Updated: Mar 1, 2020
We first did a blog about the Corona Virus, now called COVID-19, back in January. So quickly, let’s review what a coronavirus is. Coronaviruses are a large group of viruses that are commonly found in animals. In some cases, which medical professionals call zoonotic, these viruses can be transmitted from animals to humans.
A coronavirus was first isolated over 80 years ago when poultry stocks were devastated following a rapidly spreading bronchial infection. Since then, scientists say that they have found coronaviruses in mice, rats, dogs, cats, turkeys, horses, pigs and cattle. These viruses, according to the CDC, are also responsible for between 15 and 30 percent of the common cold and were first identified in the 1960s during an investigation into this seasonal illness.
What makes these viruses unique, however, is their ability to mutate rapidly, giving the public little chance to develop any natural immunity and making them extremely contagious. In the past, other contagious coronaviruses have been encountered, including SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).
According to the Centers for Disease Control (CDC), COVID-19 causes pneumonia, and because it is viral in origin, antibiotics are useless against it. The current antiviral drugs that are used have proven to have no effect on this virus. Those who become very ill and are hospitalized may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system, and of course, the condition of their lungs.
Those who have been diagnosed with COVID-19 tend to have a fever and cough, and some have difficulty breathing. The symptoms appear to set in at some point between two days and two weeks after the person has been exposed to the virus, according to health authorities.
Now, as the frenzy over this virus grows, fed by the news media, constant rumor milling and politicians looking to score cheap political points, one thing is being overlooked – the group that is actually most at risk from COVID-19. So let’s look at the numbers – the real numbers – which are both comforting on one level and concerning on another.
On February 23, the Journal of the American Medical Association (JAMA), reported on the sample of cases reported in mainland China. The sample’s overall case-fatality rate was 2.3%, higher than the World Health Organization's official 0.7% rate.
But now let’s break down those numbers, and this is important to understand – no deaths occurred in those aged 9 years and younger, but cases in those aged 70 to 79 years had an 8% fatality rate and those aged 80 years and older had a fatality rate of 14.8%, while all ages between 0 and 49 account for just 1%. Unlike other flu outbreaks, in which the very young and the very old are the most vulnerable, it appears with COVID-19 that the very young are not as vulnerable as those 50 and above.
A further look at these numbers found no deaths were reported among mild and severe cases, but the fatality rate was 49% among critical cases and rose even more among those with preexisting conditions:
10.5% for people with cardiovascular disease;
7.3% for diabetes;
6.3% for chronic respiratory disease;
6% for hypertension;
5.6% for cancer
On a news report seen on a cable news outlet, they reported that males were more likely to die from COVID-19 than females based on a study coming out of China. This study cited the numbers of male versus female deaths at 2.8% versus 1.7% for women. However, what they left out of that story was a very important fact that could account for the male death rate.
In China, nearly 50% of all men smoke cigarettes while only 2% of women do. Given the fact that COVID-19 attacks the lungs and causes pneumonia, smokers with damaged lungs would be the ideal target for this virus and account for the higher rates of death among males in the study.
The Current Numbers
As of 18:40 Greenwich Meridian Time (1:40 pm eastern time), February 29, 2020, the numbers of COVID-19 look like this:
86,020 confirmed cases
And, as of the time this blog is being written, (approx. 3:00 pm eastern time), the following has occurred:
In Washington State, the first confirmed death in the United States has occurred with a man in his 50s with a pre-existing chronic health condition;
A new case diagnosed in an 18-year-old student from Jackson High School in Mill Creek, Washington, who was ill last week. The results of the test came back positive for COVID-19. The student fully recovered and returned to school;
A woman in her 50s in Washington State with confirmed travel to South Korea;
A new case confirmed in Oregon, considered to be a community transmitted case;
A new case confirmed in Canada in a man in his 80s who had traveled to Egypt.
Keeping Things in Perspective
It is important that we keep this current virus in perspective until and unless research shows it to be more virulent than first thought. Let’s look at the numbers of those who have been affected by recent viral illness outbreaks:
When it comes to the seasonal flu, an estimated 290,000 to 650,000 people die annually throughout the world due to complications from flu viruses. This figure corresponds to 795 to 1,781 deaths per day due to the seasonal flu;
SARS (November 2002 to July 2003): was a coronavirus that originated from Beijing, China, spread to 29 countries, and resulted in 8,096 people infected with 774 deaths (fatality rate of 9.6%);
MERS (in 2012) killed 858 people out of the 2,494 infected (fatality rate of 34.4%).
