Covid-19 Is Not Routine Influenza. It’s Not Even Influenza.

By

Leonard Zwelling

https://www.wsj.com/articles/network-effects-multiply-a-viral-threat-11583684394?mod=opinion_lead_pos6

         I am being pounded with emails about my latest blogs. Several have been complimentary and I thank the writers. Others have called me an alarmist making the case that the coronavirus emerging from Wuhan and spreading across the globe to Italy, South Korea, Japan, and now to the United States is no different than seasonal flu and unlikely to be more deadly. Really? How do you writers know this? No one else seems to except you and President Trump who is more concerned about how the number of cases will affect his re-election and how the stock market is taking a beating because of corona. The truth is that we don’t know enough yet and thus, decisions to curtail individual freedoms like not paying for business trips and cancelling meetings, will just have to be tolerated until the data are in. Supply chains are being interrupted and daily life is altered. That’s why this is a crisis. And for those of us over 60, it’s doubly so as Dr. Fauci is warning us to stay home, avoid crowds, and be extra vigilant of being around the sick. By way, Dr. Fauci is 79.

         The attached article from The Wall Street Journal on March 9 does a good job of putting the current pandemic into context. And make no mistake about this. It is a pandemic now, spreading all over the globe and killing people as it does. We don’t really know the fatality rate because the inadequate testing, especially in the U.S., makes the denominator of the number infected unknowable. But as Niall Ferguson writes in his op-ed piece, “if as many Americans catch Covid-19 as caught swine flu the death toll could exceed 440,000” which would still be less than the Spanish Flu of 1918.

         I really cannot abide by those people who take a wait and see attitude about the science around this latest corona pandemic. Leaders responsible for the health and well being of thousands cannot gamble and say that they will not take containment and mitigation actions until they have definitive proof that corona is as deadly as influenza. Waiting for proof that this is a bad disease that kills even 2% of its victims is waiting too long. Remember, there is no equivalent of Tamiflu for covid-19. There is no vaccine as there is for the flu. There is no guarantee that coronavirus will have a seasonal dip in prevalence as the weather warms, and finally, there is no herd immunity to this brand new pathogen that may well have emerged from Chinese bats.

         Yes, it is true that the Internet and 24-hour cable TV are making this seem worse. None of them were around in 1918. But the fact that in 1918, the health commissioner of St. Louis took actions to protect his city while the health commissioner of Philadelphia didn’t and St. Louis fared way better is all the proof I need that the kinds of efforts being made at MD Anderson in trying to curtail travel and track those who get onto planes and return is good judgment. Expect screening at the doors soon.

I am really sorry that this offends the sensibilities of some because it infringes on civil rights. Public health does that. Measles shots, polio shots, and bans on contaminated drinking water all restrict choice. Tough toenails. It seems that some people will not be happy limiting contact among people (small meetings, limited plane flights) until the Black Plague is reproduced. That is just foolishness.

         Of course, there are inadequate data to make informed decisions. That’s the whole point and that’s the whole problem. Maybe if Trump hadn’t gutted the part of the government responsible for planning for pandemics, our response might have been brisker and the CDC would have ten million test kits out already.

         We are a highly mobile society addicted to our freedom. This is a good thing. But when an external threat (from the animal kingdom) invades our space, we may have to forego some freedoms to protect as many as possible. It is frankly infuriating that people do not take this more seriously and write that the reaction of local officials trying to save lives is an over-reaction. No one knows what an over-reaction is, but better an over-reaction than an under-reaction. And it is the local officials and business leaders who have been the stars of the response while the federal government is still trying to find its footing with sufficient numbers of test kits and good information lacking under the leadership of Trump and Pence.

         The United States may see only a few hundred deaths from covid-19. Or it could see a lot more. It is obvious that this has spread quickly, at the speed of air travel, from the west coast to almost all of the states. New Rochelle, New York is on virtual lock-down. Once testing becomes common, it is likely that a widespread infection will be made obvious, the death rate will fall and the case rate will climb. But we don’t know any of that now. Now, leaders have to make assumptions without sufficient information. That’s what leaders do and anyone second-guessing them is truly uninformed, because there are too many known unknowns. There are even unknown unknowns, I suspect.

         Until we know the prevalence of the virus, the incidence of the disease, and thus the actual fatality rate, we must plan for the worst and hope for the best. Dr. Pisters at Anderson is doing just that. My view, as expressed in this blog, is that he is making good calls and making them firmly, with authority. Those who think he’s over-reacting are entitled to their opinion. Fortunately, no one’s welfare depends on the misguided approach of a few.

         My critics are right. There’s no evidence that small meetings, no plane travel, and registering vacations will help. But, as my grandmother might say, it can’t hurt.

Leonard Zwelling