Sticking with Facts to Save Lives During the COVID-19 Pandemic
Facts vs Myths and the ‘Hit or Miss’ Model of Modelling
By now, Americans have been bombarded by facts, myths, theories, models, political rants from all sides and their own personal experiences as they deal with the coronavirus pandemic. Trying to make sense of science versus theories is difficult. We are promised results based on models that change weekly; we are offered hope based on political expediencies; and we are constantly being told whom to blame.
The reality is that we can only base our decisions on the best knowledge we have to date, understanding that the data can and will change. Knowing we are given honest and transparent information is crucial for us to all work together towards the best possible solutions. Many countries have taken different approaches to curb the spread, from almost complete lockdowns to no lockdowns, all with varying results. Looking back in hindsight is only helpful to the extent that we learn for the future. Let’s look at what we have learned so far and acknowledge how much we do not know.
1. The Contagion Rate is Significantly Higher Than the Flu’s
Fact: The contagion rate is higher than that of the flu; we do not know exactly how high due to lack of accurate data from not enough testing. The virus is spread through touching an infected surface (where it may linger for hours or even days), touching your face, or through airborne particles that linger in the air for up to a few minutes. Airborne particles may spread up to 6-10 feet from an infected person who sneezes, coughs, or breathes heavily, and up to 3 feet through speaking or normal breathing. If an infected person is in the same room and is not wearing a mask, it may be possible for very small coronavirus particles to be in the air for up to a few minutes. However, there is no conclusive proof to show whether small particles that linger in the air are enough to cause transmission. Therefore, to reduce transmission, it is imperative to wash hands after every possible contamination, not touch our faces, wear masks to reduce transmission to others, and practice social distancing.
2. The Elderly and Vulnerable Have Higher Death Rates
Fact: Elderly and vulnerable people have a much higher mortality rate. A recent study of 6840 deaths showed that .04% were in the age group 0-17, 4.5% aged 18-44, 23% aged 45-64, 25%aged 67-74, and 48% were 75 years old or older. Underlying conditions were present in a majority of the cases. Out of the 6840 deaths, 37% were female, 60%were male, and 3% unknown.[1] Scientists have determined that the coronavirus attaches to ACE2 protein receptors and there is a connection between receptor expression, which increases with age and is higher in men than in women, and the rate of infection. There may also be genetic differences that contribute to higher mortality rates.[2]
3. We Don’t Know About Immunity
Fact: There are no facts regarding immunity. Some scientists extrapolate that this coronavirus should behave like other past coronaviruses and provide at least some level of immunity for a period ranging from a few weeks to a few years. But the recurrence of the virus in previously cured patients shows there is no timeline certainty. There may be a fault with testing, with the length of time some patients need to be rid of the virus, or there may be little or no immunity – we just don’t know.
4. The Mortality Rate is Significantly Higher than the Flu’s
Fact: The mortality rate is still unknown but is higher than that of the flu. We do not know how high because of a lack of accurate testing. Below is a chart of current mortality rates based on recorded deaths and diagnosed cases in a sampling of Western European countries and the United States. Because we now know there are many undiagnosed cases, this chart does NOT accurately reflect the true mortality rate in each country.[3]
Below are some ‘theories based in fact’ that may help to explain the extreme variance in mortality rate. These theories are factual to a certain degree, but the extent of their relevance cannot be accurately measured.
Asymptomatic Cases. There are many cases that are undiagnosed. Because the number of tests given to the general population vary greatly, we cannot accurately determine mortality rates from diagnosed cases. The true mortality rate is based on a proportion of actual cases, regardless of whether the cases were diagnosed or undiagnosed, and countries with less diagnosed cases will have a disproportionately high mortality rate.
Early Testing and Tracing. The ability to catch the virus early based on more widespread testing and robust tracing may help patients recover more quickly, however, we do not know the effect this may have.
Culture. Cultural considerations such as the percentage of older or vulnerable people interacting with others as well as the way they interact change the demographics of infection.
