The coronavirus epidemic is finally beginning to make the regular news. As of this morning, more than 14,000 people are confirmed infected and 304 have died. Mind you, you’ll get a lot more hits on Super Bowl LIV if you do an online search. A little digging, however, will get you enough information to cause disquiet. I’ve been tracking this issue since it first hit the news, partly because one of my functions at my clinic is infection control. However, the world is way overdue for a pandemic – another reason my antennae went up. This is one of those “knowledge is power” things.
Cases of the illness first appeared in late December in the city of Wuhan, China. A doctor named Li Wenliang mentioned it in an online chat group with his medical colleagues. Authorities immediately questioned him and he was forced to sign a statement that he had engaged in “illegal behavior.” In other words, either China monitors such discussion groups very closely or – less likely – someone in the group reported him. Li caught the disease and has since recovered.
The Chinese government then proceeded to cover up. They silenced more doctors, did not inform the public of the risk and misled people or outright lied about what was going on. They allowed a giant potluck dinner of 40,000 people in Hunan in mid-January, well after the authorities knew the epidemic was underway. Despite pretty clear evidence that person-to-person transmission was likely, Chinese officials denied that such transmission could happen. Clear evidence as in the first victim’s wife developed coronavirus even though she had never been to the market where the disease supposedly originated. The disease was also spreading among medical workers, another sign of person-to-person transmission.
Many Chinese continued to travel for the Lunar New Year and plenty of other people were moving in and out of China on business or as tourists. Once it became clear that they had a major problem on their hands, Chinese politicians locked down Hunan – that’s the point at which the word finally started to get out.
For those who were paying attention, it was immediately evident that the situation was much worse than it appeared.
1. Item: Wuhan is building an entire new hospital to manage coronavirus victims and has started on a second. Now, Wuhan is a city of 11 million. Based on official data, they have around 50,000 hospital beds. If the epidemic was as small as it was supposed to be, there would have been plenty of beds available just by canceling all surgeries and elective procedures.
2. Item: unofficial videos and photos showed hospital emergency rooms in standing room only conditions, with shrouded bodies lying on the floor at the feet of live patients.
3. Item: authorities have locked down over 50 million people to prevent the spread of the disease. The lockdown has continued to expand
4. Item: epidemiologists outside of China began to make some calculations about the most likely numbers of victims and came up with numbers in the 30,000 to 60,000 range, which would square with the previous items.
5. Item: before you think I’m pointing a finger only at the Chinese, there have been others who have made this situation worse. The World Health Organization (WHO) dillydallied about declaring it a pandemic. Travel continued even as cases climbed. Various countries, including the US, are repatriating their citizens. Hello – when you have an epidemic on your hands, you don’t bring people out of the epicenter; that’s what quarantine is for. There was good evidence of both person-to-person transmission and the ability of the virus to be contagious before symptoms appeared. Yet US officials initially only planned to quarantine the repatriated folks for three days. Since the virus has an incubation period of 14 days, I leave the rest to your imagination. One of those people reportedly has already tried to make a break for it.
6. Item: it’s pretty obvious that coronavirus is more contagious than first thought. If you believe the figures (I don’t), 2,590 new cases appeared within the last 24 hours in China. Odds are very high that those numbers are low. Since travel was not shut down immediately, people who were incubating the disease have been out among the general population in airports and similar crowded venues all over the world. Many of those are college students. I fully expect to see more cases popping up on campuses.
So where are we now? As of this writing, Thailand, Japan, Hong Kong, Singapore, Taiwan, Australia, Malaysia, Macau, Russia, France, the United States, South Korea, Germany, the United Arab Emirates, Canada, Britain, Vietnam, Italy, India, the Philippines, Nepal, Cambodia, Sri Lanka, Finland, Sweden and Spain all have confirmed cases of coronavirus. Thailand, Taiwan, Germany, Vietnam, Japan, France and the United States have confirmed cases in people who had not traveled to China. What we don’t have (or at least I can’t find the data) is a good sense of how the numbers are changing in those countries where coronavirus has been confirmed. For example, the first death (that we know of) has occurred outside of China, in the Philippines. As of January 30, 2020, 29 patients in the Philippines were suspected of having the virus, but I’ve only been able to find actual confirmation of a couple of cases. The WHO finally decided we have an international public health emergency but says there is no need for global trade and travel restrictions (I disagree).
