Coronavirus 19, a little perspective...

Unless you are in a cave, you have probably heard a lot of information about COVID-19. So if you are tired of hearing about it and don't want to read more about it, you probably should stop now and not waste your time. But, if you would like to hear one person's perspective that may have a more calming effect than what one might hear on television, it may be worth the read.

Let me start by saying that I have not done any in-depth research and the figures I will use are based on information released by various news agencies, often citing CDC, WHO and other agencies. While the exact figures are changing daily, I believe the numbers are good enough to make some reasonable estimates and form some reasonable conclusions.  I will also use data from the CDC website as of March 10, 2020.

I keep asking myself if I am missing something when it comes to COVID-19. Listening to the various television reporters, talk show hosts and many politicians, one would think that the 1918-1919 Spanish flu was back. People are hoarding masks, cleaning out the disinfectants and hand sanitizer shelves at retail stores, stocking up on food and water, buying ammunition and worried about going anywhere that has people. Government officials are actually using terms like quarantine when talking about cities, implying that this may be needed.  I read that the Governor of New York has asked or deployed the national guard to help prevent the spread of the virus.

I learned a long time ago to not make emotional decisions when it comes to important matters. If you do, you often don't make the best decision. Enough with the talk, lets look at the numbers. As of today, COVID has infected about 100,000 people worldwide and about 4,000 people worldwide have died from it. CDC reports a total of 647 cases of COVID-19 in the United States and 25 deaths. It seems to harm the elderly (>60) and those with underlying significant disease as is often the case with many illnesses. There is currently no vaccine to prevent it and no pill or specific treatment to combat it. Like most all viruses, care is supportive.

"CDC estimates that influenza has resulted in between 9 million and 45 million illnesses, between 140-810,000 hospitalizations and between 12,000-61,000 deaths annually since 2010." It has been said that about 675,000 people a year die worldwide from influenza. 

So I ask myself, why is there so much attention on TV and media about Coronavirus.  Why are so many people not traveling i.e. taking flights. Why are countries quarantining entire cities? Perhaps we should be asking why aren't we more concerned about the flu? Why are we not quarantining cities for the regular flu? I am not being a smart A$$ when I ask why is there so much attention, even panic? If you believe what is said on the financial channels, I ask why doesn't the stock market fall more when there is a flu outbreak?

It is reported there are about 7,800,000,000 people in the world and about 327,170,000 people in the United States.  That would make the current death rate of 1 in 1,950,000 worldwide (world pop. divided by deaths worldwide from COVID-19) and 1 in 13,086,800 in the United States (US pop. divided by US deaths from COVID-19). 

As a reference, for influenza, lets use the middle of the estimates and say 40,000 people die annually on average in the US as compared to about 650,000 worldwide.  So the mortality rate from influenza virus for all the people worldwide is 1 in 12,000 and 1 in 8,179 for all the people in the United States.  

Comapring the numbers so far, it appears that people in the United States are 1,600 times more likely to die from influenza than they are from COVID-19 and people worldwide are 162 times more likely to die from influenza than from COVID-19.

Don't get me wrong, anyone who gets sick or dies from anything is sad.  I am not discounting the suffering that COVID-19 has caused.  Of course we should be concerned about COVID-19, but how much in comparison to other illnesses or diseases that cause more death or illness.  We should always be concerned about anything that can get us sick or kill us. But we must think logically and not panic when the data does not warrant panic. In fact, the data should ease fears and spread calm.  I urge all of us to help educate our patients and reach out to local reporters and news programs and provide reassurance and use accurate data to help spread that message.

Another question I have is why the rush to test so many people for COVID-19. Other than epidemiology reasons and knowing how long to "quarantine oneself," one can make the argument that it does not change anything. If someone is positive but asymptomatic or symptomatic but not ill enough to warrant respiratory support or IV hydration (aggressive treatment), the patient will be advised to stay at home, rest, drink plenty of fluids, avoid others and inform their doctor or public health official if they get worse.  There is no specific treatment or cure.  If someone is so symptomatic i.e. short of breath/hypoxic, vomiting/dhydrated, etc, they are going to require treatments, IV fluids and possible intubation and ventilation regardless of whether they are COVID-19 positive or not.  So I am not sure that testing more people is really going to change anything in terms of tretment or outcomes. It is information that is nice to know but not really helps in the management of a patient.  As an aside, I would not be surprised if the number of people who test positive is in the hundreds of thousands.  Unfortunately, I would not be surprised if the death toll increases 100 fold in the United States. If it did, it would match the same death rate that so far exists worldwide.  So long as the number who get sick or die is minimized, having a positive test doesn't really mean that much to me if you are healthy and asymptomatic.  It is reported that 10-15% of the population are Strep carriers.  They have no symptoms so how does a positive strep test help us in an asymptomatic patient?  Many people have coronavirus (not the COVID-19 variety), so what is the significance? It doesn't cause significant illness or death as compared to other illnesses. Many people likely have the COVID-19 virus but have no symptoms. Again, I am not advocating forgetting about it or doing nothing, I am simply asking for people to apply common sense and good judgment.

One thought regarding why people are so afraid of COVID-19 is that it is new and unknown.  This is true but there are many unknowns in medicine and life.  When we do not know something, we should not panic but instead look at data and try to make reasonable assumptions to help realistically reassure ourselves. If people are not panicking about influenza, they shouldn't be panicking about COVID-19.  Another reason why people may be afriad of COVID-19 is that there is no vaccine or treatment for it.  While true, this actually makes the argument for less panic for COVID-19 than influenza.  Why?  Even with a vaccine (although only 19-60% effectiveness reported) and Tamiflu as a treatment (only lessens duration of Influenza <1 day on average) Influenza still kills about 162-1600 times more people annually on average than COVID (with no vaccine or treatment) has killed thus far.  Just imagine how many may die from Influenza if there was no vaccine or treatment? Likely it would be more. Another concern is that the virus is mutating and could get worse.  While possible, I am told this is not an uncommon thing that viruses do. I believe that is part of the reason why we have to keep getting flu shots; it changes year to year.

One thought, and I hope it is not correct, is whether our government knows something concerning that they are not telling us about COVID-19.  This might explain some of the panic and may change my above hypothesis/discussion.  I might expect this from China but not the United States. So I am assuming this is not the case for the purposes of this discussion. 

I am sorry to ramble on but this is something that has bothered me and I wanted to get it off my chest. It troubles me that the news and media seem to be sensationalizing the matter and while that may help their ratings, it does not help the public. I am trying to do my part as a physician: to lessen suffering and I believe fear and panic is a form of suffering. We can prescribe accurate information along with a calm and sensible explanation to help alleviate and cure much of the fear and panic that so many seem to be suffering from. I thank you for your time in reading this and welcome your comments.  Many thanks and be safe and healthy.