By Master Coach Kesh
Approximate Reading Time: 5-7 min
Understanding Covid-19 And Its Implications
Hello dear reader. If you are taking the time to look through this article I thank you from the bottom of my heart. In truly unprecedented times, the challenge for all of us is to understand what we are dealing with before the usual channels of information (government, news, etc.,) provide explicit instructions as to what to do.
The truth is that there is no-one at any level who has a complete knowledge base of what to do, and in fact much of our current awareness sadly comes from observed and corrected mistakes of the distant and not-so-distant past. Time really is of the essence here in making a positive impact so lets do this!
There is a massive difference between living in fear due to scaremongering and a lack of knowledge versus taking precautions based around the mechanics and mathematics of disease transmission.
In this article I hope to bring clarity to some of the key terms you will hear over the next few weeks and if you find some value in this please pass it on to anyone who could also benefit. It’s an incredibly fluid and dynamic time, with much (mis)information already flooding the internet/media channels. The more of us that are armed with the basics of facts and figures the more we can help stave off any rapid influx of the virus here in Canada.
What is Coronavirus?
Coronaviruses are a group of viruses that cause disease in animals. Most are quite benign, but there are 3 in particular MERS (Middle East Respiratory Syndrome), SARS (Severe Acute Respiratory Syndrome) and now COVID19 (Corona Virus Disease 2019) that are far more aggressive - an article in the lancet.com (shared below) discusses a COVID19 mortality rate of around 5.9% as of March 1st 2020 in China where the outbreak first started then developed into an epidemic and finally the full-blown pandemic we see before us today.
https://www.thelancet.com/journals/laninf/articlePIIS1473-3099(20)30195-X/fulltext
And what on earth is a virus itself?
A virus is essentially a microscopic parasite, generally LACKING THE CAPACITY TO THRIVE AND REPRODUCE OUTSIDE A HOST BODY. It will become evident as we progress through this article why this is a key piece of information.
To learn more about viruses I’ve included a simple but thorough link here: https://www.livescience.com/53272-what-is-a-virus.html
The entire raison d’etre of a virus is to deliver its genome into a host cell so that the genome can be expressed by that host cell. The virus will then cause the normal cellular machinery to be hijacked or disrupted and the result is anything from a mild cold to dengue fever all the way to something as deadly as ebola.
With something like COVID19 the vast majority of us needn’t worry if we are otherwise healthy and seemingly below 60 years of age. Large numbers of people may indeed have the disease, be contagious and yet be totally asymptomatic, something which actually poses unique problems we will discuss later in terms of transmission.
Because a virus is TINY (the polio virus for example at 30 nanometers is 10,000 times smaller than a grain of sand!) and in a common cold sneeze there being potentially 20,000 droplets of water, each containing coronavirus, one can see the problem in terms of ‘avoiding’ a virus if in close proximity.
Preventing Disease by understanding exponential numbers
What makes an infectious disease so quick to spread? The answer to this, and a key reason you will hear the term ‘social distancing’ again and again over the next weeks is the concept of the BASIC REPRODUCTION NUMBER (BRN) of the disease COVID19.
Epidemiologists, those tasked with analyzing the spread of disease, will discuss this term as the number of individuals that are, on average, infected by a person who has the disease - assuming that all the population are susceptible to catching it. The BRN of ebola is 1.5 to 2.5, for AIDS it’s somewhere between 2 and 5. For a similarly invasive strain of influenza (the 1918 Spanish Flu strain) it’s somewhere between 2 and 3.
What does this number mean? It describes the concept of EXPONENTIAL growth - take a BRN of 2 for example: This means that a single infected person infects 2 others during the course of their disease: not a crazy thought if we just keep to our usual schedule and cough, splutter or simple touch frequently interacted-with surfaces.
This is where the concept of time becomes critical. If each infected person infects their 2 people within the first day of catching the disease themselves it would only take 25 such days for the total infected to be more than Canada’s entire population! 2 to power of 25 is a shade over 33 million.
The number 2 is therefore something of a watershed in the sense that if we end up infecting more than 2 on average the disease spreads MUCH faster, if we infect less than 2 the disease spreads a lot more slowly.
Enter the concept of social distancing and learning from the mistakes and smart thinking of our friends around the world - Italy’s heartbreak
Because the disease is highly contagious and it isn’t often evident who has it by obvious signs of illness we are prevented from our usual methods of smart practice by asking people who are or feel ill to not come to our businesses/places of gathering.
With the speed of transmission and potential for ANYONE to have the disease, healthy looking/feeling or not, the only way to guarantee not transmitting the disease (we all have to assume we have it for this to work) is to limit the amount of people we come into contact with at the inception of the pandemic on our shores.
What can we learn from the terribly sad case in Italy, for example, which has an ageing population and has been hit very hard by Coronavirus:
“The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30,000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020.”
Full article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30627-9/fulltext
By not practicing any social distancing policies until much too late, the Italian health authorities have been swamped by the number of cases needing intensive care.
It is this burden of a too-rapid rate of new infections that poses the biggest risk to Canadians: simply not having access to the needed respiratory equipment should the cases becomes severe as they are likelier to for elderly or immune-compromised people. Remember for the vast majority of us COVID-19 poses no real threat other than a mild illness, but our capacity to be carriers and the rate of potential spread if we come into contact with more vulnerable demographics is the real problem.
