So once again for those of you in Rio Linda and I’m looking at you Rush – no – this is not a “common cold†nor is it a hoax nor is it your garden variety influenza nor will holding your breath or breathing through you nose help, so here’s some of the differences between influenza and COVID-19.
Influenza:
We know what influenza is, how to identify it, how it spreads, what it is likely to do to people who contract it and what populations are at greatest risk.
We also have vaccines for influenza and while not perfect we would probably see a lot less deaths if more people got them and practiced social distancing when sick, and we also have anti-viral medications to treat influenza.
There are also reliable rapid tests to determine if someone has influenza – tests that can be done in the doctor’s office with a result in in sometimes as less as 30 minutes. Not that testing positive for influenza changes the course of treatment excepting that if it is in the 1st 48 hours of symptoms and anti-viral meds like Tamiflu can be given and the patient can be followed up for complications.
Otherwise the course of treatment is – stay home as not to infect others, get plenty of rest, stay hydrated, use a humidifier to ease nasal congestion, take OTC fever reducing meds, but seek additional medical help for:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
Flu-like symptoms that improve but then return with fever and worse cough
(It should be noted that this advice would also apply to anyone with a “mild†to “moderate†case of COVID-19 who is recovering at home.)
Because of surveillance of the predominant strains of seasonal influenza and their severities circulating in Asia and the southern hemisphere some 6 months before our “cold and flu†season begins, doctors and hospitals, the CDC and public health officials can, based on data and estimates of influenza severity, ramp up and prepare for the estimated number of cases and the number of doses of vaccines can be increased ahead of time.
As this COVID-19 virus was only detected for the very first time in late December of 2019, we do not yet know the number of COVID-19 cases that may be severe enough to flood doctor’s offices, ER’s, urgent cares and hospitals and ICU’s but we can look to China, Korea, Italy and now Spain to see what may be on its way as we are on the same trajectory but some two weeks behind Italy.
And what happens if a large number of healthcare workers and first responders come down sick, even if not critically ill or in danger of dying, are still unable to work for a week or more at the height of when they are needed most is a great concern along with what could be a shortage of critical care beds and respirators.
While influenza strain’s RNA shifts, i.e. mutates from year to year (the reason you need a flu shot every year and not a one and done shot) prior exposure to similar strains imparts some protection and immunity. You might still get sick but often not nearly as sick if you’ve had a similar strain before. And it is even believed that while the influenza vaccine has to be developed each year for this year’s predominate and RNA shifted strains, depending on the strain, a prior year’s flu shot may still impart some protection. (The good news for me is that if “Spanish†flu ever made a comeback, because I had its very close relative, the Russian Flu back in 1978, I’d probably have a good bit of immunity to it.)
And speaking of “Spanish†flu (that wasn’t really “Spanishâ€), every once and a while however, a new strain of a type A influenza comes along and causes a pandemic and an unusually high rate of both infections and deaths – 1918-19 “Spanish†flu and most recently the H1N1 Swine flu pandemic of 2009. And those are the most dangerous in not only the rate of infection, the R0, but also that those strains tend to be more lethal to younger and healthier people and children than is typical with influenza which tends to kill the very young, the very old and people with underlying health conditions and because the RNA shifted enough, less people (but not all people) had immunity.
It should also be noted except in cases of cytokine storm (a hyper over active immune response) as with what happened with “Spanish†flu and sepsis, most people who die from influenza die from secondary bacterial pneumonia. While there is a growing problem with antibiotic resistance, we still have a large arsenal of antibiotics that are effective in most cases.
COVID-19
COVID-19 is a novel, i.e. a completely new strain of coronavirus to humans so no one – I repeat – NO ONE has ever had it before and therefore no one, I repeat NO ONE has any immunity to it what so ever. In other words, if you are exposed to it you will likely come down with it.
The good news is that for many, the symptoms will be mild to moderate enough to be anywhere from a mild to a rather nasty cold or bout of influenza, and even some “may†be asymptomatic. But that is also the bad news as people who mistake it for just a cold or “just the flu†may not realize they are infected may not self-isolate or go to a doctor or get tested and therefore can spread it to others for whom it can be fatal.
While some coronaviruses are endemic, meaning they circulate every cold and flu season and are responsible for 15-30% of “common colds†that cause mostly mild illness, what we saw with the SARS and MERS coronaviruses and now with COVID-19 is much different - a coronavirus much more akin to a highly lethal influenza strain than to a common cold, one that quickly becomes pneumonia. However, while SARS and MERS had a much higher case fatality rate (CFR) neither seemed to be as contagious as COVID-19.
It is generally understood in virology and epidemiology that a virus that is very highly lethal trends toward being less lethal overall because if a large percentage of people who contract it die from it and die from it rather quickly. That is because the virus kills too many of its hosts before it can spread to others and thus peters out much as SARS and MERS (along with the aggressive containment and isolation actions with both SARS and MERS) before becoming a true global pandemic.
