Covid-19: A Quick Primer (from March 1st, 2020)
This post was originally published to my personal Facebook on March 1st, 2020. I’m reproducing it here to have some consistency with Medium as a publishing platform moving forward. Obviously the situation is fast-evolving and some of the figures are out of date.
Some light afternoon reading! I thought I’d take a moment to get some of my thoughts on COVID-19/the novel coronavirus down for anyone who may be interested. It’s important to preface this by noting that I am not a public health expert, virologist, or epidemiologist, but I read a lot and assimilate information quickly and here are my takeaways, in FAQ style. Feel free to share, if you think others might be interested. I’ve worked to cite my sources as well as I can:
1) What is the novel coronavirus?
Coronaviruses are a type of virus whose common trait is the appearance of spikes that make them look like the corona of the sun, which is where they get their name. (Not the beer!) There are more than 30 known coronavirus, but only 3–5 affect people. They cause around 20% of colds in humans, and are mostly active in winter and early spring. Chances are, you’ve had one before! [1]
THIS is a NOVEL coronavirus. This means we have not seen it before, and by all accounts, it only just recently made the jump to humans in December.
The issue with the virus being novel is that our immune systems _also_ have not seen it. While they have seen other viruses, this one seems to have certain qualities that make it difficult to fight. We also don’t know all kinds of things about it, but we’re trying to learn quickly.
1a) Why is it called COVID-19?
The disease you develop is COVID-19. (Like saying you caught the flu, I imagine we’ll develop some silly way of referring to this that’s also monosyllabic at some point, like catching “vid” or something.) The virus is called SARS-CoV-2. If that sounds familiar, it’s because you remember the SARS epidemic from a decade ago.
SARS-CoV-2 causes COVID-19.
Calling it “coronavirus” is tricky because it is *A* coronavirus, but we’re naming this one specifically because it’s novel and particularly bad.
2) Isn’t it just a “bad cold or flu”?
I see a lot of people explaining that they’re not too concerned with this virus because it seems to be essentially a bad cold or flu. Well, okay, that is strictly speaking somewhat true. It’s important not to panic, because if you’re otherwise healthy and under the age of 60, you’re very unlikely to die from this.
However, let’s break down what a “bad flu” can do to a society or economy:
Last flu season, CDC estimates 45 million people developed the flu IN THE US ALONE. From those 45,000,000, we had 65,000 fatalities. Flu is actually a top 10 cause of death in the US. (Side note: GET YOUR FLU SHOT!!!) Flu kills between 0.1%-0.2% of people, with different populations varying in sensitivity to its mortality rate depending on the strain. Last year, with those numbers, it was 0.14%.
COVID-19 is speculated to have a mortality rate of 1.5%-2%. This is a bit scary. If 45 million people develop COVID in a season, that means 900,000 of them would die.
That would quickly make COVID the leading cause of death in the US. Heart disease is number 2 with around 650,000 [2]
3) Yeah, but… that’s not likely to happen, RIGHT?
Well, we’re kind of at a tipping point right now. First and foremost, COVID is FAR more infectious than the flu.
How do we measure this? Scientists determine what is called the R0, pronounced R naught. It’s the “basic reproduction number”, or the number of people an infected person is likely to infect without controls in place to stop the spread. For the flu, it’s around 1.0 to 1.2, which means the average infected patient is likely to infect just over 1 other person. For COVID, that number is moving, but it’s been speculated to be as high as 3 to 5. On the cruise ship in Japan, it came in closer to 2.28. [9] This means, conservatively, COVID is 220%+ more infectious than the flu.
The people on the cruise ship were in a form of quarantine protocol, and it still spread to nearly 700 of the people on the ship. That’s a lot of infections. (It’s also possible that the ship environment amplified the infectivity, which is… complex and confusing and why this is hard to pin down.)
For some context, Measles has an estimated R-naught of 12–18, though some studies insist this is hard to pin down. (GET YOUR MMR VACCINE, YOU LUNATICS!) [3]
It’s worth noting that our saving grace might be that these statistics aren’t concrete at all. If, for instance, there are FAR more cases but they’re underreported, and the fatalities are the same, than the mortality rate will go down and it might not be all that bad. (But it’s likely that the R0 is even worse then.)
3b) Do I have COVID-19?
Probably not! But maybe, if you live in Seattle or Sacramento and have a dry cough and a fever. These are the most common symptoms.
3c) How do I get tested?
The CDC has really screwed this whole process up, by limiting tests to use only their kits, then sending out ineffective kits. They have released these limitations, but it may be too late.
In any event, contact your local hospital, or state health department and tell them your symptoms and travel history to determine if you need to be tested. It’s more likely just a cold, in which case, do what you’d do with a bad cold: stay home, lots of liquids, etc.
By the way, this is why electing people who care about the public good and hiring intelligent people is important. This administration is hyper-focused on the impact on the stock market and is influencing pandemic response decision making in some very dangerous ways. [7]
4) Why is this worse than SARS, MERS, Swine Flu, Bird Flu, etc?
Another point I’ve heard made a lot is that the past several “epidemics that are supposed to kill us” turned out to be nothing, so this will also blow over. It’s the boy who cried wolf.
SARS and MERS were similar coronaviruses, except that they were FAR deadlier. This actually can reduce the impact of a virus because it kills its hosts before it can quickly reproduce. It also had telltale symptoms and a pathology that made it EXTREMELY EASY to identify and build processes around.
COVID is less deadly than SARS. Which is good, on the surface! But FAR MORE people will catch it (and far more people already have), and thus far more people will die from COVID than SARS. (COVID is already over 3,000. SARS “only” killed 774. [4]
5) What about a vaccine?
