As the COVID-19 outbreak rapidly careens into a pandemic, politicians and institutional leaders are grappling with how to best deal with this crisis. Our options are limited to social distancing and isolation of disease cases while we hope that existing antivirals will be effective, and that a vaccine can be brought to bear (probably 8-24 months).
The World Health Organization recently compared influenza and COVID-19. Both are spread by contact, droplets and fomites … hence the critical importance of handwashing, not touching your face, controlling where you cough, keeping physically apart, etc. Even though influenza can spread faster than COVID-19, the incidence of infection in the community will be greater for COVID-19 because there is essentially no “herd immunity,” which is the proportion of the population that is not vulnerable to infection. It is unclear how much “asymptomatic” spread contributes to the outbreak, but it is likely that COVID-19 is shed prior to onset of symptoms just like influenza.
COVID-19 is more severe than influenza, with an estimated 80 percent of infections being “mild” or “asymptomatic.” Infections requiring oxygen account for 15 percent of cases, and 5 percent require ventilation. If these figures hold and if only 5 percent of the US population is infected, there will be more than 3 million cases requiring hospitalization in a system that does not have a lot of surge capacity. The mortality rate from COVID-19 is 3-4 percent compared to a mortality rate of 0.1 percent for influenza (i.e., 30-40 times greater). There are numerous caveats to these estimates, including whether or not you have access to quality health care or if you are stuck on a festering cruise ship.
If there is any “good” news about this event, children are less vulnerable. Based on 55,924 laboratory-confirmed cases, WHO recently concluded that the probability of a child 0-9 years old dying from COVID-19 is essentially zero. Between 10 and 39 years, the probability increases to 0.2 percent, further increasing to 1.3 percent for those of us 50-59 years old. Things start getting ugly for older people with the probability of dying increasing to 3.6 percent (60-69 years old), 8.0 percent (70-79 years old) and 14.8 percent (80+ years old). Underlying health conditions dramatically increase your risk.
Based on these figures and given no definitive therapeutics or vaccine for the time being, then the message is crystal clear. We need to “circle the wagons” to protect the elderly and most vulnerable in our community, even though we have not seen a case on the Palouse (so far).
Among other things, these folks should speak with their physicians as soon as possible about protective measures such as ensuring that they have their influenza vaccination and other age-appropriate vaccinations – not because these will protect you from COVID-19, but they will help prevent co-infections that could be incredibly deadly. There is much room for improvement. According to the CDC, only 46.8 percent of adults aged 50-64 received an influenza vaccination in the past 12 months, but better for the 65+ group with 68.7 percent compliance.
Unfortunately, without herd immunity (whether by vaccine or recovery from infection), social distancing remains our best way to protect the elderly and vulnerable.
This includes limiting large public events, which will also, unfortunately, come with a very high economic cost that will hit small communities like ours very hard. People are being urged to “self-quarantine” for 14 days if they have traveled to impacted places.
Congress and the states need to do more to ensure a safety net for those who cannot afford time away from work and for access to healthcare and testing … including immigrants who may be afraid of accessing public services (thanks to recent rule changes by Trump), and undocumented immigrants who are incredibly vulnerable to deportation.
This week the University of Washington and Stanford are moving to online course delivery. At the time of writing this column, we are not there with our local universities, but contingency planning is in progress. Barring a large outbreak however, those of us who are presumptively healthy should be encouraged to patronize our local businesses as much as possible, even if only by means of online purchases and services. We need to support what people have built on the Palouse or risk economic damage that could take years to recover from.
Doug Call is a microbiologist. He first discovered the Palouse 37 years ago.