So Let's Start Talking Facts About COVID-19 (Updated 3/18/20)

(Updates here if you've already read the original post.)

So, over the last few days, I've been reading up on this disease, and along with that, checking out social media to see what fresh misinformation is making the rounds.

There's a lot.

So, in the interest of letting my friends and family, and anyone else who wants to see this, get some real, solid, verifiable information - and put some of the mythological garbage on FB to rest - I'm going to give you some reality.

I am aware I am not a doctor. Accordingly, to prevent the claim that I don't know what I'm talking about, I will source everything I can, and update this post as new information comes down. For those not familiar with my site and its layout, links are underlined. They will also change color if you mouse over them, and I generally will link supporting documentation in my discussion of each factual claim I make, so if I said it, there's a link somewhere. Some of those links will go to .pdf files - sorry, but that's how a lot of papers are published by the medical community.

Now, normally, I am fairly incendiary in my writing; I will try to minimize that, so that when you share this with your elderly relatives who insist that swearing invalidates all the information that follows, they don't clutch their pearls and gasp.

One of the first things I've noticed going around on social media are a trio of memes, two of which purport to be from doctors or nurses - different ones each time, but still - claiming a variety of things as effective against the novel coronavirus, AKA COVID-19, AKA SARS-COV-2, which I will refer to for the duration of this post as CV19.

First, there's one claiming you need to stay hydrated (true because you die of dehydration in 2 days,) but keeping your throat and "tissues" hydrated reduces the impact of CV19.

It does not.

The same meme also claims that warm water will help but cold water can make things worse.

Water temperature has nothing to do with the effect of CV19.

The second meme claims, among other equally silly things, that holding your breath for ten seconds will determine whether or not your lungs are in fibrosis.

It does not.

This one we'll revisit later, because while the test is completely false - holding your breath doesn't test anything and is certainly not an effective test for CV19 - the fibrosis is not false, but by itself doesn't tell you anything. I promise I'll come back to it.

The third thing I've seen going around is a story about a guy in Wuhan who recovered from CV19 by ignoring antibiotics and eating manuka honey.

This one is so stupid it makes me practically burst into flames.

First, correlation isn't causation.

There may be a guy who got better. Hurray! That doesn't impart mystical healing abilities to honey. As you will see, most people who get CV19 do get better.

Ignoring antibiotics double bonus extra doesn't matter. CV19 is a viral pathogen; antibiotics are for bacteria. There is no value to antibiotics in a CV19 case unless the patient is suffering from aggravated secondary infections.

So.

Here is the situation.

Currently, there is an outbreak of unknown scope of a virus from a common family of viruses; known as a betacoronavirus, the strain currently spreading is a new strain, very similar to the virus that causes SARS. (Severe Acute Respiratory Syndrome.) Thus, the actual, official name of the virus at this time is SARS-COV-2.

This virus is dangerous for a number of reasons.

First, it has a lengthy period of asymptomatic incubation during which patients are contagious. By lengthy, I mean it lasts between 2 and 14 days. (Initial estimates were 2-7 days; subsequent information has expanded that estimate.)

This means, in non-medical jargon, that after you are exposed, you can spread the virus to other people for as long as two weeks before you, yourself, show any symptoms at all.

Which is why we're seeing these huge spikes in the numbers of cases reported; a single infected individual can spread the virus to a heck of a lot of people before they actually start to cough. Virus particles can be expelled primarily through coughing and sneezing, but once your upper respiratory system is infected, you can spread it by contact with surfaces that have been exposed, by shaking hands, by leaning in really close and breathing on someone. That's how aerosol viruses work, and it's not new; it's how influenza spreads.

Once symptomatic, the patients split into two main groups; mild and severe. For mild cases, time from onset of symptoms to recovery averages at two weeks.

For severe cases, that time extends to three to six weeks.

During that entire time, the patient is contagious. Even if displaying mild symptoms, and not reporting for medical care, they are still able to transmit the pathogen to others, and since at this time it is not known what causes individual cases to enter the severe phase, that's very dangerous.

It is important to note at this point that although the majority of the patients who have died in the initial outbreak were people with underlying health conditions, the numbers of healthy people who have died are steadily climbing. Having COPD sure doesn't help, but not having it doesn't mean you'll be fine.

So, let's talk about recovery. And then I'm going to scare the crap out of you.

At this time, approximately 80% of the patients who are infected with CV19 experience mild symptoms and then recover in a couple of weeks.

Approximately 20% enter the second, more severe, stage of the virus. Severe phase patients experience significant difficulty breathing; this stage is survivable in hospital, but attempting to ride it out is heavily contraindicated.

Approximately 6% of the total number of infected patients go into a critical phase.

Patients in this critical phase are unable to survive without oxygen therapy, artificial respirators, and significant medical intervention.

Without that medical intervention, they die.

Let me be perfectly clear about this: medical treatment has been effective enough that they have been able to save most of the critical patients at this point.

That absolutely should not reassure you, for reasons I will talk about in a minute.

But first, let's talk about the folks who have survived this disease.

