COVID-19 is NOT like the FLU#
|1) Mortality is about 10 to 20 times higher.||CFR 1.7% - 4%||CFR 0.1% - 0.2%|
|2) Serious and critical cases are more than 10 times as frequent.||15% - 20% serious 5% ICU||1.5% hospitalised|
|3) Multiple times as many people may get infected.||40% to 80% of world population (estimate)||5% - 20% of population (actual)|
|4) One person will infect up to 3 times as many others.||R0 = 2.0 - 4.0||R0 = 1.3|
|5) Without lockdowns it multiplies more than twice as fast; exponential.||ca. 3 days doubling-time||ca. 7 days doubling-time|
|6) Infectious weeks before symptoms show - Incubation||2 - 14 days. (outliers 27 days, average 5.5 days)||2 days. (infectious 1 day before symptoms)|
|7) It can be transmitted through air more than 2 - 3 meters.||possible aerosolized transmission ('airborne' virus)||aerosolized transmission ('airborne' virus)|
|8) It can be transmitted via hard surfaces for more than a week.||survives 9 days on hard surfaces||survives 1 day on surfaces|
|9) People are infectious more than twice as long.||infectious for 2 to 4 weeks||infectious for about a week|
|10) Frequently doctors and nurses die.||thousands got infected, some died||minimal known cases|
|11) Multiple reports of recurrence after ‘cured’.||14% tested positive again after being released (one report)||immediate recurrence is rare|
|12) ER and ICU’s get overloaded||frequent||rare|
Presidents downplaying COVID-19 by comparing it with the Flu#
- President Andrés Manuel López Obrador appeared to downplay the seriousness of the COVID-19 virus, saying “it isn't even equivalent to flu." Mexico confirms first 2 cases of coronavirus - ABC News (Feb 28, 2020).
- Trump: "You want to treat this like you treat the flu."... "This is like the flu"... (Press Conference Feb. 27) Gupta: "about fatality rate, the flu has 0.1%, COVID-19 CFR is 2% to 3%" - Trump: "We do not know and the flu is higher... the flu is much higher than that..." Sanjay Gupta fact-checks Trump's coronavirus claims - YouTube (Feb 27, 2020).
- Influenza (Flu) | CDC
- Facts and Statistics About the Flu (November 19, 2018).
- Coronavirus Disease 2019 (COVID-19) | CDC
- Coronavirus Update - COVID-19 Wuhan China Virus Outbreak - Worldometer (updated daily).
- The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China CDC, 2020 (Feb 17, 2020)
Mortality & Case Fatality Rate - must read: How to calculate the mortality rate during an outbreak . - As of 20 February, 2114 of the 55,924 laboratory confirmed cases have died - crude fatality ratio 3.8% [CFR 2] Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) (Feb 28, 2020).
The ≥80 age group had the highest case fatality rate of all age groups at 14.8%. Case fatality rate for males was 2.8% and for females was 1.7%. By occupation, patients who reported being retirees had the highest case fatality rate at 5.1%, and patients in Hubei Province had a >7-fold higher case fatality rate at 2.9% compared to patients in other provinces (0.4%). While patients who reported no comorbid conditions had a case fatality rate of 0.9%, patients with comorbid conditions had much higher rates—10.5% for those with cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for hypertension, and 5.6% for cancer. Case fatality rate was also very high for cases categorized as critical at 49.0%. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China CDC, 2020 (Feb 17, 2020). sCFR = 2.6% (1.7% - 4.0%) - see chart at botttom of this page (Gabriel Matthew Leung, Dean of the Faculty of Medicine of the University of Hong Kong. Leung concurrently holds the Chair of Public Health Medicine at HKU.) Covid-19 Seminar - Gabriel Leung (Feb 27, 2020). Globally, about 3.4% of reported COVID-19 cases have died. WHO Director-General's opening remarks at the media briefing on COVID-19 (Mar 3, 2020). More references: Coronavirus Mortality Rate (COVID-19) - Worldometer - Sources
- Serious and Critical Cases - see TABLE 2: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China CDC, 2020 (Feb 17, 2020).
Percentage of World population Infected: Harvard epidemiologist Marc Lipsitch told The Wall Street Journal (Feb 16, 2020) that "it's likely we'll see a global pandemic" of coronavirus, with 40 to 70 percent of the world's population likely to be infected this year. "What proportion of those will be symptomatic, I can't give a good number," added Lipsitch, who is the Director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health. Harvard scientist: coronavirus pandemic likely will infect 40-70% of world this year | TheHill (Feb 15, 2020).
Two other experts have recently given similar estimates:
Ira Longini, a biostatistician and adviser to the World Health Organization (WHO), has predicted that two-thirds of the global population may eventually contract COVID-19 (Feb 13, 2020).
