How To Deal With Coronavirus: Follow The Data
When it comes to grappling with the pandemic disease COVID-19, known colloquially as "coronavirus", our best weapon remains information. The more we know about the disease, what it can do, and where it is going, the better we can prepare, marshal resources, and develop action plans. Priority number one must always be "gather more data", and priority number two must always be "share all data."
Priority number three must always be "keep data current."
Most crises are dynamic. Information changes as events unfold. There is no assurance that what is known on one day will be known on the next. What is true today may not be true tomorrow. It is vital to adapt to changing data, revising our understanding of events as they unfold.
This is particularly true when dealing with pandemic disease. Unfortunately, the two principal agencies tasked with organizing response to COVID-19, the US CDC and the World Health Organization (WHO), are at risk of allowing their data to become stale, and their understanding of coronavirus to likewise become stale.
In the "Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)" released by the World Health Organization on February 24, 2020, we are presented with this projection of COVID-19 severity:
Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours) and 6.1% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.
81/13/6 is the "official" breakdown of coronavirus case severities. It is the breakdown cited most often by the legacy media to describe how severe a case of coronavirus can be:
Up to 80 percent of the people who are infected by the coronavirus will develop a mild case. The 20 percent who contract a severe case of the disease will require hospitalization and advanced care. Particularly vulnerable are those with underlying medical conditions such as cardiovascular disease, diabetes and chronic respiratory disease. But so far, many have gone on to recover when treated in a properly equipped health care facility.
However, the coronavirus tracking page maintained by BNO News reports the following disease statistics internationally:
South Korea: 5,186 cases, 34 severe, 11 critical
Italy: 2,036 cases, 140 severe
Japan: 274 cases, 23 serious.
Total outside of China: 11,987 cases, 284 serious/critical
284 cases out of 11,987 is 2.3%, not 20%. Italy has the highest percentage of severe cases, at approximately 6%.
We should note that several countries do not break out the severe and critical cases, and so we should not read too much into these statistics, but given that the most severely affected countries are providing detail on severe and critical cases, we may safely say that the percentage of severe and critical cases being reported is considerably less than 20%.
Following the data, the COVID-19 pandemic is mercifully much less severe than originally projected. A pity the WHO has not taken the time to let people know this.
I will pause to emphasize something: I am not a doctor, certainly not a virologist, and am making no commentary on the disease itself. People are dying from this disease, and for that reason alone it should be taken seriously. I am, however, someone who has done more than a little disaster recovery and business continuity planning. Crisis management is not a medical discipline.
The data do not support the crisis the WHO projected initially. 20% of coronavirus patients are not developing the more severe form of the disease, based on publicly reported information.
If the reporting is wrong, then we should call on BNO News and other news outlets to improve their reporting and provide correct breakouts of severe and critical patients. However, I will note the BNO page provides links to the actual press releases and updates provide by the various countries' public health agencies, which gives confidence to the breakouts being provided. A review of those materials indicates BNO is reporting what public health officials are saying, and what they are saying is that ~2-3% of cases are severe, not 20%.
The 2% Are Cause For Concern
There is one aspect of these statistics that should give everyone pause: while 284 cases globally are rated as severe or critical, 191 patients have died. 67% of severe cases have resulted in the patient dying. People who develop the more severe form of this disease are in serious trouble.
We should also note here that it was these severe cases that doctors in China first noticed in December as the early indicator there was a new pathogen causing respiratory illness. As far back as January 8, the CDC put out a health advisory on a "pneumonia of unknown etiology". While the mild cases may be mostly annoying to the patient (as would be any case of the flu), the severe cases present as downright terrifying. Any presentation of disease that kills two thirds of the patients warrants more than a little concern. By comparison, the mortality statistic for influenza-induced pneumonia during the current influenza season is 6.9%. By this metric alone, we can say that coronavirus is far more serious than seasonal flu.
More Test Kits Are Needed
As of the past weekend, the CDC has achieved the capacity to test some 75,000 patients for coronavirus. By comparison, thus far during the cold and flu season there have been 948,064 influenza tests administered. The CDC should be aiming to test 750,000 patients, not 75,000. Being able to test only 75,000 patients is not a success by the CDC, but a failure.
Still, as the saying goes, you fight with the army you have. 75,000 test kits are what are currently available, and they need to be used wisely. Obviously, not every person who walks into an emergency room off the street with flu-like symptoms can get tested--there just are not enough test kits available today. That much is basic math.
