Coronavirus / COVID-19

There is a lot of misinformation out there and hype around the Novel Coronavirus, also known as COVID-19.  Based on my research of this issue, there are many people over-reacting, and also many people under-reacting to this threat.  At this stage, in March of 2020, the virus has effectively spread to such an extent that containment is not possible.  For the latest numbers, check the Johns Hopinks GIS tracking system.  As of right now, the total confirmed cases are 116,000, and just over 4000 deaths.  If we calculate the death rate from the confirmed cases, we come to roughly 3.5%.  That means that based on the confirmed numbers so far, 3.5% of those infected have died.  That said, there are probably more cases than this that have not been confirmed or reported, which means that the death rate could be a bit lower on average - perhaps as low as 2.5%, based on some reports.  But in some countries such as Italy, the death rate is as high as 5% as the heath care system becomes overwhelmed.  Let's presume that the average death rate is actually 3%, because the rates seem to be hovering on either side of that number, depending on which data you look at.  That said, I expect the death rate in the United States to be on the higher side, due to our poor diet and extensive healthcare system, we have one of the sickest populations in the world.  We eat badly and are kept seemingly "healthy" by our extensive treatment options.  That facade of heath comes crashing down in the presence of an aggressive infection that heavily taxes your  immune system's resources.    The people who are at the most risk for death from COVID-19 seem to be older adults, and especially those with other underlying diseases such as diabetes, cancer, or other ailments which weaken immune response.  Sugar, which Americans consume in copious amounts, is one of the most powerful immune suppressants.

In contrast to the COVID-19 death rate of 3%, the seasonal flu only has a death rate of 0.1%, or 30 times lower than COVID-19.  The Spanish Flu, which killed tens of millions of people, had a death rate of around 2.5%, for comparison.  People saying that the seasonal flu is more deadly than COVID-19 are either making the assumption that it will be contained, which I believe is extremely unlikely at this point, or they are looking only at the annual flu deaths thus far versus COVID-19.  Obviously, a large percentage of the population has been exposed to the flu, resulting in a larger actual number, whereas only a very small fraction of the population has been exposed to COVID-19 thus far, so that's not a realistic comparison.  As COVID-19 spreads, it is expected by most scientists, including Ira Logini, an adviser to the WHO, that it will infect perhaps two thirds of the global population.  If we look at herd immunity numbers based on similar viruses, it would need to infect, and thus generate a herd immunity of 75%-86% of the population before it may 'burn out.'  Thus, in a nutshell that means that somewhere between 217 million and 277 million Americans should expect to become infected, eventually, if those numbers hold.  If we do the math, that means that somewhere between 6.5 million and 8.3 million Americans should expect to die from complications of COVID-19.  Based on some early numbers, the median age of death is 81 years of age, and median age of infection is 61 years of age.  Those who die from COVID-19 frequently have other underlying health issues which compromise their immune system's ability to fight the virus.  Interestingly, children seem to be the least affected by COVID-19, with a much lower than average infection rate, and an even lower rate of severe symptoms and death.  It is also possible that vaccines and other treatment options could reduce both the infection rate and the death rate, but until those options exist, we should use the numbers and the math that we currently have to guide our preparations.  It appears that up to 80% of people who become infected, mostly healthy people with strong immune systems, will have few symptoms and will not experience great difficulty from this virus.  However, between 10-20% of people may have more severe cases, especially if they have weak immune systems, and will require advanced supportive care.

COVID-19 kills people primarily through ARDS, or Acute Respiratory Distress Syndrome, which is what happens when the connection point between the alveoli, which oxygenate the blood in the lungs, become inflamed, and that inflammation, caused by the virus interferes with that oxygenation process.  The inflammation also causes the capillaries to seep fluid into the alveoli which further prevents oxygen from reaching the blood stream.  Those who have reached this stage will need treatment from a ventilator utilizing low tidal volume and lying on their stomachs, usually in an intensive care unit, likely under sedation and possibly a paralytic.  While the US has an advanced healthcare system, the demands placed upon it by a large number of citizens requiring this level of care would easily overwhelm the number of beds, ventilators, and healthcare providers available.  This is why, while containment at this point is likely not possible, slowing the spread of this virus is absolutely critical and that's why quarantines, good hygiene practices, and other precautions such as school closures are being put into place.  If there is a rapid spread of the virus, the demand for treatment will overwhelm the health care system, and millions of additional people will die that could have been saved, driving the death rate up substantially, as is happening in Italy.  I expect most schools in the US to be closed in the next 2-3 weeks.  While children and young adults are actually the least affected by this virus, they are one of the most effective vectors to spread it to their families and other people.

With all of this in mind, what can we do?  Well first and foremost we should all follow basic hygiene procedures - wash your hands thoroughly, use alcohol-based hand sanitizer, avoid touching your face, do not share food or drinks, and avoid putting yourself into situations where you're exposed to large numbers of people in close proximity.  Do everything you can to stay healthy by getting plenty of sleep and eating healthy, especially avoiding things that suppress the immune system like sugar and refined carbohydrates.  Take regular vitamins and other supplements that are known to improve immune system function such as Vitamin C, Vitamin B6, Vitamin E, Vitamin D, Folic Acid, Zinc, Garlic, Oregano, etc.  Common sense and an abundance of caution will go a long way to help fight this virus.  There is certainly no reason to panic, but sticking our heads in the sand and ignoring the deadly consequences of this virus and ignoring the basic math is also not helpful.