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COVID-19 : WE not ME

A look at the facts behind COVID-19 and why they matter

Introduction and Summary

I earned my Master’s in Public Health, with concentrations in Policy and Epidemiology, approximately 15 years ago from the University of Illinois School of Public Health. In mid to late February I noticed incomplete or incorrect information about COVID-19 circulating online and thought it was worth trying to break down COVID-19 in a fact based way.

In public health pandemics information, communication, and preparation are useful tools in mitigating community health risks.

In this piece I will try to address two main questions:

  • What is COVID-19?

  • Why should we care?

Before I get into this breakdown let me give you the headline takeaway. So what’s the 2 second elevator speech conclusion on COVID-19?

COVID-19 is a “WE” problem, not necessarily a “ME” problem.

If you are a relatively young relatively healthy individual who has no serious pre-existing condition and are not immunocompromised, COVID-19 does not, in all likelihood, present a significant or dangerous health risk to you personally (though it may still diminish your respiratory health for the future).

HOWEVER, (and this is a big however) the purpose of global quarantines and travel restrictions, as well as other “seemingly excessive” precautions, is because COVID-19 does present a very serious health risk for those that are elderly and/or have pre-existing conditions and/or are immunocompromised.

So these public health prevention measures may not be about protecting you as much as they are about protecting your parents, grandparents, and other at-risk loved ones.

The SARS-CoV-2 virus, which causes COVID-19:

  • can spread asymptomatically

  • appears to be an airborne virus

  • can survive on inanimate objects and surfaces for hours if not days. It may even live on your phone for up to 96 hours. This belief is based on the fact that, according to the WHO, SARS can live on glass surfaces for up to 4 days.

  • can spread essentially undetectably for up to 2 weeks before someone knows they're an infected carrier

  • is subject to community spread where the sources of infections can no longer be traced

  • has a case mortality rate for the elderly that is 4 times as high as for the population at large

  • has no known vaccines or proven therapeutics though clinical trials are underway for both

The Life Care Center nursing home in Kirkland, Washington is emblematic of the very worst that COVID-19 can become where an as yet unknown number of patients have been infected (63 residents have been transferred to local hospitals with 49 residents remaining in the facility). 21 of the remaining 49 residents have tested positive for COVID-19.

To date at least 13 residents have passed from the virus with 19 total deaths linked to the facility. Roughly 70 staff members have begun to show signs of symptoms as well. This is a nightmare scenario that, God forbid, may face other nursing homes and healthcare settings as the disease progresses.

So while COVID-19 may not touch you personally, or your children (whether you are infected or not) it is likely to cause real damage to the elderly and at risk population in this country, not to mention the healthcare workers.

What’s the bottom line here? If you care about the health and well being of your parents, grandparents, and/or of your friends’ parents and grandparents, you should really take COVID-19 seriously.

Additionally, because of elevated and continuous exposure, our nation's healthcare providers are also at risk of being infected - this could place a serious stress test on our healthcare system for patients battling all illnesses, not just COVID-19.

Scott Gottlieb, Trump's former FDA commissioner, predicted the coming weeks will "change the complexion in this country," adding that lockdowns of certain states or cities "are going to need to happen" or health systems will get exhausted and fatalities will rise quickly.

Let’s break this all down by the facts and numbers below:

What are coronaviruses?

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

What is a novel coranavirus?

A "novel" coronavirus (nCoV) is a new strain that has not been previously identified in humans.

What is COVID-19?

COVID-19 is short for “Coronavirus Disease 2019.” COVID-19 is the name of the disease caused by the current coronavirus known as SARS-CoV-2. So COVID-19 is the name of the disease and SARS-CoV-2 is the name of the underlying virus. SARS is short for Severe Acute Respiratory Syndrome.

What is Nsp15?

Scientists in Chicago recently created a 3D mapping of the protein structure of the COVID-19 SARS-CoV-2 virus, which allows scientists to figure out how to interfere in the pathogen’s replication in human cells. In that mapping they discovered Nsp15.

“The newly mapped protein, called Nsp15, is conserved among coronaviruses and is essential in their lifecycle and virulence,” said Joachimiak. “Initially, Nsp15 was thought to directly participate in viral replication, but more recently, it was proposed to help the virus replicate possibly by interfering with the host’s immune response."

It is believed that the continued analysis of the virus and its core proteins will lead to more targeted and effective therapeutics and vaccines.

Are there multiple strains?

