Factual Dispatch #44: You're Probably Not Dying From the Wuhan Coronavirus

The global case count has pushed past 9700. Wuhan, a city of 11 million, is a ghost town. Russia is attempting to close its border with China, the one that’s 2600 miles long. Flights are being canceled, surgical masks are out of stock, racist jokes about bat soup are getting cracked, and people are being treated like lepers from province to province, country to country. Time to call in the big guns.

I’m honored to have consulted Vidya Mahadevan, epidemiologist and public health practitioner who focuses on translating technical documents or data  – be it technology, infectious disease epidemiology, or basic health/hygiene activities – into digestible information for patients, partners, and the general public. While implementing a survey in northwest Liberia, she saw the first Ebola cases that came into the country from Guinea and saw how quickly panic and fear was able to affect experienced health professionals. She later worked in Sierra Leone, managing an Ebola Treatment center, research activities, and community outreach. Currently based in DC, Vidya has worked to improve health programs and the quality of data in 20+ countries across Asia and sub-Saharan Africa. I asked her a handful of questions that can hopefully help convince you to be alert & aware, but not panic.

What is the 2019 Novel Coronavirus (2019-nCoV)? How can I protect myself, especially if I live outside of Asia and am not in immediate danger?

This is one of a group of viruses that can cause respiratory illnesses in humans. SARS is a well known example of a previous coronavirus outbreak; this group of viruses can also cause the common cold. The 2019-nCoV is an airborne, lower-respiratory illness that may also present upper respiratory symptoms (more like a cold). This is a respiratory illness that passes through airborne transmission. Ask yourself: what do you do each flu season? Or when friends/coworkers have a cold or the flu?

Some of you should be doing more (e.g. getting the flu vaccine to protect yourself and/or people around you) and should follow basic infection prevention and control techniques (these can both mitigate your risk of getting illnesses AND prevent you from infecting others if you are). 

Basic precautions include:

1. Wash your hands regularly. 

2. Cough and sneeze into your elbow (instead of the air or onto hands).

3. If you are sick, avoid large crowds and, if possible, work from home (or keep kids from from school/daycare). 

4. Avoid contact with infected (particularly symptomatic individuals).

5. Avoid contact with common/public objects that may have come into contact with sick individuals (e.g. railings in public transit stations).

6. In a particularly high-risk situation consider using an N-95 mask (from a reputable manufacturer). A basic surgical mask can protect you from larger droplets, but will not everything else. (Many in China Wear Them, but Do Masks Block Coronavirus?).

With exception to the last item, all of these are things that you should do during a normal cold/flu season. 

What is a R0? Is it r-zero or r-naught?

R0 represents the average number of people infected by each case [ in a susceptible population]. It is a key measure of an illnesses infectiousness, providing information on the potential for spread. 

If an R0 is >1, a disease will likely continue to spread; if <1, the disease is not likely to have sustained, long-term transmission. 

You can think of spreading a rumor as analogous to “infecting” someone with a disease:

• If you tell 5 people and they each tell 5 people, this will likely spread quickly. 

• If you tell 1 person, they tell another, and so on, this will slowly sustain itself

• If you tell 1 person, they tell another, and then it stops, you have an Rumor R0 that is less than 1 and the rumor will not continue to spread. 

The high/low (and currently, constantly changing) R0 - by itself - does NOT tell us:

1. anything about how quickly this may occur OR 

2. How serious infection or illness actually is… 

Does this mean that most infected individuals will just experience something like the common cold? Or will 10%, 20%, or 50% of the infected experience severe illness and/or death? Based in the data thus far, the mortality, the virus death rate is hovering between 2% and 3%.

This image from Vox provides a good illustration (and may help me explain to friends why Measles scares the $#!^ out of me). 

What the announcement of a Public Health Emergency of International Concern (PHEIC) by WHO mean?

This can be declared to address a public health issue that affects multiple nations and would benefit from a response coordinated across states. This mandates that affected state participate in actions, key among which is daily mandatory reporting of suspect/probable cases, confirmed cases, and deaths. This is a good thing… though there is little to enforce compliance with these regulations (beyond peer pressure). With large outbreak, particularly for anything novel, this incentivizes shared information and a coordinated response (where the information and accompanying actions may otherwise be compartmentalized).

