Crozet Annals of Medicine: Going Viral

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I work with potentially deadly viral diseases on a daily basis. I see kids with croup (parainfluenza virus) struggle to breathe through inflamed throats. I see babies with bronchiolitis (respiratory syncytial virus) gasping and wheezing, nostrils flaring and ribs tugging in with each breath. I treat the fevers of sick, frail elderly patients caused by influenza viruses and admit them to the ICU when the disease is severe. I have faced swine flu, bird flu, and MERS. Of course any of these exposures could also sicken me, so it is safe to say I have viral pathogens on my mind a lot. And I wash my hands a lot.

So many years of closely observing emerging viral contagions has given me both dishpan hands and hopefully some insight into assessing the seriousness of the threat of the corona virus pandemic (officially COVID-19) that has arisen out of China and is now worldwide. With that background, let me address some frequently asked questions about what the COVID-19 outbreak means to the U.S. These answers are based on the most recent Chinese Center for Disease Control and Prevention (CCDC) Report published in JAMA last week.

FAQ’s regarding COVID-19 

Are my kids at risk? 

Of the 44, 672 confirmed cases in China, only 1% of the cases were in children less than 10 years old and another 1% were in kids from 10 to 19 years old. This is not a disease of the young. The majority of cases, 87%, were in the age group 30-79 years old. We probably won’t need to close schools, at least not to protect the kids.

I heard men are at greater risk of dying than women from COVID-19. Is this true?

It is true in China. The CCDC data recorded a 2.8% fatality rate for male patients versus 1.7% for women. While the report did not address the reasons for this, it is interesting to note that an astonishing 68% of Chinese men smoke while only 3% of Chinese women smoke. COVID-19 is a respiratory illness after all.

That brings up another question, what are the signs and symptoms of COVID-19? How do I know if I have it?

You don’t have it. No one in Virginia has it (yet). But the signs and symptoms are similar to the flu: cough, fever, and shortness of breath. Symptoms may be mild or severe.

Severe? How severe?

What you are asking is what is the case fatality rate (CFR)?  In Hubei province, where the disease first broke out, the CFR is 2.9%. Nearly three of every 100 people who got this disease died. In Hubei. Outside Hubei, in the rest of China proper the CFR is 0.4 %. Four in 1,000 people who had the disease died. This was only among the people who had the disease confirmed by laboratory testing.  If you factor in the undercounting of cases inherent in the over-stretched and under-resourced Chinese public health infrastructure the CFR is much closer to the CFR of the seasonal influenza that I am now seeing in my ER, around 0.1%.

The bottom line is that COVID-19 will likely be widespread in the U.S. population but no more deadly than seasonal influenza. The majority of the cases will be mild and many will look like the common cold.

I still don’t want to get COVID-19 though! How do I protect myself? 

Good handwashing and social distancing (see last month’s column). Surgical masks are not required in general but could be considered if in close contact with a suspected case. 

Will the COVID-19 epidemic in China accelerate the return of jobs to North America as US Commerce Secretary Wilbur Ross has stated? 

This is not really a medical question, but based on the recent steep decline in global markets, the answer is a resounding no. 

Any final words of advice?

Enjoy the spring! Get outside and get moving. If only for the social distancing. 

Gesundheit! 

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