Resources. Higher standards of care and/or more resources help patients recover instead of succumbing to the virus.
Demographics. The population of elderly or vulnerable persons vary country to country, as do the prevalence underlying health conditions.
What We Have Learned from Controlled Environments
Outlined below are a few situations where larger populations have been tested, thereby giving a more accurate number of diagnosed cases (assuming of course the tests are accurate) leading to a more accurate mortality rate.
Diamond Princess. According to the CDC,[4] almost all passengers and crew members onboard were tested, and 712 (19.2%) of the 3,711 passengers and crew aboard had positive test results for COVID-19 with 331 (46.5%) being asymptomatic at the time of testing. There were nine mortalities; a 1.26% mortality rate.
Iceland. With a population around 364,000, Iceland has been offering free testing to anyone since early March. As of April 17 there have been 1754 positive cases recorded (0.48% of the population) with nine deaths,[5] a 0.51% mortality rate. Testing positive were 13.3% from high-risk individuals (either symptomatic, recently traveled to high-risk countries or had contact with infected persons), 0.8% from an open-invitation screening and 0.6% from a random-population screening.
Other Instances. There have been other antidotal studies which show the rate of asymptomatic cases is much higher, thus making the mortality rate lower. Many scientists have found the true number to be under 1%.
Conclusions on Mortality Rate and Asymptomatic Cases
Given the latest evidence, the mortality rate seems to be somewhere between 0.4% to an undetermined higher rate depending on resources, quality of care, and the early detecting of the virus.
This article seeks not to come to a conclusion by guesswork, but to report that there is no conclusive proof of reliable mortality numbers. We can surmise, however, that the mortality rate is at least double that of the flu with a much higher rate of contagion and may even be substantially higher.
Below are several charts that give a broad understanding of how different mortality rates may be affecting the populations of different countries.
If the ‘real’ mortality rate in the United States were 0.6%, 6,192,333 people would have had the virus as of April 17th. As only 709,735 people in the US have been diagnosed with the virus, this means almost 5,500,000 people have been walking around undiagnosed. Some may have had symptoms and chosen not to get tested and some may have had no symptoms at all.
With a 1.5% mortality rate in the US, less than 1% of the US population have or have had the virus.
A 5% mortality rate, which is closer to what the US currently shows, is almost certainly unrealistic due to a lack of general testing and many asymptomatic or undiagnosed cases. In Germany and Austria (and Iceland, not shown here), such a high mortality rate would mean these countries either have undisclosed or undiagnosed deaths, or a much higher success rate of keeping patients alive.
5. Confusing Rate of Growth with the Continuation of the Spread
Fact: COVID 19 growth has stopped and is generally holding steady in the United States. Most Western countries have flattened their curve and in some countries the numbers are going down.
What most people fail to realize is that the measures taken were needed to stop the growthof the virus, but not necessarily enough to stop the spread. Think of it as a diet; if people eat unchecked, they may continue to gain weight. Going on a diet may allow them to stop gaining weight. But to actually lose weight, they may have to also exercise more and/or go on a more extreme diet.
One week after the national lockdown guidelines were put in place, Monday morning traffic in New York was 47% lower than its 2019 average, Los Angeles was down 51%, Seattle down 41% and Atlanta down 37%.[6] New Yorkers, in the heart of the epidemic, evidently took the lockdown seriously and Forbes reported the number of people on Friday, April 10 in Manhattan was down 87% from a normal Friday pre-pandemic. Nationwide, there were 40% fewer trips on a Saturday on April 11 as opposed to March 7 based on “an analysis of cellphone users’ movements conducted by the Swiss firm Teralytics for Forbes.”[7] However, Forbes further states that in comparison to the 40% drop in US users’ movements, Italians’ movements dropped 67% during their lockdown. The Italians’ more extreme reactions are reflected in their decrease in total new cases which reflects a decrease in spread of the virus.
