Reshaping an Outbreak

Dr. Carl Abraham Commentary

Reshaping an Outbreak

Earlier this week, I had a conversation with a health care worker who didn't understand all of the fuss. He pointed out that most people infected with COVID-19 were just going to have a mild cold, which is true. Why were schools closing, events canceled, and communities quarantined? Why all the media coverage?

His point of view is understandable. Are the inconvenience, anxiety, and changes required of us justified? They are. This is not just a common cold or the flu. Why is COVID-19 different?

This is an Opinion

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COVID-19 is an illness caused by a virus, a coronavirus, related to other coronaviruses that cause approximately one third of cases of the common cold. Unlike the common cold, this new coronavirus can cause serious and life-threatening illness as did the SARS coronavirus in 2003 and the MERS coronavirus in 2012.

COVID-19 appears to be also different from those coronaviruses in that it is more contagious from person to person. A person infected with COVID-19 will infect at least two or three other people. Doesn't sound like much? Experts predict that 60-80% of the world population will be infected by the end of the year.

COVID-19 is often compared to influenza (the flu), which kills about 0.1% of those infected. In contrast, COVID-19 kills about 1% of those infected, 10 times that of influenza. But that is not the whole story. If you are 60-69 years of age, the mortality rate is 3.6%. From 70-79-years-old, it is 8%. For those over 80, the mortality rate is somewhere between 15-20%; that is 15-20 deaths out of 100 people infected, 40 times that of influenza.

This does not take into account the number of those infected that require hospitalization, including admission to the intensive care unit and mechanical ventilation, which may be as high as 10-15%. And being young and strong does not guarantee that you will not have severe, life-threatening illness.

What this amounts to is the potential for the health care system (physician's offices, urgent care facilities, ambulances and other first responders, hospitals, pharmacies, etc.), both regionally and nationally, to be overwhelmed while trying to care for those extremely ill and dying people. Sounds like a zombie apocalypse? Here’s some perspective. An unnamed Italian physician told Newsweek, regarding the struggle keep up with the demand and the devastating consumption of healthcare resources caused by the COVID-19 outbreak:

"Doctors are having to choose between intubating a 40-year-old with two kids, a 40-year-old who is fit and healthy with no comorbidities, and a 60-year-old with high blood pressure, because they don't have enough beds. In the hallway, meanwhile, there are another 15 people waiting who are already hardly breathing and need oxygen. The army is trying to bring some of them to other regions with helicopters, but it not enough. The flow is just too much; too many people are getting sick at the same time."

There are other consequences when health care systems cannot deal with the load. As health care workers are at high risk of being exposed and becoming ill, there may be physician, nurse and emergency responder shortages. Routine or elective office visits or surgeries would be postponed. Routine medications may be in short supply. And those seeking emergency care may experience life-threatening delays. All of these occurred in China and are now occurring in Italy. The results are tragic.

What can I do?

A lot. You  I'm pointing at you  can actually affect the outcome of this epidemic. If we can slow the number of people who become infected, not only will we reduce the numbers of those ill and of those who die or require hospitalization, we can potentially limit the demand on health care resources so that people who need hospitalization and intensive unit care can receive that care without overwhelming the health care system. Here's what you can do: Don't get infected.

COVID-19 spreads from person to person via droplets produced by coughing or sneezing and when a person's contaminated hands touch their face. You can decrease your risk of being infected by following these recommendations:

► Avoid people who are sick. Wash your hands with soap and water for at least 20 seconds frequently, and especially if you think you have touched something that may be contaminated. An alternative to soap and water is hand sanitizer with at least a 60% alcohol base. Cough or sneeze into a tissue that you throw into the garbage right away and then wash your hands.

► Stop touching your face! This one is really difficult and takes practice, but very important. It is so important that you should point out this behavior in others so that they can also stop. Stop shaking hands.

► Clean and disinfectant surfaces that may be contaminated, using a solution of at least 60% alcohol or another disinfectant that the CDC has listed as active against coronaviruses. Avoid large gatherings.

► If you are an employer or supervisor, make it clear that employees who are ill should stay home — and enforce it!

► Stock up on about two weeks worth of water, food staples, toiletries and cold and flu remedies. Make sure your prescription medications are up to date, that you are not about to run out of refills, and if possible, have an extra month's supply at home.

► Postpone non-emergent visits to physician offices, hospitals, nursing homes and other health care facilities. Postpone nonessential travel.

► If you are exposed to someone with known COVID-19 infection, contact the Health Department immediately so that they can monitor you for symptoms and instruct you further on how to keep yourself and others safe. 

Lastly, in the words of Dr. Anthony Fauci, director of the National Institute of Allergy and Disease: "If you're a person with an underlying condition and you are particularly an elderly person with an underlying condition, you need to think twice about getting on a plane, on a long trip. And not only think twice, just don't get on a cruise ship."

In the context of this outbreak, our goal as a society is to protect and to save lives, possibly yours or a loved one's. You can make a difference. As recently reported by the New York Times, efforts such as those described here can have a profound effect to reshape the evolution and reduce the impact of this epidemic.

So take the outbreak seriously, but don't panic. Despite the opinions, myths and misinformation that are amplified by the news and social media, there are reliable sources: the Centers for Disease Control, scientists, local health departments and health care systems. I suggest we stop listening to everyone else and get down to the work of controlling our future. 

Dr. Carl Abraham is an assistant professor of clinical medicine at New York Institute of Technology College of Osteopathic Medicine at Arkansas State University. Abraham trained and has practiced as an infectious disease specialist for more than 20 years.

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