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Are We Overreacting to Coronavirus?
The Center for Disease Control (CDC) reports that since 2010, at least 12,000 Americans have died annually from influenza. In 2017-18, the worst year, 45 million were stricken with the disease, 810,000 required hospitalization and 61,000 died.
Yet life in the republic went on. The economy didn’t crater. Major events weren’t canceled, travelers traveled. Media outlets reported the numbers but didn’t wig out over them. Around half of Americans didn’t bother to take the vaccine.
This year, there have been 32 million cases of influenza and 18,000 deaths in the US so far. As of this writing, there are about 1,000 cases of coronavirus and 30 deaths or .016% the number of influenza deaths in roughly the same time period. My state of Arizona‘s numbers are six cases, zero deaths. Zero.
New cases of coronavirus are already declining in China. Yet the world is in a full-blown panic. Financial markets are in free fall, massive quarantines have been instituted with more contemplated, airline flights and numerous public events have been canceled.
Clearly this is not a rational response to the medical data. Some ascribe the overreaction to uncertainty, but the more we learn, the less the coronavirus seems particularly unusual.
In most cases, coronavirus is clinically indistinguishable from influenza or other minor respiratory illnesses. It is experienced by most patients as a cough, low-grade fever, and sore throat. Coronavirus may be somewhat more contagious than influenza.
Fatality rates are difficult to calculate because most of those infected don’t enter the medical system. Early on, a World Health Organization official received much attention for predicting a casualty rate over 6%, a figure which could have eventually resulted in significant mass casualties.
Experience and cooler heads have since prevailed. The New England Journal of Medicine estimates an overall fatality rate of around 0.1%, almost all in elderly patients. Children usually don’t even become ill.
Still, the need for strong, calm leadership in the face of all the chaos and disruption should finally bring together our political leaders in the spirit of cooperation for the public good, right? Dream on. We got instead transparent attempts to exploit the crisis for political advantage.
Nancy Pelosi said she didn’t “think the president knows what he’s talking about“ and termed his proposed response “completely inadequate.” Chuck Schumer agreed that “all the warning lights are flashing bright red” but “Trump has no plan, no urgency, no understanding of the facts.” Joe Biden claimed Trump “has defunded — he’s defunding CDC.”
Actually, not true. According to the Associated Press, funding has increased for our federal health agencies which “aren’t suffering from budget cuts that never took effect.” Moreover, the public health system does have a plan in place for outbreaks of respiratory diseases and “a playbook to follow regardless of who is president.”
Trump, in the judgment of most, did a decent job of quieting anxiety and describing federal prevention efforts. But he didn’t help his cause by talking about his “hunches” and failing initially to acknowledge that caseloads would almost certainly grow from their present numbers.
Meanwhile, the media, as usual, fully backed those trying to create panic. Single new cases have received headline treatment. The reporting has been sensationalized with “pandemic“ and “crisis” used to describe a handful of cases. Virus related developments are described in tones of heightened urgency.
All flu viruses are public health threats. Infected people are contagious well before they develop symptoms, which confounds many prevention strategies. Close monitoring, testing, and immunizations when available are all sound interventions.
Isolation strategies may need to ratchet up if future conditions warrant. Meanwhile, increased attention to personal hygiene, staying home when sick, and avoiding infected persons also make sense.
This virus will undoubtedly sicken and kill more Americans before it runs its course, which it will. But the near-total disruption of our social fabric isn’t due to a virus. It’s us. It’s fear itself.
It’s simply bizarre to see a society breaking down over a virus 1,000 times less prevalent than others we have experienced and are experiencing. We have somehow become less resilient. We have lost confidence in ourselves and our institutions. Americans were once made of sterner stuff.
Published in Healthcare
We are in the middle of an insanely irrational panic. I’m hoping it will crest sometime this weekend and cooler heads will start to prevail. But there are those in the media and in politics who see gain from egging it on.
The damage to the economy is going to be something to behold. I’ve seen projections of a 5% decline in GDP in the second quarter. The travel and entertainment industry is being destroyed right before our very eyes.
This post followed Paul Rahe’s by a few minutes. He is not so dismissive. Relevant quotes:
It is more contagious than the flu:
R0 for H1N1 flu was about 1.6. This one is higher. The number of infections doubles in a week or two.
COVID-19 makes about 1 patient in 5 very sick.
We had a chance to get ahead of this. We blew our opportunity and are playing catch up.
In another comment, I mentioned my struggles with anxiety/depression/ocd because I recognize this type of thinking. People obsess about theoretical possibilities that only occur if life is actually a Kafkaesque nightmare.
Short answer, Yes.
I’m honestly asking, what should have been done differently?
My anxiety level is nearing the point where I can no longer function properly.
I don’t fear the Wuhan Flu. I fear what school closings will do to my ability to provide for my family. We’ve always been on the edge of poverty. This has the potential to send us to a place that’ll take years to climb back out of.
If this is all for nothing, I’m going to be more pissed off than I normally am.
I have wavered a good bit about the seriousness of this threat over the past weeks. The data from Italy is not reassuring. Clearly, it is difficult, if not impossible, to assess the risk until we have a handle on the prevalence of the disease as it spreads. Nothing I have read from any source suggests that being diagnosed with bilateral interstitial pneumonia in the setting of a coronavirus outbreak is not a very serious situation. The fatality rate for that condition is much higher than most communicable diseases. If an easily obtained, accurate test for being infected with this virus was universally available, we could make much more rational decisions. That is going to be a while. In the meantime we need to pay attention to the actual disease that is killing people: bilateral interstitial pneumonia, which can be diagnosed in anyone with fever and cough by a simple X-ray. Every diagnosis of that disease in every community needs to be reported because it is very likely a harbinger of multiple deaths. This will get sorted out over time, but it is foolish to think that a virus that is killing Italians at the rate it has so far, is not a very serious threat.
