Table of Contents
- Total cases are the wrong metric
- Time lapsing new cases gives us perspective
- On a per-capita basis, we shouldn’t be panicking
- COVID-19 is spreading
- Watch the Bell Curve
- A low probability of catching COVID-19
- Common transmission modes
- COVID-19 is likely to burn off in the summer
- Children and Teens aren’t at risk
- Strong, but unknown viral effect
- What about asymptomatic spread?
- 93% of people who think they are positive aren’t
- 1% of cases will be severe
- Declining fatality rate
- So what should we do?
- Start with basic hygiene
- More data
- Open schools
- Open up public spaces
- Support business and productivity
- People fear what the government will do, not infection
- Expand medical capacity
- Don’t let them forget it and vote
Total cases are the wrong metric
Time lapsing new cases gives us perspective
On a per-capita basis, we shouldn’t be panicking
COVID-19 is spreading, but probably not accelerating
Watch the Bell Curve
A low probability of catching COVID-19
A growing body of evidence indicates that COVID-19 transmission is facilitated in confined settings; for example, a large cluster (634 confirmed cases) of COVID-19 secondary infections occurred aboard a cruise ship in Japan, representing about one fifth of the persons aboard who were tested for the virus. This finding indicates the high transmissibility of COVID-19 in enclosed spaces
“If you have a COVID-19 patient in your household, your risk of developing the infection is about 10%….If you were casually exposed to the virus in the workplace (e.g., you were not locked up in conference room for six hours with someone who was infected [like a hospital]), your chance of infection is about 0.5%”
“Transmission by fine aerosols in the air over long distances is not one of the main causes of spread. Most of the 2,055 infected hospital workers were either infected at home or in the early phase of the outbreak in Wuhan when hospital safeguards were not raised yet,” she said.
“We have never seen before a respiratory pathogen that’s capable of community transmission but at the same time which can also be contained with the right measures. If this was an influenza epidemic, we would have expected to see widespread community transmission across the globe by now and efforts to slow it down or contain it would not be feasible,” said Tedros Adhanom, Director-General of WHO.
Common transmission surfaces
- COVID-19 be detected on copper after 4 hours and 24 hours on cardboard.
- COVID-19 survived best on plastic and stainless steel, remaining viable for up to 72 hours
- COVID-19 is very vulnerable to UV light and heat.
COVID-19 will likely “burn off” in the summer
“This result is consistent with the fact that the high temperature and high humidity significantly reduce the transmission of influenza. It indicates that the arrival of summer and rainy season in the northern hemisphere can effectively reduce the transmission of the COVID-19.”
“Based on what we have documented so far, it appears that the virus has a harder time spreading between people in warmer, tropical climates,” said study leader Mohammad Sajadi, MD, Associate Professor of Medicine in the UMSOM, physician-scientist at the Institute of Human Virology and a member of GVN.
Children and Teens aren’t at risk
“Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around. And the children tend to have a mild disease,” said Van Kerkhove.
- A World Health Organization report on China concluded that cases of Covid-19 in children were “relatively rare and mild.” Among cases in people under age 19, only 2.5% developed severe disease while 0.2% developed critical disease. Among nearly 6,300 Covid-19 cases reported by the Korea Centers for Disease Control & Prevention on March 8, there were no reported deaths in anyone under 30. Only 0.7% of infections were in children under 9 and 4.6% of cases were in those ages 10 to 19 years old
- Only 2% of the patients in a review of nearly 45,000 confirmed Covid-19 cases in China were children, and there were no reported deaths in children under 10, according to a study published in JAMA last month. (In contrast, there have been 136 pediatric deaths from influenza in the U.S. this flu season.)
- About 8% of cases were in people in their 20s. Those 10 to 19 years old accounted for 1% of cases and those under 10 also accounted for only 1%.
A strong, but unknown viral effect
“Every coronavirus patient in China infected on average 2.2 people a day — spelling exponential growth that can only lead to disaster. But then it started dropping, and the number of new daily infections is now close to zero.” He compared it to interest rates again: “even if the interest rate keeps dropping, you still make money. The sum you invested does not lessen, it just grows more slowly. When discussing diseases, it frightens people a lot because they keep hearing about new cases every day. But the fact that the infection rate is slowing down means the end of the pandemic is near.”
