COVID-19 facts for dummies and why we should be concerned but not panic or be complacent

Summary (tldr): Don’t go business as usual. Our healthcare system is not ready to take in all the future severe COVID-19 cases.

From the World Health Organization (WHO): If you are in an area where there are cases of COVID-19, you need to take the risk of infection seriously

Hello reader! I’m a MS student in Biostatistics about to graduate soon. For those still in school, you’ve probably had daily COVID-19 memos. Even though my program is more math-based, we’ve been told constantly to help the educate the public and fight misinformation as a student of the Public Health Sciences.

Seeing dangerous rumors spreading or people with inadequate action, I’ve decided to write up this article to include information that’s badly necessary for everyone to know and help translate a few jargon and numbers for laymen folks like I’m talking to an 8 year old. This is actually how I google complicated statistics terms to help supplement my lectures, with my most recent search being “explain markov chain monte carlo method to a child”

So, please don’t feel dumb.

Recently, I’ve been alarmed by two groups:

1 - Those who panic and hoard supplies

My response is stop. Believe me that I understand you. Half of my family is in Hong Kong (who I haven’t seen in several years), and I understand the mentality to stock up on supplies like it’s the end of the world before it’s too late or to rant on WeChat/WhatsApp spreading conspiracy theories with dangerous skepticism.

2 - YOLO (you only live once) mentality and do “business as usual”

My response is to also stop pretty please. Do you have complications like immunodeficiency, diabetes, lung disease, heart disease, and/or in the older age group (>60 years)? You’re the most at risk of developing severe symptoms, even death. Especially, if you’re older than 80, and I’m not kidding. In China, among those who have COVID-19, the death rate shot up from 2.3% to 14.8% for those over 80 years old (look at case-fatality rate). (Update 3/24: There are few cases of young healthy adults that still require hospitalization in the US. In short, nobody is invincible).

Pfft, so what? China is a different country, and my country has different healthcare systems. Besides, that’s just 15%. Also 2.3% is so small. There are so many people dying from the flu! We never shut down the economy over the flu, so why now?? Stop scaring me!

That’s a good question! I hate being scared too. Seriously, I used to cover my mirrors in middle school or scream when I walk into a bathroom all by myself because several classmates started spreading rumors that someone saw Bloody Mary after doing the whole shebang.

But these drastic measures we see on the news like Italy being on lockdown or NBA suspending their season are guided by data and facts. Here are several reasons why:

COVID-19 is similar to the flu and potentially worse

The world is caring more about COVID-19 more because

  • It’s brand new. There’s no treatment available. Yes we see flu-like symptoms, but we don’t know truly how it will spread and so it deserves the extra precaution. It is not just “another flu”, which unfortunately was the stance that Italy took before lockdown.
  • There’s no vaccine available. It won’t appear next week. Not next month. Not by summer. Realistically, about at least a year because many types of testing need to be done to ensure the vaccine works as it’s suppose to and make sure it’s safe for the general human population. That’s where the terms ‘clinical trials’ and ‘testing efficacy’ come in. With no vaccine, pretty much anybody can get infected.
  • Reportedly more severe cases than the flu:

While the range of symptoms for the two viruses is similar, the fraction with severe disease appears to be different. For COVID-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than what is observed for influenza infection — WHO

  • WHO says that the case fatality rate is reportedly higher than the seasonal flu (2–3% vs 0.1%). Case fatality rate just means the fraction of deaths among those with confirmed cases. Yes, this may be an overestimate since we are catching more people with severe cases. From a paper in Lancet, arguably the most prestigious medical journal, titled a novel coronavirus outbreak of global health concern says “nevertheless the 1918 influenza pandemic is estimated to have had a case-fatality ratio of less than 5% but had an enormous impact due to widespread transmission, so there is no room for complacency”.

