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Coronavirus: What Should You Think?
What you should think about the coronavirus depends, of course, on your chief concern.
If, for example, like the prognosticators in the financial press, you have your eye on the stock market, and if you have no near-term need for cash, you should not sell out – not at this stage, with the market down well over 20% – even though the epidemic will almost certainly get worse and take stock prices down further. For one thing is virtually certain. When the crisis begins to pass, the market will anticipate further good news and bounce back dramatically; and, when the economy subsequently picks up, prices will climb further. Instead of selling now and losing your shirt, you should be patient. The likelihood that you can time the market precisely is exceedingly slim.
Nonetheless, you should be pondering just when the market will hit bottom – which is when you will want to wade in with whatever cash you can spare. Bad news is good news for those who know how to take advantage of it; and if, as I have suggested, you can’t time the market perfectly, you can almost certainly get a better buy a few weeks from now than you can at the moment.
Probably, however, the market is the least of your concerns. If, like me, you are over 70 and an asthmatic or if you have parents or grandparents in similar circumstances, you may well be ruminating on life and death. How bad, you may be asking, is this apt to be?
The answer is not heartening. The coronavirus is not just another version of the flu. No one, apart from the handful in this country who have contracted the disease and recovered, has what physicians call “specific acquired immunity.” All, or nearly all, of us generally have some degree of resistance to the flu – even when we are faced with a new strain. Vis-a-vis the coronavirus, we are in the situation of those, such as my mother, who confronted the Spanish flu in 1918/19. Put simply, we are very, very apt to get it. Or to put it another way, this virus is contagious to the nth degree.
Epidemiologists tend to speak of an epidemic’s reproduction rate (R0). The reproduction rate for the coronavirus exceeds 2 and may even approach 3 – which is to say that the average person who gets it infects well over two other individuals. In practice, this means that, in the absence of obstruction, the number of those who have contracted the disease doubles and perhaps even triples every few days. If you catch on to what you are up against early, you can quarantine the infected, prevent people from congregating, encourage social distancing, and greatly retard its spread. If you don’t do so, the virus will spread like wildfire.
If, say, there were two thousand with the disease in your state or country on 1 February, there could easily be more than three million infected by the end of the month, and the numbers would continue to double or perhaps even triple every five or six days thereafter. The advantage one gets from anticipating trouble is enormous. The harm one inflicts on oneself when one waits to see whether the danger is really all that great is enormous. We could have learned from the experience of the Chinese living in and near Wuhan. We didn’t.
You might want to go to the Johns Hopkins University site that tracks diagnosed cases and fatalities. If you were to do so right now while I am composing this post, you would discover that, in the entire United States, there are only 1,323 such cases and that, in Illinois, there are only 25. This might cause you to think it safe to travel to Chicago, to visit the museums there, and to take a group of students out to lunch and dinner. But these numbers would be less reassuring if you were to take note of the fact that, thus far, not many more than 5,000 test kits have been produced in the country. Put simply, actual cases vastly outnumber the cases we can diagnose. For our lack of preparedness in this regard, you can blame the ineptitude of the Center for Disease Control and Prevention. There, as in the Veterans Administrations, you can watch your tax dollars at work.
For what it is worth, we are not alone in our ineptitude. As a lengthy report in The Wall Street Journal makes clear, Xi Jinping made a terrible hash of things in Wuhan. And the Iranians and the Italians were similarly negligent.
You can probably believe the official statistics for fatalities provided by the Italians (827, to date). You should probably not believe the Chinese. Xi’s only concern is now and has always been his own survival as supreme leader, and the party leaders under him have similar motives. Their first instinct was to hide the outbreak. When exponential growth rendered that impossible, they sought to minimize the calamity, then present it as a problem solved by their wisdom and decisiveness.
You certainly cannot believe anything that comes out of Iran. The government of the Islamic republic reports 429 deaths, but between 21 and 29 February, in Qom, where the infection apparently first appeared, the authorities dug two large trenches, together more than 100 yards long, to accommodate the dead. And the disease was by no means limited to Qom. It has spread from there to 27 or more of the country’s 31 provinces.
How bad could it get? In 1918 and 1919, the Spanish flu infected one-third of the people on earth, and it killed 50 to 100 million human beings. Most of these were old folks and those with underlying conditions, as is the case with the coronavirus. And the outbreak overwhelmed the existing medical infrastructure everywhere.
