What makes COVID-19 so scary?

At the time of this writing, we are in a world pandemic where everyone seems to be comparing past pandemics or disease outbreaks to the current state of being with the SARS-COV-2 virus. The COVID-19 illness is being compared to the flu, H1N1, SARS, and other viral outbreaks that have come and gone. It’s very easy to get caught up in the past, and try to compare what the proper response to a virus like this should be.

We try to look at things like mortality rate, rate of infection, or current infected numbers. We make excuses and ways to mitigate the data given. We blame the media. We blame inaccurate statistical data, or we blame the fact that we don’t have answers to all the questions that are asked. There’s a very good reason for this, and I’ll bold it to make it very clear:

WE DON’T KNOW.

This virus has been around and been studied for a few months. We have very little data on it, and the data we do have seems to be changing every single day. Comparing this virus to anything else is not only silly, it’s irresponsible.

Let’s be clear, whether we have done too much, or not enough is left to be seen. If it turns out our response was too harsh, many will argue our response was unfounded and detrimental to our economy. If later we find that the severity and contagion veracity of the virus completely crumbles our healthcare system, we will say we didn’t do enough. Either way, it’s very important to distinguish the difference between current data that is available and hindsight. Which brings me to the point of this post.

Right now, many of us are looking at current statistical numbers. There are many websites out there, I’ve listed a few just below, and they have current daily stats of all the countries in the world, the number of infections and deaths, and other data we can look at to try and make sense of things. At the time of this writing, here are the numbers according the website https://ncov2019.live/. This website was made by a 17 year old whiz-kid from Seattle, but that’s another story.

Resources:

https://www.worldometers.info/coronavirus/

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

https://www.statnews.com/tag/coronavirus/

https://ourworldindata.org/coronavirus

https://ncov2019.live/

Let’s look at the numbers and see how they stack up against other things like the flu or cancer. These numbers are approximate and are only for the United States, and no matter what website you look at, the numbers can differ greatly, so let’s not argue semantics. There’s a point to be made here and in a minute, it will be clear.

Total confirmed cases:

Flu per year: 39,000,000 – 55,000,000

Cancer per year: 1,735,350 new cases of cancer

COVID19 per 1.5 months of data: 276,965

Total Deaths:

Flu Per Year: 24,000 – 63,000

Cancer Per Year: 609,640

COVID-19 Per 1.5 months of data: 7391

So at first glance it looks like a relatively small number of people are not only getting infected, but also an extremely low number of people are dying from COVID-19. What’s the problem, right?

Here’s what we do know by comparing data from other countries who currently are, or have been in the same situation.

Countries that do complete social lock down have had the best successes at flattening the curve so-to-speak.

Taiwan was most successful in it’s efforts to fight the COVID-19 illness from spreading by acting very quickly, and issuing a country wide lock down to suppress spreading of the virus. They saw the virus coming and took action as soon as cases started emerging in Wuhan, China. They knew they had many people traveling to and from Wuhan, and immediately put forth policies to ensure medical supplies like masks and ventilators were readily available in case of an outbreak. If you were suspected of having COVID-19 or were in contact with someone who tested positive, you were to self isolate with heavy fines ensured if you broke isolation. All travel was banned immediately.

South Korea had a quite different response to many other countries in the world, and imposed extreme testing measures to the tune of almost 1 out of every 200 people living in South Korea were tested. This allowed them to find out who was being infected and act quickly to isolate them and those around them or who had contact quickly and efficiently.

Italy was on the other end of the spectrum, and most citizens didn’t think the viral outbreak was something to take seriously. They continued on without strict social distancing measures and no mandatory self isolation, and found themselves being overrun with the disease in a matter of 10 days. Their healthcare system in some areas was on the verge of collapse, and Doctors were having to make decisions on who would be allowed to use the life saving equipment and who would not. They imposed a policy that’s purpose was to “Limit the loss of years”. Basically, if you had less years to live, younger patients who needed the treatments, ventilators, and equipment would get it, even if a patient was currently using the equipment. A grave day for anyone dealing with this kind of outbreak, but absolutely heart breaking for the hospital Doctors and staff.

Italy finally issued a complete and total lock down order on March 16, 2020. The rate of infection at that time was right around 18-25% daily growth rate. It took around 8 days for the lock down to show statistical effect with confirmed test cases which corresponded to hospital resource relief. From then they have brought their daily growth rate down to around 4% at the time of this writing. They have extended their total lock down until the end of April at this time as well.

The United States is facing a very similar scenario as Italy, but are in a much more precarious situation simply because we are in effect, around 3 weeks behind Italy, are much larger, and are still in a complete lackadaisical state of being about the disease as a society as a whole. Many states have issued non-strict social distancing measures which many Americans are not only not adhering to, but actually scoffing at. Many large cities and areas still have public gatherings, grocery stores and other large public stores deemed essential still have people conglomerating inside in masses, and the measures many take to contain the spread of the virus are misinformed and ineffective.