In order to understand the growth rate and not be misled by the wildly fluctuating daily cases, we need to focus on the rateof new cases instead of the actual numberof new cases per day. If the daily growth rate of the virus is >1 (in other words, if the percentage of new cases each day is greater than 100% from the previous day) the virus has grown. If the daily growth rate is around 1, the virus is stabilized and continuing at approximately the same rate, and if the daily growth rate is consistently <1, the virus will eventually go away.
Comparing the daily rate of new cases between seven Western countries by the week to week rate of growth from March 23 to April 17 shows that the growth rate generally dropped to around 1 or below, with the exception of Sweden where there are no lockdown measures. (Remember, a growth rate of 1 means the virus is holding steady, reproducing at 100% from the day before.)This is good news. It means the lockdown measures are working to keep the virus from growing and the growth is keeping steady, although not yet decreasing (as the rate has to be consistently be below 1 to decrease).
Looking closer, it is clear that the rate of growth has dropped as lockdowns continued and countries reached their ‘peak.’
However, the two most recent weeks shows the rate of growth has not dropped and is essentially holding steady in most countries or even growing.
As the grown rate needs to be consistently below 1 to slowly stop the virus, only Austria, Italy and Germany are showing signs of decline. Given the low overall numbers of infection and mortality, Austria will begin loosening their lockdown measures. Other countries will be able to see whether there is a second wave or whether Austria’s recommended measures of mandatory masks, social distancing and no large gatherings will continue to slow the spread.
Conclusion
Most Western countries have managed to flatten the curve, but the United States, as well as many other countries, has no further plan in place to reduce the spread. Rather, the focus is on lifting the lockdown.
Here’s what we can expect:
Unless something changes, the United States and other countries should plan for a second wave once the lockdown is eased. The second wave may even come sooner as people begin to feel the lockdowns are excessive.
Social distancing and the wearing of masks when outside the home will help mitigate the spread.
Being able to quickly identify hotspots and lockdown a high-density area will be necessary to help contain the spread. High-density areas may include workplaces, transportation systems and close-quarter living-environments, not just urban settings.
The risk of spread is much greater in places of high density, yet there is no way to impose lockdowns to reflect each regions’ needs. The conflict between protecting people and protecting the economy will force an easing of lockdowns resulting in a second wave. Each country, and in the case of the United States each state, will ease lockdowns at varying speeds depending on their own internal situations.
We cannot fully judge or understand other people’s situations. Lockdowns are leading many people to desperation and anger and some people can withstand the lockdown much better than others. Adequate private and public assistance throughout the pandemic is needed to ensure people can get back on their feet once this pandemic is over.
The political situation in the United States with elections coming up is putting pressure on the US President to end the pandemic soon. Blame will continue on all sides.
The responsibility for continuing the spread lies with each and every one of us. If we all do our very best to be vigilant about social distancing, protect others by wearing masks, and contain our own risk of contamination we can help contain the spread until a vaccine or cure is developed.
[1]https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary-deaths-04152020-1.pdf
[2]Zheng, Ying-Ying. “COVID-19 and the Cardiovascular System.” Nature Reviews Cardiology, 5 Mar. 2020, www.nature.com/articles/s41569-020-0360-5?fbclid=IwAR3Ni4Y6EokoleVLOGkmHia8Si03IwBuGV8kRTJjUJEBGS5ULlfAOHb2gHE&error=cookies_not_supported&code=fe01a0b2-8d82-417b-8c3d-be1b8a3fb86d.
[3]Based on numbers from Worldometer: worldometers.info/coronavirus/#countries
[4]https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm
[5]https://www.worldometers.info/coronavirus/country/iceland/
[6]Gastelu, Gary. “Here’s How Much Traffic Congestion Has Decreased Due to the Coronavirus Crisis.” Fox News, 24 Mar. 2020, www.foxnews.com/auto/traffic-congestion-coronavirus.
[7]Bogaisky, Jeremy. “See The U.S. Slow Down As Coronavirus Spreads In This Interactive Map.” Forbes, 15 Apr. 2020, www.forbes.com/sites/jeremybogaisky/2020/04/14/coronavirus-united-states-movement-map/#728117cf5d2f.
