The Great Pestilence Panic of 2020
I'd like to start this column by asking you all to observe a moment of silence to remember the millions of Americans who died in the great Ebola pandemic of 2014. Who can forget the unburied bodies along the roads, vital organs turned to mush, bleeding from all orifices; the whole Dallas neighborhood of Vickery Meadow decimated, with National Guard members patrolling the streets in biological warfare suits.
"Wait," you say, "what millions? What epidemic?"
So now we have a new epidemic, a viral disease with the aesthetically dreadful name "Wuhan Coronavirus (2019-nCoV)." (I'm going to abbreviate this to "2019-nCoV" or even just "nCoV").
What is it?
2019-nCoV seems to have first appeared last December. According to "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China" in the Lancet (24 January 2020, among the first cohort of patients on which they're reporting, 41 patients had been admitted to hospital with a confirmed 2019-nCoV infection. You can go read the whole description — I recommend bringing a dictionary as I certainly had to look some things up — but the long and short is that these 41 patients all had pneumonia when they were admitted, and 27 of them had visited a particular market, the Huanan 華南 Wholesale Seafood Market, which is suspected to have been the source of the infection. This is what's known as a "wet" market, which means that you can buy live animals that are then slaughtered for you.
Now, coronaviruses aren't actually a new thing. In fact, you've very possibly had one yourself: they're one of the families of viruses that cause what's called "the common cold."
"Common cold" isn't a disease, it's a syndrome, a bunch of symptoms that cluster together. Usually, those symptoms are a low fever, a cough, runny nose, and a general feeling of malaise. Sometimes people, especially old people or people with weakened immune systems, get pneumonia, get really sick and die.
So far, much like influenza.
Sometimes coronaviruses mutate into something worse. It's happened twice in the last couple decades, first with SARS and then with MERS. Both are caused by coronaviruses, and both were acting like 2019-nCoV is now: a much greater likelihood of pneumonia and a higher death rate.
I'm going to write a longer article on the disease, but here's the short version. nCoV is about as transmissible as the 'flu. Transmissibility is measured by a number R0, which is basically an estimate of the number of people who will be infected in the future from each current case. This is computed using a model that fits to the number of cases.
The first estimates gave nCoV an R0 estimate of 3.6 to 3.8, but that was quickly revised downward to around 2.6.
Now, even 2.6 isn't great. You want a number less than one — that means it's going to die out on its own. But, by comparison, influenza is somewhere between 2 and 5, and measles between 12 and 18.
When it was first identified, all 41 patients were already sick enough to be admitted to hospital, and of those, 13 went into the ICU and six died.
Genetically, 2019-nCoV is most similar to Middle East Respiratory Syndrome (MERS-CoV) and also similar to Severe Acute Respiratory Syndrome (SARS-CoV). Both of them caused severe respiratory distress in some patients, and MERS-CoV in particular was fatal in about a third of diagnosed cases. All three are similar to coronaviruses in wild bats in China and the middle east.
Now it's time for a short interlude on interpreting numbers. MERS was fatal a third of the time among diagnosed patients. But SARS, MERS, and now nCoV are often either asymptomatic or cause mild cold-like symptoms. Right now, mortality in nCoV is running around 5 percent among diagnosed patients. Neither number reflects what it would be if we included all the people who "had a cold" and never had the virus tested.
What It's Not
- It's (almost certainly) not the start of a worldwide pandemic that will kill hundreds of millions or billions of people. It's not as deadly as SARS or MERS were; think back to when MERS was around, remember how worried you were, and worry about 16 percent as much.
- It's (almost certainly) not some Communist Wuhan Secret Lab bioweapon. Basically, remember Occam's Razor: the simplest explanation is to be preferred. This is another variant of a virus that's probably been around forever and was probably killing people in Confucius's time. The difference is that without gene sequencing and modern medicine, it was called "it's so sad, grampa caught pneumonia and passed away" instead of "scary death-virus coronavirus." But as a bioweapon, when it's only got an R0 of 2-3 and a 5 percent mortality, it sucks.
- It's not because of eating bat soup. The virus can't survive being boiled long enough to make bats tender. The first patients probably did get it from being around live bats.
So what should you do about nCoV?
First of all, if you can avoid getting it, you should. That's my considered medical advice.
Luckily, the odds are extremely good that you can — there are in the order of tens of thousands of people who have it and billions of people overall. If you weren't in China or countries near China recently you're very unlikely to get it.
Don't hang out with live bats. But in this country, that's more likely to give you rabies than coronaviruses, and believe me, if you get rabies you'll wish you just got nCoV.
In particular, if you're over about 60, definitely avoid getting nCoV. The median age at death from reported cases by the 25th was 75. Considering how many people smoke in China, I'd bet money that death and existing pulmonary disease are very highly correlated, although the medical reports just say "significant comorbidities."
If you have been in China, and particularly in Hubei or especially in Wuhan, and you think you're catching cold, wash your hands, put on a surgical mask or cover your mouth with a handkerchief, and go to the doctor. At the doctors they'll probably have masks available at the door. And make sure to tell your doctor where you've been.
If you haven't been to China, and you're not old, and you don't have COPD or serious asthma or tuberculosis, well, wash your hands a lot anyway. We say these viruses are "air transmitted" but that's more often by contact.
Again, though, look at the numbers. CDC estimates millions of people get the flu every year; of those, hundreds of thousands are hospitalized, and tens of thousands die. We've mostly stopped measles in this country, but among people who do get the measles, about one in a thousand die.
The same precautions you would take against nCoV are the precautions you can take against the flu, and flu is far riskier overall.
Remember the History of Disease Panics
We in the U.S. had no Ebola epidemic in 2014. We did have an epidemic of Ebola panic, and the Ebola panic — like a lot of false news stories — had lasting effects. (I mentioned those millions of victims sarcastically elsewhere and it was completely believed. In fact there were only about 29,000 cases and 11,000 deaths reported in the 2014 epidemic. (Some estimates were that as many as 70 percent of the cases went unreported, but even doubling the reported cases would only be about 58,000 cases.)
But there were absolutely reliable sources explaining how the CDC was covering it up, how it was really a Russian/Chinese/CIA bioweapon, how someone they know on social media said that people were dropping dead in the street and rotting.
Then, of course, there was cannibalism in the Superdome, and before that a flood of radiation that was going to kill everyone on the West Coast after Fukushima...
And you'd think people would eventually learn.