The Hong Kong Hospital Authority is reporting that between 16% and 25% of the people who have recovered from CV19 are experiencing a loss of lung capacity of between 20 and 30%.

A permanent one.

This is where we talk about what CV19 actually does, and that fibrosis thing I promised to talk about earlier.

See, when CV19 enters your lungs, it begins to attack your lung tissue. That's bad. (And heart tissue, which is also bad.)

What's worse, is that it can allow secondary microbial attacks, including damage to the stem cells that allow your lungs to repair damage. Which means that the longer it progresses, the more of your body's ability to self-repair is destroyed.

This has a bonus side effect; it drives your immune system absolutely crazy, causing your immune cells to attack both damaged lung tissue and healthy lung tissue, causing further damage and scarring. The term fibrosis refers to damage and scarring in the lungs; this is absolutely a result, and aftereffect, of CV19; but by the time the patient has fibrosis, they are either too busy dying to hold their breath, or they are "recovered" with permanent lung damage.

But they live.

This is survivable.

However, as I said above, that should not reassure you.

Because resource scarcity is a real thing, regardless of people's opinions.

And keeping critical-phase patients alive long enough to recover is resource-intensive.

Very much so.

At a number of cases measured in thousands, the hospitals in China were overwhelmed. Patients were being treated in the halls.

So let's talk about contagion again.

Because recovered patients continue to be contagious, even after the end of symptoms, for as long as five weeks. (37 days being the longest duration currently recorded.)

This means that even after they're better, even after they're out of the hospital and at home, they can continue to infect people, generating new cases, for over twice as long as they could before they figured out they had it in the first place.

And CV19, while not particularly durable in its aerosol form, can survive on surfaces for a long time as well.

Up to 72 hours.

Which means that China is now reporting patients being re-infected after "recovery" - by going back to their insufficiently sanitized houses, touching their kitchen counter, and then their eyes or nose. (I note here that this has thus far not been lab-tested; so far it's just news reports, and since it's really, really bad news, scientists are denying until it's demonstrated in a lab. So, unproven, but reported. Can't say it's factual, but it's possible. There are at least two different strains of CV19 running around out there, and immunity to one doesn't make you immune to the other.)

Want to take that 80% bet twice?

There is currently no known antiviral agent effective against CV19.

Antibiotics have no effect on it.

There is currently no medication known to work on it.

The only current treatment for it is palliative - they try to ameliorate the symptoms long enough for you to recover on your own.

But guess what? After you "get better," you are *not* necessarily immune to it. It may be possible for you to catch it again, just like the common cold.

And the best estimates I've been able to find so far about the development of a vaccine say that it may take as long as April - of 2021.

Let's be clear; they've gene-sequenced this virus.

They understand its likely origin point (a bat.)

They understand its means of transmission.

They just can't kill it.

And they can't prevent you from getting it except in one way, which we'll talk about in a minute, after I get done showing you why that way is super important.

So, a week or so ago, I started seeing people talking about how H1N1 influenza spread to millions of people.

Yeah - about 80 million people worldwide.

So, at this time, I want you to remember that about 6% of the people infected with CV19 go into the critical phase.

6% of 80 million people is 4.8 million people.

Hospitals in China were overwhelmed with thousands of cases.

No matter how proud you are of the state of medical care in the USA, there is simply no mathematical way for hospitals to absorb, and treat, 4.8 million people who all require respirators, artificial blood filtration, and lung lavage to survive.

Because of resource scarcity.

Limited numbers of respirators.

Limited supplies of IV needles. (They're a large, but finite number.)

Limited numbers of caregivers.

Limited hospital beds.

And against 4.8 million people, those supplies will simply run out.

4.8 million people is more than the 2010 census reported as the total population of Houston and Chicago combined.

That is not a number the medical establishment can simply absorb.

That is not a number the country can simply write off.

That is not an acceptable number.

So. This disease has a contagious period ranging verifiably up to nine weeks. During the majority of that time, it shows no symptoms whatsoever.

The fact that the lethality numbers thus far are as low as they are is a testament to the dedication and skills of hospitals in the areas of initial infection.

The problem is that as the disease spreads to countries which aren't responding with the same quarantine fervor displayed by China and Korea - say, Italy, for example - that lethality number is steadily climbing. The hospitals in Italy are overwhelmed, and as they run out of supplies, they're starting to lose more and more patients.

The US is following the exact, identical epidemiological curve that Italy did.

Except so far, the quarantine measures we've taken are even less effective.

Italy is in lockdown; and although they're struggling to keep people cooperating with it, it's working to reduce the spread of the infection.

The US is not.

They're recommending "social distancing."

They're closing schools.

They aren't closing businesses, unless it's voluntarily.

And we're talking about a disease that - so far - kills roughly 5-6% of the people who get it according to The Lancet; a disease that is contagious for up to 9 weeks, can possibly re-infect, and causes permanent lung damage in up to 30% of the people who recover.

Now, this is not the end of the story.

Quarantine measures appear to greatly reduce the spread of infection.

A nine week quarantine would be a huge burden to everyone.

Major adjustments would need to be made. Business estimates would need to be revised; medical leave - with pay - made available; quarantine enforced. People are already seeing impact, from school closures and child care, to difficulty obtaining basic supplies.

