Saturday, March 14, 2020

Nearly 500,000 People To Die From Coronavirus In U.S. In Coming Months Says Disease Expert

Below is a summary of an interview with Michael Osterholm, Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center For Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, University of Minnesota. He is also the author of "Deadliest Enemy - Our War Against Killer Germs." 

How bad is coronavirus?

Coronavirus is not "just the flu," but it's also not the end of the world. It's about 10 to 15 times worse than regular flu in terms of fatalities. Regular flu has a 0.1% death rate, which means one death in every 1000 cases. Coronavirus in the U.S. is expected to have a death rate of between 1 and 2 percent, that is 10 or 20 deaths out of every 1000 cases. Estimating conservatively, the U.S. will have 96 million cases over the next three to seven months, with 48 million hospitalizations (appears to be a vast overestimate - ed.), and 480,000 deaths. China has had a death rate between two and three percent. Spanish Flu (1918) had a death rate of 3.0 to 3.2%.

Northern Italy was fine a month ago, but is now experiencing a tsunami of cases, forcing doctors into the position of having to decide who they can save and who they have to let die. Doctors and nurses who are sick with coronavirus, but without serious symptoms, must work to save others. This is not just an "old person's disease", as Italy is now seeing an alarming number of people in their forties dying. Over 4000 health care workers in China have become infected with coronavirus, and many have died.

What are the risk factors?

Advanced age, smoking, obesity, high blood pressure, diabetes, an already compromised immune system, pregnancy. 45% of Americans over age 45 are obese, so the U.S. may have a death rate from the disease as high as 2 percent.

What is the incubation period of coronavirus?

Four days. Unlike SARS, coronavirus can be transmitted by asymptomatic carriers of the disease for up to four days, making it particularly difficult to track. 

What's the prognosis in the U.S. for coronavirus?

The crisis will last for months, and there will be no vaccine for at least a year or two. Confirmed cases of the disease are doubling every four days, which means in a few weeks we will be inundated in cases.

How is coronavirus transmitted?

Primarily by breathing. This means that wearing standard masks and gloves as a preventive measure is "largely nonsense." Hand-washing is a good general practice, but won't have much impact on coronavirus, which spreads by sharing breathing space with infected people. Avoiding crowded venues and keeping six feet of distance between oneself and others is the best preventive practice we have. Trying to stop the spread of this highly infectious disease is like "trying to stop the wind."

How will it come to a stop then?

Eventually the disease runs its course when enough people have natural immunity from having contracted the disease, so that no further transmission is possible. For example, if there are three people in a room, and two of them have had coronavirus and recovered from it, they can't infect the third person. The build-up of natural immunity in the general population is like inserting cobalt rods in a nuclear reactor core to stop the chain reaction of atoms (so the plant shuts down). Once enough people have had the disease, new cases become less and less likely. But this only happens when very large numbers have become sick. It's far better to develop a vaccine.

What is the effect of closing the schools?

Maybe not as positive as we hope. Only 2.1% of cases in China were of children and teens (under 19). On the other hand, 38% of nurses in the U.S. have children in school. When they are sent home, this presents an obstacle for nurses to go to work during the pandemic. Our thinking is too short term. We are getting ready for a brief skirmish when in fact we're in for a prolonged siege. Coronavirus will be with us for months to come, and we cannot remain shut down for such a length of time.  

What is the biggest challenge related to coronavirus?

Our public health system in general, which is vastly underfunded, and operates haphazardly on a crisis-to-crisis basis. Once a given crisis abates, public concern wanes, as does emergency funding - until the next time.

Right now supply chains have gone down and we are discovering that many of our life-saving drugs come from China. Hospitals are under-stocked with needed equipment - IV bags, medicines, masks - because of unwise budget austerity and "just in time" production.
Our front-line people don't have what they need. N-95 respirator masks are in short supply, for example, which increases the chances of doctors and nurses falling sick. Stockpiling 500,000,000 N-95 masks in advance would "have made all the difference" in handling our current crisis.

What about a vaccine?

It may take two years to develop a safe vaccine. We need to have a strategy for dealing with diseases in general, not just react instinctively in crisis mode when the latest one makes its appearance. Other diseases are coming. We need to be ready.

We should fund public health departments the way we fund the fire department. We don't wait until a fire breaks out to build a station with fire trucks and trained firefighters. We make sure to have all the necessary personnel and equipment in advance.

The vaccine for regular flu is about 50% effective, which sounds pretty good when we are faced with a serious disease without any vaccine protection.

Source: Interview With Michael Osterholm, Joe Rogan Experience #1439, March 10, 2020

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