Corona Virus

[The War Wagon]

SHOUT THIS FROM THE ROOFTOPS!!!

Coronavirus Myths Debunked-Episode 2

https://regenexx.com/blog/coronavirus-my...unked/#top

[This post was updated on 3/12/20].
As a physician, I’ve posted on the coronavirus two times this past week to try to answer the bevy of patient and family questions I have received. My second post was shared very widely and generated lots of comments from many freaked out and frightened people. Hence, I’ve taken the biggest misconceptions I have seen in those comments and in the media and reviewed them with this post.
Please Don’t Panic!
I have to say, that after being a doctor for 31 years, I’m not sure that I’ve seen anything quite like this level of abject panic regarding a respiratory virus in my career. While this is a bad bug that can overwhelm health systems and should be taken seriously, the misinformation is spinning out of control. Again, if you focus on the actual hard data, it paints a different picture.
As of this morning, we have just over 4,000 deaths worldwide. Again, the average seasonal flu kills between 291,000 to 646,000 people worldwide each year (15). The CDC just announced that the US had 20,000 flu deaths this season with 350,000 hospitalizations (16). Today, on average, 48,219 people will die of cardiac disease (17).
So why the abject panic? It’s being fueled by some in the media. As I’ll show below, when you have trusted names like Sanjay Gupta fanning the flames of fear rather than correctly interpreting data, you can see why people are so freaked.
My Top Coronavirus Misconceptions List

• The mortality rate of coronavirus is 2-3%! 
  

This has been reported many times. Most recently by Sanjay Gupta who should know better. At a White House press conference, Dr. Sanjay Gupta said, “the flu has a fatality rate of about 0.1%, this has a fatality rate of somewhere between 2-3%…”

COVID-19 DOES NOT have a 2-3% mortality rate. That number comes from the Chinese Wuhan data. The issue is that that number represents mostly sick people tested for the disease versus total deaths. Regrettably, that’s NOT how a mortality rate is calculated, which uses all that have contracted the disease as the denominator. See my diagram below:

The outside of Wuhan mortality, where there was wider testing of most that had contracted the disease, was 0.4% based on a report published by the Chinese CDC (7). Mortality on the Princess Cruise outside Japan (the only place so far where you can be sure that you tested all exposed in a closed environment), was 0.85% and only those over 70 died (8). In South Korea, which has tested more than 100,000 people,  the case fatality rate is 0.65% (18). Germany has announced that it’s mortality rate is 0.2% (20). So what’s the real mortality rate? Under 1%. 
The mortality rate for influenza varies by type and immunization effectiveness, but mortality among those 75 years and older is much higher than for the young and is over 1% (9). So we have mortality rates that are pretty close here. Hence, Sanjay Gupta wasn’t reporting accurate information.
The statement that in the elderly the coronavirus is about as deadly as the flu is more accurate. You could also say that it’s harder to treat than the flu and that more middle-aged people need intensive care and that these needs can quickly overwhelm health systems. However, Sanjay should know that the 2-3% number he threw out is likely not accurate and the reasons why it’s likely inflated. 
Here are some media outlets I would like to congratulate as they have actually reported on the evolving science rather than hype:

• SLATE-COVID-19 Isn’t As Deadly As We Think
  
• HumanProgress-The Misleading Arithmetic of COVID-19 Death Rates
  
• NPR-Why The Death Rate From Coronavirus Is Plunging In China
  
• ABC News-Early mortality rates for coronavirus are likely misleading, experts say. Children and adults have done extremely well in terms of recovery, say doctors.
  

• Coronavirus is aerosolized and the flu is not, hence the spread of this disease is much more than the flu.
  

This is nonsense. The flu virus is also aerosolized which is the primary way it’s spread (1).

• Coronavirus survives MUCH longer on surfaces than the flu virus, which is up to 9 days on plastic!
  