The coronavirus epidemic could spread to about two-thirds of the world’s population if it cannot be controlled, according to Hong Kong’s leading public health epidemiologist. ... Prof Gabriel Leung, the chair of public health medicine at Hong Kong University, said the overriding question was to figure out the size and shape of the iceberg. Most experts thought that each person infected would go on to transmit the virus to about 2.5 other people. That gave an “attack rate” of 60-80%. “Sixty per cent of the world’s population is an awfully big number,” Leung told the Guardian in London, en route to an expert meeting at the WHO in Geneva on Tuesday. Coronavirus 'could infect 60% of global population if unchecked' | World news | The Guardian (Feb 11, 2020).
Speed of Spread - R naught: Integrating these estimates and high-resolution real-time human travel and infection data with mathematical models, we estimated that the number of infected individuals during early epidemic double every 2.4 days, and the R0 value is likely to be between 4.7 and 6.6. The Novel Coronavirus, 2019-nCoV, is Highly Contagious and More Infectious Than Initially Estimated | medRxiv (Feb 11, 2020).
Initial: The early outbreak data largely follows the exponential growth. We estimated that the mean R0 ranges from 3.30 to 5.47 associated with 0-fold to 2-fold increase in the reporting rate. With rising report rate, the mean R0 is likely to be below 5 but above 3. - Current: The early outbreak data largely follows the exponential growth. We estimated that the mean R0 ranges from 2.24 to 3.58 associated with 8-fold to 2-fold increase in the reporting rate. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak | bioRxiv (Jan 29, 2020).
- Doubling-Time: COVID-19 epidemic doubling time by Chinese province was increasing from January 20 through February 9, 2020. Yet, the harmonic mean doubling time was relatively short, ranging from 1.4 (Hunan) to 3.0 (Xinjiang) days, with an estimate of 2.5 days for Hubei. Epidemic doubling time of the COVID-19 epidemic by Chinese province | medRxiv (Feb 28, 2020).
- Incubation Period: 2-14 days represents the current official estimated range for the novel coronavirus COVID-19. However, a case with an incubation period of 27 days has been reported by Hubei Province local government on Feb. 22. Coronavirus Incubation Period (COVID-19) - Worldometer - Sources (more references there).
- Aerosolized Transmission: "The aerosol transmission refers to the mixing of the virus with droplets in the air to form aerosols, which can float for long distances and cause infection after inhalation." Novel coronavirus can transmit via aerosol: health authorities - Xinhua | English.news.cn (Feb 19, 2020). - Korean TV: Chinese health authorities admit COVID-19 can be transmitted through aerosol, including sewage (Feb 19, 2020). - "Officials said the coronavirus can be passed on through aerosol transmission if a person was exposed to high concentrations of droplets in the air mixed with the virus in a relatively closed environment for a long time." China: Coronavirus can transmit through aerosol | NHK WORLD-JAPAN News (Feb 19, 2020). "Although routes of transmission have yet to be definitively determined, CDC recommends a cautious approach to interacting with patients under investigation. Ask such patients to wear a face mask as soon as they are identified. Conduct patient evaluation in a private room with the door closed, ideally an airborne infection isolation room, if available. Personnel entering the room should use standard precautions, contact precautions, and airborne precautions, and use eye protection (goggles or a face shield)." Coronavirus in South Korea - Warning - Level 3, Avoid Nonessential Travel - Travel Health Notices | Travelers' Health | CDC (Feb 24, 2020). Also see 'Respiratory Protection' (below).
- Transmission by Touching Hard Surfaces: The evaluated studies, which focus on the pathogens Sars coronavirus and Mers coronavirus, showed, for example, that the viruses can persist on surfaces and remain infectious at room temperature for up to nine days. How long coronaviruses persist on surfaces and how to inactivate them | EurekAlert! Science News (Feb 7, 2020).
- Period of Infectiousness: Those who are sent home as 'cured' after apparently testing negative are still required to self-isolate for another 14 days.
- Doctors and Nurses Die: Peak timing of onset of symptoms among health worker cases occurred on February 1. In the 422 medical facilities serving COVID-19 patients, a total of 3,019 health workers have been infected (1,716 confirmed cases), and 5 have died. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China CDC, 2020 (Feb 17, 2020).
Multiple reports about recurrence or reinfection. - About 14 per cent of patients who recovered from the novel coronavirus and were discharged from hospitals in southern China's Guangdong province were tested positive again in later check-ups, according to the local health authority. A positive test suggests the recovered patients may still carry the virus, adding complexity to efforts to control the outbreak. 14% of recovered coronavirus patients in China's Guangdong tested positive again, East Asia News & Top Stories - The Straits Times (Feb 26, 2020).
Japan is reporting its first case of a person becoming reinfected with the coronavirus after showing signs they had fully recovered, according to Reuters.
Osaka’s prefectural government confirmed Wednesday a woman working as a tour bus guide tested positive for coronavirus for the second time after developing a sore throat and chest pain. The woman, who is said to be in her 40s, first tested positive in late January and was discharged from the hospital on Feb. 1 after showing signs of recovery.
