By Mary O’Brien, M.D.
Everybody calm down. Fear is spreading faster than the coronavirus at this point. Financial markets are in turmoil over fear of a global economic slowdown caused by the virus. Worries about lost productivity in China, reduced demand for oil and consumer goods, and disruption of travel, tech, and financial sectors have investors around the world hyperventilating. The price of gold has reached its highest level in seven years, and the yield on the 10-year treasury is near record lows (1.37%) — both signals of a flight to safety. Caffeine-toxic media types are nearly histrionic. As is typically the case, the only two things missing from their breathless banter are knowledge and perspective.
Here are the facts, as of Monday evening, February 24, 2020:
- The number of global cases of COVID-19 is around 79,000.
- Virus-related deaths are at 2,600. The overwhelming majority of deaths is still in China, but China is only reporting in-hospital deaths.
- The current mortality rate is still around 2–3%. The mortality rate of SARS was 10% and the mortality rate of seasonal flu is 0.1%.
- COVID-19 is more readily transmissible than SARS (Severe Acute Respiratory Syndrome), but less deadly.
- The incubation period is still considered to be 14 days.
- Viral transmission of COVID-19 appears to occur through large droplets in respiratory secretions. Both oral and anal swabs have detected virus (viral particles can be found in the GI tract).
- Both SARS-CoV and MERS-CoV infect intrapulmonary epithelial cells more than cells of the upper airways. As a result, transmission occurs mostly from patients with recognized illness and usually not from patients with minimal symptoms. COVID-19 seems to work the same way.
- The most serious symptoms involve the lower respiratory tract and lungs, as opposed to upper airways. The resulting disease is now called “novel coronavirus-infected pneumonia” or NCIP (NEJM, Feb. 20, 2020).
- So far the clinical breakdown of cases is fairly predictable:
- 80% are mild illness (requiring little or no care).
- 14% are of moderate severity.
- 5% are critical (requiring mechanical ventilation).
- 2–3% are fatal.
- U.S. cases – 35 (nearly all travel-related).
- Italy confirms 152 cases around Milan with more than 200 cases throughout the country. South Korea confirms 833 cases after testing over 20,000 people.
- The most vulnerable patients are older individuals and those with chronic underlying illness. (CAD, CHF, COPD, DM, chronic kidney disease).
So now what? We wait for more facts. The headlines will reflect a frustrating level of paranoia for another 2–3 months — at least. Universal precautions in medical settings, careful personal hygiene, and common sense are always prudent. `
Don’t panic. Don’t dump your investments. Don’t overdo the caffeine. And one more thing: Everybody, please calm down.