This rumor was started by the Washington Post and is also not accurate as written (10).
First, for comparison, the flu virus survives on hard surfaces for about 9 hours and several hours in fluid droplets (aerosols) in the air, with low temperatures increasing the survival of the virus in these droplets (2). Many respiratory viruses die off as the temperature goes up. This is why the flu season is in the winter.
At this point, according to the CDC, there is no evidence that Coronavirus is spread by surface contact (3). The Washington Post article was based on a statement in the conclusion of a research study that found that on most surfaces, other coronaviruses (NOT the SARS-CoV-2 virus that causes COVID-19) survived various lengths of time from hours to days (11). The study that reported that a coronavirus could survive for 9 days on plastic really didn’t say that exactly (5). While that research showed that a different coronavirus survived for 9 days on plastic, by 48 hours the viral load was 10,000 times less! So “survives” is a relative term. In fact, another study included in the same review paper showed a similar coronavirus only practically survived for 2-3 days on plastic, which fits with the fact that the viral load is falling steeply after that time (4).
So how “spreadable” is this virus? The data from the Princess Cruise (Japan), a closed environment where you have almost 4,000 people that live in one space for 2 weeks and infected people touch all sorts of shared surfaces, shows that only about 20% of the people on the ship were positive (8). Given that this one spreads through water droplets from coughing and cruise ships are known to spread respiratory viruses, that spread is pretty typical for the average flu or cold virus.
On the other side of that argument is a new study out of China which has not been peer-reviewed yet (19). This suggests that the coronavirus is more contagious than the flu. It will be interesting to see how this paper fares in the stringent peer-review process. However, it’s critical to look at data from both sides of this argument.

• The coronavirus will ramp up in the US over the next few months and by summer we will become China, a country on lockdown with millions of cases and our health system will crash.
  

Blogger Liz Specht gets a raspberry for getting this one out there. She reported that by May we would have some 5.4 million cases in the U.S. using her pandemic math. The problem is that Liz isn’t a physician, so she seems to have missed this graph put out by the CDC (12):

The peak months of U.S. viral flu transmission (which this virus will follow as well as it’s primary spread is aerosolization through coughing) are December through March. This is because the survival of viruses in water droplets falls off the map when the temps heat up. Note that in the 36 years graphed here (1982-2018) we have never had a flu peak in April or May. The graph for other viruses looks similar.
Hence, while the spread of the virus may well be somewhat contained by testing and quarantine which is unprecedented in the US at this scale, mother nature will be the rate-limiting step in the U.S. pandemic math since warmer weather reduces viral spread.

• Forget about China, the real disaster is Italy!
  

It’s hard to get much data on Italy at this point. I’ve tried translating press releases put out by the Italian Health Ministry, but they don’t have all that much information. We do know that Italy as of this writing has 9,172 coronavirus cases and has had 463 deaths. So while it’s true that the numbers look awful and their health system is seriously overtaxed (the reports are that they are running low on critical ventilators), an interesting bit of information was reported by the BBC. The Italian health ministry says that the average age of death for Coronavirus is 81.4 years (6). Why is that number VERY important? It means that the data out of Italy so far is following the information we have from the Princess Cruise ship. The mortality is clustering around the very old, which is the same for the flu (13).

• If you have cold symptoms, you probably have the coronavirus!
  

I heard this one on a local radio station. The main symptoms of COVID-19 are not the sniffles or a runny nose or sneezing. The main symptoms are a fever and a dry cough with or without shortness of breath (14).

The coronavirus misinformation machine continues to spin out of control. You can’t turn around without hearing a factoid from usually credible sources that can be easily debunked. So listen to the CDC and get yourself tested if you have symptoms. Observe strict quarantine protocols if you test positive. If you’re sick and unsure, just stay home. In the meantime, wash your hands and take a deep breath!

