CORONAVIRUS

Much information on the coronavirus is flying to and fro. We’re in a whirlwind of info-seeking and info-sending. Some good, some bad, most true, some not-so-true.
 
From my clinical perspective, here are a few thoughts.
 
There seems to be a tendency to overshoot in an effort for the authorities to calm the public and assuage fears. The CDC officials come across as more sobering and less pretentious than any of the politicians and news anchor talking heads who are either in the wagon with power-seekers and power-keepers, or those who entertain.
 
The nearest active case is in Santa Rosa County, Florida, 150 miles away. It will be on the Mississippi Gulf Coast sooner rather than later and that the virus will find its way to all 50 states. Probably before the end of May.
 
Regarding the mortality rate of the coronavirus. The true mortality is higher than what is being reported at 2%. Here’s why.
 
People who are currently infected but have not had an outcome (recovered or died) are being included in the calculation. The wrong assumption in calculating the mortality rate this way is that everyone who is currently infected but have yet to have an outcome, will live. This of course is not true. Some percent die, thereby affecting the mortality rate. This dilutes (lowers) the actual rate.
 
Take, for example, a 100 people who have or had the disease and 5 died, 75 recovered, and 20 currently have the active infection. To include the 20 who currently have the disease, but have yet to die or recover, will dramatically lower or raise the mortality rate. If all 20 died, then the death rate would be 25 died (5 +20), divided by 100 total cases (outcomes) = 25%. If all 20 live, then the mortality rate would be 5 died and 95 (75 + 20) recovered, or 5/100 or 5%.
 
Using today’s numbers from the CDC, Worldometer, and Johns Hopkins’ websites, here are the current (March 6) global stats:
                Number of deaths:                          3,412
                Number of recovered:                   55,996
                Total cases with outcomes:           59,408
 
Mortality rate = Deaths / Total outcomes = 3,412 / 59,408 = 6.0%
 
This is 3x the death rate being reported in the media and all around. Why? Your guess is as good as mine but it probably has something to do with tamping down public panic. Or, they prefer to include active cases without outcomes to get the lower result. But it’s for certain much, much higher than the influenza mortality rate.
 
A 2% death rate means 1 in 50 die.
A 6% death rate means 1 in 16 die.
 
This, I believe, explains the discordance in the dramatic behavior and herculean efforts of China to quarantine their citizens and the 2% reported death rate by the media. The truth of the matter is reason to heed the advice of avoidance, social distancing as reasonable as possible, and cleanliness with handwashing, and protecting one’s self with appropriate cover (masks, gloves, etc.) to the extent possible.
 
As for masks, I understand the rationale to the public to not wear them in order to ensure they are available for medical personnel. When the virus arrives locally in our community I will be wearing one when I am out and about. They claim it doesn’t help, as the virus can travel through the mask, and this is true. But it at least can prevent exposure from large droplets contacting you and if nothing more it makes you feel as if you’re doing something to protect yourself. Wearing a mask is more effective than doing nothing, especially if you’re standing in front of someone in line at Walmart, who is actively coughing, sneezing, or snorting (runny nose). As for me, if the virus is in the community, I’ll have one on. Home Depot and Lowe’s has the N95s. In the exam rooms and office I will be wearing one and will ask patients with respiratory symptoms to wear one.
 
If more than three people group in our waiting room, any of whom are actively coughing, we will ask them to wait in their car and call them on the cell phone on their turn. This way it will minimize exposure for those without respiratory symptoms.
 
Before it became discovered that the coronavirus was community acquired, meaning people get infected almost out of thin air, more or less, here were some documented common social circumstances in which people contracted the illness: driving or riding in a taxi, attending church, shopping, household members of contacts, medical personnel, commercial flights, tour guide, living on a floor in an apartment below an infected person, and eating in a restaurant.
 
Anyway, the big plus in all of this is that overwhelmingly most people recover from this illness. Many have only mild to moderate symptoms and discomfort. Don’t be surprised when the virus is detected in our community. The main thing is to stay calm, live your life, use common sense, respect your neighbor, and keep God in your life, and if you can, help or watch out for the other guy. It’s not the end of the world.