No.

Grant, while I understand your intent in this matter, you recommend actions which are foolhardy at this time. This is in fact the exact time for each of us to be our brothers' and sisters' keeper by not taking chances in exposing anyone, including ourselves to COVID-19. Heading out to eat places everyone, employees, owners, and patrons, in the position of doing the exact opposite of helping one another.

The responses of many have already detailed the important issues regarding insufficient healthcare screenings, likely shortage of hospital beds, and one contributor who has wisely pointed out that true support for these businesses will come at the other end of this outbreak. I hope you will seriously consider what these folks have to say.

It is my sincere hope that you will, after considering their sober approaches and recommendations, issue an amended email to your subscribers.

Patricia W.

Lynnwood, WA

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Walt_1143069

That email will not age well.

https://www.bostonglobe.com/2020/03/13/opinion/coronavirus-cautionary-tale-italy-dont-do-what-we-did/

Todd_Shewman_38102

Some sanity for the group

Chris Centeno, MD / March 10, 2020

As a physician, I’ve posted on the coronavirus two times this past week to try to answer the bevy of patient and family questions I have received. My second post was shared very widely and generated lots of comments from many freaked out and frightened people. Hence, I’ve taken the biggest misconceptions I have seen in those comments and in the media and reviewed them with this post.

Please Don’t Panic!

I have to say, that after being a doctor for 31 years, I’m not sure that I’ve seen anything quite like this level of abject panic regarding a respiratory virus in my career. While this is a bad bug that can overwhelm health systems and should be taken seriously, the misinformation is spinning out of control. Again, if you focus on the actual hard data, it paints a different picture.

As of this morning, we have just over 4,000 deaths worldwide. Again, the average seasonal flu kills between 291,000 to 646,000 people worldwide each year (15). The CDC just announced that the US had 20,000 flu deaths this season with 350,000 hospitalizations (16). Today, on average, 48,219 people will die of cardiac disease (17).

So why the abject panic? It’s being fueled by some in the media. As I’ll show below, when you have trusted names like Sanjay Gupta fanning the flames of fear rather than correctly interpreting data, you can see why people are so freaked.

My Top Coronavirus Misconceptions List

The mortality rate of coronavirus is 2-3%!

This has been reported many times. Most recently by Sanjay Gupta who should know better. At a White House press conference, Dr. Sanjay Gupta said, “the flu has a fatality rate of about 0.1%, this has a fatality rate of somewhere between 2-3%…”

COVID-19 DOES NOT have a 2-3% mortality rate. That number comes from the Chinese Wuhan data. The issue is that that number represents mostly sick people tested for the disease versus total deaths. Regrettably, that’s NOT how a mortality rate is calculated, which uses all that have contracted the disease as the denominator. See my diagram below:

The outside of Wuhan mortality, where there was wider testing of most that had contracted the disease, was 0.4% based on a report published by the Chinese CDC (7). Mortality on the Princess Cruise outside Japan (the only place so far where you can be sure that you tested all exposed in a closed environment), was 0.85% and only those over 70 died (8). In South Korea, which has tested more than 100,000 people, the case fatality rate is 0.65% (18). Germany has announced that its mortality rate is 0.2% (20). So what’s the real mortality rate? Under 1%.

The mortality rate for influenza varies by type and immunization effectiveness, but mortality among those 75 years and older is much higher than for the young and is over 1% (9). So we have mortality rates that are pretty close here. Hence, Sanjay Gupta wasn’t reporting accurate information.

The statement that in the elderly the coronavirus is about as deadly as the flu is more accurate. You could also say that it’s harder to treat than the flu and that more middle-aged people need intensive care and that these needs can quickly overwhelm health systems. However, Sanjay should know that the 2-3% number he threw out is likely not accurate and the reasons why it’s likely inflated.

Here are some media outlets I would like to congratulate as they have actually reported on the evolving science rather than hype:

SLATE-COVID-19 Isn’t As Deadly As We Think

HumanProgress-The Misleading Arithmetic of COVID-19 Death Rates

NPR-Why The Death Rate From Coronavirus Is Plunging In China

ABC News-Early mortality rates for coronavirus are likely misleading, experts say. Children and adults have done extremely well in terms of recovery, say doctors.

Coronavirus is aerosolized and the flu is not, hence the spread of this disease is much more than the flu.

This is nonsense. The flu virus is also aerosolized which is the primary way it’s spread (1).

Coronavirus survives MUCH longer on surfaces than the flu virus, which is up to 9 days on plastic!