• Click here for Coronavirus Episode 1-Why I am NOT Concerned About the Coronavirus
  
• Click here for Coronavirus Episode 3-Keep Calm and Carry On…
  

[Given that the comments sections on prior coronavirus posts were not constructive, they will be suspended for this post]. 
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References:
(1) Tellier R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis. 2006;12(11):1657–1662. doi: 10.3201/eid1211.060426
(2) Greatorex JS, Digard P, Curran MD, Moynihan R, Wensley H, Wreghitt T, et al. (2011) Survival of Influenza A(H1N1) on Materials Found in Households: Implications for Infection Control. PLoS ONE 6(11): e27932. https://doi.org/10.1371/journal.pone.0027932
(3) Centers for Disease Control. Environmental Cleaning and Disinfection Recommendations: Interim Recommendations for US Households with Suspected/Confirmed Coronavirus Disease 2019. https://www.cdc.gov/coronavirus/2019-nco...tion.html. Accessed 3/9/20
(4) Duan SM, Zhao XS, Wen RF, Huang JJ, Pi GH, Zhang SX, Han J, Bi SL, Ruan L, Dong XP; SARS Research Team. Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. Biomed Environ Sci. 2003 Sep;16(3):246-55. https://www.ncbi.nlm.nih.gov/pubmed/14631830
(5) Rabenau, H.F., Cinatl, J., Morgenstern, B. et al. Stability and inactivation of SARS coronavirus. Med Microbiol Immunol 194, 1–6 (2005). https://doi.org/10.1007/s00430-004-0219-0
(6) BBC News. Coronavirus: Italy in ‘massive shock therapy’ pledge to offset virus impact. https://www.bbc.com/news/world-europe-51799956 Accessed 3/9/20.
(7) Chinese Center for Disease Control and Prevention CCDC Weekly. The Epidemiological Characteristics of an Outbreak of 2019 Novel
Coronavirus Diseases (COVID-19) — China, 2020. Vol. 2. No. 8. http://weekly.chinacdc.cn/fileCCDCW/jour...VID-19.pdf
(8) Faust J. COVID-19 Isn’t As Deadly As We Think. Slate. https://slate.com/technology/2020/03/cor...think.html Accessed 3/6/20.
(9) Chung, J., Hsu, C., Chen, J. et al. Geriatric influenza death (GID) score: a new tool for predicting mortality in older people with influenza in the emergency department. Sci Rep 8, 9312 (2018). https://doi.org/10.1038/s41598-018-27694-6
(10) Washington Post Staff. Everyday Objects and the Coronavirus. Mar. 6th, 2020. https://www.washingtonpost.com/graphics/...ronavirus/ Accessed 3/9/20
(11) Kampf, G. et al. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection, Volume 104, Issue 3, 246 – 251. https://www.journalofhospitalinfection.c...0046-3/pdf
(12) Centers for Disease Control. The Flu Season. https://www.cdc.gov/flu/about/season/flu-season.htm Accessed 3/8/20
(13) Czaja CA, Miller LA, Alden N, et al. Herlihy, Age-Related Differences in Hospitalization Rates, Clinical Presentation, and Outcomes Among Older Adults Hospitalized With Influenza—U.S. Influenza Hospitalization Surveillance Network (FluSurv-NET), Open Forum Infectious Diseases, Volume 6, Issue 7, July 2019, ofz225, https://doi.org/10.1093/ofid/ofz225
(14) The Centers for Disease Control. Coronavirus Disease 2019 (COVID-19)-Symptoms. https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html Accessed 3/10/20
(15) Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study [published correction appears in Lancet. 2018 Jan 19;:]. Lancet. 2018;391(10127):1285–1300. doi: 10.1016/S0140-6736(17)33293-2
(16) Centers for Disease Control. Weekly U.S. Influenza Surveillance Report https://www.cdc.gov/flu/weekly/index.htm Accessed 3/8/20
(17) American Heart Association. Heart Disease and Stroke Statistics-2019 At-a-Glance. https://healthmetrics.heart.org/wp-conte...3-2019.pdf Accessed 3/10/20
(18) Kolate G. Coronavirus Is Very Different From the Spanish Flu of 1918. Here’s How. The New York Times. https://www.nytimes.com/2020/03/09/scien...s-how.html Accessed 3/10/20
(19) Sanche S, et al. The Novel Coronavirus, 2019-nCoV, is Highly Contagious and More Infectious Than Initially Estimated. medRxiv Preprint Server. doi: https://doi.org/10.1101/2020.02.07.20021154 Accessed 3/11/20
(20) Der Tagespiegle. So leben die Menschen in der „roten Zone“. https://www.tagesspiegel.de/wissen/itali...21354.html. Accessed 3/12/20.