The World Health Organization (WHO) finally confirmed this week that COVID-19 is a global pandemic. The number of people affected worldwide is increasing rapidly. Should you be alarmed? I have been following the global health experts daily and here’s what you need to know:
Worldwide status and forecast
COVID-19 is now present in well over 100 countries. The peak of the outbreak in China, where it started, now appears to be past, but cases are quickly accelerating worldwide. Though I am a stolid optimist, it is clear that the situation will get much worse before it improves. Epidemiologic models predict that the peak of the worldwide epidemic may not occur until late April or May 2020.
How dangerous is COVID-19?
Potentially very dangerous for certain groups of people. Data from China shows that about 80% of people infected will exhibit minor illness, 15% will have severe disease and 5% will be critical. COVID-19 is clearly more dangerous in the elderly. In China, deaths ranged from 0.2 % or less in those under 40 years of age to almost 15% in those over 80 years old. Deaths have also been higher in those having other medical conditions such as heart disease, diabetes, or respiratory disease.
Infectious disease specialists use the term Case Fatality Rate (or CFR) to calculate the percentage of people who get a disease that will die. So far, this number has been difficult to pin down for two main reasons. First, the definition of who is suspected of being infected (known as a case) varies from country to country and even changes as the disease spreads. Second, many people infected with COVID-19 may not have symptoms or seek testing and so the true number of total infected individuals can only be determined with widespread, population based testing. Data thus far shows the CFR for COVID-19 to be in the range of at least 1% which means that 1 or more out of 100 people infected will die of the disease. The WHO has suggested it may be as high as 3.4%. Keep in mind that these numbers reflect the estimated death rate over an entire population. CFRs vary widely depending on circumstances of transmission and care and resources available.
How does Coronavirus compare with the flu?
The CDC estimates that so far this season in the US there have been at least 32 million flu illnesses, 350,000 hospitalizations and 20,000 deaths from the flu. Historically in the US, approximately 0.1% of people infected with seasonal influenza (the flu) will die. That makes COVID-19 potentially at least 10 times more lethal than the flu.
Scientists measure the contagiousness of a disease by it's reproductive number, known as R0 and pronounced "R naught". R0 represents the number of additional people an individual with the disease could spread it to. The R0 for seasonal flu is consistently about 1.5. Extensive data so far estimates the R0 for COVID-19 to be in the range of 2 to 2.5.
Symptoms of both COVID-19 and the flu include fever, cough, runny nose and shortness of breath. Both can lead to complications, including pneumonia and death. We have antiviral medications that can lessen the severity of the flu, but no proven treatment is yet available for COVID-19. Nine different vaccines to prevent influenza are currently approved for use in the US. A widely available vaccine for SARS-CoV-2 (the virus that causes COVID-19) is estimated to be at least 12 – 18 months away.
How is the virus spread?
Per the CDC, COVID-19 is spread mainly from person-to-person; between people who are in close contact with one another (within about 6 feet), and by respiratory droplets produced when an infected person coughs or sneezes. It may be possible that a person can get COVID-19 by touching an infected surface or object and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. No case of COVID-19 has been attributed to transmission on an aircraft thus far.
The incubation period (the period between exposure to an infection and the appearance of the first symptoms) is 2 to 5 days on average, but can be up to 14 days. Evidence suggests that the virus can be spread by individuals who are infected but not showing any symptoms, but asymptomatic transmission is likely a rare occurrence and not a major driver of the epidemic.
What can I do to prevent getting COVID-19?
- Make sure you have had your flu shot for this season (everyone over the age of 6 months), since the symptoms of influenza are indistinguishable from those of COVID-19 infection. Also ensure you are up to date with your pneumonia vaccines if you are over 65 or have other chronic illnesses.
- Avoid close contact (less than 6 feet proximity) with people who are obviously sick.
- Wash your hands often with soap and water (for at least 20 seconds). If soap and water are unavailable, use an alcohol based sanitizer.
- Avoid touching unwashed hands to your face, eyes, nose and mouth (even if you are wearing a mask).
- Stay home when you are sick. If you have a cough, practice “cough etiquette”. Cough or sneeze into your sleeve or cover your mouth with a tissue and dispose of it immediately.
- Avoid touching potentially contaminated surfaces in public areas and consider wiping down frequently used surfaces with a disinfecting wipe.
What does it look like for the U.S.?
Listening to my colleagues in Asia, it became very clear to me how far behind the curve we are in this country in dealing with a national health emergency. The true extent of infection and spread of COVID-19 in the US is essentially unknown because widespread population testing is still not readily available.
By comparison, South Korea (the current focus of a large outbreak) has performed 4,099 COVID-19 tests per million of population. As of March 10, the number of tests performed in the US was 26 per million. Hong Kong and Singapore are both very densely populated centers of international travel and exchange that undertook a systematic government-led approach very early in their disease cycle and were able to limit cases to only a few hundred. Singapore has had no deaths to date.
A genetic analysis of the virus in Washington State, where most of the deaths in the US have occurred, suggested that the illness could have been spreading within the community for as long as six weeks before the first case was detected. Measures to mitigate the spread of COVID-19 in the US have only started in earnest this week.
What if I have upcoming travel plans?
The situation remains very fluid, and regulations and travel restrictions are changing every day. Many countries are instituting mandatory 14-day quarantines for incoming travelers, which can make short term trips unfeasible. Some regions and land borders have closed in an effort to quell the outbreak. Large gatherings around the world are being cancelled. Many travelers and tour companies have already canceled or are postponing travel plans until the full effects of the pandemic become clearer.
TravelBug Health remains committed to providing you with factual, evidence based information. Call to schedule a consultation for more destination specific information or for peace of mind, especially if you are over 60 or have other health issues. We have access to published travel advisories and restrictions updated on a daily basis, which can help you plan.
Most vaccines are valid for several years, or provide lifetime immunity, so there is no reason to delay an appointment with us if you have plans for later in the year.
And finally...
The world is still in the early stages of this rapidly evolving pandemic. Trends will become clearer as more data becomes available. It’s hard to find the good news in all of this, but for the average healthy person the danger from COVID-19 is small and there is no reason to panic. Despite reports of hoarding, there are no conceivable threats to our supply of toilet paper in the near future. As with any crisis, “this too shall pass” and at some point we will be able to return to the unrestricted travel and social interaction that adds joy and flavor to our lives.
In the meantime, we can reduce the risk to ourselves and our loved ones with social distancing, and especially look out for our elders who are at greatest risk. Support your immune system - which is all you have to fight the disease – with exercise, plenty of sleep and healthy food. Turn a potential disruption to your normal routine into an opportunity to shed some of your life’s stresses and stay tuned…
Trivia of the day : The now deserted streets and waterways of Venice, Italy are home to the origin of the word “quarantine”, which comes from the 14th century Venetian dialect meaning “40 days”, which was the length of time incoming ships were isolated off-shore to prevent the spread of the Plague.