What, you might want to know, is the fatality rate for the coronavirus? The true answer is that no one knows. If you base yourself on the statistics supplied by the Chinese, you would say 3.8%. If you looked to the Italian statistics, 6.6%. The Iranian statistics would suggest 4.25%. But all of these numbers are worthless. Even if these reports were honest (and the Italians are probably not lying), all of these ratios are based on the number of deaths due to the disease (which may be known) and the number of those actually infected (which is not known).
To the best of my knowledge, there is only one country in the world that has produced enough test kits to be able to diagnose everyone likely to have become infected, and that is Korea. Because of their sad experience a couple of years ago with SARS, the Koreans knew what to do. And when the outbreak in China was announced and the genome of the coronavirus was mapped, they moved quickly to mass-produce diagnostic kits. To date, in Korea, there have been 66 deaths and 7,869 individuals diagnosed with the disease. If these numbers are sound, the fatality rate is 0.83%.
That would be reassuring were it not for the fact that the fatality rate with the Spanish flu was similar, and it means that the coronavirus is eight or more times as lethal as the worst of today’s flu strains. If a third of the people in the United States were to contract this disease, more than 2.7 million would die. Moreover, to judge by what the Chinese report about the age distribution of those who died in Wuhan and elsewhere, a very high proportion of these would be over 65, and many of the rest would be individuals with underlying conditions – diabetes, asthma, high blood pressure, heart disease. The list is long.
Something like 80% of those who come down with coronavirus have a mild version. The circumstances for the remaining 20% are deeply unpleasant – even when they survive. I recommend reading The Daily Mail’s report concerning the vicissitudes of an intrepid English schoolteacher in Wuhan.
There is a moral to this story. We need to do what the authorities in St. Louis and Milwaukee did a century ago when the Spanish flu spread in America. For a time, we need to do everything in our power to prevent people from congregating – whether in schools, at colleges and universities, in churches, at sports events, in restaurants, and the like – and we need to encourage social distancing. Some institutions – such as Harvard, Yale, MIT, the University of Michigan, Michigan State University, Colorado College, Boston College, and, yes, Hillsdale College – are taking this seriously. Here, in Michigan, the Governor, the Department of Education, and the Department of Health and Human Services are dithering, as hacks and bureaucrats are apt to do. Perhaps someone should put up money for an award for ineptitude. I suggest it be named after China’s mini-Mao.
I had engagements planned for the spring that required my taking 14 flights. I canceled nearly everything last Saturday. I am preparing to do my teaching for the rest of the semester over the internet from home, and I am contemplating pulling my children from their school. My suspicion is that everyone should do the like.
I was not surprised to learn that three TSA employees at the San Jose Airport tested positive for coronavirus. Every infected individual in the United States who has done any air travel in the last three months has passed through the hands (sometimes, literally) of TSA employees. They are among the people in this country who are most likely to have been exposed to the disease and who are best positioned to spread it.
Published in Healthcare
I have a question. I’m in Cali Colombia. I can stay till about April 24, then I’m obligated to leave the country. I have reservations to leave with a direct flight from Bogota to NY on April 3. The disease is limited in Colombia especially very warm Cali. I could cancel my flight, which I’ll lose, try to let them extend it for a month more, or just leave on April 4. My impression is that it will get worse for some time and I should just get home, a rural home not near any big city. What are the likelihood that it will get better or worse over the next one or two months.?
With all due respect–and I have a great deal for you when you are talking within your area of specialization–you are not correct on several of your statements and assumptions. First of all 1918 pandemic flu had about a 10% overall case fatality rate; the current virus is looking to have a rate below 1% and likely lower in the developed world when all subclinical cases are taken into consideration. We really don’t know the actual number of cases in the US, though I recently heard an estimate of about 30,000. When broken down by age, the highest case fatality is in the oldest group (>80 years), where it is about 15%.
There has been a pandemic of panic and an exponential increase in armchair epidemiology. Please, y’all, stop running around with your hair on fire; please leave some toilet paper in the store for people who are, you know, actually out of it; take precautions that you should always be taking, particularly during flu season, when it comes to being aware of the importance of hand-washing; and just calm down. Flu has already killed at least 20,000 people in this country alone this season. The one good thing that should come out of this panic has already occurred: the flu rate seems to be dropping even beyond seasonal expectations. That will demonstrably save lives.
