Fear vs. Reality - Coronavirus

Over the past week, our amygdalas (the fear centers of our brain) have been in overdrive.

As Coronavirus (and anxiety) spread, I’m concerned by the level of pandemic fear circulating through our news and social media.

The goal of this blog is to give you a thoughtful alternative to fear… to contextualize what you are hearing…

Let’s talk about death rates… While this is no apples-to-apples comparison, how we react to death is primal. And when we hear about Coronavirus-induced deaths, we go on red alert. But allow me to contextualize the numbers for you.

(Disclaimer: The below compared populations are different (China vs. world), and infectious diseases do not maintain a consistent daily average. But the point still stands…)

On one of the worst days for Coronavirus in China (February 10, 2020), 108 people died. But on a given day, globally:

• 26,283 people die of cancer;
• 49,041 people die of cardiovascular diseases;
• 4,383 people die of diabetes.

Meanwhile, suicide takes on average 2,191 lives….

Mosquitoes take the lives of over 2,740 people, and….

And HUMANS kill an average of 1,287 fellow people, every single day.

In response, this blog covers two key takeaways:

(1) The hard numbers to help you decide: Should I travel? Do I overstock my pantry? And is the world coming to an end? Let’s look at the data on how Coronavirus compares to typical influenza (the “flu”). (SPOILER ALERT: we’re seeing over 1000X more deaths from the regular flu, as of early March.)

(2) A brilliant blog on the realities of Coronavirus by Dr. Paul Sax, a Harvard Medical School classmate of mine (now Professor at our mutual alma mater), who serves as clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital. His blog is brilliant. Read it. Share it.

Let's dive in.

(Note: If you like this blog, share it! | Facebook | Twitter | LinkedIn | Or send your friends and family to this link to subscribe!)

Part 1: The Numbers… Let’s look at the data

COVID-19 has come out of left field and left us blindsided.

But people are largely fearful because we don’t understand it. 

So let’s look first at the numbers.

During the 2017-2018 flu season, CDC figures put U.S. influenza deaths at roughly 80,000. Meanwhile, global estimates indicated anywhere between 290,000 - 650,000 influenza-associated deaths from respiratory causes alone.

And in terms of deaths from influenza-induced lower respiratory tract infections, a 2019 study estimated 99,000 - 200,000 deaths for the 2017-2018 flu season.

The following year, CDC figures estimated 35.5 million Americans fell ill with influenza, resulting in 490,600 hospitalizations and 34,200 deaths.

And since this past October, the regular influenza has infected as many as 49 million and killed between 20,000 - 52,000 in the U.S. alone.

By comparison on a global scale, the Coronavirus outbreak has infected over 90,000 people as of early March, resulting in 3,462 deaths worldwide (today’s stat).

While the fatality rate of Coronavirus now appears to be slightly higher than that of typical influenza (estimates range from 1.4% to the WHO’s 3.4%), the toll of the common flu is staggeringly higher than that of COVID-19.

Concern—as with any infectious disease—is warranted, yes.

But knowing the numbers helps limit our fear of the unknown, and battle our amygdalas against irrationality.

These figures are not to suggest we should live without precaution. Regardless of how willing you are to sacrifice enjoyment for safety, it’s critical to understand expert concerns and how to mitigate them.

How much risk are you willing to take? What are you willing to sacrifice in everyday enjoyment and carefree living? And should you really be hoarding toilet paper?

This is the blog that I have shared with my family and friends and hope it is useful to you:

Part 2: Infectious Disease Doctor: What Does (And Doesn't) Scare Me About The Coronavirus

By Dr. Paul Sax, Harvard Medical School

Being a specialist in infectious diseases right now is an interesting experience.

Added to the usual challenges of our everyday practice — caring for people receiving transplants or chemotherapy, those with HIV, surgical infections, tropical diseases and others — we now must manage a deluge of coronavirus-related questions from friends, family and colleagues.

Here are a few recent examples in bold, along with my responses.

Frequently Asked Questions

Q: My baby has a pediatrician’s appointment next week, and the doctor’s office is right next to the hospital. Is it safe to go?

A: Yes.

Q: Should I wear a mask while commuting to work on the T or other public transit?

