I’m a doctor and a technology product manager. I do not get overly hyped where I don’t think concern is justified. However over the last few weeks, I’ve heard a lot of discussion against the preparation of COVID-19. Generally the argument says that the coronavirus is like the flu, and the flu kills far more people per year than coronavirus, hence we are over hyping it.
Coronavirus is very different to the flu, and here is why:
- It is novel. That means we do not have immunity against it. Our general immune system will respond, and for most people, it’ll cause zero to moderate symptoms. However, for anyone very young or very old or immunocompromised, it can be catastrophic. Coronavirus has so far been the most deadly against males over 70 years old.
- It’s underlying characteristics make it easier to spread. The coronavirus has an R0 (transmissibility score) of 2–4. That means for every one person who gets it, they infect 2–4 people. This is partly because COVID-19 has an incubation period that is far longer than the flu and previous global pandemics. It can stay undetected for 2–14 days (peak case of 21 days). This makes it easier to spread undetected and is likely the reason we now have community cases worldwide (spread of unknown origin).
- It’s mortality rate is very likely higher than the flu. Medical professionals call this the case fatality ratio (CFR). In its simplest form this ratio is the number of confirmed deaths from disease / number of cases of disease. According to this simple ratio, the CFR of COVID-19 is about 2%. As a comparison, the flu is 0.1%. So the coronavirus is atleast 20x more deadly. However, this is an over simplification because both the numerator and denominator can be very different. Let’s start with the denominator. We already know the COVID-19 has a long incubation period and the disease can remain undetected in a lot of people. Which means number of actual cases can be far greater than we know causing the CFR to be lower. Without testing everyone in a community, we will never know the true denominator or the number of cases with disease. As for the numerator, the disease at outbreak is almost always worst to take control of because it is unknown. The doctors don’t know how to diagnose it or how to treat it. Hence, CFR can be higher at the beginning. The disease can also spread more widely at the beginning due to lower containment precautions, which means the vulnerable are more likely to be exposed. However, once the disease is at a steady state in a community, it’s unlikely to be deadly against those that are less vulnerable and the CFR can lower over time. We see this in China, where the initial provinces like Hubei have a CFR of over 4% and subsequent provinces are as low as 0.2%. Finally due to the long incubation period, the ideal CFR ratio is deaths at day X / cases at day X-(average length of incubation). This calculates of all the people infected at day x, what percent are likely to recover or not. With this more relevant formula for COVID-19, the CFR can be as high as 15%. All this to say, we don’t know yet what the true CFR is.
- It requires an enormous sleuth of resource to help with the recovery of those most sick. About 17% of cases require ICU care, but that number can be overinflated due to the diseases initial onset when the world was less prepared. If this number stays this high or close to this high, our healthcare system is not prepared to respond with such high touch care for such a large number of patients.
It is difficult to be precise with the R0 and CFR during an outbreak because of the unknown variables related to both disease and response such as unconfirmed cases, differences in preparedness due to time of onset of global pandemic and differences between geographies including demographics like percentage of population that are vulnerable.
Suffice to say that the Coronavirus is not like the flu and should be taken seriously.
COVID-19 spreads via contact (usually within 6 feet). If someone sick with COVID-19 coughs, they can excrete the virus in their cough and those droplets can land on someone who may consume them. Or they can land on an inanimate surface like a table, where COVID-19 can survive for an average of 12 hours (up to 9 days on some surface types) and a passerby can pick it up and consume it.
If you are in the non-vulnerable population, you can help those that are more susceptible by ensuring you don’t become an asymptomatic carrier or get sick yourself. This means everyone should take extra precautions.
What you can do to prepare:
- Wash hands regularly and do not touch your face in public spaces until after you’ve washed your hands.
- Self-quarantine when needed for upto 2–3 weeks so you can help limit the spread of disease. This includes not needing deliveries of essentials at home, which can help spread the disease via the delivery driver. It also overburdens them when they should be serving the most vulnerable. To effectively quarantine yourself you’ll need water, non-perishable foods like lentils, rice, oat meal etc and any prescription medication for 2–3 weeks for you and your entire household.
- N95 masks have sold out in many areas already but they are not essential to be prepared. They help you not spread your germs to others and serve as a reminder to not touch your face. But if you do the above two actions, then you will not need them.
Our world has seen many pandemics in the past decade such as SARS, MERS, H1N1 (or swine flu). What distinguishes the spread of COVID-19 most from the above is the long incubation period. It is essential we support each other and especially the most vulnerable among us by taking the proper precautions above.