COVID-19 FAQ and what to expect for the next 6 Months

What do we know?!

A common refrain on the difficulty of the situation is the uncertainty. “We don’t know how long it will last” or “Everything changes from day to day” or “I just hate not knowing” and the like.

Unfortunately this couldn’t be further from the truth. This virus is not new.

We can see exactly how it behaves by looking at the rest of the world; giving us ample models for reacting to the virus with varied measures of success and failure.

It is our choice as a nation, and a globe, to determine our future based on our actions.

The only countries that have managed to stave off disaster despite early infection are:

• Singapore: 385 cases, no deaths, first case Jan 23
• Taiwan: 135 cases, 1 death, first case Jan 21
• Hong Kong: 256 cases, no deaths, first case Jan 22

The only country that has had massive infection and death, brought the virus under control, and allowed people to work again is China.

• 80,000 total cases, 3248 total deaths, 39 new cases, 3 new deaths

Countries that are under massive infection that do not have it under control include

• Iran: 19644 total cases, 1433 deaths, 1237 new cases, first case Feb 19
• Italy: 47021 total cases, 4032 deaths, 5986 new cases, first case Jan 31
• Spain 20412, total cases, 1050 deaths, 2335 new cases, first case Jan 31

[references https://www.worldometers.info/coronavirus/ and wikipedia “2020 coronavirus pandemic in xxxx”]

All other countries seem to follow one of these three trajectories:

• They either avoid significant spread of the outbreak by taking drastic measures
• They suffer a difficult infection spread but manage to contain it — such as South Korea
• They suffer a difficult infection and are unable to contain it — Switzerland, Germany, France, UK, US

The outcomes are a direct result of the actions taken by each country in response to the pandemic.

Currently the US (19,285 cases, 250 deaths) is on the same trajectory as Italy, which is one of the most catastrophic outcomes possible. https://www.vox.com/future-perfect/2020/3/20/21179040/coronavirus-us-italy-not-overreacting

Some say the infection isn’t that bad and compare it to other current diseases such as the flu. They maintain that US is expected to have 36M cases of influenza with 370K hospitalizations, and 22,000 deaths and as of last week there were only 2250 COVID-19 infections and 39 deaths.

This argument ignores the rate of infection of COVID-19 and the rate of severe permanent damage and death.

Some facts:

COVID-19 is likely more infectious than the flu (the average flu patient infects 1.3 others, the average COVID-19 patient infects 2–2.5 people).

• The high infection rate is likely related to people being highly infectious before symptoms set or even when asymptomatic, whereas the flu is most contagious only 3–4 days after symptoms appear
• This means that it would be expected to spread more than the flu and we could expect up to 150M-200M Americans to contract it if treated as the flu — that is, no real action

There is no evidence currently that it will subside in warmer climates as the flu does given warm countries such as Thailand, Australia, India, etc are all suffering from COVID-19 infection and spread.

While 80% of Coronavirus patients are mild to moderate — from mild symptoms to fever and pneumonia, with most healing at home, 20% require hospitalization. That is 10x more than the flu which is only a 1–2% hospitalization rate.

• This means if we do nothing we could expect up to 40 Million Americans to be hospitalized.
• This means that most people who have it will not know they have it and be infecting others

Coronavirus has at least a 1% death rate, which is 10x higher than the flu, leading to up to 2M Americans dying if we treat it like the flu. In Italy the death rate is 8.5%. In China it was 4%. In Iran it is 7.3%. In Spain it is 5%. In Singapore, Taiwan, and Hong Kong it is near 0. The death rate is directly proportional to how quickly the virus spreads based on human actions, and the availability of medical care which has been overwhelmed in many countries, including the US.

40% of people being admitted into ICU’s right now are between 20 and 54, NOT just the elderly. Even if this isn’t killing them it is causing horrible and often irreversible damage. https://www.nytimes.com/2020/03/18/health/coronavirus-young-people.html

Children are not immune. While 90% will only have mild to moderate cases similar in symptoms to the flu, they are still highly contagious. Moreover, 6% develop severe or critical illnesses. https://www.livescience.com/coronavirus-children-serious-illness.html

COVID-19 is especially harmful to those older and with compromised immune systems, especially with comorbidities — other conditions such as high blood pressure and diabetes. The death rate for those in their 70’s is 9.8%, for those in their 80’s it is 18%. As such is it is CRITICAL for them to stay isolated as much as possible, as people infected without symptoms will seriously put their lives at risk. I will not see my parents until after this is over for fear of putting them at risk. https://www.vox.com/2020/3/12/21173783/coronavirus-death-age-covid-19-elderly-seniors

https://www.npr.org/sections/goatsandsoda/2020/03/20/815408287/how-the-novel-coronavirus-and-the-flu-are-alike-and-different

So how do we treat it?!

We don’t. There is no vaccine, nor known proven treatment to cure the Coronavirus. The best we can do is intubate patients suffering respiratory damage and failure, and prevent them from dying of Sepsis — which is in essence shock from the body trying to fight an infection which damages critical organs. https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214

Drs and researchers are currently experimenting with treatments such as Remdesivir (blocks RNA dependent polymerase), Chloroquine (blocks viral entry to endosome), Oseltamivir (blocks neuraminidase), Lopinavir (protease inhibitor), Tocilizumab (reduces inflammation), Corticosteroids (reduce inflammation) (@nickmmark a seattle MD intensivist). None of these have been proven to treat COVID-19 but they are being investigated for their ability to reduce its duration and symptoms. They cannot however prevent infection nor its spread, however if we’re lucky they may reduce mortality.