The Senate will be considering the bill to take care of some of the leave, pay, and other issues, hopefully tomorrow.

I don't think it's good enough.

People need to go home and stay there.

Not go to the movies, or take their kids to the park.

Home. Stay there.

If they do, the infection will become a much less significant threat. Doctors and hospitals can handle this disease, provided that they are not inundated with millions of simultaneous cases. Slowing the spread will work; they can handle some cases.

Just not everybody at once.

This disease is scary.

It should be scary.

And we should be doing more about it.

Eating honey doesn't help.

Holding your breath doesn't work.

Drinking warm water exclusively doesn't work.

Gargling with vinegar doesn't work.

Saying "I'm young and healthy, I will be fine" doesn't work. (Lethality still at 0.9 even with no comorbidity factors.)

Quarantine does work.

And we should be doing far more of it, as soon as possible.

At a guess, if the US government manages to catch on to the idea that pretty much everyone currently in it has been exposed thanks to that one staffer, and pretty much everyone in it is in the highest risk category, we'll go into lockdown by the 20th of March.

If they decide to really let the cows out before closing the barn door, the 27th of March.

Honestly, considering how the numbers will jump tomorrow, I hope they freak out and lock everything down in the morning.

The CDC updates its estimates Monday through Friday; as of Friday, their estimate in the US was 1629 cases. That number has doubled over the weekend.

We'll see what that looks like tomorrow - and I will update.

(Updates as of 3/18/20)

So, first up on the list, bad news: the USA now has 9385 reported cases and 154 deaths. Up from 1689 cases on Friday. That is not a good trend. (This tracker seems to be updating far more frequently than CDC, and I'm going to leave this link here for later reference.)

Second, apparently ibuprofen, and other common-use NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) can make symptoms worse. So... Take Tylenol.

Third, Italy is swamped; 35,713 cases currently under treatment, 4025 recoveries... and 2978 deaths. Which is why early quarantine measures (like the ones the United States has already skipped) are so important. Running out of hospital beds and treatment options is a death sentence for a lot of people.

Right now, Italy has 591 cases per 1 million people in population.

The USA has 28 cases per 1 million people in population.

Now, we pinky swear that we have more hospital capacity per population, more medical caregivers, more everything.

So, numbers-wise we'll be in a comparable situation to Italy if we hit 200,000 cases. If we can manage 200,000 cases as well as Italy has, we'll end up with 16,755 deaths.

As of right now, we're several days in the contagion spread past the point where Italy began to seriously try to contain the disease. So it will likely be quite a bit worse than that.

Guys, I want you to know, I want nothing more than to be wrong about this. I want this disease to be a flash in the pan and then gone, something that inconveniences us for a few weeks and then disappears.

But right now, Congress is debating the response they'll make to this - because each and every Congresscritter and Senator seems hellbent on riding the necessity of the response into getting their particular legislative wishlist inserted into the bill - and that means that the bill will die. And nothing will get done.

Mayors countrywide are responding.

Governors, the same.

The federal government? Absolute paralysis.

And both teams are to blame. Let nobody be fooled here; it doesn't matter which side of the aisle you're on, both teams are complicit, both teams are playing disaster brinksmanship; and we won't see any serious, immediate action until one of them actually falls ill. (Further update: Mario Diaz-Balart (R-Fla) and Ben McAdams (D-Utah) are our big winners! Lo and behold, now it affects the political elite! We'll see how Congress reacts to the knowledge that literally every member of Congress has been exposed at this point -  tomorrow, I'd guess.)

Third piece of bad news: as the Italian hospitals are failing, they're finding out that the "survivability" of this disease for younger people is a total illusion. Younger people are less likely to get the severe form, but less likely doesn't mean they don't get it, and without proper treatment, they're dying too. It hasn't happened in the USA yet because the hospital system isn't overwhelmed, but the operative word in that sentence is "yet."

However, there actually is some good news; there are several drugs showing signs of reducing the severity of the symptoms, and reducing the duration of the actual COVID-19 disease. Two different antiviral agents - remdesevir, and a cocktail of Tamiflu combined with several drugs used to treat HIV - have shown serious promise as palliative therapy. There's been some sign that chloroquinine - used to treat malaria - may also help. And there's a Japanese antiflu medication called Favipiravir because scientists aren't any better at names than the U.S. DOD is.

Kaletra, however, has failed its first major clinical trial and is likely to be discarded as a potential treatment.

I will note here that although Cuba has been making loud claims about their plethora of drugs available for treating CV19, so far they have produced zero clinical evidence that those drugs actually help. (If anyone comes up with an actual clinical study showing some effect from any of their suite of medications, I'd love to see it. Please forward it to me so I can read up on it and add it here!)

As far as an actual vaccine, there are several vaccine candidates progressing through different phases of testing. They're all still months away, but they're all solid candidates - which means that this virus may be preventable, even if we're not there yet. Vox - not generally a bastion of fine journalism - actually did a great writeup on the various vaccine trials and the story behind them, so instead of reinventing the wheel I'm just linking it here.