Luckily, this coronavirus does not seem to be as lethal as its cousins SARS and MERS. The death rate (again assuming you believe the data, which I don’t) seems to be around 2%. The SARS death rate was around 10%, while MERS was a whopping 34%. However, it does seem to spread pretty rapidly and people do get pretty darn sick, with pneumonia being the most common complication. In addition, it is still flu season and flu is widespread in the US. That means people who have what they think is garden-variety flu are undoubtedly out there spreading coronavirus.
One thing nobody seems to be talking about too much is the disruption caused by lockdown and quarantine. Food, medical supplies, gas, oil and other necessities of today’s life have to get to people from their point of origin. The food map I mentioned in a recent post shows how vulnerable the US is to disruptions in the food supply. Allowing deliveries means your quarantine is less effective. Not to mention that there are plenty of people who are going to figure out ways to go around the quarantine zone, especially if they can’t get what they need where they live. Reports from China are already mentioning medical supply and food shortages, and unauthorized pictures of grocery stores show shelves stripped bare.
As far as long-term fallout, China is a source of a wide variety of products for the rest of the world – that includes medical products. Many of the other Asian countries where the virus has been confirmed also manufacture things we buy. The economic fallout from the pandemic is going to be a big problem in a world that is already teetering on the edge because of massive debt and financial bubbles. Especially considering that most pandemics run six to nine months.
So, what can you do? Here are a few suggestions:
1. Make sure (and I mean right now!) you have adequate supplies of food, water and basic necessities like toilet paper or diapers on hand. Ditto pet food if you have pets. If the epidemic becomes as bad in the US as it is in China, you can expect some degree of lockdown.
2. Get some extra cash and keep it handy; recent fire evacuees have repeatedly noted that ATMs get stripped bare in nothing flat.
3. Try to stay away from crowds, especially if you live in large cities with an international airport or university.
4. Obviously, don’t travel to China, but if possible don’t travel at all. So far, all the US cases but one in Chicago (the husband of a woman who traveled to China) are in people who were in China or Wuhan. I expect that to change, as there are undoubtedly cases incubating in our population.
5. From a health standpoint, elderberry and blackberry syrup, as well as fire cider, are known to have antiviral effects. They are all easy to make, although it takes about a month to make fire cider. Take them as a preventive.
6. Follow the basics to keep your immune system healthy – adequate sleep, regular exercise, avoid sugar and refined foods. Eat some fermented foods daily to help keep your gut healthy. If you do get sick and need antibiotics, start taking probiotics immediately to keep your gut microbiome as healthy as possible.
7. About hand-washing – don’t overdo it. You’ll strip the natural protective oils from your skin. Don’t use antiseptic soap, either. Plain soap and warm water, for about 20 seconds, will do the trick. Wash before you eat and after you go to the bathroom or change a baby’s diaper. If someone in the family is sick, increase that to every time you have direct contact with them.
8. Masks will soon be in short supply if the current trend continues. Surgical masks are probably OK for the general public. N95s must be fitted properly to be effective and probably aren’t necessary for most folks. You can also make your own from cotton fabric and elastic or string ties. In all cases, the key is to wear them consistently, especially if a family member gets sick.
Finally, don’t panic. Yes, this truly is a pandemic and there’s still way too much soothing syrup coming from the various medical and government authorities. However, as noted above, this coronavirus is contagious but not – so far – highly lethal. One of worries with a virus is what’s called viral shift, a sudden mutation. A shift can make the virus much more contagious, much more lethal or both. Odds are the Spanish Flu epidemic of 1918 probably resulted from such a shift. Do continue to monitor the situation. Be alert for signs of a shift, such as rapidly increasing reports of confirmed cases or a surge in the death rate. Expect that the authorities are probably not going to give you all the information (yes, that includes those in the US). Keep your BS detector on high. And remember what Sargent Phil Esterhaus said at the end of every Hill Street Blues briefing: “Let’s be careful out there.”