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News: 04/01/2020

COVID-19 Facts and Figures



This column was updated on the evening of March 29, with all data coming in as of the reports for that date. This is a swiftly changing situation. The information herein was compiled from a variety of official sources including the World Health Organization (who.int) and the Centers for Disease Control (cdc.gov).

The COVID-19 pandemic by the facts and numbers

SARS-CoV2 is a novel (new) coronavirus that emerged in late 2019. The disease that it causes has been named COVID-19. The outbreak began in Wuhan City, population of 11 million and the capital city of Hubei province, China. The outbreak was listed by the World Health Organization as a Public Health Emergency of Global Concern on Jan. 30, and was revised to be listed as an official pandemic on March 11 (globally widespread and being transmitted from person to person).

As of March 29, there are 718,685 reported cases globally, with 33,881 deaths. The United States leads the world right now and is reporting 139,675 cases and 2,436 deaths. Italy is second with 97,689 cases and 10,779 deaths.

What is a coronavirus?

Coronaviruses are a family of virus pathogens that can cause mild to severe disease responses. Other examples of coronaviruses include Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). COVID-19 is novel, or new, because this is the first time this strain has been seen in humans. The surface elements of these viruses resemble a crown when imaged and this is where the descriptive category name comes from.

Zoonotic

Like both SARS and MERS, COVID-19 is listed as zoonotic, which refers to pathogens that are transmitted between animals and humans. COVID-19 has a likely origin of ďa wet animal marketĒ although the exact animal host is not yet officially listed.

Symptoms

Also similar to SARS and MERS, COVID-19 has been causing respiratory illness that ranges from mild to severe to life-threatening. Symptoms include fever, dry coughing, and shortness of breath. Hospitalized patients are being monitored for fever-control and some have been put on respirators via intubation. Death rates are higher in the elderly, those with underlying respiratory conditions, and those with compromised immune systems. A vaccine for COVID-19 is in development but will likely not be ready for 12-18 months.

Illness and death rates

Death rates are calculated by dividing the number of reported deaths by the number of total cases. That puts the average global death rate, as of March 29, at 4.7 percent. This number will almost certainly fluctuate wildly, because we are at the beginning edge of a pandemic, and will eventually go down, because the denominator (number of total cases) will certainly go up as there is increased testing. South Korea is the country that has done the most widespread testing and their calculated death rate from COVID-19 is currently 1.6 percent. A confounding factor is that many individuals can have the virus but show no symptoms. This is known as an asymptomatic carrier. Early estimates have suggested that on average 20 percent of infected persons will have symptoms in a severe category and may require significant interventions including hospitalization. The other 80 percent of cases seem to produce mild to no recognizable symptoms. These numbers are calculated similarly to the death rate and thus are subject to volatility and are likely to change as we push more into this pandemic. The take-home is that predictive calculations will become more reliable as more data are added.

How does COVID-19 compare to other epidemics?

The seasonal flu is caused by influenza viruses; there are many different strains and they vary from year to year. On average, the flu death rates are in the range of 0.1 percent. The SARS epidemic landed on a death rate of approximately 9.6 percent and MERS was calculated at 35 percent. With COVID-19 sitting now at 4.7 percent (globally) but perhaps dropping as low as 1.6 percent, this virus is likely to be much more widespread but not as deadly as those other recent coronavirus outbreaks. Similar also to SARS and MERS, death rates are higher among the elderly but low for children. Data out of China are suggesting the death rates for ages 80+ could be as high as 15 percent. Individuals who have cardiovascular disease, diabetes, hypertension, or respiratory conditions all have death rates between 5 and 10 percent. In addition, males have a slightly higher death rate than females. Again, these data are specific to China and cultural differences play a part here. For example, about 52 percent of Chinese men smoke compared to only about three percent of Chinese women. This alone could help to explain the gender difference for the disease.

