Coronavirus / 2019-nCoV / Wuhan Flu Virus Update

COVID-19 Virus Image

The hard facts of the 2019-nCoV (Coronavirus) transmission, lethality, best treatment and more are still being discovered, but this information is being distorted by the huge array of pseudofacts and other factors that result in intense fear in many people. For some interesting information (generally) to review, please see this information from Johns Hopkins Global Health Now (COVID-19 Expert Reality Check)

What is Coronavirus ??

There are 7 strains of human coronaviruses, 4 producing symptoms of the common cold (but can lead to death in some higher risk people)...

  1. Human coronavirus OC43 (HCoV-OC43) - continuously circulate in humans worldwide
  2. Human coronavirus HKU1 - continuously circulate in humans worldwide
  3. Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus) - continuously circulate in humans worldwide
  4. Human coronavirus 229E (HCoV-229E) - continuously circulate in humans worldwide

There are 3 strains associated with higher risk of severe symptoms or death...

  1. Middle East respiratory syndrome-related coronavirus (MERS-CoV)
  2. Severe acute respiratory syndrome coronavirus (SARS-CoV or "SARS-classic")
  3. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or 2019-nCoV or "novel coronavirus 2019"

For context, the influenza virus statistics are tracked by the CDC and can be seen here (Influenza Statistics). In the US, the range (as seen over the years) has been 9.3 MILLION to 45 MILLION infections A YEAR, and 12 THOUSAND to 61 THOUSAND dead A YEAR. This has been based on data going back 10 years. 

 

What is a pandemic?

Currently, we are in the throes of a worldwide pandemic. Although the precise definition and characterization of a pandemic has been variable (as listed on the WHO website), you can think of a pandemic as happening when a new virus emerges to infect people and can spread between people sustainably. When immunity to the organism is minimal or not existing, it allows spread to be worldwide. 

We have seen various methods of responding to this Coronavirus in various countries. A (what is now) reliable source of reviewing viral infections worldwide can be seen here (Johns Hopkins Coronavirus Resource Center). 

 

What should I do?

Here is where it is more complicated. We all know that you have to use your good judgement and basic knowlege to help reduce your chances of infection (ie wash hands appropriately and frequently with soap/water, stop touching your face and putting your fingers in your nose or mouth (and try to stop biting your nails), cover your cough or sneeze into a tissue that you discard or the crook of your elbow AND look away, etc). 

 

Do we need to close down all business to control this pandemic in the USA? 

What isn't clear is the validity of the total shutdown of whole states and all of their businesses (ie California) vs powerfully addressing current "pockets" of outbreaks and much more targeted interventions (vs the current sledge-hammer approach). Is this an effective and prudent approach? Does the data demand that we do this extremely disruptive response that will result in extreme economic hardship for millions? Is this the only proper way to get this virus under control and minimize deaths in our country? 

I am concerned because, in fact, data does not support the superiority of the non-targeted lockdown approach vs a more targeted approach to minimize morbidity and mortality - particularly when considering the devastating effects that will follow with our entire economy if kept in place for extended periods of time. If businesses can't function, resupply can't happen, basic services will falter, and nothing good will come of that. We can look to the South Korean experience (using targeted lockdowns) as one that looks to be quite successful in controlling the first wave of Coronavirus infections. 

According to Dr. Eric Toner, MD - a senior scholar at Johns Hopkins Center for Health Secruity...

"This pandemic will last until most people are immune, whether through vaccination or from having gotten the illness [COVID-19] and recovered. The 18-month figure comes from reports that we won’t have a vaccine in less than 18 months, but that would be in unprecedented, in record-breaking time. We’ll eventually have a vaccine, but that may be in 18 months or 5 years from now. (editors note: current data shows a vaccine sooner then later). 
 
I think there will be waves of the epidemic across the US. What’s happening now in Seattle and New York, and to a lesser extent in San Francisco, will happen in Baltimore and Dallas at different times. Each wave will last a couple of months—from valley to peak to valley. As we begin to relax social distancing efforts—which we will have to do because society can’t stay like this—the disease will start to come back. The hope is that it will return more slowly because there are fewer susceptible hosts, we’ll have more ubiquitous testing, and more [targeted] interventions instead of the sledgehammer we’re using now".
 

As I am staying abreast of information on this topic, I intend to update as needed... 

 

Other Information to Review Concerning Coronavirus

A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

Written by John P.A. Ioannidis is professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center.

Mortality Rate for COVID-19 May Be Closer to Influenza

Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia

Author
Michael Citron, MD Michael Citron, MD, is a functional medicine specialist practicing at FoundationMED, located in Raleigh, North Carolina. Dr. Citron has been practicing medicine for over 30 years and is committed to helping patients address the underlying conditions that impact their health. Dr. Citron began to explore how physicians might do better at preventing the need for visits to the emergency room and discovered functional medicine. Now, he focuses his practice on identifying and then eliminating or minimizing the root causes that eventually lead to health problems and the need for reactive health care.

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