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

 

 

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The Who’s and What’s of the Wuhan/nCoV virus

The world is in shock, twitter is in meltdown and China looks like the zombie movie World War Z (without Brad Pitt unfortunately). “Facts” and panic are disturbingly intertwined. To provide some guidance, here for all non-medical people (and maybe even some medical) a brief summary of what is going on and how worried you should be.

An old friend presented in a novel way

Coronaviruses have been around us for a long time. The name Corona comes from Greek meaning Crown because of how it looks under the microscope. There are different forms of coronavirus and we’ve known a few already:

– CoV: common cold, super common and mild symptoms

– SARS-CoV: Severe Acute Respiratory Syndrome

– MERS-CoV: Middle East Respiratory syndrome

And now with the new outbreak:

– nCoV: the not so creatively named “novel Coronavirus”

In your life you have been infected with many coronaviruses only not with the dreaded novel, SARS or MERS variant, … just the common cold.

Don’t push the Panic button (… yet)

A little perspective, yes, the world is on high alert but at this moment there is no need to panic yet. I say “yet” because we’re still in the outbreak and who knows what will happen next.

At this moment the majority of the misery is in China. They have the highest number infected and deaths. There was only one country outside China with one death (Hong Kong not counting as separate country…), no other countries have yet reported. If you look at this table you can see how nCoV relates to the other Coronavirus pandemics as well as the H1N1 pandemic.

	nCoV	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	28.276	2.494	8.096	208.269
Case fatality	susp 2%	37%	9.6%%	4.20%
Countries with reported infections	25	27	27	175
Countries outside origin with reported deaths	1	16	8	124

You can see that although the infection is spreading fast in China, the spread outside is still rare as well as the number of deaths outside of China. This is all very reassuring for the rest of the world although it doesn’t helpt China much.

This is de guidance of WHO pandemic criteria and you can see we’re currently in phase 4. The big questions is, will we get to phase 5 or 6? In other words: will there be an outbreak of the nCoV in a different country than China? Time will tell…

source: https://www.peakprosperity.com/coronavirus/

No hahahatjooo, Do hahahahandhygiene

You never know what happens next so just be cautious. The most important way of prevention of most infectious diseases is hand hygiene. Not just a quick splash of water on your hands but a real soapy two-minute wash and dry your hands after. Do this after visit to the toilet, before eating and after coughing/sneezing and you will be alright. Also please cover your mouth while coughing and sneezing to protect your surroundings. And if you’re sick don’t go to work or a different place where you can infect many others (see also “8 things you though you knew about the flu“).

Facemasks: if it won’t help Spiderman and Batman, it won’t help you

Wearing an ordinary medical facemask, although you look super cool with it, doesn’t help against viruses. Sorry. You would need a special very tight mask that prevents you from even smelling perfume if it was sprayed on your face.

If you do wear a facemask, please put the outside on the outside. It seems a complete “duh” remark but trust me I’ve seen public health professionals getting it wrong. And finally dispose the mask yourself and don’t put others at risk.

Stay safe and keep informed!

For more information: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

8 Things you thought you knew about the flu

Flu season is upon us. Many will stay at home with their runny noses, sore throats and sad little coughs. Others will push through the misery, but will subsequently infect all their co-workers. And for sure many will have some grandmothers’ wisdom, or some google results telling them how to prevent or cure the flu. Well, look no further. Time to dive into 8 things you thought you knew about flu, but guess what: you are probably wrong…

1. You can cure the flu with antibiotics

Really? We’re not getting back in to this right? Read the previous blogs! Nope, not doing it again. … Ok, just this time, the summary: the flu is a virus (influenzavirus), antibiotics kill bacteria, not viruses. There. Done. Can we drop this now please?

2. You can’t get immune for the flu

Hmm, difficult fact. Because basically you can. For your immune system to recognize a virus, picture that they need to recognize a 100 digit code (think of ten back-to-back phone numbers). If all 100 digits are recognized, you don’t get sick. If your immune system has seen the virus before, it will remember all those digits easily and rapidly. But there is a difficulty with the flu, the virus changes a lot every season. As if you are still wearing soft denims and velvet dresses. Hello? Soooo 2016. When only one digit is different, the puzzle is solved rather quickly, you get a runny nose for one day and that’s it. But what if ten digits (one phone number) are different? Then it takes time. You can get immune for the flu that you had, but you might encounter a different one this year.

3. The flu shot works/the flu shot doesn’t work

Both facts are true, so both fact are false. I know, it’s a mindf@#k, crazy world we live in. Again, the flu changes every season. The flu shot is a calculated guess on what viruses will be targeting us this year, giving you about five different flu virus digit combinations for your immune system to remember. Seeing that it’s a guess, you can still get the flu. However, with the flu shot, your immune system will have a lot more digits right at the first try. This means that if you had the flu shot and still get the flu, you’re less sick then you would have been without the shot. It is like coming to a party in a black dress, but everyone is wearing colored padded dresses. At least you wore a dress.

4. The flu shot gives you the flu

The whole idea of a vaccine is that you get immune without getting the disease. So no, this is not true. The viruses in the flu shot are dead or better, inactivated. They just serve as a practice for your immune system. They can’t do anything else. You know someone who got the flu after a shot? Well that’s obviously possible, since you’re surrounded by viruses.

5. H1N1 was a hoax organized by the pharmaceutical industry

The whole H1N1 hysteria resulted from the fact that this particular virus had a lot of different digits. People would get very sick, very fast and could (and did) die. Maybe the pharmaceutical companies benefitted in the end, but the threat was real. No hoax.

For the real nerds (like me): the H and N stand for the proteins “Hemagglutinin” and “Neuramidase”, they live on the surface of the virus and differ all the time (the 100 digits). 

6. Everyone has had the real flu at least once in their life

My husband would ask: what is real? But he is in that philosophical stage in life that all close-to-forty-year-old men are in. So, let’s stick with my answer: everyone has had the real flu? No. N. O. Definitely no. The real flu makes you so sick! Just ask the people that suffered the Spanish Flu in 1918. Oh, wait you can’t, they died.

7. You can catch the flu by going outside in the cold with a short skirt

That’s at least what my mother tried to convince me off in order to get me to wear trousers. Although a short skirt can get you in all sorts of trouble (no, not deserved), it won’t give you a higher risk of getting the flu. You can get the flu if you, with your mini skirt on, go to a bar with a lot of people that cough in your face or, better yet, put their face on your face.

8. Chicken soup cures the flu

Well, maybe partly true. Just the fact that someone takes care of you might make you feel better. And the warm liquid in your throat helps as well. And a foot-massage. And a Friends marathon. And chocolate. But not really.

So let’s stop whining and accept things as they are. Stay at home not because you’re so sick (“man flu” doesn’t count) but because you don’t want to infect others. Cough in your hand, not somebody’s face. Get the flu shot and be happy you can get it. Put on your mini skirt (yes, also the guys can if they want) and dance until this season is over.