Wednesday, February 26, 2020

COVID-19 *Is* Coming: Should You Panic?

In a word: no. Panicking is never good, gets you nowhere, and invariably makes things worse.

But COVID-19 is coming to the United States. And by that, I mean coming everywhere, as common as the cold or flu. Am I certain that it's going to be widespread? No, but I'm confident at this point that this is a virus that might have been contained at the very beginning, perhaps a week or two into infecting humans, but that opportunity was missed (perhaps squandered), and we are now in a place where the reality is that COVID-19 is going to infect a lot of people. Containing its spread is highly, highly unlikely.

One of the central problems of understanding COVID-19 in the early 21st century is the confusion surrounding public understanding. This reflects the confusion that people have in general with respect to news: there are simply too many sites, and not enough of those sites are reliable and provide responsible journalism that is, for lack of a better word, nutritious. It's mostly junk food for the brain. More on that another day.

Let's start with one of the most simple of aspects of the virus: its relationship to other respiratory seasonal virus illnesses, the cold and the flu. COVID is definitely more deadly than a typical influenza virus. Based on a study of the first ~72,000 cases in China, just over 1,000 people died from the infection, and it becomes a simple matter of dividing the fatalities by the total, and you get a case fatality rate of 2.3 percent. The typical influenza case fatality rate is a little less than one per one thousand, somewhere between ten and twenty times less deadly than COVID.

Now, a 2.3 percent lethal disease may seem trivial when placed against Ebola or Marburg, viruses with case fatality rates in excess of 50 percent (though now there is treatment for Ebola that may drop it to a pedestrian 30 percent). But COVID spreads efficiently. Really efficiently. Take a look just at the number of total cases in South Korea: as of today, the number stands at 1261; one week ago, that number was 51. That is breathtakingly fast. By comparison, the total number of Ebola cases in Liberia in late August 2014--when it was the number one story in the world--was about the same as Korea's total is today (1,378 confirmed and suspected cases). How long did it take to go from fifty cases to that number? Give or take, it took six months--a lumbering pace compared to COVID's lightning-fast spread.

So it is deadly but not Ebola-deadly, and it is efficient at spreading. Part of its efficiency is linked to that relatively low mortality rate: while a few suffer terrible consequences, many more have mild symptoms, some to the point where they do not seek medical care at all, such that they don't change their daily routine, continue to work, shop, and all the other activities that can expose other people. Others may be spreading the virus before they have symptoms, which makes procedures that isolate sick people useless at containment. (The CDC page linked is cautious about this information, noting that pre-symptomatic spread isn't the main way transmission occurs.)

Stopping a virus like Ebola turns out to be relatively easy in the sense that you can perform "contact tracing" by connecting the sick to the sick to the sick, and so on back to Patient Zero, the original source of the outbreak. But there have already been cases in the COVID outbreak that have no obvious source--no contact that would clearly link them in a chain going back to Hubei Province over the past two months. Indeed, one estimate is that for every known transmission outside China that could be traced back to a Chinese citizen, there were two transmissions to outsiders that have gone undetected. This is why the virus has popped up in unexpected places, and will continue to do so.

Which includes the United States--and as if to prove the point, just during the time I've been writing this, it appears a new case has arisen in California. This is breaking news as I type this, so it may require revision. But even if it turns out not to be a confirmed case, it highlights how this virus is already spreading in places we cannot yet know, and the US will be no exception.

So if it's coming anyway, and it's only got a measly two percent fatality rate, why be concerned at all? Instead of panicking, maybe we should just shrug it off, like Rush Limbaugh, that purveyor of well-reasoned political analysis, has opined recently, likening COVID to the common cold?

Similarly: no. Two percent of a lot of people dying in a very short span of time is going to tax the healthcare system to its maximum. There are only so many ventilators in a given area, and areas in an outbreak may not have enough ventilators to go around. We have already seen in China that the people on the front lines taking care of patients become infected and sick, taking them away from non-COVID patient care duties. Who will be able to do the emergency appendectomy when the one surgeon in town is down and out themselves? Will women get needed urgent C-sections if anesthetists aren't available for emergency procedures? The list goes on. This happened during the Ebola outbreak, and people died as a result, without ever having contracted the virus.

That's where I'll stop for the moment, other than to note that, if one can't panic, and one still has to take this with the gravity it deserves, then perhaps the proper mentality can be found in our British cousins--that we should steel ourselves for the coming storm, and simultaneously Keep Calm, and Carry On.