning life upside down. In our household, the kids are home from school indefinitely, my husband is teleworking full time, and we are keeping our ventures out of the house to a minimum. My refereeing responsibilities have more than doubled and will probably continue to increase. It is always amazing to me how the kids are kind and respectful with everyone in the world except each other. (Sadly, my wardrobe lacks black and white stripes.) I am beyond grateful for the schoolwork packets that keep them occupied and learning for a couple of hours each day, giving me some time to do some writing.
Earlier this week, I read an article about divorce rates spiking in China after couples were forced to spend more time together. So far, I have no thoughts of killing my husband, which seems promising. Even so, I am thinking about how unusual and nice it is to have some extra time with my favorite person and that this is something to appreciate. Soon enough, he will be back to commuting and the house will seem very quiet.
Beyond all that is happening in my personal world, the rest of life seems surreal right now. We are in the midst of what could be a once-in-a-lifetime type of crisis. When something like this happens, you see all of the extremes. Some are panicking and hoarding. Others are going about life like everything is perfectly normal. I feel like both panic and “head in the sand” responses are counterproductive, and I try to find the informed, rational approach. This can be quite an undertaking in our world of abundant misinformation and changing information.
As it turns out, this particular situation is not so difficult for me. I write under a pen name to respect the privacy of the people I will be writing about: my husband and children in particular, but also extended family and friends. However, my real name includes some credentials, and my fields of expertise are microbiology and genetics. I am not a medical doctor, and will therefore not be providing medical advice, but I do know some things about pathogens like Coronavirus. So, I am going to write for the next few days about the questions I see people asking and the changing information from the scientific community that may seem confusing.
In answering questions, I will sometimes refer to influenza because it is a virus most people are familiar with and that causes pandemic disease periodically. I am in no way suggesting this is just like seasonal flu, as you may have read elsewhere. It is not, and I will describe some of the reasons for that in answering questions. Keep in mind, we do have vaccines and targeted antiviral medications to prevent, minimize, and treat influenza. The novel Coronavirus currently does not have a vaccine or treatment. Critically ill patients are treated to minimize their symptoms and keep their body going while it fights, and hopefully overcomes, the infection on its own.
Q: How bad is this going to get?
A: No one knows for certain. There are many factors that determine how severe an outbreak of a new infectious disease will be. Some of them are:
- How easily it spreads from person to person
- How frequently it kills an infected person
- How long the virus can live in the environment
- The incubation period
- How long it takes for an infected person to become contagious
- The way people respond to prevent spread of the disease
Q: How does Coronavirus spread?
A: There is evidence that this Coronavirus spreads both by the respiratory route and by indirect contact. That means the virus can spread if an infected person coughs or sneezes and someone else inhales some of the droplets that contain viruses. It can also spread if an infected person touches or sneezes on an object and someone else touches the same object then rubs some part of their face so that the virus can get into the eyes, mouth, or nose. Since we obviously need to breathe, and we have a tendency to touch our faces much more often than we realize, this virus does spread quite easily. The current evidence suggests the average person is more likely to get coronavirus than influenza, so this could infect a very large number of people.
Q: What is the fatality rate, and why is there so much uncertainty about it?
The fatality rate is a topic I have seen discussed quite often and with a large amount of disagreeing and changing information. The reported fatality rate for COVID-19 is preliminary. A reliable rate won’t be calculated until the pandemic has died down. In the meantime, health organizations track a preliminary fatality rate because it can give us information about the severity of the disease and the groups of people who are most at risk of dying.
The preliminary fatality rate stands at about 1.4%, according to the World Health Organization (WHO). This will probably change in the coming weeks and months. It is true that fatality rate does tend to decrease as the disease spreads through the population, but the rate can also increase and there are a number of factors.
At the moment I am writing this, there are about 270,000 verified cases with about 102,000 either recovered or dead. That mean that there are about 168,000 cases that are ongoing. We don’t yet know how many of those will contribute to the fatality rate. Hopefully, that will be a small number. With so many unresolved cases, it leaves a lot of room for the fatality rate to change.
It is also true that the more severe cases are usually reported while mild cases are under-reported. This is the case for all diseases. For example, I have never tested positive for influenza, but I am very certain I have had influenza multiple times in my lifetime. So, the real fatality rates are pretty much over-stated across the board. This is not some scientific scandal, though. Scientists can only work with the numbers they have. It would be impossible to accurately estimate how many people have any kind of mild infection so that exact fatality rates can be calculated. While not exact, having an idea of the severity of any infection can give us an idea of what we are dealing with and the best ways to minimize the impact of a disease.
Fatality rates can be different in different groups of people. The initial fatality rates in China were lower for Coronavirus, while the fatality rate in Italy is much higher. No one knows precisely why yet, but it could be that the first groups of people had a smaller percentage of individuals who qualify for the high risk category. Another factor could be that those individuals had a history of infection with other coronaviruses and had some existing immunity because of it. Their immune systems have been given at least a heads up instead of being caught off guard. Whatever the real combination of factors, those infected early in China experienced a lower fatality rate, and we have seen an increase in that rate as it has spread across the globe.
In addition, viruses are notorious for rapid mutation. Scientists have found evidence of at least two distinct strains already, and there could be more as the epidemic proceeds. There is no way to predict how fatal the various mutant forms will be. Some will be more fatal and others less so. We see this with influenza. The average fatality rate of seasonal flu is about 0.1%. The Spanish flu from the 1918 pandemic had a fatality rate around 2.5%.
The overall take home message here is that even if the current rate of 1.4% is over-estimated, that number is still cause for concern. Seasonal flu kills about 290,000 – 650,000 every year worldwide. If Coronavirus settles into a fatality rate of just 1% and it infects a similar number of people, we could be looking at worldwide deaths in the range of 3 to 6 million people. Again, no one knows enough to say if this will or won’t happen. The point is that the potential is there and should be taken seriously.
There are other questions, and I will discuss more next time. In particular, as scientists are able to investigate and gather more data, the information being reported is changing. In the meantime, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) both have sites for information about Coronavirus and guidance for managing your own and others’ risk. The links below are for each of those sites:
WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
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