Anna, one of my grandfather’s two sisters died of the Spanish flu in 1918. She was 24 years old, a teacher in a one-room schoolhouse in the countryside outside of Philadelphia. To my knowledge she didn’t have any underlying health conditions.
This is a scary situation. Most people on social media are talking about the possibility of themselves getting sick. But my understanding is that most people under 60 will just be sick and get better. What I’m afraid of is that I’ll contract it, not be aware that I have and infect my parents who are 88 and 85.
Italy is shut down for no good reason. It just is.
It seems to me that nations are responding to something. Is the State of Italy just in a panic?
Why do you feel it’s no good reason, @bryangstephens?
Well, there is a Hillsdale College National Leadership Seminar scheduled for April in my neck of the woods, Bellevue, Washington. Dr. Rahe, will it be cancelled? We just got the invite last week, and have registered and gotten hotel reservations. I really don’t want to see it cancelled, but if it is, I know the hotel will accept our cancellation.
I, too, am in the “old folks” high-risk group, but I don’t have any underlying conditions other than arthritis which should not affect my susceptibility. I am not panicking in any way, still going to work every day, and watching my financial portfolio tank. Not selling into a down market, either. I’m just glad I have chosen to keep working full-time, long after my normal retirement age. I would not like to be a retiree watching my life’s savings melt away. But like the good Professor says, the market will go back up again.
You will hear soon, I suspect. The decision to close things down and go online for awhile came down today.
It will get worse. The best account I have seen can be found at https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca.
I don’t even know what I should think about the 1918-1919 Spanish Flu. One of my great-grandmothers died from the Spanish Flu (at least according to family lore; I do worry about family lore after the shaming of Pocahontas).
I vaguely recall being taught that the Spanish Flu killed about 20 million, not the 50 million mentioned in the OP. This is from old memory, probably in my high school days — 20 million for the Spanish Flu, about 75 million for the Black Death.
A CDC website says 50 million (here), but then I get paranoid and note that this page is for the 100th anniversary of the Spanish Flu, and that CDC has an incentive to overstate the death toll (to get more funding). It is really hard to know who to trust.
Here is a paper from the American Journal of Virology in Dec. 2018 (by Spreeuwenberg et al.), estimating the total Spanish Flu death toll to be 17.4 million. Conveniently, this one is actually available online — the others are not, but are discussed in the Spreeuwenberg paper. There was a 1927 estimate of 21.6 million; a 1991 estimate of 30 million; and a 2002 estimate of 50-100 million.
It’s hard to know who to credit. Personally, I’m sticking with the roughly 20 million that I was taught in my youth, which is consistent with the most recent estimate.
This seems to be the most solid part of the OP, but even here the figures are speculative as to Korea, and the math is wrong as to the US.
First, the math error. If the death rate is 0.83% and a third of the people in the US get the disease, the number of deaths would be about 900,000, not 2.7 million: 327 million population * 33% infection rate * .0083 death rate = 904,700.
Second, the bigger problem with this analysis is the presumption that the Koreans have tested everyone likely to be infected. The Koreans seem to be doing a good job with testing, but the latest information that I’ve seen (from a comment by Kovak, here) shows that the Koreans have tested about 189,000 people — out of a population of over 51 million.
So what if — as seems very likely — we’re picking up just about all of the deaths, but not detecting low-level cases? For this reason, I worry that all calculations are very speculative.
Be nice if it would go back up some before I have to take out this year’s RMD, which was based on a market high.
No one knows what the fatality rate or infectious rate of this disease is yet. We will know fairly soon. Clearly the low rates of serious infection in Hong Kong, Taiwan and South Korea, so far, compared to Italy, justifies the prudence of isolation and quarantine.
I was being sarcastic.
It is all speculative.
Ahhh….
Thanks. That means get moving as quickly as possible.
Dr Rahe and everyone: We’re getting way too mathy in our analysis. This thing has been working its way across the Northern Hemisphere now for two and a half months and has largely run its course in certain areas, and has killed 5000 people total. Yes, that number continues to grow, but it does so in sporadic unpredictable ways – certainly not in an exponential growth curve. And yes, C-19 continues to flare up in new places, but if the crazy exponential growth projections being thrown around here were all there is to it, South Korea, for instance, a country of many tens of millions, wouldn’t be coming through the worst of it, as it is, with the loss of mere dozens. Things are not so simple as to say contagion rate this, death rate that, therefore etc. And spring is coming. Quit scaring yourselves.