Who should get tested? Again, not being an healthcare professional, I will not speculate on medical criteria. What I will say is that testing, along with every other healthcare resource deployed to address this disease, needs to be focused on addressing the needs of the severe cases, and the vulnerable patient groups most likely to develop the severe form of the disease: the elderly, the immunocompromised, those with pre-existing conditions such as CVD, COPD, CHF, asthma, and diabetes. These are the groups who need the greatest care and for whom the greatest precautions are necessary. Testing criteria should reflect these priorities and allow resources to be directed accordingly.
If the mild cases are simply mild, the severe cases are where attention should be focused. That is simply good resource management.
Symptoms Do Not Wait On Tests
We should all pause to remember one basic fact of disease: it does not wait on the patient or the doctor. People are going to contract coronavirus, just as they contract influenza or any other ailment, with or without a diagnostic test. No one needs a coronavirus test to know if they have a cough, shortness of breath, fever, or any other "flu like" symptoms, and they certainly do not need a test to take appropriate actions based on their symptoms. Hospitals do not need a coronavirus test to determine if a pneumonia patient needs to be admitted.
Given that there is neither a cure nor a vaccine for COVID-19, people should realize that supportive care is all that can be done at this time.
There is no specific treatment for the virus. Patients are generally given supportive care for their symptoms, such a fluids and pain relievers. Hospitalized patients may need support with breathing.
However, this is why it is important to stay abreast of the data. There might not be a cure, but for the overwhelming majority of cases one is simply not needed. Mild cases of coronavirus will resolve in time. The same cannot be said for the severe cases.
COVID-19 is thus more and less severe than originally thought. Less severe in that fewer patients are developing severe symptoms, but more severe in that, among those who are developing severe symptoms, most appear to be dying. This is what the publicly reported numbers are saying.
Forget The Headlines. Follow The Data.
Dr Drew Pinsky, more widely known as "Dr Drew", has an excellent piece of advice for the media: shut up about coronavirus.
“The press should not be reporting medical stories as though they know how to report it,” Dr. Drew continued. “If we have a pandemic, I won’t know how to tell that we’re actually having a pandemic because everything is an emergency. People that are infectious disease specialists, the CDC, the epidemiologist[s], need to take this very seriously. The press needs to shut up because you’re more likely to die of influenza right now.”
While that advice might be sound, the media is not going to follow it.
What people should do is recognize that the media--legacy media in particular--are amplifying the hysteria over coronavirus. The legacy media amplifies hysteria as a general rule, owing to their mantra "if it bleeds, it leads". The media is going to make every case report seem more dramatic for the simple reason that is their business model. The legacy media is far more interested in "infotainment" than actual news.
Forget the headlines. Disregard them. They are at best a sensationalized view of the meat of a story, and at worst a complete misrepresentation of the story.
Instead, follow the data. Be aware of how many cases there actually are, particularly in your area. Be aware of how many of those are severe or critical. Be aware of the symptoms of the disease. Be aware of what mitigations and personal protections there are (i.e., wash your hands). Gauge your own risk based on your own health profile, and take appropriate steps to reduce that risk.
Do Not Panic
With fewer than 12,000 cases of coronavirus infection outside of China, one thing should be absolutely clear: there is no reason whatsoever to panic. Coronavirus is not a disease apocalypse. Armageddon is not around the corner.
Emptying the local Costco of supplies because one person tests positive for coronavirus is simply not warranted. Blind panic has never helped anyone in any crisis, and it is not helping anyone now.
Common sense preparations are warranted. Given the nature of coronavirus, that means that what you need to prepare against is not the virus, but the panicked reactions of others. Stock up the pantry with non-perishable food items. Stock up on toilet paper and disinfectant wipes. If panic buying comes to your neighborhood, having a supply of these things on hand means you won't need to join in the frenzy. Not only will you spare yourself that stress, but by avoiding the crowd at the store you will limit potential exposure to coronavirus, as well as avoiding contributing to the general feeling of panic that drives such impulse purchases.
Give the stores the chance to digest that wave of impulse buying and restock their shelves. A few basic supplies now will limit inconveniences later.
Between complacency and panic there is a middle ground called "concern". That is where people should keep their heads over coronavirus. People should be concerned and people should be prepared. People should not ignore this disease nor should they regard every sneeze and sniffle as indication of the disease.
Follow the data. Keeping abreast of the data will help ensure you are responding to what is actually happening, not what you think might happen, or what the WHO and CDC fear might happen.
Don't let news headlines tell you how serious coronavirus is. Let the data do that--that is its job.