This rumor was started by the Washington Post and is also not accurate as written (10).

First, for comparison, the flu virus survives on hard surfaces for about 9 hours and several hours in fluid droplets (aerosols) in the air, with low temperatures increasing the survival of the virus in these droplets (2). Many respiratory viruses die off as the temperature goes up. This is why the flu season is in the winter.

At this point, according to the CDC, there is no evidence that Coronavirus is spread by surface contact (3). The Washington Post article was based on a statement in the conclusion of a research study that found that on most surfaces, other coronaviruses (NOT the SARS-CoV-2 virus that causes COVID-19) survived various lengths of time from hours to days (11). The study that reported that a coronavirus could survive for 9 days on plastic really didn’t say that exactly (5). While that research showed that a different coronavirus survived for 9 days on plastic, by 48 hours the viral load was 10,000 times less! So “survives” is a relative term. In fact, another study included in the same review paper showed a similar coronavirus only practically survived for 2-3 days on plastic, which fits with the fact that the viral load is falling steeply after that time (4).

So how “spreadable” is this virus? The data from the Princess Cruise (Japan), a closed environment where you have almost 4,000 people that live in one space for 2 weeks and infected people touch all sorts of shared surfaces, shows that only about 20% of the people on the ship were positive (8). Given that this one spreads through water droplets from coughing and cruise ships are known to spread respiratory viruses, that spread is pretty typical for the average flu or cold virus.

On the other side of that argument is a new study out of China which has not been peer-reviewed yet (19). This suggests that the coronavirus is more contagious than the flu. It will be interesting to see how this paper fares in the stringent peer-review process. However, it’s critical to look at data from both sides of this argument.

The coronavirus will ramp up in the US over the next few months and by summer we will become China, a country on lockdown with millions of cases and our health system will crash.

Blogger Liz Specht gets a raspberry for getting this one out there. She reported that by May we would have some 5.4 million cases in the U.S. using her pandemic math. The problem is that Liz isn’t a physician, so she seems to have missed this graph put out by the CDC (12):

The peak months of U.S. viral flu transmission (which this virus will follow as well as its primary spread is aerosolization through coughing) are December through March. This is because the survival of viruses in water droplets falls off the map when the temps heat up. Note that in the 36 years graphed here (1982-2018) we have never had a flu peak in April or May. The graph for other viruses looks similar.

Hence, while the spread of the virus may well be somewhat contained by testing and quarantine which is unprecedented in the US at this scale, mother nature will be the rate-limiting step in the U.S. pandemic math since warmer weather reduces viral spread.

Forget about China, the real disaster is Italy!

It’s hard to get much data on Italy at this point. I’ve tried translating press releases put out by the Italian Health Ministry, but they don’t have all that much information. We do know that Italy as of this writing has 9,172 coronavirus cases and has had 463 deaths. So while it’s true that the numbers look awful and their health system is seriously overtaxed (the reports are that they are running low on critical ventilators), an interesting bit of information was reported by the BBC. The Italian health ministry says that the average age of death for Coronavirus is 81.4 years (6). Why is that number VERY important? It means that the data out of Italy so far is following the information we have from the Princess Cruise ship. The mortality is clustering around the very old, which is the same for the flu (13).

If you have cold symptoms, you probably have the coronavirus!

I heard this one on a local radio station. The main symptoms of COVID-19 are not the sniffles or a runny nose or sneezing. The main symptoms are a fever and a dry cough with or without shortness of breath (14).

The coronavirus misinformation machine continues to spin out of control. You can’t turn around without hearing a factoid from usually credible sources that can be easily debunked. So listen to the CDC and get yourself tested if you have symptoms. Observe strict quarantine protocols if you test positive. If you’re sick and unsure, just stay home. In the meantime, wash your hands and take a deep breath!

montebello1964

I'm a professional medical researcher and co-founder of a biotech company in China, so I've been following this closely since the earliest days (and canceled a trip to China because of it in early February). Coincidently, a friend of mine is one of the first patients in the Boston area (the majority of cases here so far are linked to a meeting held by a big biotech company, although that may only be the tip of the iceberg).

So I find doctors like this that downplay the consequences of this pandemic almost as dangerous as those individuals that blow things out of proportion, since people use them as excuses to avoid the most simple of precautions. As we speak, there are Irish pubs in Boston packed with patrons.