Yes. Scientists with Peking University’s School of Life Sciences and the Institut Pasteur of Shanghai in a preliminary study found that one strain — type “L” — of the virus was more aggressive and accounted for about 70 percent of the strains analyzed. The second — type “S” — was less aggressive and accounted for about 30 percent of analyzed strains.

It is possible for more strains and mutations to occur, which makes understanding COVID-19 more of a moving target.

Is COVID-19 like the flu?

COVID-19 is not the flu – they are caused by different viruses, they require different treatments, they transmit differently, they have different incubation periods.

Again, COVID-19 is NOT the flu.

Similarities:

They both present with similar symptoms:

  • Both cause fever, cough, body aches, fatigue; sometimes vomiting and diarrhea.

  • Can be mild or severe, even fatal in rare cases.

  • Can result in pneumonia.

  • Both can be spread from person to person through droplets in the air from an infected person coughing, sneezing or talking.

Differences:

  • Causes:

  • COVID-19 is caused by a new novel coronavirus named SARS-CoV-2.

  • The flu is caused by influenza viruses.

  • Transmission:

  • COVID-19 appears to be transmitted also through the airborne route (though it is unconfirmed) - meaning that tiny droplets remaining in the air could cause disease in others even after the ill person is no longer near. For this reason the CDC recommends health professionals adhere to CDC airborne protocols.

  • The flu does not.

  • Treatment:

  • Antivirals and home therapeutics exist to treat or mitigate the flu. For example, you can get a Tamiflu prescription to take at home. The flu also has vaccines available (flu shots).

  • There are no current known therapeutics or vaccines for COVID-19. Remdesivir from Gilead appears promising. Takeda Pharmaceuticals is also working on hyperimmune globulin treatments that may also have some promise as an in-hospital therapeutic. Vaccines will not be available till sometime in 2021, but multiple labs are preparing their vaccines for clinical trials as early as April.

A few things to keep in mind when contrasting the flu vs COVID-19.

  • According to the WHO COVID-19 is presently 3 times as deadly as the flu: “Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected.”

  • Domestically, COVID-19 can be between 10 and 30 times as lethal as the death rate of the flu. In the US the flu mortality rate is around 0.1% according to the New York Times and Dr. Anthony Fauci.

  • COVID-19 cases can present as asymptomatic for up to 14 days, so it is harder to know who is carrying / spreading the disease because they are not presenting with symptoms as fast as with the flu.

  • On average someone with the flu will give the flu to 1.3 more people (the R0 value) - with Coronavirus that value is 2-3 times higher but we have seen instances where an individual can directly lead to more than 10 cases and indirectly lead to a mass breakout. For example despite China and Italy's quarantines, epidemiologists have traced cluster outbreaks in both countries to travel between the two nations. The Brazil cases have been linked to travel from Italy, and so on and so forth.

The Good

The positive aspect of COVID-19 is that if you are a relatively young, relatively healthy individual your health is not at serious risk of being seriously harmed by contracting COVID-19.

According to the World Health Organization, as of February 20, 2020, 78% of COVID-19 cases are found in the 30-69 age group. According to China’s CDC as of February 11, 2020 87% of the cases in China are found in the 30-79 age group. Approximately only 2% of cases were found in those age 19 and under, with less than 1% of cases found in those age 9 and under. Similarly, fatality rates, according to China’s CDC appear to be 0.2% in those aged 10-39.

According to the World Health Organization the overall mortality rate of COVID-19 is under 3.5% and more than half of those that have contracted COVID-19 thus far have recovered.

The Bad

The bad news is that COVID-19:

  • cannot be contained despite global lockdowns

  • has no known vaccines (trials are underway)

  • has no proven therapeutics (trials are underway)

  • may reappear in the second half of the year as a seasonally recurring disease

Despite the virtual lockdown of 150 million people in China, the virus has spread around the world in a matter of months, including Italy, and South Korea which also have enacted their own broad lockdowns. Italy has now expanded its emergency measures nationwide.

These lockdowns are unable to prevent the spread of the virus as epidemiologists have traced the virus from China to Italy to Brazil and around the world to nations such as South Korea, Japan, and the United States.

On March 11, 2020 the World Health Organization designated COVID-19 a global pandemic.

Currently, clinical trials are currently underway for the development of vaccines and therapeutics such as Remdesivir and other antivirals.

While the hope is that COVID-19 will "burn itself out" as SARS did in 2003, Fauci has said that COVID-19 may reappear seasonally, necessitating a vaccine that is at least a year away from being deployed.