Exactly my feeling on it.
The South Koreans — like the Taiwanese, the Hong Kong residents, and the folks in Singapore — have taken precautions . . . which we are only now beginning to do.
Exactly.
I think the idea of flattening the curve makes a lot of sense.
??? This is a response to a straw man which was not presented in my comment.
Of course we should take precautions. And given its proximity to China, East Asia’s exposure was likely further along than ours before precautions ramped up. Yet the terrifying math above didn’t manifest there. It likely won’t here either if we are vigilant till spring cooks this thing dead, a cavalry-to-the-rescue advantage that we have that parts of East Asia didn’t have a month ago.
Also, Hong Kong and Singapore actually had a relatively low-intervention approach – certainly compared to S Korea, and even to us presently. Singapore never closed schools for instance. But they’ve emerged more or less unscathed. Why? Heat.
This is by way of being a teaser for the work of Peter Grant, an expat South African with both military and anti-apartheid fighting experience and extensive African work and travel, and now a medically retired prison chaplain. If you like non-fiction, his prison memoir is excellent. He also writes fantasy, mil SF and well researched Westerns. Basically, if he writes it, I’ll read it. I’ve been doing that since his days in rural Lousiana running communications for the local volunteer first responders during Hurrican Gustav and its aftermath — and the difference in the quality of the response under Bobby Jindal to the mess during Katrina.
In his latest COVID-19 update, he has some news which I wanted to draw your attention to. Emphasis added:
RTWT.
This is a side note. There are reports of people either relapsing or getting reinfected after recovery from COVID-19. It’s not yet certain which it is. (Relapsing means you never actually fully recovered from the initial infection. Reinfection is you got it again.)
Different testing materials in different countries may be at the bottom of some of the cases. But if enough people get it, there will be some who don’t mount an effective antibody response and who could get it again. Or who encountered a strain that was different enough from their first one that their antibody response didn’t cover the second one. This virus mutates rapidly.
There will also be people whose health is badly damaged by this illness. I had a neighbor who, after getting the flu, rapidly developed type I diabetes. Antibodies to her pancreatic beta cells. Her diabetes was pretty unstable until she started a ketogenic diet.
None of the above are going to be common responses. We are learning some things: If somebody says “this is basically just another flu,” unless they mean “just another Spanish flu,” they don’t know what they’re talking about. This is from the WSJ; the graph and data are from China:
Also the WSJ:
We won’t really understand this outbreak for many months. I’ve been critical of the CDC’s response. There are problems at the State level as well.
The lesson from this is not “throw the bums out.” Not necessarily or always, anyway. (Sometimes, though. . .) There are very good people in state health agencies doing their best with tight budgets.
It’s how many things have to get done right for a country to have a good response to a crisis.
Oh, and those recommendations to get the flu shot as part of your preparations for the COVID-19 epidemic.
This looks to have been a well done study:
(The multi-center study population was military personnel, who are required to get the annual flu shot, and their dependants/families.)
Virus interference?
What did they find?
No virus interference for most viruses. There was significant protection during the 2017-2018 flu season against flu, parainfluenza, respiratory syncytial virus, and many non-flu viral coinfections.
But for coronavirus (generic coronavirus, not any specific strain,) individuals who received the recommended flu vaccine were 1.36 more likely to contract a coronavirus infection than non-vaccinated individuals (odds ratio vaccinated/unvaccinated 1.36, confidence interval (1.14, 1.63), p<0.01)
There’s also an interesting paper done on a student population that gives some relevant information on live (flu) virus bearing aerosols.
Highlights:
• You don’t have to cough to produce virus bearing aerosols, you just have to exhale
• It looks as though people with a higher BMI are more likely to produce virus bearing aerosols
• If you got a flu shot, you’re more likely to shed influenza A virus than a non-vaccinated person; this wasn’t true for influenza B. The caveat is that vaccination status was self-reported, in contrast to the military population in the first study.
Hat tip to Sayer Ji at Green Med Info for drawing my attention to both papers.
Gotta say: I’m grateful to Coronavirus for smoking you out of wherever you’ve been hiding, Dr. Rahe! Have the Spartans been keeping you occupied this whole time?
Welcome back, and please drop in on us during the election madness!