Tuesday, May 26, 2020

Covid-19 - What We Know

As we're facing a time of transition with the current global situation, it seems a good time to reflect on a couple of important points: what we know and what we've learned.  I think it is especially true given how much there is that we actually do not know about this disease, the future, and how to proceed.  These are important grounding tools when facing uncertainty, focusing on what information we do know and what lessons we hopefully have learned in the process.

Today, we look at what we do know about this virus and the global response.  Please note, this information likely can and will change as we continue to learn more about this virus and its effects.
  • Covid-19 is highly contagious - Though an exact transmission rate is hard to pin down, we do know that the R0 rate is over 1.0.  This means 1 infected person infects multiple people.  Generally, it is ideal for the R0 rate to be below 1.0.  That would mean the virus would die out on its own.  If the R0 were 0.5 for instance, 100 people infect 50 people, who then infect 25 people, who then infect 13, and so on, and so on.  The numbers keep decreasing.  In March, the World Health Organization put the R0 rate for Covid-19 between 2.0 and 2.5.  This would mean 100 people would infect 200 would would then infect another 400 who would then infect 800, etc.  You can see how quickly it could spread.  It is important to note that, as with most things regarding this virus, the R0 value is highly localized and changes over time.  As people get infected and recover, the R number drops, and that's the goal for our facing the virus.  Covid-19's number has varied from around 0.4 to 5.5 or more, depending on location and time.  
  • It is most likely transmitted through droplets - From the CDC, "The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet)."  This is why face coverings over the mouth and nose, social distancing of more than 6 feet apart, and hand-washing and proper hygiene are so important.  They reduce the likelihood droplets will be transferred from person to person.  Face coverings keep your droplets closer to you.  It's a barrier from you spreading them farther away.  Social distancing greater than 6 feet increases the distance a droplet would have to travel, decreasing the likelihood it would reach another person.  Proper hand-washing and keeping your hands away from your face prevents transmitting droplets from your hands to your mouth and nose.  
  • You can transmit the disease even though you have no symptoms - While people are thought to be most contagious when they are symptomatic (feverish, coughing, sour throat, etc.), asymptomatic carriers are the great danger of this disease.  You can spread it without ever even knowing you had it.  This is particularly true of younger populations.  Children, teenagers, young adults can all transmit the disease but feel no ill effects.  This is another reason why wearing face coverings, social distancing, and proper hygiene are so important, even among those who appear to be healthy.
  • Though high contagious, most people will have no to mild effects - Though the disease can be easily transmitted, only around 7-15% of the infected are getting a serious version of the disease.  The vast majority of people become infected will have mild symptoms, if they experience symptoms at all.  For those with more moderate symptoms, it can feel like a prolonged or more severe flu.  Only a small percentage of the population gets a more serious version of the disease.  Unfortunately, that more serious version of the disease is lethal.
  • For those that do get sicker, the virus is lethal - The global mortality rate for Covid-19 is around 6%.  That means 40%-80% of serious cases are lethal.   That's largely because...
  • We do not know how to treat this virus - This virus is presenting in ways that doctors have never seen.  We do not have a known medicine to administer to treat.  Recent tests on hydroxychloroquine, the one drug that has been mentioned the most, have not been promising, with seriously ill patients being more likely to die on the drug than off.  Further, the disease is presenting in several different ways.  For example, for some young people, their first symptom of the virus has been a stroke, given the blood clotting effects of the virus.  Doctors are confronting things they've never seen before.  "Happy hypoxemics," or patients with abnormally low levels of oxygen, but able to breathe relatively easily.  The one thing we do know, is that the virus affects certain populations much more severely - the elderly and those with underlying conditions.  94% of the deaths related to Covid-19 have had underlying conditions.
  • America has a lot of underlying conditions - we have one of the worst diets globally, we are the 12th most obese country in the world, and around 12th in heart disease.  This is suspected to be the reason we are seeing more Covid-19 cases among younger populations. 
  • Covid-19 has reached all corners of the globe - There are Covid-19 cases on every continent across the globe, with the exception of Antarctica.  5,563,260 cases of Covid-19 worldwide, 346,680 deaths.  Virtually every country on the planet has been faced with this crisis and they are reacting to it in a variety of ways.  Rest assured, the lockdown, its duration, frustration with the government response, these are not unique problems to the United States of America.  Everyone is struggling with how to respond, what to do, how to react and balance issues related to the virus with economics and other considerations.
  • The Covid-19 Crisis is not over - the virus is not dead, nor is it cured.  It is still spreading, though thankfully at slower rates due to the measures that were taken.  There will be a likely second wave come the fall/winter.  There will be spikes as more things open up.  We will still be working at finding effective treatments and a vaccine.  
These are all important to remember in order to contextualize why we have taken the steps that we did.  Why things closed.  Why we wear masks.  Why we social distance.  It's particularly for those among us that are most at risk.  Because those who get a serious effects from the virus are very likely to die.  Especially given that we don't know how to treat this virus, yet.  We take every precaution we can so that we are not the carrier of the virus to someone who cannot handle it.  

We remember this to remember we are doing all of this, taking these steps and precautions for the benefit of other people.  

For the greater good.

E pluribus unum.

Tomorrow, what we have hopefully learned from this virus and the effects it has made on society.

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