What about asymptomatic spread?
“We still believe, looking at the data, that the force of infection here, the major driver, is people who are symptomatic, unwell, and transmitting to others along the human-to-human route,” Dr. Mike Ryan of WHO Emergencies Program.
93% of people who think they are positive aren’t
- UK: 7,132 concluded tests, of which 13 positive (0.2% positivity rate).
- UK: 48,492 tests, of which 1,950 (4.0% positivity rate)
- Italy: 9,462 tests, of which 470 positive (at least 5.0% positivity rate).
- Italy: 3,300 tests, of which 99 positive (3.0% positivity rate)
- Iceland: 3,787 tests, of which 218 positive (5.7% positive rate)
- France: 762 tests, of which 17 positive, 179 awaiting results (at least 2.2% positivity rate).
- Austria: 321 tests, of which 2 positive, awaiting results: unknown (at least 0.6% positivity rate).
- South Korea: 66,652 tests with 1766 positives 25,568 awaiting results (4.3% positivity rate).
- United States: 445 concluded tests, of which 14 positive (3.1% positivity rate).
In general, the size of the US population infected with COVID-19 will be much smaller than originally estimated as most symptomatic individuals aren’t positive. 93% — 99% have other conditions.
1% of cases will be severe
Looking at the whole funnel from top to bottom, ~1% of everyone who is tested for COVID-19 with the US will have a severe case that will require a hospital visit or long-term admission.
Early reports from CDC, suggest that 12% of COVID-19 cases need some form of hospitalization, which is lower than the projected severity rate of 20%, with 80% being mild cases.
Declining fatality rate
“Reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.”
- 4.06% March 8 (22 deaths of 541 cases)
- 3.69% March 9 (26 of 704)
- 3.01% March 10 (30 of 994)
- 2.95% March 11 (38 of 1,295)
- 2.52% March 12 (42 of 1,695)
- 2.27% March 13 (49 of 2,247)
- 1.93% March 14 (57 of 2,954)
- 1.84% March 15 (68 of 3,680)
- 1.90% March 16 (86 of 4,503)
- 1.76% March 17 (109 of 6,196)
- 1.66% March 18 (150 of 9,003)
- 1.51% March 19th (208 of 13,789)
- 1.32% March 20th (256 of 19,383)
- Pneumonia and influenza: 1.53% — 1.93%
- Chronic lower respiratory disease: 1.48% — 1.93%
- All respiratory causes: 3.04% — 4.14%
- Heart disease: 3.21% — 4.4%
- Cancer: 0.68% — 1.05%
- Diabetes: 0.26% — 0.39%
- For all underlying conditions: 10.17% — 13.67%.
- S. Korea — 11.5
- Germany — 8.3
- China — 4.2
- Italy — 3.4
- United States — 2.9
- Singapore — 2.4
So what should we do?
The first rule of medicine is to do no harm.
Start with basic hygiene
- QR code scanning and online reporting of each person’s travel history
- Health symptoms were used to classify traveler infectious risks based on flight origin and travel history in the past 14 days
- People with low risk were sent a health declaration border pass via SMS to their phones for faster immigration clearance
- Those with higher risk were quarantined at home and tracked through their mobile phone to ensure that they remained there during the incubation period
- Taiwan also proactively seeks out patients with severe respiratory symptoms (based on information from a national health database) to see who had tested negative for influenza so that they could be retested for COVID-19
Open up public spaces
Support business and productivity
At this rate, we will spend more money on “shelter-in-place” than if we completely rebuilt our acute care and emergency capacity.
People fear what the government will do, not an infection
Infection isn’t our primary risk at this point.
Expand medical capacity
None of the countries the global health authorities admire for their approach issued “shelter-in-place” orders, rather they used data, measurement,and promoted common sense self-hygiene.
Does it make more sense for us to pay a tax to expand medical capacity quickly or pay the cost to our whole nation of a recession? Take the example of closing schools which will easily cost our economy $50 billion. For that single unanimous totalitarian act, we could have built 50 hospitals with 500+ beds per hospital.