To Your Health: Let’s talk about the coronavirus

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[Welcome to To Your Health.  Our goal here is to create a space where we explore what’s important to people’s wellbeing, how we can live better, feel better and be healthier.  In sickness and in health, as the saying goes.  We’ll value facts over opinions and work to understand them, whether we like them or not.]

Let’s talk about the coronavirus

“I don’t get sick often, but when I do get sick….”

OK, you got me, that’s a Dos Equis tag line on a piece about Coronavirus, but it seems fitting since it seems that there is at least some confusion about the relationship between Corona the beer and Corona the virus.

Confusion seems to be the order of the day, and while the beer issue may be silly, this is a scary situation and it hits us in a vulnerable place — our lack of ability to understand statistics and probability.

Humans struggle to internalize small differences between likelihoods. For example, in baseball, a hitter with a 25-percent chance of getting on first base is one of the worst guys on your team, while the guy with a 30-percent chance of getting a hit goes to Cooperstown. In other words, 5 percent (1 hit every 20 at bats) is the difference between a short, forgettable career and immortality.

So, let’s try to break it down a bit: Coronavirus (Covid-19) is a viral infection that causes a range of illnesses from mild to severe with severe disease hitting the people you’d expect to be at risk (the elderly and those with prior heart and lung disease). Children are less affected.

As of March 1, 2020, there were about 90,000 cases and 3,000 deaths. The virus is now present in more than 60 countries and seems to be spreading, especially in China, Japan, South Korea, Italy, and Iran. The US has a new cluster of activity in Washington State that is concerning.

So what’s going to happen?

The eventual severity of a pandemic comes from a few independent factors:

o How contagious is it? In a given community, how many people will ultimately get it?
o How dangerous is it? How many people out of a 1,000 will die from it?

Let’s look at the second question first. The current mortality rate for Covid-19 is 3 percent (3,000/90,000), but experts think it’ll be more like 2 percent when all is said and done. It’s generally been a bit lower outside of China. (Again, it’s critical to repeat that nobody yet knows this number).

At that rate, on a per case basis, coronavirus would kill 10 to 20 times more people than the average seasonal influenza. The Spanish Flu, which killed millions in 1918, had a 10- to 20-percent estimated mortality rate.

So the real question is the first one, how many people would get sick if it cannot be contained? Again, the honest answer is that we don’t know, but let’s look at what we do know.

Hubei, the city in China with the most cases has 66,000 cases and that number will grow at least some, but Hubei has 6 million people, so only 1 percent of people in Hubei have coronavirus. Compare that to flu season in your child’s classroom, where 8 out of 25 kids might be out of school during a bad stretch (32 percent).

Ultimately, the number of people who get sick will be a function of how infectious the virus is. Some scientists have been concerned that it is spread more easily than flu, but this isn’t yet known and the opposite may be true. The slowing of new cases in China may suggest that it’s less contagious than previously feared.

The other question, because this is a new virus, is whether anyone is naturally immune. On the Diamond Princess, the cruise ship in Japan that encountered the virus, about 20 percent of the people became infected and about 1 percent of those who got sick have died. This is obviously a higher rate of exposure than people who are staying in their homes, but we have to see this as possible.

So, how do we make sense of imperfect data and uncertainty? Covid-19 isn’t the king of viruses, but it’s not a minor leaguer either, and if it spreads widely with a 1 to 2 percent mortality rate, we’ll all feel its impact. If Page County saw a 10 percent case rate (half the cruise ship rate) and a 1 percent mortality rate (same as the cruise ship, but half of the expert opinion), we’d see 2,400 people get sick and it would take 24 of our loved ones, most likely those 70 and over with known lung disease. That would be terrible and could be repeated in every county like ours.

The truth is that we can’t know, and that is hard. We’ll worry for our loved ones and ourselves and try to take reasonable precautions. I’ll be with you hoping that we dodge this bullet and preparing in case we don’t and, until next time… Here’s to your health.

The author is a Board Certified Family Physician who resides in the Shenandoah Valley.

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PUBLISHER’s NOTE: As a reminder, Center for Disease Control always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Follow CDC’s recommendations for using a facemask.
    • CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.
    • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to  others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

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