For those of you in the US, this can be thought of as similar to an emergency declaration in order to secure funding and coordinate a coherent response.

How do you approach the numbers coming out of China that some have rejected out of hand?

Writing information off completely is never a good place to start…With a new, previously unknown illness like this, the situation is rapidly changing. There is always a delay in some of the data (as systems are put into place for diagnostics, data collection/analysis, and others). It is likely that the number of cases are being under-reported… but that isn’t abnormal for a respiratory illness with airborne transmission (as we see each year with cold and flu estimates). 

Some discrepancies or delays in data are to be expected and should not be interpreted as malevolent in intent or the basis for conspiracies.

What terms you’ll encounter mean:

SUSPECTED CASE - Someone likely to have been exposed (often with key symptoms). They will either be confirmed as a case or test negative. 

CONFIRMED CASE - Someone who has been tested positive for coronavirus.  Main outcomes are recovery or death.

RECOVERED CASE - A previously confirmed case that no longer tests positive. 

CASE-FATALITY RATE - This refers to the number of deaths that occur among people with the disease. As of Jan 30, the official WHO data reflects a rate of 2.2%. For comparison:

INCUBATION PERIOD - The time between exposure/initial infection and the appearance of symptoms.

INFECTIOUS [PERIOD] - The ability (and corresponding period) when an infected individual can pass, or transmit the disease to others.  Like many respiratory illnesses (including the flu), individuals infected with nCoV can be infectious before symptoms appear.

PERSON TO PERSON TRANSMISSION - the first confirmed case of this isn’t new or surprising… it just happens to be the first time it has happened among the 6 cases in the US. (This is like being surprised when the first flu case of the season happens in your state, and finding out that this person got it from someone else. It’s to be expected.)

What are signs you should start to be worried about this virus? What should I do about the media coverage?

If the mortality rate starts to rise OR if any particularly vulnerable populations begin to emerge (and you or any of your people are among that group). 

For example, some illnesses target children and the elderly; others target young, healthy adults (with a more robust immune response). If you are likely to be exposed and seem particularly vulnerable to severe illness, then it is even more imperative to follow basic IPC precautions.

Step 1. Don't panic. (unless you have a state-of-the-art, sustainable bunker with room for me, take a deep breath to calm down… and then take me with you. I’ll bring the whiskey.)

During previous public health crises that i’ve worked on (e.g. Ebola), scaring health care workers and the general public doesn't help. The only thing that panic and fear-mongering can guarantee: people will lose their heads and be too frantic to follow basic precautions or use information that they already know. Keeping a clear head and staying calm is the first step in any emergent or crisis situation . 

Step 2. Get Informed. 

What does all of the information in the news actually mean? 

Are you at risk? If so, what are you at risk of? (symptoms presenting like a mild cold? Permanent disability? Causing harm to others? Or perhaps missing a few days of work?). 

Take just a little bit of time to see if and how you are affected… and what you can do to actually mitigate your risk (of exposure/infection and adverse outcomes if you do fall ill). Make sure to utilize reliable sources. 

Some of my favorites (I start with these for any crisis and then add others as relevant for each emergency or outbreak):

• The World Health Organization (WHO) produces regular situation reports (aka. sitreps) with key information on a daily or weekly basis (depending on the urgency, scale, and context) for every major outbreak. The nCoV sitreps are currently produced daily and include epidemiologic data, geographic coverage, potential interventions, and other relevant information. 

• ReliefWeb - an information/communications hub managed through the UN Office for the Coordination of Humanitarian Affairs (OCHA). This is a great place to find fact-based maps and visualizations, in addition to reports and sitreps from a number of NGO, UN, and other key stakeholders

Step 3. Take appropriate precautions 

(note the use of the term “appropriate”.) 

Any precautions you take should be evidence-based and related to current risk and exposure. 

(Massive thanks to Vidya for this! Now go wash your hands!)

Why am I spending so much time on getting correct information vs. just listening to the loudest voices out there? Because there’s some terrible shit being spread around. Buzzfeed has a great round-up of the more putrid disinformation campaigns being run, but even independent of the ops, bad stuff is happening:

• The assertion that the coronavirus originated in a Wuhan seafood market is being contested by researchers who are tracking the evolution of symptom reports from December to now, trying to nail down if the virus is mutating. The wild & exotic fish and fowl have also mysteriously disappeared from Chinese food delivery apps.

