Some people claim that this new strain of coronavirus is a lot like the viruses that cause colds, and if you get it, it will probably just seem like a bad cold, or nothing at all. Depending on who you are, this statement is probably true. But it is incomplete. The missing information is the key to understanding the threat of COVID-19, and what it brings to us.
Coronaviruses have been around for a long time, and are a class of viruses that cause colds among other things, but this one is unique. The coronavirus that causes COVID-19 is new to the human population- so no one has any immunity to it, is very easy to transmit through respiratory droplets (which are basically teeny tiny drops of spit that can stay in the air for up to 3 hours), has a long life on surfaces, and, in about 20% of patients causes severe illness requiring supplemental oxygen or mechanical ventilation. Even with medical care, people will die from this infection.
Some of those people will get so sick that they cannot be saved and will die. The overall death rate for people who develop symptoms seems to be 2 or 3 percent. The number is still being researched because this virus is so new. Once we have enough testing to find out how many people caught the virus but did not develop symptoms, the death rate might come down to about 1 percent, optimistically.
Although this seems like a small number, please remember that we are looking at a percent. When you consider that 40-70% of the world’s population will likely be infected, 2 or 3% of that number is quite large. It is at least 10 times higher than the mortality rate for the seasonal flu, for example. So just on that math, we could be looking at 600,000 or 700,000 dead in the United States. The risk from COVID-19 is dramatic.
What has been seen is also worrying. Older people with existing health problems such as diabetes, high blood pressure, cancer, and so many more are much more vulnerable. The mortality rate of the new strain of coronavirus among people over age 80 may be 15- 20%-. There is a 7- 8% mortality for people aged 70 to 79. And 40% of hospitalizations for COVID -19 in NYC are in patients between the ages of 20-49.
What this means is that even if you don’t die, you can get really, really sick and require mechanical ventilation if you catch this virus. Or, if you are a healthy younger person, you can catch the virus and, without developing serious symptoms yourself, (40% of people show no symptoms of infection for the entire course of infectivity!) you can pass it along to other people.
The number of asymptomatic carriers spreading disease combined with the severity of disease in those showing symptoms and the death rate are all factors that make the threat of COVID-19 so serious.
Scientists measure the spread of an epidemic by a number called R0, or “R naught.” That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer spreading infection? It measures contagiousness. The R0 for coronavirus, if left unchecked by strict social distancing measures is a number close to 3 – maybe a bit higher or lower, but around there. That number is modifiable if we employ social distancing to decrease the number of people each infected person comes into contact with.
So, let’s see how this works. Let’s say you catch the virus and feel fine and decide to have a small get together with a friend or a small group. Statistics show that you will spread it to 3 other people, and they will each give it to three others, and so forth. Here is how the math works, where you, number one, are the top line:
So, in 15 steps of transmission, your virus has infected 14.3 million other people. Those 15 steps might take a few weeks. You may be young and healthy, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in you. The exponential growth of infection in a population is another reason why the threat of COVID-19 is grave.
We do not have approved treatments for this strain of coronavirus yet. We do not have a vaccine. The only tool we really have now is to try to slow down the chain of transmission so that all those people don’t get infected at once and overwhelm the medical system. This is called “flattening the curve” which you may have heard about.
This can be done. We truly can stop the spread of this virus! YOU personally can make a difference. If we can get the R0 number measuring contagiousness below 1, the epidemic will die out.
The threat of COVID-19 is why public health professionals are begging people to stay home and not socialize with anyone outside of our home.
While it is likely that the majority of Americans will get this virus, it is crucial that we slow the spread. The healthcare system has limited resources. We have about a million hospital beds in America. We have well under a million ventilators. If millions of Americans get sick and require treatment at the same time, we will move to a form of battlefield triage, where the doctors focus on trying to treat those with the best survival. This is a brutal, heart-wrenching way to make decisions. We do not want this to happen. The threat of COVID-19 is grim.
This is not theoretical. It has already happened in China and Italy and is beginning to be discussed in certain areas with booming infection rates in America. Older patients (above 65) or patients with preexisting conditions such as a history of cancer (even cancer survivor), diabetes, heart disease, a history of stroke, obesity, etc, will not be given advanced care to help save their lives. This sounds horrendous, but doctors are being faced with these grim decisions right now all over the world INCLUDING IN AMERICA.
Additionally, during this COVID-19 crisis, all the usual stuff that makes people sick continues to happen.
People will continue to get asthma attacks, appendicitis, allergic reactions, car accidents, heart attacks, strokes and the like. People will give birth. If there are no hospital beds left to care for these patients, we will have unnecessary deaths from things that are survivable. We will have hundreds of thousands of UNNECESSARY DEATHS in AMERICA alone.
We need time to care for sick people, to manufacture supplies and personal protective equipment to protect health care staff so we don’t start dying and further overwhelm the system by creating a deficit of health care providers.
We need time to develop a vaccine, to ramp up universal testing so that we can get a better handle on who is infectious. We need to develop antibody tests to see who has already had this virus and is safe to return to the workforce.
We need time to find a safe, and effective treatment.
Right now, none of that is in place, and so right now, we need to take extreme and economically impactful and emotionally impactful measures. Immediately. In fact yesterday. In fact several weeks ago, at a national level.
So, what do we individually need to do right now to address the looming threat of COVID-19?
We need to cancel all non-essential interactions with people who don’t live with us. This doesn’t just include “gatherings less than 10 people” as you are being led to believe by our government. It includes ALL personal contact with ALL people who don’t live with you. This includes not having one or two friends who feel well over. This includes not seeing significant others (EXCEPT OUTSIDE AND 6 FEET APART) unless you are going to cohort together and be a “family unit” for the duration of this pandemic.
- Stay at home, or go outside in nature and exercise but stay 6 feet away from any other person not in your “family” unit.
- Cancel anything in person that is not absolutely essential.
- Work from home if you can.
- Go out to buy groceries and medicine, but make the trips quick, purposeful, and as infrequent as possible.
- Buy enough food to last for 1.5 to 2 weeks.
- Don’t hoard.
- Wash your hands after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers and to include the thumb.
- Sunlight and alcohol (no, not drinking it) and bleach(no, not drinking it) will kill the virus. Wipe down all high-touch surfaces frequently.
- Please tell your friends, call out people who are not practicing these measures, and stop passing around statements on social media claiming that the situation is not serious or is being exaggerated. A public shaming helps no one, but a gentle, private message can often start a forum for a genuine exchange of information.
The threat of COVID-19 is a global crisis.
We all need to be prudent, take personal responsibility, not panic, and do our part sacrificing things we love to do, and visits with the people we love in order to save ourselves, our families, our community, our country, and in order to save humanity. The threat of COVID-19 is real, present, and immediate, and this is our chance to be heroes.
Guest Author: Mario Trabulsy, MD
Mario Trabulsy, MD is a board-certified emergency physician with over 27 years experience in the field. She has been a renowned and award-winning Educator at University of Vermont Larner College of Medicine, and University of Vermont College of Nursing and Health Sciences. She is a fierce breast cancer survivor, lover and creator of joy, single mother of 3 young adult or teenage boys, a dear friend, advocate for, and mentor to many, an avid outdoor exercise enthusiast and single track mountain biker.