A: Only if you’re sick yourself, because the mask will protect others. Otherwise masks probably don’t do anything to protect you. Here's what you should do: Wash your hands!

Q: I’ve had a trip planned for a year to Australia and New Zealand and am supposed to leave in early April — should I cancel now and get a partial refund?

A: Only cancel if the anxiety of going would make you not enjoy the trip.

Q: I’m just back from France and have a bad cough, sore throat and a chill. How do I know if it’s the flu or coronavirus?

A: We really can’t tell. Reach out to your doctor and see about getting tested for both.

Q: Should I avoid Corona beer?

A: There’s no coronavirus-linked reason to pass on Corona beer — but in my opinion, it’s not very tasty.

OK, so my friends, family and colleagues haven’t really asked about that last one — but it is a thing.

Now, there was one actual question that caught me off guard: “What are you afraid of?”

Before responding, let me acknowledge that I am by nature an optimistic person — my family even gave me a T-shirt with the words “half full.”

Plus, we infectious diseases specialists are, by our very training and clinical activities, repeatedly handling situations that would make others uncomfortable — such as treating patients with anthrax, SARS, MERS, West Nile, H1N1 influenza, Zika and Ebola in the last 20 years alone.

But several aspects of this incipient pandemic cause me great concern.

5 Big Concerns

(1) Our health care system does not have “surge” capacity. This is especially true during flu season, when many hospitals run at nearly full capacity. Adding a high volume of patients with respiratory infections — all of whom would require private rooms — will severely strain most institutions. It will further block other important hospital activities, such as elective surgeries and transfers from other hospitals. This is already happening in northern Italy.

(2) Here in the U.S., testing for the new coronavirus was initially sharply limited. For a variety of reasons — misguided policy, regulatory limitations and faulty tests — we only recently started broad testing for coronavirus among people with compatible symptoms — some two months after the disease was first reported. (Initially, only those who had traveled to regions with coronavirus outbreaks were eligible for testing.) While other countries have already conducted thousands or even tens of thousands of tests, as of last week the U.S. had done fewer than 500. While the logjam on testing should end soon, it's probably too late to prevent extensive community transmission.

(3) The people at greatest risk for severe or fatal coronavirus illness are already our most vulnerable patients. Like other viral respiratory tract infections — flu, respiratory syncytial virus, even rhinovirus (cause of the common cold) — older age and concurrent medical problems make coronavirus infection much more serious. Estimates from China suggest the mortality rate among those older than 80 is 15%. That's why the reported identification of cases in a Washington nursing home is particularly worrisome.

(4) Hoarding of masks and other protective equipment could stress the supply chain, putting health care workers at risk. All of us in health care accept that exposure to infection is part of our job. But to do so without the appropriate protective supplies cannot be permitted. It is critical that we have access to the specialized N95 masks and other gear, especially during procedures that increase the risk of exposure.

(5) Political pressures might make it difficult for public health officials to tell the truth. Does Dr. Anthony Fauci — longtime director of the National Institute of Allergy and Infectious Diseases and someone who has navigated outbreaks for decades — really need to have his statements cleared by Vice President Mike Pence? When Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said a global pandemic was highly likely, only to be contradicted later that day by the president, who should we believe? The Trump administration on Saturday denied muzzling public health officials, but I find these examples troubling.

3 Important Reasons For Optimism

If that list seems like a lot to worry about, let me mention a few things I’m not worried about — and that even give me hope.

(1) We know the disease is mild in most people who get it. At least 80%, most likely more, won’t have an illness bad enough to warrant hospitalization. We’ll have a better idea once testing is more broadly applied, but it would not surprise me if the widely cited case fatality rate of 1-2% is eventually less than half that.

(2) Children seem particularly protected from severe coronavirus disease. Many of the sniffles and colds kids experience are due to existing milder coronavirus strains, possibly giving them partial immunity to this more serious new threat.

(3) There has been extraordinary global cooperation from doctors, scientists and public health officials. In most cases, this has included remarkable sharing of clinical data and research. It is wonderful to see the medical community responding in such a unified voice, all of us trying to solve this new problem.

Guess I can still wear my “half full” T-shirt.