The truth of the matter is we don't know what to expect as we have never encountered this virus before. Based on what we have observed so far, I for one expect the number of deaths to significantly exceed that for the annual influenza. By how much is speculation at this point, since the fatality rate is still unclear, we have only theoretical models for how widespread it is right now, and we have no proof the pandemic will recede in April like the flu does (and if it does, it is likely that it will expand from April - September in the Southern hemisphere).

Todd_Shewman_38102

They simply laid out facts thus far. Interpret them as we may, but so far, he is spot on w/ stats. With approx 55M people (est via CDC) contracting the flu and est 55T deaths (cdc again) for 2020, why was there no alarm? This is very close to the 20% he claims.......The infection rate (as he points out) for the flu so far is approximately the same as is the fatality rate. So, I suspect he's not panicking as the 80%+ rate of mild cases being little to no symptoms and fatality rate isn't much different (and possibly better). He's not discarding diligence at all (he emphasizes this) and urges people to follow the guidelines. He's simply pointing out the math does not equal the hysteria......or we should be freaking out annually due to the flu.....

Walt_1143069

He's already changed his tune. I'm not usually one to say I told you so, but I told you so.

Manfred__101170

The development goes so rapidly, any quick thought, motivated by a good attempt is overrun by tomorrow.

Manfred__101170

Posting from Bavaria/ Germany whereas of today all public live is shoot down, means all Restaurants and Bars are closed, schools, universities and public offices. Drugstores, Supermarkets remain open for public. The Country has fall silent and this for a good reason!

I really appreciate the attempt to calm a Situation by a comparison to something we knew as the flue.

The discussion on were to take base to comprehend the magnitude of this pandemic, the comparison with the annual flue is here in Germany and likewise in other European Countries is out of the discussion. It is simply incomparable on the fact that, yes, there are annually high numbers of death to be mourned on the flu, but there are well working therapies for Influenza Type A and B. If we would not have those therapies, the deaths claimed by the flu would be exponentially higher and close, if not above the Spanish flu. There are treatments to the flue. Every year health organizations call early in the year to get your shot for flu immunization bevor the flu season starts. In short, we have flu under control. With Convid-19, as to the present day the only protective measure we can take is heighten personal hygienic standards and social distancing. There is no therapy yet!

The point is, national health systems are not fit for a pandemic of this magnitude, pressing down the number of infects by any means necessary, will put us all in the situation to deal with the virus infection on al level to preventing a situation causing the total collapse of the health system, until a proven vaccine is developed. Until than we only can take sharp measures to stretch the numbers of infections over a longer period. That really is the only chance we have today to keep the death numbers down and not have to resort on triage.

In addition, the flue incubation period takes 1-3 Days. Convid-19 incubation period is 10-14 Days. This alone makes it extremely easy to infect undetected on a far higher pace than any other virus infection we have dealt with by today.

This may go on worldwide for a longer period well into 2021, as the pandemic goes in waves. China > Europe > North and South America > Afrika > Russia and the Indian Subcontinent.

Personally, I went through two bacteriological pneumonias and a lung embolus and in combination of my age over 60 this makes me a high-risk person, even a heavy flue can pose a dangerous, yet manageable situation. I am doing fine and well and don’t panic about it at all, but this also means if I get infected my survival chance today is at 10% at the best. Probably I can push it up to 50% after I have received my pneumococcal vaccination this week.

Still enjoy cooking and dining.

Folks…, keep up the spirit!! May be now is the best time to do all the home projects you have planned, but never had time for because of your social engagement.

Walt_1143069

Two seconds of research or sane thinking would have revealed his original message was unethical at best. No need to defend him. It's nice he came to his senses, an apology would go even further. His advice was had deadly consequences. Not the time to be glib.

Walt_1143069

That lengthy email he sent encouraging people to go to restaurants in SEATTLE of all places, was not just a quick thought. It was a foolish and uninformed one.

montebello1964

Sorry, but fundamentally, this is NOT equivalent to the seasonal flu in any way (it is effectively more infective because asymptomatic carriers can transmit, and its most severe symptoms can affect a higher proportion of younger people than the flu, and there are no available prophylactic or therapeutic treatments other than supportive care).

But more important than the still emerging epidemiology, misguided comparisons to the flu give readers a feeling that everything is OK, since for most people the flu season is something that they barely notice (and are always surprised to hear causes so many deaths).

Fortunately, yesterday evening Massachusetts' Governor Baker instituted some of the most restrictive controls in the nation, shutting down all schools, banning gatherings >25 people whether public or private, and shutting down all bars and restaurants except for delivery. That is not an excessive response in my humble opinion.

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