COVID-19: Don’t Panic, Just Spread That Peanut Butter please

As the shit is hitting the fan (hence the crazy stockpiling of toilet paper), our current pandemic world relies on YOU! Yes, you. Usually people wait for the government and scientists to solve the problem. Now, YOU are the key figure in containing COVID-19.

And I’ll coach you through it.

COVID-19 tip #1: Forget the numbers

The actual numbers don’t mean much in the middle of an epidemic. Tests for COVID-19 are sparse almost everywhere. Who knows how many people are actually infected? South Korea is said to be a dangerous place because they have a lot of infections. But actually; South Korea did a great job testing its population and are one of the few countries where the amount of new infections per day is going down. In other countries it’s still rising every day. (https://www.worldometers.info/coronavirus/)
In countries where they barely test, like the USA, or where they don’t test family members of infected person, like the Netherlands, the numbers might indicate that they have fewer infections than factually would be the case.
Is it safer to go to countries with lower numbers? Or is it more dangerous because people are walking around unaware of their infection and that they are infecting other people?

Numbers are meaningless unless you know the proportion of people that has been tested.

9 infected on a total of 10 tested: bad.

9 infected on a total of 100.000 tested: still bad, but less bad.

https://www.worldometers.info/coronavirus/covid-19-testing/

COVID-19 tip #2: Think about the implications

Let’s talk about you. You might feel fine. Great. You might think you won’t get sick. Cool, I hope you are right. You might even think that when infected with COVID-19 you will be ok. Well, good for you! Maybe you’ll just have a sore throat. Aaaah. You think you can go to work with a small fever and a cough. Wow, aren’t you a tough one. Or why not bring your kid to the daycare, kids have runny noses all the time. And if you or your kids do get COVID-19, you might be really sick, but you won’t die. What are the chances?

You are ok, you’ll manage, the kids will be fine, so no worries … ERRRRRRRRRRRR (the sound of a game show buzzer indicating that something is wrong).

Who do you meet during the day? Do you bring your children to their grandparents for a day? Do you visit that birthday party? With or without (mild) symptoms you, yes YOU, are a small but very important ‘number’ who influences the implications: the spread of the outbreak.

Think about the implications of your actions and behavior. Think twice, and don’t do what you would normally do.

You want to know why this helps governments, scientists and especially hospitals?

COVID-19 tip# 3: Just Spread the Peanut Butter

You might have seen the picture of this post in newspapers or online. Don’t we all keep refreshing our news feeds in an unhealthy way? But it is important, so I am also going to explain it, my way:

Think of Peanut Butter, imagine that the Peanut Butter is the COVID-19 infected people.

Think of slices of bread, imagine that the slices of bread are the region where you live.

Think of a mouth, imagine that mouth is your regional hospital.

What happens when you feed all the Peanut Butter in the jar to a mouth in one go? The mouth can’t handle it. The mouth can’t swallow the load. Peanut Butter falls on the floor.

What if people with no or mild symptoms infect a huge vulnerable group at the same time? They go the regional hospital. Some end up in an intensive care unit. The hospital in your town will be full quickly, the other ones in the region as well. The hospitals needs to make choices, they save people that have the most chance of survival.
What happens to the Peanut Butter that fell on the floor? It’s gone.

What do people mean with the picture? What do people mean with “flattening the curve”?

Spread the Peanut Butter on the slices of bread. Feed the Peanut Butter bread bite by bite to the mouth.

You are part of this. Together with all your relatives, neighbors and colleagues you hold the knife. The knife represents your actions, the knife represents your behavior.

In an epidemic it’s unavoidable that people get seriously ill. Flattening the curve – or Spreading the Peanut Butter – means that instead of causing many people to be sick at the same time, the people will get sick divided over a longer stretch of time. It is the difference between overloading hospitals which then must choose who lives and dies, and helping the hospitals to manage the outbreak.

You can flatten the curve. Just Spread the Peanut Butter:

– Wash your hands

– Social distancing: Avoid social contacts and crowds unless needed (you need groceries, shopping for a new skirt can wait)

– if you have symptoms, ANY symptoms, even just “a runny nose”, stay home!

– If your child has symptoms, (just a runny nose): keep that child at home. Don’t let it go to school, don’t let it play with friends and definitely don’t send that child to grandparents or other people in the vulnerable group.

Good luck everybody, stay safe!

 

Illustration: SAM WHITNEY; CDC

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COVID-19; is it time to hit the PANIC button?

Say hello to the madness; we are in a pandemic. In my last column I mentioned that the spread outside of China was still rare. Eeeuh, that didn’t age well… Today, three different continents are confronted with outbreaks of the virus, probably others will follow soon. Thousands are infected and a percentage of them have died. Since the virus hit the West it almost seems the world is in panic mode. There is such an overflow of good/vague/bad information surrounding this outbreak that is hard to keep track of it all and put things in perspective.

Luckily, I am here to change that: your very own, Thailand based, Infectious Disease Epidemiologist.

CO-NA-NA, what’s my name?

The issue with a new disease is that it is hard to immediately give it the right name. Some parents might now this feeling, waiting days after a birth to name their kid. The current disease almost changed names more often than Sean Combs, Puff Daddy, P. Diddy, Diddy, Puffy, Fluffy, Duffy, H. Duffy, Hilary Duffy, Hilary Duff did.

Today we call what used to be the “Wuhan-virus”, the “Corona Virus”, the “nCoV” by its WHO approved official name: COVID-19. It stands for “COronaVIrus Disease”-2019 (let’s don’t do a 2020 or 2021 version), the virus itself is called SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).