Reuters reports Health Minister Katsunobu Kato said the government would need to monitor the condition of others who were infected and later discharged as health experts investigate testing positive for COVID-19 after an initial recovery. “Once you have the infection, it could remain dormant with minimal symptoms,” Philip Tierno Jr., professor of microbiology and pathology at New York University, told Reuters. “And then you can get an exacerbation if it finds its way into the lungs,” he said. There have been a number of cases of reinfection in China, particularly in Wuhan province where the coronavirus outbreak originated in late December. Japan confirms first case of person re-infected with coronavirus | TheHill (Feb 27, 2020).
According to doctors in the city of Wuhan who asked to remain anonymous: “It’s highly possible to get infected a second time. A few people recovered from the first time by their own immune system, but the meds they use are damaging their heart tissue, and when they get it the second time, the antibody doesn’t help but makes it worse, and they die a sudden death from heart failure.” Chinese doctors say Wuhan coronavirus reinfection even deadlier | Taiwan News (Feb 14, 2020).
- Overloaded ER & ICU’s: Numerous reports about lack of hospital beds from China, Korea and Italy. Two hospitals with thousands of beds built in one week in Wuhan. How China Built Two Coronavirus Hospitals in Just Over a Week - WSJ (Feb 6, 2020). Hospitals having to turn away suspected cases. Hospitals in China Turn Away Other Patients Amid Coronavirus Outbreak | Time (Feb 20, 2020). "Patients waiting for a hospital bed to become available in the city of Daegu are dying in their homes, local medical authorities told the Chosun Ilbo newspaper. More than 1,600 people with the virus have been quarantined in their homes, but at least four have died while waiting for in-patient care." Coronavirus: Doctors collapse from exhaustion as virus spreads through South Korea (Mar 3, 2020). Alarmingly, 10% of Lombardy’s doctors and nurses cannot work because they tested positive for the virus and are in quarantine, the region’s top health official, Giulio Gallera, said Monday. ... Hospitals in hard-hit Lodi and Cremona were so overwhelmed at times last week, with more sick people arriving than could be accepted, that they closed their emergency rooms and new patients were taken elsewhere. “Effectively some of the hospitals in Lombardy are under a stress that is much heavier than what this area can support,” Dr. Massimo Galli, head of infectious disease at Milan’s Sacco Hospital, told Sky TG24. “This epidemic is on a scale that is larger than anyone could have thought, imagined or prevented.” Italy's health system at limit in virus-struck Lombardy - ABC News (Mar 3, 2020).
- Droplets transmission is a form of contact transmission in which respiratory droplets carrying infectious pathogens transmit infection when they travel directly from the respiratory tract of the infectious individual to susceptible mucosal surfaces (nasal mucosa, conjunctivae, and less frequently, the mouth) of a recipient, "generally over short distances, necessitating facial protection." For diseases classified as being transmitted by the droplet route, surgical masks are recommended to protect the mouth and nose. (typically 1 to 2 meters - SARS, Influenza, Mumps)
- Aerosol transmission has been defined as person-to-person transmission of pathogens through the air by means of inhalation of infectious particles. Particles up to 100 μm in size are considered inhalable (inspirable). These aerosolized particles are small enough to be inhaled into the oronasopharynx, with the smaller, respirable size ranges (eg, < 10 μm) penetrating deeper into the trachea and lung. Aerosols may be transmitted whenever an infected person coughs, sneezes, talks, or exhales. Pathogens transmitted by respiratory aerosols can travel short or long range from the source depending on the size and shape of the particles, the initial velocity (eg, cough vs exhalation), and environmental conditions (eg, humidity, airflow). (more than 2 or 3 meters - COVID-19, Influenza)
- Airborne transmission is defined as dissemination of either airborne droplet nuclei or small particles in the respirable size range containing infectious agents that remain infective over time and distance. It states that microorganisms carried in this manner may be dispersed over long distances by air currents and may be inhaled by susceptible individuals who have not had face-to-face contact with (or been in the same room with) the infectious individual. (Tuberculosis, Chickenpox, Measles)
- Surgical masks offer some protection for the mucous membranes of the nose and mouth of the wearer from large droplets and splashes but will not protect against inhalation of aerosols. The filtering efficiency of available masks varies widely; most do not effectively filter small particles from the air, and many studies have demonstrated the poor filter performance of single (or even multiple) surgical masks.�
- Respirators such as N95 filtering facepiece respirators or elastomeric respirators with N95 filters are devices that are tested and certified by NIOSH to provide at least 95% filtration of 0.3-µm particles. A certified respirator filter will have much higher efficiency at particle sizes both smaller and larger than the test size. Therefore, because a respirator filter offers very good protection, the most important aspect of respirator protection is how well it fits and seals to the face.
Respiratory Protection for Healthcare Workers: A Controversy (Apr 28, 2011).
Case Fatality Rate in comparison: Coronavirus vs Influenza#