Here’s a nice infographic visually showing how COVID-19 is showing up to be worse than the seasonal flu.

https://www.vox.com/future-perfect/2020/3/12/21172040/coronavirus-covid-19-virus-charts

Numbers and %’s need to be read in context

So yes the flu is killing more people at the moment. There’s tens of thousands dead from the flu and about 38 deaths in the US from COVID-19 as of 3/12/20.

That fatality rate of 2–3% for COVID-19 seem small. Flu’s fatality rate is also small with 0.1%, but what does that really mean?

It depends on how many were infected (namely, the denominator). If you had 1000 people infected, then that means 20–30 people would die from COVID vs no one or 1 person dying from flu.

Now, there are MILLIONS of people living on this planet earth. Put simply, for every 100,000 infected, 2000–3000 would die from COVID-19 vs 100 dying from flu (some countries have varying case fatality rates due to different access to and quality of healthcare).

That means COVID-19 is ~20 times more deadly than the flu.

This is why it’s grossly inaccurate to simply compare the flu absolute numbers with the COVID numbers because the overall picture isn’t the same.

So, we must also think about the potential aftermath of COVID-19 if we don’t change some of our behaviors now.

What are those changed behaviors? Washing hands for 20 seconds, staying home if you’re sick, disinfecting surfaces including your phone, not going to large gatherings, and wearing a face mask if you need to go outside if you’re sick.

(If you’re in America) “Democrats are making this situation more serious than usual to make Donald Trump look bad. They’re always looking to take him down. MAGA!”

It’s actually the large groups of health professionals that are sounding the alarms as loud as they can…So, if you resonate with the above sentiment, then please read the following below:

The major reason for that “media frenzy” you’re wondering: Lowering the Epidemiological Curve (‘Epi Curve’)

What’s that? Well, it’s basically a graph that describes disease outbreaks over time.

First, let’s accept the fact that COVID-19 spreading. I remember two weeks ago that US only had 55 cases. Now it’s ballooned to 1,700+. (Update 3/24: It’s been 10 days since I’ve published this and now it’s 40,000+ cases in US alone.)

With experts testifying in congress saying there will be spread, believe them. They’ll get convicted for lying. So, it will spread, but don’t panic and just follow those precautionary measures.

Now, one major reason we’re taking drastic actions to slow the spread is to not overwhelm the healthcare system. There has yet to be an exact estimate by the American Hospital Association on how much we should expect, but the consensus is that we must lower the curve or flatten the curve.

Here’s a qualitative picture to help explain this phrase:

Note: Qualitative graph means that its purpose is to demonstrate a concept. So, the actual peaks may differ, but the general relationship of the disease being over or under our healthcare capacity being dependent on early containment measures is the main takeaway of this picture.

The orange line represents our capacity to treat. If we’re above the line (which is what happens if we don’t contain this early enough), then our healthcare system will reach a tipping point and will most likely collapse. Why? Hospitals don’t have unlimited supply of beds, masks, equipment for critically ill patients, and doctors.

But if we do enact those early containment measures, we can contain the spread as much as we can such that the epi curve is below our hospital capacity (the green stuff under the orange curve).

Italy is already facing a flood of new cases with stories of how patients are treated in the hallways. Have you also heard the horror stories that happened in Wuhan? There’s loads of eyewitnesses on Youtube who used VPN to override China’s firewall to alert the world.

We cannot afford to flood our hospitals with COVID-19 cases when there are also patients with life-threatening disease who also desperately need help.

That’s why we must do our duty to help spread out the cases to not overwhelm our healthcare system.

If you think: No way! US has amazing healthcare system!

Again, I’m still awaiting the final estimates but several experts have already stated the opposite. But I’ll leave this article for you: NYU doctor says US hospitals are unprepared for coronavirus and will be ‘flooded’ (Update 3/24: NYC mayor says its hospitals will run out of personal protective equipment (masks, shields, gowns) in 10 days. Many hospitals across the nation are already rationing their supplies. We haven’t hit the peak yet.)