• The accusations from poorly informed that the virus is a bioweapon is NOT HELPING.

• The racism due to these allegations has gone from gross, to super gross, to other countries airlifting their important nationals out.

• People are clinging to the louder, more panic-inducing voices, and ignoring legitimate public health outlets, shouting them down and accusing them of betraying them to corporate interests.

• There is a non-trivial amount of evidence that China’s censorship units were preventing information from getting out, with journalists now being punished for criticism of how they handled the virus response. We need to understand how much of this is simple ignorant stereotyping of Chinese responses, and how much was actually them messing around in the dark.

• China’s film industry is a significant part of American movie revenues, and it’s gone all the way to zero so far this year because of fear.

• Given China’s Belt & Road Initiative, how is China ensuring that its global logistics network doesn’t become a disease pipeline the next time something like this surfaces?

But are there actually things that are coming out of this crisis we can have hope for? Possibly, take your pick:

• Though the virus might not have come from the wet markets, they have been shuttered for the time being. There has been a significant push to get wet markets banned across China permanently, but this might not be enforceable, nor is it totally viable to totally ban the wildlife trade in some of the more distant provinces.

• More and more institutions are putting out “what you need to know” calls for calm, which can help stem the tide of fear.

• A vaccine for the African Swine Flu has been completed, which will help China’s food markets recover from the massive price shocks and meat shortages it suffered last year.

• Australian scientists have created a synthetic version of the virus to study in the hopes of accelerating vaccine and treatment development.

• PUBG, a popular mobile game, was inundated with new Chinese players who were forced inside during the outbreak.

• Purell has been pretending it is effective at fighting Ebola & Flu, now the Coronavirus, and they’re getting called out hard for it.

Eye-Watering Data Visualization of the Week: Our world from the wet side.

Vaguely Dystopian News of the Week: A New York Times journalist was targeted by the NSO Group’s Pegasus spyware, launched somewhere in Saudi Arabia. This is the same spyware that was used against Jamal Khashoggi before he was killed by Saudi Arabia’s leadership. Also, now that Facebook has named a producer of Fox & Friends, Gretchen Carlson, and Dana Perino, to head Facebook’s video strategy going into the 2020 election, you’ll excuse me for rejecting anything they say about election security, impartiality, and civic duty.

Annoying-But-Correct-Take of the Week: Toxic masculinity in veterans led to more severe PTSD.

“Huh, Interesting” Read of the Week: Steve Rogers, better known as Captain America, came from a very specific time & place in America’s history. Think about that before you pretend he’s been messed with by the SJW-police. Cap was standing up for the huddled masses long before alt-right idiocy made its way onto the scene, and never wavered on punching Nazis.

Royal Sampler

While the Coronavirus has reached Xinjiang, Sarah Topol’s portrait of model Uighur citizens is a painfully necessary reminder in this week’s New York Times Magazine. For more info on Zulhumar’s tribulations, Foreign Policy had her on their First Person podcast last March.

Everyone loved dumping on WeWork, but even with the most insane start-up boondoggle, workers are still hurt. We need to focus on protecting them, not dunking on stupid capitalists, as the stupid capitalists tend to walk away with a golden parachute, while laid off employees get nothing.

The Hustle details how all-you-can-eat buffets are still making money on you, no matter how much damage you think you can do.

It’s probably cheaper to mine for precious metals in electronics waste & sewage than it is to dig it out of the ground.

ProPublica created a stunning/depressing database compiling all of the “credible accused” lists of priests that the Catholic Church has released at the local level.

Cherie Hu looks at the economics of lo-fi hip hop streaming, YouTube, Spotify, and how to put food on your table from making vibes.

Something I definitely need more help with myself, Lifehacker has a great write up of how to set digital boundaries with your friends and family.

An explanation from a professional helicopter pilot explaining how badly Kobe Bryant’s pilot fucked up, is both infuriating and terrifying. 

Dunk of the Week: I think every woman I know has played this game at least once.

One day, things will all be different.

Yours,T