Wednesday, April 22, 2020

Covid-19 is "no worse than the flu"

What a politically charged statement these days,

Saying that Covid-19 (AKA SARS-CoV-2) is like the flu can be horribly misinterpreted by people who aren't aware that influenza can cause 24,000 – 62,000 deaths per season. Likewise, the common cold (rhinovirus) can lead to complications particularly in people who have a weak immune system.

Common human coronaviruses, including types 229E, NL63, OC43, and HKU1, usually cause mild to moderate upper-respiratory tract illnesses, like the common cold. Most people get infected with one or more of these viruses at some point in their lives. This information applies to common human coronaviruses and should not be confused with coronavirus disease 2019 (formerly referred to as 2019 Novel Coronavirus).

The thing is that influenza and colds are so "ordinary" and treatable that most people don't really consider that there can be serious consequences if those diseases aren't treated. On the other hand, some people like to trot out the 1918-20 "Spanish Influenza" as an example of how bad a pandemic can be.

The Spanish influenza is caused by the H1N1 virus, and you might see where I am going with this. The 1918 influenza pandemic was the most severe pandemic in recent history. To recap if you missed the first episode:
Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.
The surprise to the story is that you may have had this horrible disease. That's because:
In June 2009, the World Health Organization (WHO) declared the new strain of swine-origin H1N1 as a pandemic. This novel virus spread worldwide and had caused 18,500 laboratory-confirmed deaths with an estimated 151,700 to 575,400 deaths total by August of 2010. On 10 August 2010, the World Health Organization declared the H1N1 influenza pandemic over, saying worldwide flu activity had returned to typical seasonal patterns.

There are a few reasons why the 2009 outbreak differed from the 1918-20 one. First off, there was a vaccine available. Secondly, there are the treatments mentioned above: antibiotics to treat secondary bacterial infections that can be associated with influenza infections.

One of issues with Covid-19 is that the docs don't have an accepted treatment, which is where the hydroxychloroquine "controversy" comes in. Well, hydroxychloroquine is controversial because Trump used it as an example. Otherwise, there has been a fair amount of experimentation with it, but there are mixed results. I would add that they are also testing massive doses of vitamin C and nicotine patches for Covid-19! See also this link.

Also, there are lots of Coronaviruses. The common human coronaviruses, including types 229E, NL63, OC43, and HKU1, usually cause mild to moderate upper-respiratory tract illnesses, like the common cold. Most people get infected with one or more of these viruses at some point in their lives. This information applies to common human coronaviruses and should not be confused with coronavirus disease 2019 (formerly referred to as 2019 Novel Coronavirus).

I would add that SARS and MERS are also caused by Coronaviruses. One of the issues in addressing Covid-19 was trying to figure out how virulent it actually is. My uneducated opinion is that the Docs don't really know since there hasn't been extensive testing. The testing out there says that there might be no symptoms in most people infected with the disease. Covid-19 might also be a disease of the immune system instead of a primarily respiratory disease.

COVID-19 is, in many ways, proving to be a disease of uncertainty. According to a new study from Italy, some 43 percent of people with the virus have no symptoms. Among those who do develop symptoms, it is common to feel sick in uncomfortable but familiar ways—congestion, fever, aches, and general malaise. Many people start to feel a little bit better. Then, for many, comes a dramatic tipping point. “Some people really fall off the cliff, and we don’t have good predictors of who it’s going to happen to,” Stephen Thomas, the chair of infectious diseases at Upstate University Hospital, told me. Those people will become short of breath, their heart racing and mind detached from reality. They experience organ failure and spend weeks in the ICU, if they survive at all.
The problem is that there are a lot of problems with the US reaction to this. One of which is that there isn't really the ability for the Feds to control how the states handle this. The states have reacted from how California and Washington made their strict lockdowns to downright lackadaisical. And neither party has really done the right thing.


 The problem is that the end to all the "lock down" may not be until there is a vaccine, which could be WAY OFF in the future.

When Covid-19 spread across the world, some countries reacted with alarm and thorough preparations, given their previous experiences with MERS or SARS. In these countries, such as South Korea, Taiwan, Singapore and Vietnam, containment of the novel coronavirus became the imperative, regardless of cost. However, other countries chose to treat it as if it was a bad flu strain that would be unstoppable and spread across the population until some kind of immunity was reached. The responses depended on how seriously the governments took the threat. Or how prepared they were to handle the threat and the effort properly addressing would take.

My point is that the flu, or even the common cold, can be deadly if not properly treated. Some places were not properly prepared to address the crisis despite having had "Pandemic Threat assessments".

Now is not the time to blame or shame, but to act decisively. The real winner will be the person who can show leadership in addressing this and take the actions necessary to minimise the suffering.

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