A vaccine is probably 12–18 months away from widespread use, unless some amazing developments occur. We have never developed and released a vaccine for a coronavirus. This is an important detail because it’s an entirely new ballgame.[5]
We’re hopeful that a treatment from earlier research may work, and studies are underway. Anti-virals are complicated, but there’s a promising candidate.
There is an Israeli research group claiming they’re very close to a vaccine, because they had done some work on a coronavirus vaccine for a previous version that’s adaptable for this, which is hopeful, if it’s true. [6]
But a vaccine will still need to go through clinical trials (even if expedited) and the production and distribution process is… significant for something like this.
6) How bad will it get in the US?
It appears that “community spreading” is already occurring in the US. This means that cases are developing that don’t have a clear link to a previous case or travel to an affected country. This means it walks among us. Worse, it feels very much like the horse has bolted the stable here: we’re quarantining and tamping down environments were cases are appearing, but it’s likely that the virus was already spreading in those environments for a week or more before, which means… we’ll just see more and more community cases develop.
It wouldn’t surprise me if it was in all 50 states within 3–4 months, with some leeway made for the fact that summer is coming, and these sort of viruses don’t particularly thrive in dry heats, so here’s hoping Phoenix works against it!
There is also research showing that it may have been silently spreading for weeks now in the Pacific states. (As many as six weeks!!! Not great, because it means it could already be spreading elsewhere and working to develop a foothold.) [8]
COVID appears to be able to spread while a person is asymptomatic (though less infectiously), and its long incubation period (7–21 days) is troubling because of that fact.
7) So what will happen and how should I prepare?
I would put it at decent likelihood to a near guarantee that you’ll notice this affecting your life sooner than later. The best way to reduce the impact of a pandemic like this is to slow its spread as much as possible, and the best way to do that aside from washing your hands and not touching your face is social distancing. Social distancing means no longer shaking hands, congregating with large groups, or interacting closely (within 6 feet) of people.
Other countries are already cancelling events over a certain size for fear that they could precipitate a fast-spreading cluster.
So consider that an affected county, like the Seattle area, may start to preemptively cancel concerts, tradeshows (this is already happening), sporting events, and other similar large gatherings. Movies theaters, malls, museums, schools, and others are going to be high on the list of places that would be wise to avoid, and that I would expect to close temporarily. I think states will hold off on closing airports as long as possible, but it probably makes sense to avoid airports in known outbreak areas.
As people shift into a quarantine/hunker-down mentality, stores will see runs on them for supplies. This is already happening in areas both with and without cases. It would be wise to have enough toilet paper, medicine, and staples to last you at least 4 weeks.
This isn’t a natural disaster in the sense that it’s likely we’ll lose power, water, internet, or other utilities: those will be considered necessary so things like generators and other zombie-apocalypse prepping is probably a bit too much. But expecting it’s hard to find TP for a week or two at a time? I’d make sure I’m prepped for that.
7b) What about masks?
They won’t work. Surgical masks don’t prevent you from being infected. N95 masks block most particles, and have a better chance of preventing infection, but they need to be fitted and properly used and you won’t do that correctly. There are other complications with N95 masks as well that make them not worth wearing. If you have some symptoms, you should be staying home anyway, but if you MUST go out, be courteous and wear a mask, since even the basic masks DO help stop YOU from spreading the virus.
Otherwise, leave the N95 mask supply to the healthcare workers who need them to stay healthy while they do their job. It’s about to get shitty for them.
8) How bad will it get economically?
This one scares me the most. The market doesn’t know what to think here. If we’re at a tipping point and we’ve already tipped… it’s going to get rough. The economy counts on people out and about and spending their money. People afraid of a virus don’t shop, don’t travel, and don’t even show up to work. There will be some significant ripple effects if the outbreaks continue and worsen, vs. start to level off soon.
9) TLDR:
- “You probably won’t die.” — Direct quote from our President, but… technically true, even if it misses all of the broader points.
2) There’s a decent chance we’ll all catch this. And for almost all of us, it’ll be just like a bad cold, or even not as bad. But there’s a higher chance with COVID-19 of it turning into pneumonia or turning fatal, which will tax our healthcare system.
3) It COULD die off. But it’s more likely at this point to continue to spread, and to start spreading very quickly. China’s new cases slowing down gives cause for hope though, but the means they took to get there are… challenging, and their accuracy of their numbers is… also challenging.
4) Stock up on TP, medicine you need, and enough food to hunker down for a bit if you don’t want to go out and about. Don’t bother with masks.
5) Start practicing social distancing. Avoid shaking hands and hugging and sharing drinks and food. Try to limit touching your face. (You touch your face 300–500 times PER DAY. Good luck with that.) If there are known cases in your area, REALLY start avoiding these kinds of contact.
6) Bored? Watch Contagion. It’s a fantastic movie that is basically describing what’s happening right now with an only marginally worse pathogen. It’s not a horror movie and it’s not over the top. Instead, it’s well-researched, well-acted, and very, very scientifically accurate:
https://www.amazon.com/Contagion-Marion-Cotillard/dp/B006IVBSBU/ref=as_li_ss_tl?&tag=cc91447836-20
[1] https://www.webmd.com/cold-and-flu/cold-guide/common_cold_causes
[2] https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
[4] https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome
[6] https://www.sfgate.com/science/article/COVID-19-coronavirus-vaccine-Israel-15093659.php
[7] https://twitter.com/JeremyKonyndyk/status/1234180123244580864
[8] https://twitter.com/trvrb/status/1233970271318503426
[9] https://www.ijidonline.com/article/S1201-9712(20)30091-6/fulltext
