I’ve been thinking quite a bit about COVID-19, the Wuhan coronavirus, over the last week or so and I’d like to share a few of my thoughts.
First, to the best of my knowledge, no successful vaccine as ever been developed for a coronavirus, at least not successful in the sense that the smallpox or measles vaccines are. There is no vaccine for SARS or MERS, relatives of the Wuhan coronavirus. I know that there are claims that they were very close to a SARS vaccine but then they lost their funding. That would be blithe but I’m skeptical of such claims. In my field there have been developments that have been right around the corner since I was in grad school.
Consequently, I think the prediction that Wuhan coronavirus will ultimately become endemic is a better one than that a vaccine will be developed and that will be the end of it.
Second, based on what we know at this point, a little back-of-the-envelope calculation will tell you that we should expect tens or hundreds of millions of people to die of the Wuhan coronavirus. Something depends on how many people you think will get it and what you think the mortality rate is. Back in 1918 the Spanish flu infected about a third of the human species. Even if the mortality rate is only a small fraction of the 2% that’s presently being estimated, that would mean millions of deaths.
Finally, the stories of relapses or reinfections actually concern me more than either the contagiousness or virulence of the disease. What if, once you’ve contracted it, you may become asymptomatic but still have it and it may re-emerge at any time?
Have a nice weekend.
“Finally, the stories of relapses or reinfections actually concern me more than either the contagiousness or virulence of the disease.â€
If a vaccine cannot be developed then this is indeed the most concerning. It’s a perpetual motion machine.
I think until test kits can be massively distributed, with easy access to them, a base line will not be known of how many people have actually contacted the Coronavirus, with or without symptoms. Once that has been established, a more accurately derived mortality percentage can be put out there. As it is now projected numbers of 1-3% are more fear-based than calculated via facts.
Although, the degree of relapses and reinfections is concerning, it still resides in the uncertainty zone, remaining a possibility not a realty, thus far.
We are getting our first cases here now. Some schools are closing. The lack of ability to test is contributing to problems. In at least one case a primary care doc had wanted to test but couldn’t get permission. The person who did not get tested assumed that since they didnt meet the criteria for testing being set at that time (criteria were pretty strict since there were so few tests available) thought they were safe, so they attended a big school event. Their PCP called them back in when testing was available and they tested positive.
We are clearly going to have more cases, just not sure how many more. A part of me thinks that our more atomized culture may actually help as I dont think we spend so much time in close contact with others as do many other cultures. However, we dont follow rules very well.
I dont knew about vaccines. I am hoping that since it seems mohave such a specific affinity for lung tissue that also means it will be more likely that we can develop a vaccine since it will have such specific markers. We will see.
It is causing me to have some difficult conversations. Some of my young docs and nurses have already had private conversations with me. They want to do their jobs, but they dont want to die. (Kind of ironic since I am well over 60 and the one actually at risk.) Since I was a corpsman this is something I never really thought about. Of course you take care of sick people and if you catch what they have and die, then you die. Part of the job. They all have young kids. Part of this is related, I think, to the fact that we dont have much in the way of training for this. I had some in the military, 30 years ago, but what we have are just videos showing what to do to put on and take off PPE. No clear guidelines yet on what masks and when to wear them.
We have always relied on a bit of luck assuming these things will burn out, and maybe this one will also, but if it gets bad there will be a lot of tough decisions.
Steve
Lack of testing kits causes health authorities to make a lot of assumptions. Targeting testing at recent arrivals from Italy tells us nothing about the rate of infection in the general public.
The virus may for instance, be more widespread yet less infectious than currently believed. Having arrived earlier and commonly mistaken for flu.
It is eerie that this viral outbreak occurred about 100 years after the Spanish Flu.
I do not think we will see tens of millions, millions, or even hundreds of thousands of deaths. The simplest reason is the mortality rates by age. So far, in all countries, not one person under 30 has died. And death rates between 30-50 is extremely low, something like 0.1%. But 50+ it is 1-10%.
From that you can deduce Africa, Latin American, India, parts of the Middle East which have very few old people (50+) will have few deaths.
It is the “old†countries – like Japan, Germany, US, China (the median age is about the same as the US) that have vulnerable populations.
As for treatments, what we need is less then a 100% effective vaccine. A 50% effective vaccine like what we have with the flu, or an antiviral to reduce the severity of the illness to reduce complications like sepsis, would help a lot.
On that front; something happening within a year is achievable. Esp since Gilead has an antiviral that is entering phase III trials now.
I give vaccines a lower priority to viable, rapid response test kits and anti viral meds, as this will immediately be helpful, rather than giving down-the-road assistance like vaccines will do. I also second Steve’s comment about being worried catching something when employed in the medical field. When I was actively working as an RN, my well being did not come into play. It was all about the patients under my care. My husband, however, did voice his concerns, and now says he’s glad I’m out of that field.
Well, that didn’t take long. A woman flew into Omaha from the U.K., went to a special Olympics event 50 miles north of here for eight hours, went home, had trouble breathing, went hospital, corona virus positive.
Many attendees were from Lincoln and we are right in the middle of high school basketball tournaments.
I don’t think quarantine is going to work.
Quarantine can work — even in a democracy, like in Taiwan, or very liberal societies like Hong Kong / Singapore — they have all managed to limit the spread of coronavirus.
People and governments need to take these measures seriously. For example, why are cruise ships still sailing, in San Francisco, or Miami, when they are cases in those states. Why is the NCAA not cancelling all sports (like March Madness)? Gov Cuomo said there are people who will not obey isolation orders.
There is lots of complaining about the government, but in our open societies, Governments are not the only ones who can or should take action.
Perhaps I should write a post on this subject. I’m skeptical that the United States can successfully utilize quarantine to limit the spread of Wuhan coronavirus for several reasons including
and so on. My guess is that quarantines can be successful in small compact countries, in countries with high social cohesion, in places with high willingness to comply, and in authoritarian countries. None of those characterizations applies to the U. S. Singapore—yes (small, compact, and authoritarian). Canada—yes (higher social cohesion and willingness to comply). U. S.—no.
Consider Italy. They’re preparing to quarantine a third of the country. But they’re relatively small and compact, have higher social cohesion than in the U. S., and a more compliant population. Here in the U. S. the complaints that quarantines are racist or only directed against the poor would be heard practically immediately.
Yes, I remember some other contagious virus going around while I was still working. They said people running a fever should stay home from work. Ours was like everywhere else, efficiency had brought us to the point we were working short staffed as it was. We actually laughed at the idea. Again, it won’t work.
The town with the special Olympics event, Fremont, Ne. Has announced schools closed for a week. That’s the problem, 7 days is not enough. But a month off school you just know they won’t do. Plus, those idle kids will never stay home.