From analysis at John Hopkins:

Obviously government needs to take serious action, but us individuals can do something. What are they again? I’ll repeat to drill this into your mind: Washing hands for 20 seconds, staying home if you’re sick, disinfecting surfaces including your phone, not going to large gatherings, and wearing a face mask if you need to go outside if you’re sick.

Speaking of face masks….

How to wear and dispose face masks properly

First, we shouldn’t be hoarding face masks and stealing from hospitals. Some hospitals are reportedly running out. The doctors are the soldiers fighting this virus war for us. If they run out, we’d all be much more at risk.

However, if you’re sick then by all means, please get a face mask!!

There’s a serious lack of information in the western media on how to properly remove face masks compared to those in Asian countries. That’s troubling because knowing how to remove is just as important as wearing them. (And, I’m guilty of this as well).

Why? You may potentially touch the germs that you’ve been trying to avoid, rendering the purpose of the face mask useless. Here’s a detailed guide on how to use and remove them from Center for Health Protection from Hong Kong, the epicenter of SARS outbreak. Surely they know a thing or two, yeah?

Here’s also a short 2 minute video:

Being Chinese doesn’t mean they automatically have COVID-19

This is no excuse to show your racism and bully others. There have been stories of kids being bullied simply because they’re Asian, and that is utterly unacceptable. Since it’s now a pandemic, it could be from anyone. Even our beloved Tom Hanks has it.

I understand your fear that by avoiding Asians you would think you’re less likely at risk. But, I hate to break it to you that the virus does not discriminate. If it can get to you, it will. That’s why washing your hands for 20 seconds, disinfecting surfaces and phones, staying home if you’re sick, and not going to group gatherings are THE recommended guidelines. COVID-19 doesn’t care if you have almond shaped eyes with black hair. But if you don’t wash your very own hands, then COVID-19 would love to infect you.

Don’t fall victim to misinformation

If you were contracted with a terminating illness, then who would you trust: A doctor with many years of training and expertise who has dedicated their life to understand how the human body works and goes through tests to keep their license every two years (who would take tests for fun?) OR a person you see on TV or Youtube with self-proclaimed “medical expertise”?

So, please listen to the experts. Here’s how:

If someone posts a fancy graph with shocking conclusions, look for the source and actually read it. If it’s a news article, read it and look for legitimate experts.

https://www.factcheck.org/2020/03/viral-social-media-posts-offer-false-coronavirus-tips/

If it’s copy pasta like the picture shown to the left showing a false viral Facebook post quoting “Stanford University” and “Taiwanese and Japanese doctors” giving tips to self-test, then please google it to check for yourself. I got this copy pasta from WeChat and I too fell for it. But a quick google search like this: “Stanford University and coronavirus leads to lung usually having 50% fibrosis”, which combines the famous institution and one alarming statement, will show you whether Stanford wrote those comments or not (answer is they didn’t).

If it’s a scientific article, just read the abstract (<150 words). Science articles have the responsibility to report how they’ve conducted the study, concrete results, and any startling limitations of their study.

If you want one particular source, please look at sites that end with “.gov” or “.edu” and maybe some “.org” sites for anything to take seriously.

In general refer to World Health Organization for updates. For America, the CDC is finally ramping things up and adding more detailed information. Refer also to your local public health counties.

Thanks for reading! If you ever wondered what to say to those who want us to “calm down”, I hope the information above can help you. If they’re not fluent in English, please translate for me (and try to maintain my attempted “humor”). My university has proceeded to online classes via Zoom. However, I’m not sure how other schools will enact this since not every institution has tons of $$$. I do know that Google has offered Advanced Google Hangouts for free through July 2020 and a dedicated webpage for educators to help continue their jobs.

Please share and tell your grandparents and those in the high-risk group about these important details. We will get through this. Don’t panic because panic leads us to not think clearly. But don’t just do nothing.

#2020Trojan

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