Whereas one that is trends more contagious but somewhat less lethal trends to being more lethal overall because it circulates easily, infecting many more and killing many but not killing enough and quickly enough as to burn itself out. COVID-19 seems to be in that concerning “sweet spot†the virologists and epidemiologists are most concerned about - that of being contagious enough to rapidly spread but not so lethal as to quickly burn out but still lethal enough to kill many, many people before it is over.
Along with being highly contagious several recent studies are indicating it is possibly airborne for up to 8 hours and lasting on surfaces for up to 48 hours, much longer than influenza.
There is currently no vaccination for COVID-19 and none for at least 12-18 months. While there’s been a lot of progress on anti-viral medications, they are all in clinical trials, none having been approved for mass use.
A few other points to consider:
COVID-19 is coming at the same time as we are seeing a moderately severe influenza season and one impacting more children and for many with severe cases more complications than typical, so many doctor’s offices, ER’s and hospital beds and ICU units are already near or at or over capacity.
It is also instructive to look at the number of healthcare workers in China and other countries who have fallen ill and or even died. Even if healthcare workers in the US do not become severely ill and or die from it, any who do become ill will be out of commission for a minimum of 14 days or more and either self-quarantined at home or quarantined in other places, further straining an already overburdened system. FWIW we just had a case of a medical professional screening for coronavirus at LAX being diagnosed, someone reportedly experienced in public health screenings and wearing PPE.
Another point to consider and as I understand, the people who die from pneumonia as a result of COVID-19, the pneumonia is not bacterial but a direct result of the viral infection so antibiotics are of no help.
We don’t yet know the R0 value or the CFR but what we do know is that the CFR seems according to WHO to be anywhere around 3.4% to 1 % which even on the low end is much higher than typical influenza and at the midpoint in the same territory as “Spanish Fluâ€. However, the CFR may and will likely go down as Dr. Tony Fauci indicated, as more mild and or asymptomatic cases are identified through increased testing, but that is “if†and “when†we ever get enough testing to conduct widespread testing and IMO testing as many people as we can, is important. And while the Trump task force is working on that, we aren’t there yet.
And there are still many other unknowns to be sure. For instance, we also do not know if COVID-19 will go away in the spring with warmer weather (miraculously) as do many (but not all) respiratory viruses (and it should be noted that MERS spread during warm/hot weather in the Middle East), but even then, it is unlikely to disappear completely and may re-emerge in the fall. If that re-emergence happens we do not know if it will be a similar, milder or a deadlier strain which is why it is so important to contain and stamp it out now.
For reference on viral seasonality and re-emergence, the “Spanish†flu first appeared in the US in the early spring of 1918 and while some doctors who first saw that outbreak recognized it as like “flu†or “grip†as it was then called, but worse than most had ever seen before in Haskell County, Kansas, and then to Ft. Riley , the first place where it the outbreak was first recognized and where many soldiers died, it seemed to disappear by summer but then after a few months only to come back that October with a vengeance – a much more virulent and a much, much more deadly strain and then a third wave in the spring of 1919 - more deadly than the first but somewhat less deadly than the second wave. The death toll of the “Spanish Flu†pandemic lasting 1 1/2 years was 675,000 in the US and 50 million worldwide – more than all the casualties in WWI and more in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351.
Keep in mind that with “Spanish†flu and other H1N1 pandemics, in particular the 2009 H1N1, when looking at infection and death rates - that encompasses data on infections and deaths over a 1 ½ to 2-year period where as with COVID-19 we are only 4-5 months in if you count back to the first cases in Wuhan going back to November 2019. If this were a baseball game, we’d only be in the second or third inning of a 9 inning game with COVID-19 – way too early to predict outcomes.
It is true however that most people who get COVID-19 will not require hospitalization but for those who do and require intubation, the prognosis is grim. The death rate for those in ICU and requiring intubation is extremely high at some 46%. That and even those who become very ill but not requiring ICU level care, many remain ill for 3 weeks or more. Even among some younger and healthy people, some got at first minor “cold†symptoms that got much better only to return as a more serious flu like disease.
Briton who contracted coronavirus in Wuhan explains symptoms
www.youtube.com/watch?v=PU2ut5Ark3QIt is true based on current data that the greatest number of fatalities are among the elderly and OR those with underlying health conditions, but keep in mind that underlying health conditions include HBP, heart disease, diabetes, obesity, COPD and other lung ailments, asthma, cancer and both current AND FORMER smokers. So that I think expands the cohort beyond just your 80+ year old nursing home patients with one foot in the grave and the other on a banana peel demographic. And as Dr. Fauci noted, there will also be the outliers – those who are younger and healthy, some in this demographic have already died and more are likely to also succumb.
