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Getting through COVID – Part I

April 1, 2020

Introduction:  This is Part One of a Two Part blog dealing with my understanding of the COVID crisis, I have tried to dig behind the headlines for information, rather than opinions or sensation. I have included hyperlinks to sources of information and hope that you find the article informative. If you return for Part Two, I will be addressing the economic impact.

Getting through COVID is going to take mindfulness, care and careful consideration for our health and well being, both physical and financial. Everyone has already been impacted by the COVID, like it or not – mostly financially. The health impact of the virus and the risk of death is, as yet, relatively low, when compared to the sheer volume of seasonal flu. The economic implications of the actions taken to contain the spread of the virus will be severe and are likely to be felt for many years to come. There are, however, some things we can do to mitigate both the health and financial implications.

Neither the flu nor COVID are to be taken lightly, both are very serious illnesses with significant consequences for our health and well being. Both viruses have very similar means of transmission, largely through droplets in the air and on surfaces.

COVID: “The virus is thought to spread mainly from person-to-person. Between people who are in close contact with one another (within about 6 feet). Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.” – CDC

The Flu: “People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes.” CDC

A major difference between the two viruses is found in the symptoms themselves, it has been reported that COVID is mostly benign and symptomless. Most people infected with the COVID virus don’t show any symptoms and they feel fine, a significant portion have only mild symptoms. Even when patients are symptomatic the symptoms may not emerge for weeks and the virus can be shed (passed on) for up to 38 days from the time of infection. The flu on the other hand is always symptomatic, it hits all its victims hard and fast within the first few days of infection and the shedding period is shorter – 5-10 days. When someone is coughing and wheezing its less likely you will shake their hand than a person who appears to be perfectly well, it is this insidiousness that makes COVID not only hard to spot but much more contagious. It would be fine if everyone infected by COVID were to remain asymptomatic, but they don’t, a small percentage get very, very sick and some will die while infected (not necessarily from the infection per se.

Each virus has the potential to kill infected patients, and in each case the most at-risk populations are the elderly and infirm. Most often people with underlying heart, lung, kidney or liver problems are likely to face the most severe health risks. The flu has been around for a long time and perhaps we have, in some ways, become complacent to its ravages. Possibly because we have a better understanding of how the flu works its way through the community, and maybe because so many of us have been infected during our lifetimes.

Looking at the data the flu appears to have a broader reach, but the world has never reacted to the flu in the same way as it has COVID, to curtail the spread. The flu is surely one of the deadliest viruses’ humans have encountered with about 50,000,000 people, worldwide, dying from the well reported Spanish flu of 1918. The largest difference between then and now is of course not vaccination but simple hygiene. In 1918 few people had flushable toilets, if they were fortunate enough to have a toilet at all, and even fewer had access to clean running water – much less soap and detergents.

We have experienced unprecedented and economically paralyzing shutdowns around the world as a result of the COVID Pandemic, yet the reaction to the seasonal flu has never been so quick or so assertive. The data set below comes with some interpretive caveats, most notably the depth and breadth of available information on the flu relative to COVID. However, since it has been estimated that more than 50% of COVID cases are asymptomatic they are mostly unreported in healthcare data sets.

Seasonal Flu*COVID
Globally
Annual Infections1,000,000,000785,807
Annual Deaths650,00037,820
COVID
Infections 2019/2041,9817,435
Deaths**3,50089
*Because COVID is new, data sets are still evolving, data is estimated to-date based on recent reports it is a moving target and by the time I have finished writing this article will be quite different again.
**We are not yet at the end of the flu season data, 3,500 deaths are reportedly the annual average – in 2018 the government reported 8,511 flu related deaths in Canada, COVID deaths are expected to increase substantially

Italy has reached the headlines on almost every news delivery channel, whether online or in print. The numbers of infections and deaths were remarkably swift and high relative to other countries. While Italy has been hit hard by COVID it did take extraordinary measures to control social interaction at levels never before seen in that country. When we compare flu and COVID data sets we must be mindful of the differential treatment of each outbreak. The flu infected and killed far more Italians over two flu seasons than COVID has (so far) but again the same social distancing measures were not in force during the flu epidemics, but have mitigated the spread.

*Seasonal FluCOVID
Italy(years 2013/4 and 2016/7)2020
Infections5,000,000101,739
Deaths68,00011,519
*The flu rates are from two recent seasons that were particularly severe, this illustration is not intended to downplay the severity of the COVID virus but rather to underscore the impact of seasonal flu infections

Canadians have been very worried about the COVID virus and have largely overreacted by assuming that every cough or sneeze may be symptomatic. Unfortunately, a fear driven panic has strained important medical resources.