FACT 1 : COVID-19 (still) not as bad as previous outbreaks

Let’s update the table from the last blog:

	COVID-19	MERS	SARS	H1N1
Year	2019	2012	2002	2009
Origin country	China	Saudi Arabia	China	Mexico
Source	Bats	Dromedary camels	Bats	Swines
Number of people infected to date	82.294	2.494	8.096	208.269
Case fatality	Susp. 2%	37%	9.6%%	4.20%
Countries with reported infections	57	27	27	175
Countries outside origin with reported deaths	7	16	8	124

https://www.who.int/docs/default-source/coronaviruse/situation-reports/; MERS-CoV: Middle East Respiratory syndrome; SARS-CoV: Severe Acute Respiratory Syndrome; H1N1: Swine flu

Although COVID-19 seems to be “better” than SARS, MERS and H1N1, it loses the battle in a who-is-a-good-disease competition to seasonal flu. In comparison with the seasonal flu COVID-19 has a higher case-fatality ratio. Seasonal flu has approximately 0.5% mortality rate, COVID-19 currently has a 2% rate (please read FACT 3).  COVID-19 also has a higher reproduction number; seasonal flu infects about 1 to 1.5 other person (tiny persons also count for 1, it is just statistics), COVID-19 appears to infect 1.5-2.5 other person. This means that COVID-19 could spread more widely. Lastly, for seasonal flu we have a vaccine!

FACT 2 : Younger than 50? No reason to panic

(Rest assured: this does not imply the following: Older than 50? Call your local undertaker at 555-…..)

Let me remind you that Coronaviruses have been among us humans for a long time already. Yes, this is a new variant and yes, it is more severe than the previously known ones, but if you look at the figures published by the Centers for Disease Control, China, you can see that if you’re younger than 50 years old, you will be fine.

And even if you do catch the virus, you would probably not even go to see a doctor. Symptoms are fever, dry cough and shortness of breath but range from mild (80% of the cases), severe (14% of the cases) and critically ill (5% of the cases).

Men are at higher risk of dying from COVID-19 than women (rate 3,25 to 1). And people with underlying illnesses like COPD (smoking history), diabetes or a bad working immune system due to medication or old age are also at higher risk [1]. These vulnerable groups are also the people that we usually give the vaccine for seasonal flu. You can see how they are at higher risk of dying from the COVID-19.

Also, <10 years old there have been (to date) no deaths and very few infections reported.

Characteristics	Confirmed cases,	Deaths,	Case fatality
	N (%)	N (%)	rate, %
Overall	44,672	1,023	2.3
Age, years
0–9	416 (0.9)	−	−
10–19	549 (1.2)	1 (0.1)	0.2
20–29	3,619 (8.1)	7 (0.7)	0.2
30–39	7,600 (17.0)	18 (1.8)	0.2
40–49	8,571 (19.2)	38 (3.7)	0.4
50–59	10,008 (22.4)	130 (12.7)	1.3
60–69	8,583 (19.2)	309 (30.2)	3.6
70–79	3,918 (8.8)	312 (30.5)	8.0
≥80	1,408 (3.2)	208 (20.3)	14.8

[2]

Just to clarify: these current mortality rates only apply on people of whom it is determined that they have COVID-19 (see again FACT 3). If you don’t have COVID-19: well, don’t text and drive!

FACT 3 You can have the virus and be fine

The symptoms of COVID-19, like I stated above, can be very mild with just some cough and runny nose. Recently, Yan Bai et al. published an interesting article of how even asymptomatic carriers can transmit the virus [3]. This means that you can be infected with COVID-19 and not have any symptoms.
That sheds an interesting light on the 2% mortality rate in FACT 1. If we would test the whole world, we would probably get a higher number of infected persons. Infected persons without even knowing it. This affects the mortality rate: which is deaths from the virus divided by persons infected by the virus. If currently more persons are unknowingly infected the mortality rate could be much lower (as the nominator increases). The absolute number of deaths of course doesn’t change, which is sad, but it might put the severity of the COVID-19 in a different perspective.

Conclusion: during an outbreak it is super difficult to make sense of any of the numbers and to have a complete picture of the outbreak.

FACT 4 Closing an office for 48 hours is pointless

Some companies close their office for two days when an employee is found to have COVID-19. The reason? Intensive cleaning of the office. This does not solve anything!

Yes, the virus can survive long on surfaces, so a good cleaning is very smart. But if after the big cleaning you will re-open the office again you might as well not have bothered. Persons have the disease in them for at least two weeks … spreading it to others … who probably come back to the office on day 3 … you understand where I am heading?

Recently I was in a hotel and at check in they took my temperature and every morning before breakfast they checked me before I could enter the breakfast room. That is a much smarter way to contain the outbreak. That gives us FACT 5.

FACT 5 Do’s and don’ts

Do	Don’t
Wash hands regular	Go to the current outbreak hotspots
Use desinfecting handgel	Go to a place where you are packed with other people with potential bad hygiene
Sneeze and cough in elbow	Panic
Read scientific facts	Trust Facebook
Think twice before traveling anywhere	Panic!!

Do the do’s and stay home when you have any symptoms and you are helping to stop this outbreak.

Well done, stay smart, until a next update!

 

References:

1. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J Med Virol 2020.
2. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.
3. Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA.Published online February 21, 2020. doi:10.1001/jama.2020.2565