Coronavirus: What you should know

Craig Story,

Great job summarizing the COVID-19 virus outbreak. You presented a good balance, with a watchful, measured response, but no need to panic at this point. We should all be concerned, and use good hygienic practices, but the more immediate concern for most of us is actually seasonal influenza. It kills far more people each year than coronaviruses. Hopefully it stays that way.

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While the curmudgeon in me wants to grumble about people overreacting to a viral breakout, the scientist in me recognizes the potential threat of a zoonotic disease spreading through the human population. Quite frankly, the international community has done really well reacting to this outbreak with what seems to be a measured approach, at least from what I have seen and based on my very limited experience. Even if this virus ends up being less virulent than was initially thought it is still better to overreact than to react too late. It gives me a little peace of mind that modern human society may actually be able to stop a nasty pandemic virus from spreading if it does emerge.

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Welcome to the forum, Joel! Some of wear masks around here too until we develop immunity to the verbal assaults, but seriously, we are glad to hear your voice, and look forward to knowing you better.
I agree that flu seems a lot scarier statistically. We just had our third flu death of the year in the area, and an estimated 14,000 to 30,000 deaths overall this flu season.

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The flu is a particularly virulent strain this year, and the vaccine wasn’t particularly effective. My wife and all her coworkers were vaccinated, but it still managed to get all of them. I have a pretty robust immune system from working around kids for years, but the flu knocked me on my butt for a week, and the hacking cough hung on for another week after that.

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Health warning: Jim Bakker’s snake oil contains colloidal silver, which can permanently turn a person’s skin blue. Spread the word to any gullible friends or relatives.

American televangelist Jim Bakker is selling a liquid that allegedly ‘kills’ the coronavirus for $300 pic.twitter.com/sQYL9eJTq6

— NowThis (@nowthisnews) February 13, 2020

This is what it looks like:
335x220_what_is_argyria_ref_guide

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I’m all for avoiding overreaction, but there are reasonable grounds for considerable concern with this virus. No one has ever tried to contain an outbreak of a respiratory virus by isolating and virtually shutting down entire cities before, and I’m pretty skeptical that it’s possible with probably hundreds of thousands already infected.

The big question is how many asymptomatic infections there are. If there aren’t very many, then containment is more likely but the fatality rate per infection is likely to be uncomfortably high (maybe something like 0.5%), judging from the number of fatalities occurring in diagnosed cases outside mainland China.

On the other hand, if there are lots of asymptomatic infections, then the fatality rate per infection is a lot lower (yay), but the chances of containment are practically zero. And whatever the fatality rate, if containment fails there are likely to be a lot of infected people. I talked to someone in an epidemiology modeling group today, and they said that their current model has 60% of the population becoming infected (barring effective public health intervention, like a vaccine). That is unlikely to be catastrophic but it could be quite unpleasant.

Obviously, the modeling could be wrong for all sorts of reasons – the virus could become attenuated through mutations, there could be innate resistance in a lot of people, whatever. But there are good grounds for public health agencies and researchers to take this very seriously.

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Yike. With a 0.5% mortality rate, 60% infection kills a lot of folks.

Sure – but that’s pretty much a worst case scenario. Much more likely is that, say, 90% of those infected show no symptoms at all. In that case, 6% of the population would get sick and 0.5% of them would die. That’s still an additional burden the world doesn’t need, and plenty of reason for trying to contain the virus. In the best case, it’s still going to take months and possibly years of vigilance until the threat is gone.

As I said, there’s good reason for professionals to take this virus seriously – but everybody else should worry about other things. I know the Massachusetts Department of Health is already fielding calls along the lines of, “I’m worried about the coronavirus – my neighbors are Chinese.” That kind of thing we really don’t need. In the US, fortunately, neither political party would dream of stoking fear of foreigners for political purposes.

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The threat disappears as soon as springtime arrives, according to our President.

There is not only a panic in western countries, there is a lot of blatant hypocrisy
We get mass panic from a new virus that may affect us, but what about many in poorer countries who die from viruses we have vaccines for and no longer suffer from?
What about the cost of those vaccines and their distrubution in those countries that need them?
Are we as Christians concerned about that?

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Very good. @glipsnort can teach us about that too, based on his research… Thanks.

While I am not a member, some close family members are very involved in Rotary Club. Despite the criticism some have of civic clubs, Rotary is to be commended for their efforts in polio prevention, giving 2 billion dollars to the cause, and helping bring us to the brink of eradication. Here is a link to a Rotary article discussing the effort and the economics:
https://www.rotary.org/en/our-causes/ending-polio

And yes, I agree the church should be actively involved.