“The National Microbiology Laboratory’s summary of people tested in Canada as of March 29, 2020 10 a.m. EDT Total number of patients tested in Canada 205,097; Total positive 5,658; Total negative 189,626”

In researching the information for this post, I learned, somewhat surprisingly, that adults on average get three (3) colds each year and younger children get ten (10). The common cold can be quite severe for some people, especially those with underlying health conditions. The cold virus can make you feel very ill which is probably a contributing factor to the over-testing that we have engaged in. The media frequently refers to “presumptive cases”, one might “presume” that every sneeze and cough is a COVID symptom, however, that is clearly not the case with about 97.5% of those tested being negative for COVID. The common cold is also a coronavirus, which is really just a description of how the microbes look under a microscope. The COVID is described as a novel coronavirus because it has no known associations with human infection, unlike the common cold, and so because it is novel, having jumped from animals, we have no acquired immunity, yet.

Viral mutations have the public alarmed, but still inadequately informed. A headline in the media that states “COVID-19 Has Mutated” might lead to more concerns, perhaps it has become “bigger, more aggressive and even deadlier that it’s predecessor”. But no, science tells us that mutant RNA tends to weaken more often that it strengthens and, if anything, simply maintains the same or substantially the same characteristics as its precursor. But the media loves sensation and often reports soundbites, endlessly, mindlessly and finds all sorts of twists in their presentation. When you cut to the chase the information probably hasn’t changed but the angle, the spin or projection of the story has.

As with all viral outbreaks the most powerful weapon we have at our disposal is not vaccines, but simple hygiene. The media often reflects on the Spanish flu outbreak of 1918, which killed some 50,000,000 people worldwide. But, the crucial difference between then and now was not vaccinations, it is simply the availability of hygiene, flushing toilets, running water and soap, access to medical care and better-quality nutrition.

At-risk populations, for both viruses, are primarily the elderly and infirm as well as those with underlying health problems, mostly associated with organ weakness or failure. The good news for younger and healthier populations is that regardless of whether you get the flu or COVID you have a much greater chance of surviving it than dying from it, unless you are a member of one of the at-risk populations (organ failure). Nonetheless, it is everyone’s responsibility to practice good hygiene to slow or curb the spread especially amongst at-risk populations. Studies have show that prior to arrival of COVID an alarming 62% of men and 40% of women do not wash their hands after using the toilet.

Summary:

COVID is dangerous mostly because of its insidious nature, it can best be abated by the continued practices of social distancing and good hygiene. The same holds true for the flu, with hygiene proving to be even more important than vaccination. According to a Cochrane Review about 2% of the general population will get the flu each season, based on attendance at a medical facility. Of course, many more people get the flu but stay home and treat themselves (practicing self-imposed physical distancing) having only milder symptoms. The number reduces to 1% among vaccinated populations that statistic can be looked at in several different ways, vaccine manufacturers might say there is a 100% difference between 1% and 2%, while young health adults would view it as reducing the chances of getting by a mere 1% dropping from a 98% of not getting it to a 99% chance.

Then of course the data itself is flawed because people who have been vaccinated would be much less likely to report having flu symptoms than people who were not vaccinated. In any event it is, and should continue to be, a choice whether or not to be vaccinated. Wash your hands after interacting with other people, whether making direct contact as in shaking hands or just sharing documents in the office. In all likelihood you already, instinctively, distance yourself from people showing flu symptoms, extend the practice to people who don’t wash their hands or disinfect tables, and other shared items, avoid crowds when you can. We live in a changing world, frequent and easy access to travel hasten the spread of viral infections – stay home, conduct more business by phone or virtually with online meetings. But most importantly breath, this too will pass, and most people will still be here when it does – stay healthy!

COVID has impacted all of our lives, whether or not we, or anyone we know, have contracted the virus. The government, to its credit, has responded relatively quickly to implement measures intended to contain the spread of the virus. Of course, there is justifiable criticism for the earlier handling by not reacting quickly enough to close the borders and quarantine travellers from infected areas as well as calling people xenophobic and racist. But, while the government’s efforts to contain and control the spread of the virus have generally been laudable the same may not be said for its response to the economic fallout. More of that in the second part of this two-part blog.