There have been other epidemics and pandemics that have affected the world in the 20th century (Epidemic refers to a sudden increase in the number of cases of a disease above what is normally expected while a Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people);
The flu pandemic of 1918-1919 death toll worldwide was said to be between 20 and 50 million people with over 500 million infected by the virus. The death rate for 15 to 34-year-olds of influenza and pneumonia was 20 times higher in 1918 than in previous years. Those struck with illness on the street often died rapid deaths, some before they could even return home for their next meal. One physician wrote that patients with seemingly ordinary influenza would rapidly "develop the most vicious type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate." The flu pandemic of 1918 occurred because of a virulent new strain, which some say originated in China, appeared for which there was little or no immunity among people worldwide. It is thought to have traveled quickly due to the movement of troops and refugees as the war came to an end;
In 1957-58, the flu pandemic killed some 2 million people worldwide including over 70,000 here in the United States;
The flu of 1968-1969 saw over 30,000 people die here while nearly a million succumbed worldwide;
In 2010, the swine flu, also called the H1N1 virus, killed more than 12,000 of our citizens.
So this is what we know:
As of February 29, 2020, the CDC reports that anyone of any age can contract COVID-19;
Unlike seasonal influenzas which have fatalities in the very young and in older and elderly adults, COVID-19 deaths appear to be occurring only in older adults and overwhelmingly in those with pre-existing conditions;
Those deaths that have occurred in those under 50 are overwhelmingly in those with pre-existing health issues.
Given that, the concerns we should have if COVID-19 continues to spread should be for older adults with chronic health concerns and the disabled. Organizations and facilities that serve those in these groups, such as long-term care facilities, rehabilitation centers, group homes, assisted living programs, senior centers and affordable Housing Programs for the Elderly and Disabled, need to have contingency plans and supplies in place.
These plans should include educating both residents and staff about recognizing the symptoms of COVID-19, plans for cleaning large areas and deep disinfecting, guidelines for travel and visitors, possible quarantining of properties, how staff will be treated if exposed to COVID-19, and urging those with these symptoms to see a medical provider immediately.
For the final word on this, we reviewed an editorial published February 28, 2020, in the prestigious New England Journal of Medicine stating that COVID-19, currently causing panic in world markets, could turn out no worse than “severe seasonal influenza” in terms of mortality.
Citing an analysis of the available data from the outbreak in China, the authors noted that there have been zero cases among children younger than 15; and that the fatality rate is 2% at most, and could be “considerably less than 1%.” As in all cases of viral outbreaks, many have contracted COVID-19 and cleared it without anyone knowing they were sick, so the actual fatality rates may be much lower.
Those who have died have been elderly or were already suffering from another illness — as with the ordinary flu. The underlying data suggest that the symptoms vary, and fewer than one in six of the cases reported were “severe.” The vast majority of patients recover, and among those who are hospitalized, the median stay has been about 12 days.
UPDATE (5:03 pm, Eastern Time, February 29,2020): Washington state reported on Saturday the first death in the U.S. from the new coronavirus, the first health care worker to be infected with the disease, and most worrying, the first known outbreak in a long-term care facility.
The deceased, a man in his 50s with underlying health conditions, was not a resident of the facility, and officials have not yet found a link between his case and the outbreak in the nursing facility.
At a nursing facility in Kirkland, Wash, approximately 27 of the 108 residents and 25 of the 180 staff have some symptoms, health officials said during a teleconference with the Centers for Disease Control and Prevention. Authorities report that some of them have pneumonia.
So far, two people from the nursing facility outbreak have tested positive for Covid-19. One is a health worker in her 40s, who is currently in “satisfactory condition,” Duchin said, while the other is a resident in her 70s with significant underlying chronic health issues and is in “serious condition.”
Jeff Duchin, health officer for public health for Seattle and King County stated that older adults and people with underlying health conditions like diabetes, heart or lung disease should be especially careful to protect themselves by washing their hands, not touching their faces, and avoiding contact with people who are sick.
This latest report from Washington State highlights the importance of being aware and having a plan in place. The bottom line remains, stay aware and be prepared, but do not panic and keep things in perspective.
The author, Don Drake, oversees Connelly Law's Community Education Programming. He is a retired licensed clinician in the Commonwealth of Massachusetts with over three decades of experience working with older adults diagnosed with HIV/AIDS, substance abuse disorders, chronic homeless and mental illness. Prior to his retirement, he was the director of a unique treatment program for older adults with histories of mental illness, cognitive disabilities, and addiction at Shattuck Hospital in Boston. He was also a director at Steppingstone, Inc. in Fall River, Massachusetts where he was the clinical trainer, program and curriculum developer for the agency and oversaw treatment programming for older adults. He has over 40 years of human service and law enforcement experience and has worked as an administrator at programs in Boston, Hartford, Providence, and Philadelphia, helping to structure, hire and train staff in providing behavioral and addictions treatments for adolescents and adult clients. Drake also worked as a trainer for the Massachusetts Department of Public Health presenting training on QPR, a suicide prevention curriculum for the general public, the Massachusetts Council for Problem Gambling and the Crisis Prevention Institute, an international training organization that specializes in the safe management of disruptive and assaultive behaviors. He is also a retired professional wrestler who is in the New England Professional Wrestling Hall of Fame. Drake can be reached at Connelly Law Offices, Ltd. at firstname.lastname@example.org