Special Edition…Coronavirus

When the first issue of the newsletter dropped last week, I got a ton of awesome suggestions about what to write about. And I’m going to do it! Stay tuned. Later this week I’ll send out a shorter version with some links, and then the week after we’ll back with facts and data. But: by far the biggest question I got was about Coronavirus - should I barricade myself in my house? What about traveling? Spring break trip to Japan/Italy/Florida - should I go? It seemed like this couldn’t wait. So, here’s my take. What is Coronavirus? Seriously? Let’s move on. How Confident Are You in What You Say Below? One of the things that is most complex about this situation is that it is rapidly evolving. This is true both on our understanding of the disease side, and on our understanding of the political/public health/etc side. In a week, things may look very different (could be better or worse). I think this is especially true on the side of the political reaction; not much to be done here. For the medical details, here and here are a couple of the sources I relied on. How dangerous is it, medically? Early estimates out of China suggested a mortality rate of 2.3%. This is high - the seasonal flu is more like 0.1%. HOWEVER: this mortality rate is very likely to be an overestimate, perhaps an extreme overestimate. To see why, not that to calculate this, we rely on dividing number of deaths by number of known cases. Deaths are observable. Cases aren’t necessarily, and since it seems like many, many people have very mild reactions to the virus, it’s likely our estimates of the total number of cases are way, way too low. This would inflate the mortality rate. In line with this, some viral analysis suggests the virus may have been around for weeks already in Washington State, with the first detectable cases and deaths only coming in now. We’ll know much more about this question in the next weeks as the testing and screening improves and more data comes in. How Infectious Is It? Very. This is part (I think) of what has been prompting so much anxiety. The infection rate measure (basically, a measure of how many people an infected person is likely to infect) is over 2, which makes this much more infectious than (say) the seasonal flu (although much less than something like measles). Is it especially dangerous for pregnant women and children? There are many illnesses - seasonal flu comes to mind - which are especially dangerous to pregnant women and children. With the flu, kids tend to be pretty vulnerable. Actually, the current flu season is quite a bad one for kids. Is the same true of the coronavirus? It seems like no. Children actually seem to be much less affected than adults; cases seem to be concentrated in older adults, without the older-adults-plus-young-children pattern that is seen in the flu. Children who do get the virus thus far seem to have a mild course, although of course they spread it around a lot. For pregnant women we do not really know. There is no literature on this yet, no significant analysis. On the one hand, that’s probably encouraging - if this was especially bad for pregnant women we’d likely know. On the other hand, not much to go on. At the moment it seems safe to assume that one should generally be more cautious about infectious disease during pregnancy, but there isn’t anything to make use think this particular virus is an issue. So it seems like you think this is no big deal medically? Well, no. There are some populations for whom this is very risky - older people, especially men, and those with underlying medical (especially respiratory) conditions. Smokers seem to be more heavily affected. And any new virus is just that, new. So it is really hard to know whether we see the full picture. But I think it is fair to say that, yes, for the vast majority of people infection is not likely to be a significant medical issue. Should I take a trip to Japan? I have gotten a lot of this question. It’s spring break! People want to travel to Japan/Italy/Florida/Panama. Should you do it? Medically, you can read the risks for yourself but I probably wouldn’t cancel for medical concerns. But: the risk of travel disruption and disruption on the way back in is very real. For example, my kid’s school just sent an email saying if you go to Italy, China, South Korea or Iran for spring break, you’ll have to wait 14 days after your return to go back to school. This is pretty costly. Never mind the possibility you might literally not be allowed to return to the US. Or the possibility that flights will be cancelled (Delta just stopped flying to Milan, Italy). Or the fact that once you get to Italy, everything will be closed. For me, what this means is that if I had a domestic trip planned in the next couple of weeks (I do! It’s just driving, though) I would plan to go through with it. But I’d probably be more cautious about travel outside the US, lest I be unable to return. Did you do anything to prepare? Yes. I bought this peanut butter on Amazon. Seriously, I reviewed and updated our emergency food kit, just in case Whole Foods is closed for a while. My concerns here revolve, basically, around people’s reaction to the virus rather than the virus itself.

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