This blog contains very helpful information in understanding COVID-19 and its progression, written by one of our board members, Dr. Richard Lane. He is a recently retired MD with years of experience with emerging diseases dating back to HIV/AIDS in the 1970s. Dr. Lane also holds degrees in Public Health and Tropical Medicine.
As I write today, March 19, 2020, the cumulative global case count of a novel strain of Coronavirus, COVID-19, is destined to cross the quarter million mark by morning. That is 250,000 people. We fully expect 3-5% of infected people to die. I added my date to my first sentence because the statistic will be a distant memory in just another day. Today marks the end of the third month since the virus emerged from a wet market in Wuhan, China. The cluster of patients presenting with a SARS-like illness consisted primarily of stall workers from the market. Wuhan is a large metropolitan area with a population of 19 million. By mid-December 2019, the existence of a new disease was evident. In just three months, the disease has increased from 0 to 250,000!
The Chinese government investigated the situation and on December 31st the WHO China Country Office informed the world of the news. The following day, New Years Day, the markets were closed to stop the disease. I barely noticed the announcement. It was a holiday. The news from China was far away. On January 3, a total of 44 patients with the pneumonia of unknown etiology was reported. Eleven cases were critical. The Chinese isolated the new virus on January 7, my anniversary. This year was not going well but the world was largely unaware.
I waited to hear more. The news arrived just 5 days later. The CoV-SARS-2 had a unique genome. Before long it would have a new name, COVID-19. That very day, China reported the first 6 deaths from the new disease and distributed the genome of the new virus to researchers around the world. Only 9 1/2 weeks have passed since that day. Over 10,000 people have died from a disease with a name no one knew at the dawn of the new year.
The disease quickly spread globally over the next few weeks. First into Asian nations, then to Europe and the Americas. The number of cases has risen exponentially. Every 3 days or so the number of cumulative cases doubles. Two becomes 4 becomes 8 becomes 16…becomes 250,000. We could possibly reach one million in a little over a week if we are unsuccessful managing this disease.
Today, China reported no new cases. After 3 months and more than 81,000 cases, they have managed to contain the outbreak. Over 3,100 people died before they found success. Today Italy surpassed China for the greatest number of deaths — 3,405 as I check the Johns Hopkins arcgis map filled with red circles. Italy is overwhelmed.
Most people in my own nation were sadly underwhelmed by the viral monster from the wet markets. I marked my birthday in February, listening intently to the story of the first repatriation of Americans from Wuhan ahead of the epidemic. These people were confined in isolation, waiting to see if the virus had made the trip with them. They endured repeated tests for the virus and a 14-day quarantine. Some never lived to see home. Meanwhile, unknown travelers arrived home without the knowledge of their own infection. An estimated 85% of people have mild disease or no symptoms at all, but they too can pass the disease. We did not know this until February 29, Leap Day. The country’s first death occurred in a nursing home among people most vulnerable to the virus, the elderly with preexisting chronic illnesses. Those over 70 years have a 8% case fatality rate. The rate is 14.8% for those over 80 years. In the Life Care Center nursing home population of frail individuals, the rate topped 27%.
The first bright spot for this disease is the relative death of young people. In fact, among the first 44,000 patients, no one under 15 years of age died.
From February 5 until today the cumulative number of cases in the United States has risen to 13,408. In the past week the cumulative case numbers have doubled every 3 1/2 days. Deaths have risen to a total of 181. Washington state, the location of the now infamous nursing home is located, took an early lead. They were followed closely by California in the early weeks. A week into our outbreak, New York joined the most undesirable of clubs. And a week ago, March 11, 2020, we all heard the proclamation we had awaited: Pandemic.
Pandemic, in the most simple terms, is a worldwide epidemic. The declaration requires local spread of disease on multiple continents. The disease has reached nearly every country to some extent. The mere mention of the word evokes visions of the great diseases – Bubonic Plague, Spanish Influenza, Cholera, HIV/AIDS. This disease is none of those. Yes, it has the potential to infect millions and will kill many more people than a seasonal influenza. Thankfully, most of us will survive. The overall case fatality rate in the United States is under 2%.
As I write, NY has now claimed first place among the states, with 5,366 cases, more than the next 11 states combined! NY added 2,280 new cases today. NY, WA & CA account for half the total cases. The recent availability of additional test kits final gives us the power to find this microscopic killer of the elderly. The case fatality rate FR fell to 1.3% as our denominator grew with the addition of unrecognized cases through community testing.
Young people, the 20-40 y/o group, in the US have the highest infection rate right now; therefore, more young people will require hospitalization and mechanical ventilation. Deaths in this group will climb unnecessarily because of disregard for the directive to practice social distancing. Fortunately hope is on the horizon. A number of medications from among the arsenal of existing medications for other diseases were approved by the FDA for use yesterday. The initial studies looked so promising the FDA decided to make the drugs available for the new indication. Newer, previously known drugs are in trials as well. And a brand new vaccine began the first round of trials so another wave of the disease can be prevented entirely.
But what of our less privileged neighbors to the south and in Africa. Places where resources are already stretched and services sometimes far and few between. Prevention is still possible.
- The simple practice of hand washing reduces the risk of acquiring COVID-19. The virus can remain on contaminated surfaces for hours, awaiting the touch of an unsuspecting host. Washing hands after any contacts with people or things destroys the virus.
- Additional protection comes from avoidance of sick people and social distancing from others by 2 meters (6 feet) during the duration of an outbreak.
- Proper cleansing and sanitizing of counters, door knobs, touch screens, gas pump handles, etc. further reduces the spread.
The final measure to prevent the spread of infectious diseases is to simply stay home when sick. People acquire infectious disease from direct or indirect contact with sick people. Sharing is not caring. Please remain home if sick and always remember to cover your cough, preferable with a tissue, to prevent the spread of viruses in respiratory droplets. Then, wash your hands.
– Richard A. Lane, MD, MPH&TM
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