For example:

• Keeping people spread out 6 feet apart when checking out, but having them all touch the pin pad to put their pin in when paying for their goods.
• Or a shop cashier wearing gloves to protect him or herself, but handling money and touching door handles and cooler handles with those same hands and giving dollar change and placing goods in bags for customers. See my article about Cross Contamination and Science of a Virus if you have some time.

The United States is in quite the predicament at the moment. We didn’t have the foresight to see what was impeding upon us, ignoring many other warning signs and constantly issuing conflicting statements from the current administration government and virus panel, immunologist, and disease control experts. Sadly, in 2018, our administration disbanded the Pandemic Response Team, and left us extremely vulnerable to this type of attack. This brings me to my main point:

Foresight vs Hindsight

It’s easy to look back on a historical event that has already happened, and say “you should have done this” or “we didn’t react correctly”.

With something like a pandemic, there are 2 main outcomes to how history will talk about our reaction.

1.) Total overreaction

2.) Not nearly enough reaction.

Hindsight gives us the advantage of choosing which one of these outcomes fits our response in the United States. We can’t see into the future, that’s for certain, but trying to compare a pandemic like this to past viral outbreaks is also just as futile.

Currently, many non-experts and opinionated public try to compare COVID-19 to past outbreaks or current medical viral issues we deal with on a yearly basis, such as the flu.

This is faulty thinking and extremely clear to anyone who think about the differences between COVID-19 and the flu. The most obvious reason is, the flu isn’t new. It’s been around for centuries. We have tons of data on the flu, we know the virus, how it works, and have a pretty good grasp on it’s infectious qualities, it’s mortality rate, and how it will affect our current hospital and medical field resources.

We know the flu doesn’t cause pneumonia. We know the flu has many, many strains, and we know that we can issue flu vaccines each year to combat some of these strains and curve the flu season hospitalization numbers by administering these vaccines. We know the flu is a rather ugly, but pretty docile bug in regards to how our bodies and immune systems fight it off. The flu also causes symptoms in almost everyone it infects. That’s important, of which I’ll explain later.

COVID-19 has been around for 3 months. We have very little data on the virus, and are uncovering new things about it every single day. COVID-19 is not the flu. COVID-19 in some people causes extremely severe respiratory infections and can easily transgress into pneumonia. Many cases of COVID-19 in young and old people alike, have caused lung fibrosis (scarring of the lungs) and reap permanent damage on it’s victim. The SARS-COV-2 virus doesn’t cause COVID-19 in every person it infects, and many times people have little or no symptoms. The incubation period of the virus is between 2-14 days, which is a long period for someone to be walking around with no symptoms passing it to other people who could catch it and have much more severe symptoms listed above. All this is exponentially more dangerous than the flu, of which I have outlined below.

There are 3 main things we need to consider when we think of how “Dangerous” or “Deadly” a virus or disease is.

I’ll give you a hint. Mortality rate isn’t one of them.

1.) R0 Rate (“R-Not”)

What do R0 values mean?

Three possibilities exist for the potential spread or decline of a disease, depending on its R₀ value:

• If R₀ is less than 1, each existing infection causes less than one new infection. In this case, the disease will decline and eventually die out.
• If R₀ equals 1, each existing infection causes one new infection. The disease will stay alive and stable, but there won’t be an outbreak or an epidemic.
• If R₀ is more than 1, each existing infection causes more than one new infection. The disease will spread between people, and there may be an outbreak or epidemic.

Importantly, a disease’s R₀ value only applies when everyone in a population is completely vulnerable to the disease. This means:

• no one has been vaccinated
• no one has had the disease before
• there’s no way to control the spread of the disease

This combination of conditions is rare nowadays thanks to advances in medicine. Many diseases that were deadly in the past can now be contained and sometimes cured. For example, in 1918 there was a worldwide outbreak of the swine flu that killed 50 million people. According to a review article published in BMC Medicine, the R₀ value of the 1918 pandemic was estimated to be between 1.4 and 2.8. But when the swine flu, or H1N1 virus, came back in 2009, its R₀ value was between 1.4 and 1.6, report researchers in the journal Science. The existence of vaccines and antiviral drugs made the 2009 outbreak much less deadly.

SARS-COV-2 virus has an R0 rate of 2.2 – 3.5. Let that sink in.

2.) Type Illness and it’s possible serious complications

COVID-19 causes extreme respiratory issues in many cases it infects. This means many people will need to go to the hospital. This means that the hospitals will get inundated with COVID-19 patients very quickly. This means that equipment will get used up. This means that as these numbers grow, and grow quickly, the number of people who contract the disease will increase, which will increase the number of severe cases that need to be hospitalized, putting more strain on the medical system. Eventually, this system gets overloaded, and people who contract the disease who would normally recover with medical assistance can’t get the help they need. So they die. Then people who need normal procedures or have relatively benign issues could be at risk because the system is overloaded with COVID-19 patients. So the mortality rate increases exponentially because of the extreme number of cases that form because of the R0 rate of the disease. You see the spiral?

We mentioned mortality rate above, and of course this number is important. If you have a virus that kills 50% of the people it infects, like the Ebola virus, this number is terrifying. People will listen to experts if they say stay in your home and self quarantine. If you knew you had a 50% chance of dying if you contracted something, you’d do everything in your power to keep you and your loved ones safe.

