Coronavirus risk in context: How worried should you be?

The coronavirus which causes coronavirus disease 2019 (COVID-19) appears to be a highly contagious disease. Some older people and those who are immune compromised are more at risk.  The highest risk are for older people who already have cardiovascular, diabetes, respiratory disease, and hypertension. In addition, older men over 65 years are much more at risk; however, many are smokers who have a compromised pulmonary system. Previous meta analysis showed that smoking was consistently associated with higher risk of hospital admissions after influenza infection. Nevertheless, it is reasonable to assume that over time all most all of us will become exposed to the virus, a few will get very sick, and even fewer will die.

The preliminary data suggests that most people who become infected may not even know they are infectious. Make the assumption that everyone could be contagious unless tested for the virus or antibodies to the virus since people appear to be infectious for the first four days before experiencing symptoms.

The absolute risk that one would die of this disease is low although if you do become very sick it is more dangerous than the normal flu; however, the fear of this disease may be out of proportion compared to other health risks. For detailed analysis and graphic summaries see the updated research reports on the Coronavirus disease (COVID-19) by Our World in Data and Information is beautiful. These reports make data and research on the world’s largest problems understandable and accessible.

It is worthwhile to look at the absolute risk of COVID-19.  To read that more than 332,000 people world wide have died in the last five months is terrifying especially with the increasing death rate in Europe and New York; however, it needs to be understood in context of the size of the population.  The epicenter of this disease was Wuhan and Hubei Provence, China with a total population of about 60 million people.  Each year about 427,200 people die in the Wuhan and Hubei Province (the annual death rate in China is 7.12 deaths per 1000 people). Without this new viral disease, about 71,200 people would have died during the same two month period.  The question that has not been discussed is how much did the total death rate increase.  Would it be possible that some of the people who died would have died of other natural causes such as the flu?

The World Health Organization (WHO) and governments around the world should be lauded for their attempt to reduce the spread of the virus. On March 6, 2020, the United States Congress allocated $8. billion dollars to fight and prevent the spread of COVID-19. 

This funding will only partially prevent the spread of the virus because some people have no choice but to go to work when they are sick–they do not receive paid sick leave! This is true for about 30 percent of the American workers who have no coverage at work or the millions of self-employed workers (e.g. gig/freelance workers, waiters, cashiers, drivers, nannies, house cleaners).

To reduce the risk of the spreading COVID-19, anyone who feels sick or thinks they have been exposed, should receive paid sick leave so that they can stay home and self-isolate. The paid sick leave should be Federally funded and provide basic income for those whose income would be lost if they did not work.  Although it is possible that a few people will cheat and take the paid sick leave when they are well, this is worth the risk to keep the rest of population healthy. To provide possible relief, at the moment the House and Senate are working on a greater than $2 trillion dollar stimulus package. 

Personal and government responses to health risks are not always rational. 

Funding for health and illness prevention is driven by politics. For example, gun violence results in more than 100,000 people being injured each year and more than 36,000 killed—an average of 100 per day. Gun violence is a much more virulent disease than COVID-19 and more than 1.7 million Americans have died from firearms since 1968.

The Federal Government response to this gun violence epidemic has been minimal. For the first time since 1996 did the 2020 federal budget include $25 million funding for the CDC and NIH to research reducing gun-related deaths and injuries.

It is clear that the government response does not always focuses its resources on what would reduce injury and death rates the most.  Look at the difference in the national response to COVID-19 virus that has killed more than 120,000 people in the USA ($8.5 billion for the initial response and then $2 trillion stimulus package) as compared gun violence that kills 36,000 people a year in the USA ($25 million funding to study the causes of gun violence).

Be realistic about the actual risk of COVID-19 without succumbing to fear.

COVID-19 is a pandemic and I expect that 30% to 70% of us will be infected this year.  Hopefully, in the next 18 months an effective vaccine will be developed.  In the mean time, there is no known treatment, thus optimize health and reduce the exposure to the coronavirus.

• How to reduce exposure to the coronavirus
  • Optimize your health and immune function by eating healthy, getting enough sleep, enjoying some exercise/movement and reducing stress.
  • Increase social distance  when with other people–greet people by staying separated by at least six feet or more from each other instead of a handshake or a kiss on the cheek.
  • Wash your hands after touching surfaces that others may have touched or after going out for shopping, work,  pleasure and/or meeting other people.
  • Avoid touching your face especially your mouth, nose and eyes.
  • Sanitize hard surfaces.  Malia Jones, PhD, MPH points out that  you can make your own inexpensive antimicrobial spray by mixing 1 part household bleach to 99 parts cold tap water. Spray this on surfaces and leave for 10-30 minutes. (Note: this is bleach. It will ruin your sofa).
  • If you think you have the disease or have symptoms, contact your healthcare provider. Wear a mask and self-isolate to reduce spreading the virus to others.
  • Increase fresh air circulation and avoid room that have poor ventilation.
• Reliable information about COVID-19
  • World Health Organization (WHO): https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
  • Centers for Disease Control (CDC): https://www.cdc.gov/coronavirus/2019-ncov/about/index.html 
• Graphic representation of the background of  the COVID-19 infection and relationship to other diseases
  •  Summary of what is the corona virus:  https://ourworldindata.org/coronavirus#citation
  • Graphic representation of coronavirus in context to other diseases:  https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/
  • Accurate information on number of infections, new cases and deaths: https://www.worldometers.info/coronavirus/

To make sense of the danger of COVID-19, look at it in context to the flu. The risk is the greatest for people with co-morbidity (obesity, diabetes,  emphysema, immune suppressed illnesses, and people who smoke and vape). While the risk for young people and children is no different for being infected with Covid-19 or influensa A and B in hospitalization rates, intensive care unit admission rates, and mechanical ventilator (Song et al. 2020). Depending upon the severity the  flu, 9,000,000 to 45,000,000 people get sick from flu and between 12,000 to 61,000 die from its complications as shown below in Figure 1.  

Figure 1. The estimated U.S. influenza burden by year (from: https://www.cdc.gov/flu/about/burden/index.html)

This year the CDC estimates that there have been 20,000 to 40,000 deaths in the United States so far this year.  

Song, X.,  Delaney, M., Shah, r.K. et al. (2020). Comparison of clinical features of Covid-19 vs seasonal influenza A and B in US children.  JAMA Network Open, 3(9):e2020495