Learning from South Korea’s honesty
“In the aftermath of a 2015 outbreak of the Middle East Respiratory Syndrome that killed 38 people and cratered the economy, South Korea took a hard look at what had gone wrong. Among the findings: A lack of tests had prompted people ill with the disease to traipse from hospital to hospital in search of confirmation that they had MERS, a coronavirus far more virulent than the one that causes COVID-19. Nearly half the people who got the disease were exposed at hospitals.
Korean officials enacted a key reform, allowing the government to give near-instantaneous approval to testing systems in an emergency. Within weeks of the current outbreak in Wuhan, China, four Korean companies had manufactured tests from a World Health Organization recipe and, as a result, the country quickly had a system that could assess 10,000 people a day.
Korea set up drive-through test stations, an approach only now being launched in the United States. Health officials initially focused their efforts on members of a secretive megachurch in Daegu with a branch in Wuhan, but they then broadened their reach to Seoul and other major cities.
As of Saturday March 14th, South Korea has tested more than 248,000 people and identified 8,086 cases. So far, 72 have died, or 0.9% of those infected. Compare that with the Chinese province of Hubei, where the coronavirus first emerged. With no forewarning, the fatality rate for the province currently stands at about 4.5%.
The contrast to the United States, which tested a few thousand people in the weeks when health experts say the outbreak was spreading across this country, could not be more stark. Instead of using the template approved by the World Health Organization, the Centers for Disease Control and Prevention set out to create its own test from scratch, only to see that effort plagued by delay and dysfunction that continues to this day.
America’s inability to know who is infected has broad implications. It means that infected people have wandered through offices, buses, restaurants, emergency rooms and malls, indiscriminately spreading the virus.”
Taken from the propublica report on South Korean vs. American testing policies and implications.
That last sentence: “America’s inability to know who is infected has broad implications. It means that infected people have wandered through offices, buses, restaurants, emergency rooms and malls, indiscriminately spreading the virus.” is what we need to take very seriously here in Canada.
We simply don’t know who might already have the disease with only a smattering of businesses closing and travel restrictions only just in place. As such, we stand at a crossroads in terms of the practice of restricting our physical interactions to others whilst the government are able to provide some data on the epidemiological structure of the disease: how many are infected? Where are the hotspots? What’s the contagious time period? Etc.,
This is why the rationale of “Im ok, I don’t want to live in fear, etc.,” is whilst admirable unfortunately playing into the very hands of the disease - its precisely through this mechanism that those who cannot deal with the disease will be much more likely exposed to it.
By staying home, making the call to close you business whilst the disease is hopefully still in its infancy, we have a real chance of lowering the BRN or basic reproduction number, genuinely saving lives either through not infecting people or by sparing the health authorities an influx of infected folks.
Flattening the Curve
Another term you’ll hear often is rooted in the last concept above.
“"If you think of our health care system as a subway car and it's rush hour and everybody wants to get on the car once, they start piling up at the door," says Drew Harris, a population health researcher at Thomas Jefferson University in Philadelphia.
"They pile up on the platform. There's just not enough room in the car to take care of everybody, to accommodate everybody. That's the system that is overwhelmed. It just can't handle it, and people wind up not getting services that they need.”
Harris is the creator of a widely shared graphic visualizing just why it is so important to flatten the curve of a pandemic, including the current one — we've reproduced his graphic at the top of this page. The tan curve represents a scenario in which the U.S. hospital system becomes inundated with coronavirus patients.
However, Harris says, if we can delay the spread of the virus so that new cases aren't popping up all at once, but rather over the course of weeks or months, "then the system can adjust and accommodate all the people who are possibly going to get sick and possibly need hospital care."
People would still get infected, he notes, but at a rate that the health care system could actually keep up with — a scenario represented by the more gently sloped blue curve on the graph.”
This is unfortunately whats already played out in Italy (negatively) and what we are trying to avoid here - its also exactly what happened to Philadelphia and St.Louis in the 1918 pandemic, and illustrates the difference a single week can make: as a World War I parade took place in Philadelphia hundreds of thousands of people some infected mingled with uninfected, resulting in the deaths of some estimated 16000 six months later.
St.Louis took much tighter social distancing precautions as fast as the 2nd day of cases being discovered and suffered 1/8 of the deaths in Philadelphia, but had they waited even another week or two the story could well have been very similar to Philadelphia.
What sort of measures did St.Louis take? Limiting peoples travel, isolating and treating the sick, quarantining those who might have been exposed, closing schools etc., - sound familiar?
What can we do here in the present day?
I’ll discuss individual strategies to stay healthy and keep our spirits strong in another article but in terms of societal responsibility the numbers and history and lessons appear clear: stop all activity that unnecessarily brings us into close contact with those outside your direct circle of family. Its vital that we stop worrying about the potential economic ramifications of this because there is a much bigger hierarchical worry: that of limiting the spread of this disease, saving our elderly and vulnerable populations and easing any potential burden on our healthcare systems.
Yes this will sting in the short to medium term, there’s no getting away from that - but if the payoff is that we can all be responsible for saving lives, I think its worth it.
Similarly upping our hygiene game and especially preventing the spread through hand sanitizing should be a no-brainer, I hope I don’t even need to explain this one!