Now we give something a mortality rate of say, 1%. Not so scary, right? Now we say, it affects mostly older people or people with compromised immune systems. Now even less scary.

But these numbers are misleading. Ebola, while deadly, only spreads from person to person by extreme close contact. And if you catch Ebola, you know it. It’s fast moving, has a very low incubation period, meaning, it shows symptoms very quickly, not to mention these symptoms are absolutely horrific and terrifying, and the R0 rate of this virus is extremely low in comparison to things like, the flu, or, you guessed it, SARS-COV-2.

3.) Asymptomatic contagious individuals and viral load

Being asymptomatic in this reference means that you contract the disease but show no symptoms. Let’s discuss this briefly to go over how this affects the spread of the virus and why it’s important.

Being asymptomatic does not mean you do not carry the virus. The virus still has an incubation period of 14 days. Your viral load can still be extremely high (we’ll go over viral load in a minute), and you can still spread the disease just like someone who has symptoms would. It just means you don’t get sick. That’s all. It means you’re lucky. Your immune system caught the virus early, and worked it’s magic to contain the virus and keep your body from being overloaded. But it still takes time for the virus to be completely expelled from your body, and it still takes time for your body to create the antibodies to become immune to that strain.

Viral load is basically the amount of virus contained in a sample taken by a Doctor, such as a throat swab, saliva, or blood. For ease of explanation, the COVID-19 viral load taken by both asymptomatic and symptomatic people alike, have been show to contain 10,000 times the amount of virus as samples taken from people who were tested positive with the flu. Ten. Thousand. Times.

So why is this so important?

We know how contagious this virus is, arguably higher than any other virus we’ve encountered. We understand how serious of an illness it can cause. We know it can cause death. We understand the repercussions of it spreading too fast and too quickly. We understand what asymptomatic means, and how viral load counts and R0 rates don’t change just because you don’t have symptoms. We understand that mortality rate is very low on the totem pole of things to watch out for when dealing with a pandemic. But why does the possibility of many people being asymptomatic so important?

Because this changes everything. This changes the way we deal with a virus. This changes the way we look at a virus, and how we determine it’s “deadliness”. This changes the way the media portrays the virus. If you show someone bleeding from the eyes, nose, and mouth with the headline “Virus liquefies man’s insides”, this changes how we react to the virus. But if you say, “This virus has a mortality rate of 1%, some people get really sick, but others don’t have symptoms and all, and it’s mainly an old person’s disease”, this is a totally different narrative.

So you have people not taking a virus seriously, walking around with no symptoms, passing it to friends and family, who could then get sick, or not, and then pass it to other people who will get sort of sick, or extremely sick, or die, or not. But there’s one very important thing to take note of here: You will pass it on.

So what happens next?

Current strategy for any country getting this disease is to do what’s called “flattening the curve”. Currently we are on a growth rate curve in the United States of about 15-18% a day on average. The math on this is very easy, and I’ve put a nice little excel formula below to show you what experts have been looking at for the last 60 days. Graphs you find online are neat, but when you do this in a spreadsheet, it really hits home because it helps you understand how these graphs were formed.

In an excel document, go to the first row, first column (A1), and put in today’s COVID-19 confirmed cases. At the time of this writing it was 276,965. Then in A2 type the following:

=(A1*18%)+A1

Then copy this formula down by dragging the bottom right corner for 30 days. Now do 60 days.

I’m sure you’re saying to yourself “this can’t be true” or “no way, these are too high”.

This is what’s called exponential growth.

Terrifying isn’t it? Are these real you ask? Can this actually happen?

If we do nothing, this is exactly what happens. Without extreme self isolation measures or a vaccine, this is exactly what happens over the course of the next 30-60 days.

These numbers with that formula have been used since we found out about this virus. I’ve been doing this since January 22, and so far, my numbers have been too conservative. The virus has beat me on my predictions.

I mentioned earlier we are trying to flatten the curve, not cure the disease. This is because while a vaccine is being created and tested, the general population won’t see it for at least 12-18 months. But why you ask? I’ll give you an example:

In 2008, at the University of Montpellier in France, they came out with what seemed like a workable vaccine that effectively cured HIV. They gave it out to the HIV infected community in hopes to cure the deadly disease, and 6 months later found that it made their patients more susceptible to contracting AIDS. The exact opposite of what it was supposed to do. This has happened several times in history, and now, a vaccine must go through clinical trials to be put out to the masses. We don’t want a “cure” that’s worse than the disease type of scenario.

Flatten the Curve

So for now, we flatten the curve. We flatten the curve to develop herd immunity until a vaccine can be released. We flatten the curve to save lives. We flatten the curve in an attempt to keep a disease that has the potential to collapse our entire healthcare system to a reasonable level. We stay at home to flatten the curve. We don’t go out to flatten the curve. We take the virus seriously to flatten the curve.

I’ve written a small article here about the Economic implications of this viral pandemic and my opinions on possible solutions.

Tell me your thoughts! Debating information is welcome and encouraged.