Be Prepared

Week 9 (Feb 24 – Mar 1)

I’ve been fielding a lot of questions about COVID-19 lately. Here’s a summary from your friendly neighborhood epidemiologist:

1. 𝐘𝐞𝐬, 𝐭𝐡𝐞 𝐜𝐨𝐫𝐨𝐧𝐚𝐯𝐢𝐫𝐮𝐬 𝐢𝐬 𝐩𝐫𝐨𝐛𝐚𝐛𝐥𝐲 𝐜𝐨𝐦𝐢𝐧𝐠 𝐭𝐨 𝐚 𝐭𝐡𝐞𝐚𝐭𝐞𝐫 𝐧𝐞𝐚𝐫 𝐲𝐨𝐮. The testing criteria has been so restricted in the US, we’ve likely missed dozens of mild cases that were imported weeks ago. A vaccine will not be available for at least a year. Exactly when the virus will hit your community depends on a lot of factors, but it could be sooner than you think, so good to be prepared and informed.

2. 𝐒𝐡𝐨𝐮𝐥𝐝 𝐈 𝐛𝐞 𝐟𝐫𝐞𝐚𝐤𝐢𝐧𝐠 𝐨𝐮𝐭? At this precise point in time, an American is more likely to die of seasonal influenza than COVID. But that could change dramatically if COVID starts transmitting through the US population. COVID is far more deadly than seasonal flu, even accounting for uncertainty in the fatality rate.

The risk for severe disease follows a 𝒔𝒕𝒓𝒐𝒏𝒈 𝒂𝒈𝒆 𝒈𝒓𝒂𝒅𝒊𝒆𝒏𝒕, with most deaths in those over 70. That said, substantial mortality has also been observed in people in their 50s and 60s. And the millions of younger adults with chronic conditions (e.g., COPD, diabetes, hypertension) are also at risk. Testing has so far been so limited to severe cases so it’s hard to know what the denominator of mild cases is. But even a 1-2% fatality rate is extremely high [as context, Spanish influenza killed 20-50 million globally and had ~2% fatality rate in 1918}.

But the best news so far is that young children seem to be getting spared.

3. 𝐈𝐭’𝐬 𝐧𝐨𝐭 𝐭𝐨𝐨 𝐞𝐚𝐫𝐥𝐲 𝐭𝐨 𝐚𝐬𝐤 𝐲𝐨𝐮𝐫𝐬𝐞𝐥𝐟: 𝐝𝐨 𝐈 𝐡𝐚𝐯𝐞 𝐭𝐡𝐞 𝐬𝐮𝐩𝐩𝐥𝐢𝐞𝐬 𝐭𝐨 𝐬𝐡𝐞𝐥𝐭𝐞𝐫 𝐢𝐧 𝐩𝐥𝐚𝐜𝐞 𝐟𝐨𝐫 𝐰𝐞𝐞𝐤𝐬 𝐨𝐫 𝐦𝐨𝐫𝐞, 𝐢𝐟 𝐧𝐞𝐞𝐝𝐞𝐝. If you get infected and don’t require hospitalization, you may need to be self-quarantined in your own home for several weeks. Self-quarantine may also be an option for those at high risk when the epidemic is peaking in your community. Especially for retirees, teleworkers with existing health problems, you should think what degree of social distancing you can reasonably achieve. Between now and then, it would be good to think about stocking up on vital medications and essential supplies so you can minimize time in the community. It’s hard to know exactly how long a virus will be widespread in a given area. It’s a lot of complicated math that takes into account the characteristics of how the virus transmits and the demography and movement patterns of the community. It could be weeks, it could be months.

4. 𝐖𝐢𝐥𝐥 𝐬𝐜𝐡𝐨𝐨𝐥𝐬 𝐜𝐥𝐨𝐬𝐞? Japan’s recent decision to close schools is not because kids are at risk for severe disease, but more because the country is under enormous pressure from the 2020 Olympics and it’s not clear if kids with mild infections are important in community transmission. It doesn’t look like children are driving community transmission, but government officials at all levels will be under extreme pressure to show they’re doing something, and without a vaccine or therapeutics, school closings may be all they have.

5. Q&A section:

– 𝐂𝐚𝐧 𝐈 𝐞𝐚𝐭 𝐚𝐭 𝐂𝐡𝐢𝐧𝐞𝐬𝐞 𝐫𝐞𝐬𝐭𝐚𝐮𝐫𝐚𝐧𝐭𝐬?
YES!

– 𝐒𝐡𝐨𝐮𝐥𝐝 𝐈 𝐛𝐮𝐲 𝐚 𝐦𝐚𝐬𝐤?
Most masks only protect against large respiratory droplets, not the fine aerosols that transmit viruses. Masks tend to be most useful when worn by someone who is already infected to prevent infection to others.

– 𝐖𝐨𝐧’𝐭 𝐭𝐡𝐢𝐬 𝐚𝐥𝐥 𝐝𝐢𝐞 𝐨𝐮𝐭 𝐢𝐧 𝐀𝐩𝐫𝐢𝐥 𝐰𝐡𝐞𝐧 𝐭𝐡𝐞 𝐜𝐨𝐥𝐝 𝐬𝐞𝐚𝐬𝐨𝐧 𝐢𝐬 𝐨𝐯𝐞𝐫? Pandemics don’t follow typical seasonality. Recall that the 2009 ‘swine flu’ pandemic started in April and the first wave went through June. Even if coronaviruses are typically winter pathogens, when there are so many susceptible people in a community with no immunity to a novel pathogen, it can transmit fine outside their regular season.

– 𝐖𝐡𝐚𝐭 𝐚𝐫𝐞 𝐭𝐡𝐞 𝐭𝐡𝐢𝐧𝐠𝐬 𝐈’𝐦 𝐩𝐞𝐫𝐬𝐨𝐧𝐚𝐥𝐥𝐲 𝐦𝐨𝐬𝐭 𝐜𝐨𝐧𝐜𝐞𝐫𝐧𝐞𝐝 𝐚𝐛𝐨𝐮𝐭?
* The low availability of tests in the US.
* Health systems that lack the protective equipment, beds, tests, etc. needed to protect their workers on the front lines and serve their community during the peak of the epidemic.
* Politicization of the outbreak. The 1918 Spanish flu was one of the worst disease events in history, killing 20-50 million people, more than all world wars combined, and it was so bad because during the war politicians didn’t want to hurt morale and hid the details, exposing millions of people. They actually held huge war parades in cities in the middle of the epidemic. The best way to fuel an epidemic is to put politics ahead of transparency and information.