But on that note, I really have to point out what I see as a bit of hypocrisy.
Mike Bloomberg made the comment “Y’know, if you show up with prostate cancer, you’re 95 years old, we should say, ‘Go and enjoy. Have a nice [inaudible]. Live a long life. There’s no cure, and we can’t do anything.†And he was excoriated for it especially from the conservatives who likened him to a Nazi and him calling for “death panelsâ€, not caring about older Americans, etc.
Yet I seem to be hearing some people on the conservative side passing off COVID-19 as only killing very old folks with underlying health conditions, (hey they are the very old and sick – one foot in the grave and the other on a banana peel so no big deal) folks who were likely going to die soon anyway as a way of passing off the seriousness of the situation. We can’t have it both ways. JIMHO - YMMV
With all that being said, I do not think this is the end of the world as we know it, a near extinction event or the collapse of civilization event. This is not The Stand, The Andromeda Strain, or The Walking Dead…although I will say that the movie Contagion was pretty accurate, at least more accurate than most Hollywood movies in depicting a novel virus pandemic in a worst case scenario but I do not think we are there….yet….
I haven’t gone to the bunker yet (not that I have one) nor do I advise anyone else to. We don’t need to stock pile a years’ worth of rice and beans and TP and hand sanitizer and guns ammo and God knows what else. We don’t need to and really shouldn’t be in panic mode. Although I did stock up on some soup and pasta and cereal and some other staples but not all that much. But it isn’t a bad idea anytime to have at least a two week supply of non-perishable food and meds and basic supplies.
What we should be doing is practicing common sense.
If you are sick and especially if you are running a fever – STAY THE HELL HOME and as much as you can away from other people and that’s common sense for every cold and flu season even without COVID-19. Also unless you are advised against it because of allergies or other conditions, GET YOUR DAMN FLU SHOT! The less people flooding ER’s and urgent care with severe flu symptoms or infecting the vulnerable the better. Yes, heard immunity is a thing.
Wash your hands often and thoroughly – use lots of soap and water and for at least 20 seconds or as long as it takes to sing Happy Birthday twice. Personally I like to use the National Anthem instead. : ) This is good too:
www.youtube.com/watch?v=gBDeTzFCKMEAnd in between washing your hands, avoid touching your face. Don’t touch your face! Stop touching your face (yea I know that’s hard) but stop touching your face.
www.youtube.com/watch?v=_0e8SxK-_qwIf possible, avoid people who appear visibly ill and practice social distancing. But don’t be a jerk about it. Like as when you see a person who “looks Asian†you don’t need to treat them as if they are a carrier of the “Wuhan Plagueâ€. (And no, while it started there, calling it that or calling it a “foreign virus†as Trump did is, well stupid. And no, a boarder wall isn’t going to stop it and in fact Mexico has very few COVID–19 cases so perhaps they might want to build a wall to keep us out right now). And also remember that just because someone sneezes or coughs, that doesn’t mean they have COVID-19 or even a common cold or influenza. They might have allergies as I do or asthma or COPD. Without knowing however, you should distance yourself but don’t be this guy:
If you have to sneeze or cough do it in your elbow rather than in your hand or if in your hand sneeze into a tissue but then immediately dispose of it and then immediately wash your hands or use a hand sanitizer before touching anything else.
Please don’t look for every Twitter post, YouTube video and blog for factual information. There are a lot of unsubstantiated rumors, conspiracy theories and outright fake crap being posted that I see people sharing and reposting as truth. Remember that just because it is posted on the World Wide Interwebs, that doesn’t make it true.
If you want to take vitamin D or C, etc. or herbal supplements in “safe†amounts, go ahead. It’s not likely to guarantee you won’t contract COVID-19 (or any other viral disease) or cure you but it probably will not hurt either unless you go overboard on dosages or think it gives you superpowers.
But do not, I truly implore you, do not do things like ingesting colloidal silver or MMS (miracle mineral solution is a highly toxic industrial bleach and lethal if ingested) or other so called “cures†as eating lots of garlic or swathing yourself in oregano or sesame oil or coconut oil as they will not give you immunity or cure you and some like MMS may actually kill you. And giving yourself a false sense of security by using sham “cures†will only help spread the disease.
We will get through this. But it isn’t going to be by listening to the TV or radio pundits or every blog or twitter post or second, third, fourth hand info like, “I heard from a friend who has a cousin who is friends with the boyfriend of his sister’s auto mechanic whose dad works at the CIA who said….â€
You are right to mistrust politicians on both sides of the aisle and on all ends of the political spectrum who politicize this for their own ends.
But that doesn’t make this virus a hoax any less real or any less dangerous or serious.
And no, breathing through your nose isn’t the answer either.