But how do we beat the Coronavirus?

There is only one way we can beat the Coronavirus. That is herd immunity, which is what we have with most of the diseases we get vaccines for. Herd immunity means that most people in a society are immune to the virus, so if someone infected walks among them, they can’t spread the infection to those immune, and the probability that someone infected just so happens to interact with someone without immunity is very low.

There are two ways to get herd immunity:

50–70% of the population gets and recovers from COVID-19.

• This means over 1.5M Americans die.
• This may not even work because every time someone gets infected, the virus can mutate with a high probability that over time new strains emerge and then spread anew even among those that have recovered from an old strain, getting sick again, leading to more infections, more spread, and more dead.

We develop a Vaccine

• this is at least 9–12 months out even by the most aggressive estimates https://www.technologyreview.com/s/615375/what-is-herd-immunity-and-can-it-stop-the-coronavirus/

So what can we do?!?

We must learn to live with COVID-19, limiting the spread as much as possible until a vaccine is developed 9–12 months minimum. This is precisely how China, Singapore, Taiwan, and Hong Kong have managed to contain the spread.

• This includes heavy quarantine initially to stop the spread of the virus, to let as many people as possible recover whether they know they have it or not, and to treat those that are ill.
• This then includes heavy testing of anyone suspected of having it and even for those who have recovered (antibody tests).
• Finally it means submitting, temporarily at least, to a surveillance state.

In China, everyone in the country is given a QR code — including foreigners. Anywhere they go — work, restaurants, taxis, their QR code and temperature are checked. If you contract the virus you and your close friends and anyone you’ve been in contact with are tested and quarantined. (Reported from a close friend in Shanghai)

In Singapore, Taiwan, and Hong Kong, the state heavily monitors your digital footprint and if you contract the virus, likewise, you and everyone you’ve been in contact with goes into mandatory quarantine. In Singapore, if you break quarantine you go to prison. While in quarantine you’re expected to check your temperature and send it to a carer 3x a day, as well as send photos of you at home. If your temperature increases you need to send it every hour. (Reported from a friend in Singapore, https://www.nytimes.com/2020/03/17/world/asia/coronavirus-singapore-hong-kong-taiwan.html, https://qz.com/1822215/hong-kong-uses-tracking-wristbands-for-coronavirus-quarantine/)

These measures may seem drastic, but the result is that people are now able to leave their homes, go to work, eat at restaurants, attend gatherings of under 250 people, and find a new normal — as difficult as submitting to a surveillance state may be. Without this, the virus would quickly spread again in a second wave and we would all have to go back to heavy self isolation again, destroying our economy once more.

In theory this should only be required until a vaccine is found and then we can develop herd immunity and return to a truly normal life.

What now?

This is our only future as I see it. We have the choice to contain the virus and start a limited but functional surveilled life, or to suffer thousands of dead before we adopt it.

While I don’t like this reality (I’m a big proponent of personal liberties and privacy), there is no other option as far as I can see; short of a miracle treatment being discovered. But even then it would need to be manufactured and distributed at scale which wouldn’t happen for months and in the interim we have thousands contracting COVID-19 every day and our death toll continues to rise.

As our government is often too slow to react and I don’t believe our population is ready to take these drastic measures, it saddens me to think that we will lose countless more before ultimately some sort of martial law starts to be enforced and we truly quarantine the whole country for 1–2 months and emerge on the other side in a controlled and surveilled life where big brother NSA is watching us.

But what should I do?!

With that in mind, please stay at home. Please quarantine yourself and maintain social distance. Don’t be one of those that contracts the virus and infects others with a 1 in 5 chance of hospitalization yourself.

Don’t go get tested at the hospital unless your symptoms are severe and you truly need to be hospitalized — you have a greater chance of being infected at the hospital than at home recovering.

Find ways to help and reach out to others virtually — call an elderly person, have zoom parties, play games, read books, or even better find someone to quarantine yourself with and stay together for the duration.

Oh and after 14 days of social distancing/self quarantining, PLEASE, give blood, there is a tremendous blood shortage.

This isn’t going away anytime soon, I anticipate a serious self quarantine/isolation for at least 2–3 months, ending only if we get the spread under control and submit to being tracked to ensure the virus does not spread again.

Oh, and one more note, every day this continues has a very real economic impact. Businesses are shuttered, and many unable to sustain themselves are letting go or furloughing employees, or worse, going out of business. People in the service industry, who are self employed, or the gig economy are left with no income and no way to pay rent or buy food. Entire sectors of our economy are being severely impacted — from travel, to restaurants, to entertainment, to retail, to manufacturing. Every day we delay serves to increase the economic recession we will fall into.

Our government needs to take action and support people unable to pay basic bills, to extend loans to small and large businesses to sustain themselves in this crisis, and to provide healthcare and support to those affected because this affects all of us. Support your local businesses that are open by ordering from local restaurants, small bodegas, and the like. Buy gift certificates for gyms, classes, restaurants, etc to give them much needed cash to keep afloat in these difficult times. We can only get through this by helping each other.

Oh and stay at home, please!