We should have gotten more testing sooner and isolated the infected. That is where we dropped the ball. In many ways now we are playing catchup. This is also how Italy and Iran got into the mess they find themselves.
YES
way over reacting
As a doctor, what else can you tell us?
I’m sorry to hear this, @drewinwisconsin. When the time is right, let us Ricochetti know how we can help. (I’m not worried about finances for survival right now; I’m worried about how businesses and individuals will survive financially and a little worried about my and my husband’s IRA’s that we will need to draw on in less than a decade).
Some doctors and politicians are saying 50% or more of the population could get infected. Angela Merkel said 70%. If my understanding of these things is even close to correct, this would make it far more infectious than measles. And its vectors of transmission would be much greater than what most sources are telling us now, namely that you can only get it if someone coughs or sneezes on you, or you touch a surface recently infected and then pick your nose.
Tom,
Thank you, Mr. Patterson, for helping us see the reality here. You can’t stop living to reduce a near-microscopic threat to your life. This panic will shortly be severely damaging the lives of tens of millions of Americans. Those who must always find a way to criticize the Trump Whitehouse will manufacture ever more misleading statements. In the last 3 years, they’ve relentlessly puffed up Russiagate and then the impeachment fiasco. You might hope that public health would somehow not be a target for that kind of politicization. Dream on. They have a compulsive need to criticize and the fact that they are obviously creating a panic won’t stop them.
They were disgusting before because of their unbridled lust for power. Now their complete disregard for the health & safety of the American people is beyond obscenity.
Regards,
Jim
I mentioned in another comment that while I found his overall demeanor flippant, Dr. Drew made a point that seemed correct: mass testing was a panicky response that would involve throwing everything we know about differential diagnosis out the window with little to no actually benefit. People seem to cite South Korea in support for the idea that mass testing works, but the alternative explanation is that their other policies are what helped them through it. Mass testing dropped the mortality rate – not because it helped with the disease in significant way – but because it added a lot of insignificant cases that would have gone unnoticed to the denominator.
It’s entirely possible that mass testing is one of those “common sense” solution that involve little political cost (because it doesn’t involve travel bans and cancelling the NCAA tournament) but are actually counterproductive. Then again maybe not.
What I haven’t heard an explanation for is, if this is just something like the flu, why China reacted the way it did. This isn’t a government with a lot of concern for human life. If they thought it was just the flu, even a very bad strain that might kill millions, they would have ignored it. Yet they effectively shut the country down, with severe economic consequences, in attempts to contain it. Clearly they think there is something very dangerous about it. Are they just wrong?
Let me restate the point I want to make. How many people in your county or city have been diagnosed with bilateral interstitial pneumonia in the last week? Those are the people who are likely to die from this infection. If you don’t know that, you don’t know what your risk is. Period……
He’s also misleading when he states that the cases in China are decreasing as though it happened by magic instead of because of the draconian control measures they took because that would contradict his thesis.
At the same time he seems to be saying that the Chinese overreacted because this whole thing is a nothingburger.
The post is pablum of the highest order.
Their mass testing also showed a mortality rate of something like .06%. I assume that if we tested at the same level that they tested, we’d see the same.
I thought on this real hard and I think this will be a repeat of the 1918 Spanish Flu. This is something equally contagious and equally novel, so we should expect 30% to catch it. If we do everything right to delay cases and warm weather slows this down and we develop really good retrovirus meds and we expand ICU, then we’ll only see 120,000 deaths in the next 12 months. If we don’t do a lot of things right, then we’ll be like Italy where doctors are picking and choosing who gets a respirator.
Are it on purpose to see how far down I can spiral?
Travel restriction sooner, movement restrictions sooner. Not wasting time on security theater like making temperature screening the main measure at portals of entry… for a disease with a long incubation period and which about a quarter of the people who can spread it never really get sick.
The CDC on 2/28:
But:
Originally, plague ship evacuees were supposed to go to Travis AFB and March ARB.
But then….
Costa Mesa got an injunction. The city wanted to know:
The .gov didn’t have good answers.
I’m just a guy who reads blogs. I have some I’ve come to trust; they use open source info. They were way ahead of the CDC on this.
If this is all for nothing it will be not because we were good. It will be because we were very lucky. Be pissed off about other things. Don’t worry, you won’t run short of what to be pissed off about.
The initial test was designed to test for multiple flu strains plus 2019-nCoV. That was a bridge too far, best the enemy of good, etc., etc., etc. That wasted precious time.
We also should have shut down travel sooner. We had China to watch, and we made the wrong decisions. As you say, we’re playing catchup now.
It’s been observed to be contagious under circumstances that make it nearly a certainty that it’s spread by aerosol as well as droplets. 15 feet on a bus, and it is reported to have spread via HVAC systems in China.
This is not relevant everywhere, but for, say, San Francisco… it is also spread in feces. Want to play bet your life that when that stuff dries enough to be dust in the wind, it doesn’t carry active virus?
It would have been really, really nice to have the capability of doing mass testing but then deciding to be more selective. But we didn’t have enough test kits, and clinical labs have only recently been offering testing. We had lead time, and we squandered it.
South Korea, on the other hand actually made progress in finding out what the real numbers are. Be grateful to them.
I don’t know if your health and any meds you’re on will permit it, but HIIT plus rhodiola, or plus St John’s Wort, (or plus both herbs) can do very nice things for mood. It doesn’t need to be HIIT ’til you puke, either.
Doing one like for all the interesting details you added above.
My personal history shows this is true.