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No Comparison

“While many worry about coronavirus, the seasonal flu has been storming across the country. The CDC estimates 19 million flu illnesses, 180,000 hospitalizations and 10,000 related deaths so far”

https://www.newsday.com/news/health/flu-season-2020-influenza-coronavirus

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I enjoyed your well written article, Craig. As a nurse practitioner with a fairly good amount of experience in infection control, I am interested in the transmission of this virus. While it is primarily respiratory and everyone is understandably wearing masks, the virus continues to spread. I wonder if people also realize just how important good hand washing is. I read an article in a Chinese newspaper online last week that discussed and demonstrated a change in plumbing in that country in 2016. It referred to a case of Coronavirus that occurred in a man on the 10th floor in a specific apartment building and the case of a woman on the third floor directly beneath him. Supposedly the vent pipe from the toilet in her bathroom had become detached and was venting into her bathroom. While this would infer the aerosolization of the virus, it would also seem to suggest that the original source was fecal. This would also seem to support the theory that it entered the original host while eating an infected animal. Has there been any discussion about enteral transmission in addition to respiratory? I haven’t seen anything mentioned elsewhere but wonder if anyone else has.

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Yes, that’s been suggested. 10% of patients reported GI signs/symptoms prior to the onset of respiratory ones. See here for the source of the report and comments on the meaning.

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I’ll try to comment when I have a chance.

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Lots of possible responses here. Mostly, hearty agreement. Western countries, and specifically Christians in them, should be more concerned about the enormous burden of preventable and treatable disease in poorer countries. The death of one child is a tragedy; we shouldn’t treat the preventable deaths of a million as less important just because they live in other countries or because their skin is a different color than ours. (On the other hand, do note that it’s human nature to be more frightened of novel threats than familiar ones. It’s very common to feel more fear of terrorist attacks or mass shootings than of car crashes even though you’re much more likely to die in that last one.)

A couple of caveats, though. I’m not sure vaccine cost is the most important target. I don’t know much about the details of global health delivery, but my impression is that vaccine cost, while still sometimes an issue, has been much less so since the creation of the vaccine alliance, Gavi, twenty years ago. In general, inadequate health care (and other) infrastructure and ineffective national governments are a larger problem in both the prevention and the treatment of disease. That doesn’t mean the problems are insoluble – it just means that solutions require long, sustained engagement. Putting political pressure on the US government for more foreign aid targeted at health (something like Bush’s Presidential Malaria Initiative) would be a good start.

Second, there are plenty of people out there, Christians and others, who do care about global health and are devoting their lives to improving it. I’m sitting in a room with a bunch of them right now.

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Steve, I’m happy to see you responding, and I’m happy to see many comments from others. I agree that there is just a lot still not known about the virus. There is good reason to be more concerned than flu (not that we should not be concerned about flu). It is the uncertainty that leads to greater level of concern, and for good reason. Practically every day there is new information. Everyone should find and cite sources of info. I was pleased to discover multiple wikis (including wikipedia) with lists of known misinformation. The good point is made here that the “containability” is dependent upon multiple factors which are only now partly known (infection rate, persistence in the environment, transmission mechanism(s)…) The story of the cruise liner which apparently was seeing more infections over time gives me pause. Causes for hope include: developing a vaccine that works… drugs to deal with the lung inflammation symptoms in time before immune response can kick in, possible therapeutic passive antibody infusions… all of these could potentially be set into place pretty quickly. The development of an effective vaccine could be a “game changer” in the anti-vaxx movement. Couldn’t it? Oh, and jstump, I have not actually read this actual book, but Quammen is great: Check out “Spillover” by David Quammen. https://www.amazon.com/Spillover-Animal-Infections-Human-Pandemic/dp/0393066800

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“Inside Bill’s Brain: Decoding Bill Gates” is a documentary on Netflix. I think the documentary is a bit self serving, but it does go into detail about the Gates Foundation effort to eradicate polio. There is absolutely no lack of money when it comes to polio vaccination in poor countries, with some reports stating that the Gates Foundation has spent $3 billion on this effort. The real problem is misinformation (similar to anti-vax in the US), lack of infrastructure, difficulty of canvasing populations in poor countries, and many other issues.

But I would agree that we in the West are selfish. If malaria was killing as many people in the US as it does in Burkina Faso we would jump to action to fight malaria.

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I doubt anything will change the minds of most anti-vaxxers.

“Let your conversation be always full of grace, seasoned with salt, so that you may know how to answer everyone.” -Colossians 4:6

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