First, some definitions. The disease is called COVID-19, and the virus is called SARS-CoV-2 (SARS like coronavirus 2). It shares many similarities to the SARS virus, but is a bit less deadly (SARS was close to 10%), trading this attribute for higher infectivity, which it achieves by having a bit longer incubation & slightly less symptoms — fever was common in all SARS cases, but only appears in about 77% of COVID-19 cases.
As you all know, the Government’s response has escalated significantly over the weekend of 14–15 March 2020, implementing many measures that will affect our lives for a while.
It’s sad but hey… for the first time in many of our lives we have to recognise that we are playing a role in something bigger than ourselves and have to behave contrary to ‘do as you please’.
We have a significant public health responsibility to change our behaviour quickly, and suddenly, to reduce the rate of spread of this condition. This will protect the elderly and vulnerable, allow our hospitals to give best quality care to all who need it, and allow all the other patients who have demands on the health system (expectant mothers, people with cancer, people in accidents) to also receive high quality care.
As the Stone & Chalk community skews young, many of my co-residents will have looked at the mortality figures for their age group with some relief.
This is an easy misconception and you should not be comfortable that this is likely to just be ‘a bad flu’. For my own age group, 31–40, current mortality figures suggest 0.2–0.4%. It is not yet clear if those 1:250–1:500 have other conditions that increase their mortality risk -we know that in older demographic groups, poor outcome is associated with high blood pressure, heart disease, respiratory disease and diabetes.
I am treating the risk to my age group as applying indiscriminately, therefore, despite being otherwise healthy, consider that contraction of the virus would have a 1:250 personal risk of dying.
A further concern is that around 1:100 in this age group are needing high-level hospital care (ventilator support).
I am not willing to play Russian roulette with a 100 round revolver, and neither should you — after scaling your age-risk appropriately.
You have heard the Prime Minister and other world leaders talk about flattening out the curve. This is essential because the difference between being able to give best available care to all who need it may change the mortality rate from ~0.9% (Beijing/South Korea). to 3–4% (Wuhan/Italy).
This is why it is essential to wash your hands regularly, and properly — see this BBC link for a reminder. This is also why it is essential to avoid large crowds and not shake hands. Stop touching your face, stop biting your nails, putting your fingers in your mouth and then on surfaces and then in your mouth again — we all do this all the time. Apparently we are about to receive a big Government Ad Campaign detailing just this — it works, do it.
Rather than fear, remember this — you’ve all been in a house or office with someone who is sick and has had cold/flu and NOT caught it. Most people so far are diagnosed 5 days after catching it — so are generally spreading it for 4 days. So in all those thousands of interactions in going about their daily lives, they only manage to infect 2.4–2.6 more people.
Masks are not helpful for avoiding catching the virus, but are very helpful for infected people to avoid spreading it — and also for healthcare workers — so please, don’t stockpile masks and don’t waste them on a walk down the street.
If we all take sensible precautions like I’ve outlined above, we can reduce the R0 of the virus, maintain our health system, and continue to maintain some semblance of a normal life for the next several months whilst the virus runs its course.
Look after yourselves, look after others, and look forward to the future.
Dr Rob Pearlman
16 March 2020