There is growing concern about younger patients showing up in new case reporting. While it is true (and was also true in the Chinese data) that young people can get the virus, be symptomatic, and even be hospitalized, the data still suggest that unrecoverable symptoms are far higher in patients over 50 years old versus under 50 years old. However, there do appear to be higher hospitalization rates in the 20-44 year old range in several countries including the United States, than was earlier reported. An interpretation of this is not clear at this time but, again, the deaths from this virus rise significantly with increasing age. Over 70 percent of all reported deaths have been in patients over 50.

Symptoms requiring hospitalization could, however, cause long-term damage in patients who recover from this virus, independent of age group. Severe cases take weeks to recover from and demand ICU-level attention. This is one of the reasons that availability of equipment and personnel is becoming an increasing topic of discussion.

Flattening the Curve

Italy is suffering a complete overwhelming of their health care system regionally. They currently have a reported death rate of 11 percent, which is just staggering. Why is it so high? One reason is that their population is skewed toward older ages. They will have a larger number of patients who are over 50 years of age. In addition, health care workers are running out of space, equipment, and supplies needed to combat the symptoms brought on specifically by this virus. As such, they are making terribly difficult decisions on who to save and who to ďlet go.Ē It is tragic. If they had unlimited supplies and personnel the death rate would not be as high. To be clear, Italyís healthcare system is very good. In fact, in sheer volume, they have many more hospital beds per capita than we have here in the United States. Overwhelming our healthcare systems here, especially regionally, is a real and grave concern, not hyperbole.

Other countries are looking at the situation in Italy and attempting to take evasive measures such as extreme social distancing policies and shelter-in-place orders. (The entirety of India went on lock-down on March 24 even though they only had 460 recorded cases, compared to the United Statesí approximately 44,000 at the same time.) The idea behind this is to flatten the curve represented by numbers of cases over time. Letís say we are likely to see 40 percent of Sonoma County residents become infected (within the range suggested by Governor Newsom). If we donít flatten the curve, that could happen within a time span of just a few weeks and completely overwhelm our regional healthcare capacity. If we can spread that out through changing our behaviors it may reduce the number of overall cases, but most importantly, it changes the time frame from a few weeks to several months. Also, it gives the county time to ramp up testing to better isolate and contain as we move forward, instead of where we are now which is chasing the cases that represent the ghost of what was happening several weeks before. Sonoma County is currently listing 58 cases and at least 8 of those are residents of the Sonoma/Glen Ellen/Kenwood region.

Closure of schools, parks and events, and shelter-in-place orders may seem drastic and like an over-reaction, but epidemiologists have modeled these situations out for years and this is the exact recommendation. For this virus, look no further than the swift actions taken by Japan and Singapore, and notice how they managed to contain and isolate the disease. Countries that in the past decades have been through some of these other serious outbreaks (including other coronaviruses) have a first hand memory of what works and what doesnít work and are more likely to take swift action.

Outlook

A vaccine for COVID-19 is in development but wonít be ready for 12-18 months. In the meantime, countries are struggling to identify and contain the outbreak as well as treat the ill. The biggest concern is an over-burden on the healthcare infrastructure. One potential hope is that the timing of expansion of COVID-19 infections in the United States will coincide with the drawdown of seasonal flu. It is currently not known if this virus will have a seasonal component, in other words it is not clear whether or not it will subside as the northern hemisphere comes in to summer. There are cases in southern hemisphere countries where it is now late summer, so seasonality may not be likely for COVID-19. Australia currently has 3,980 cases with a death rate of 0.4 percent and Peru has 852 cases with a death rate of 2.1 percent. Most healthcare and disease experts that Iím following or talking to are predicting the peak sometime in mid-April, and itís all dependent on how well we flatten the curve.

Shannon Lee, PhD, is a Glen Ellen resident and an instructor in the Biology Department at Sonoma State University. She has been a science educator for 20 years having taught previously at UCLA and California State University Northridge.


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