By Kris Neuhaus, MD, MPH
If you’re like me, you probably take advice from experts with the proverbial “grain of salt”. That is just part of our midwestern heritage. As often as not, the warnings turn out to be over-blown, or at least seem to be when viewed from the rear window. Think Y2K bug, which had our Kansas government hunkering down in a bunker in Topeka, supposedly, yet which turned out to be a classic “nothing burger”.
Now, a big part of why the computer bug turned out to have a very limited negative impact had to do with a massive amount of preparation to keep it from messing up every data record since the advent of computers. So, having foresight can be useful, if that foreknowledge is acted on thoroughly and efficiently, as was done with the Y2K bug. Governments and industry world-wide became aware of the problem months ahead of time, and were able to transition to the new dating format before everyone’s transactions and accounts could go up in a puff of fairy dust at the stroke of midnight of the new millennium. Catastrophe averted.
When it comes to the non-digital type of bug, if you’ve been around long enough you have likely heard similar scary stories issued by experts. Swine flu, bird flu, Zika, Ebola… and now COVID19, a novel human Coronavirus disease first identified in 2019. Other Coronaviruses cause cold-like illnesses in people and have been around a long time. This one is different though, like the 1918 influenza virus is different from the seasonal flu.
The problem with this new virus is its virulence (how sick it can make you) combined with its apparent ability to be transmitted by people who don’t know they are infected. The SARS virus, a closely related Coronavirus, was more virulent than COVID19, but less contagious, which made containment in the early stages of the outbreak possible.
From data available so far, around 18% (almost one in five) of those who are identified as infected need to be hospitalized because they are seriously or critically ill (source: https://www.worldometers.info/coronavirus/). So, let’s look a little closer at that 18% figure. What that means is, it’s quite possible that multiple people on any given block will need to be hospitalized during a wave of the outbreak. And not just hospitalized for isolation purposes. According to the current statistics aggregated at the link above, 18% are in “serious or critical condition” which generally means they need an ICU bed or at least more intensive care. Without measures to slow the infection rate, around 70% are estimated to become exposed rather quickly and of those, and optimistically, maybe only 10-12% of those will need hospital care.
This level of demand would cause a huge burden on our clinics and hospitals. Not enough beds, protective supplies, personnel, equipment, medications, etc. With the health system overwhelmed by the sheer number of cases, many people may either wait to get care or avoid it altogether, meanwhile spreading the illness. Some may even delay seeking care over concerns about the resulting bill. Yes, for those under 40, you may have just mild cold symptoms, or even no symptoms at all, but you may spread it to others with a much higher risk of dying, especially if they have any of a number of common medical conditions. Of the resolved (“closed” in the data linked above) cases, the death rate has remained at 7% this week, dropping from 8% last week. (Note: the actual “case fatality rate” is unknown because we don’t know how many people have been infected but not come to the attention of those who are counting the statistics. In math terms, we don’t know what the real denominator is. The case fatality rate is currently estimated to be around 2% of everyone who is exposed, roughly equivalent to the death rate during the 1918 influenza pandemic).
With all the interstate commerce, air and road travel, and commuting to cities for work it’s just a matter of time (maybe weeks) until it arrives here. Here in the United States, it is unlikely that there will be quarantine zones like there are in China right now. First off, the virus is too geographically widespread already. In Washington state, it is estimated that the virus has already been present for weeks and may have infected several hundred people already, not just the two unrelated cases we know about so far.
Secondly, quarantines are really hard to enforce effectively, requiring a lot of personnel to manage the logistics. Add to that the fact that in the US, particularly in employment like restaurant worker, janitor, secretary, day care teacher, cashier, Amazon delivery or warehouse worker, laundry worker, etc. sick leave, even unpaid, is the exception, meaning that people tend to go to work even when they’re feeling off or even sick.
So, what to do? Because containment hasn’t work this time in China or anywhere else — the cows are out of the barn and half-way around the world already — the CDC and other health experts like the WHO have had to resort to the next best approach, given the situation: a strategy of “attenuation”. What does that mean? Basically, it means to stretch something, to thin it out. Instead of a massive flood of sick people over a few weeks, efforts will be aimed at forcing the epidemic to spread more slowly, affecting fewer people at a time and avoiding a complete gridlock of medical services. It will also mean that the epidemic will be around longer, but this strategy will also buy us time to develop a vaccine and more effective antiviral medications.
So, how do we accomplish this attenuation of the Coronavirus outbreak? The tactic currently being deployed is called “social isolation” and is exactly what it sounds like: limit the contacts you have with others to the extent possible once it’s known to be in your area. What we’re seeing of this so far is that affected locations are closing big venues (sports events, museums, schools) and encouraging anyone who can, to work remotely. Schools may be doing remote teaching. By self-isolating as much as possible (think micro-quarantine) we will not only reduce our own chances of getting sick, we will also be protecting our neighbors and coworkers. Then, even if you get sick later, your chances of accessing any needed care will be better than during the peak of the epidemic.
Nobody alive in the US today has lived through anything like what China is dealing with now, and like it or not, it is headed our way. Rather than two equally useless approaches, either ignoring the problem until it’s too late, or over-reacting and causing panic (like the stock markets right about now), what we can all do immediately is to prepare for a period of disruption of our normal daily activities, possibly for an extended period of time.
The current recommendation is to stockpile two weeks of necessities (food, medicines, pretty much all the stuff you buy every week except perishables). However, two months of dry goods and other long shelf-life items seems more prudent, as production in China is not recovering yet and most of the stuff in stores comes from there. I can certainly live without more plastic anything, but I really hate running out of toilet paper. Based on what we’ve seen in China a month into the epidemic, it is just now seeming to peak (fewer new cases than previously) and without a vaccine or other effective intervention to shorten the outbreak, the peak is, at best, just the half-way point.
Many of us live paycheck to paycheck, but remember that whatever you stockpile now will still be good in a couple of months, so you will be spending less later on. Food could be more expensive during the recovery period, so you might even save some money by stocking up now.
It also might be a great time to quit smoking if you’ve been on the fence about it (https://kansas.quitlogix.org/). In China, the mortality rate among men (heavy smokers) is twice that of women (fewer smokers). Even a few weeks of smoke-free breathing will allow your lungs some recovery, which might make a real difference in how sick you get. Use that extra money to stock up on supplies!
KRIS NEUHAUS, a medical doctor and master of public health in Kansas, contributed this article to ThisCantBeHappening!, the uncompromised, collectively run, six-time Project Censored Award-winning online alternative news site at www.thiscantbehappening.net