By Jason Beans- Rising Medical Solutions.
With all the fear and doom and gloom out there, I think it is important to share the data and any positive news.
It is important to keep in mind, that as of the writing of this article, the average age of those that have died (in Italy, US, worldwide, etc.) is 81 years old. No children under 9 have died (unlike the flu). Just like any virus, this impacts those with weakened immune systems the most. I have multiple friends undergoing cancer treatment, friends with immune disorders, and elderly family and friends. These are the people we are trying to protect.
Let's start with this isolation period and its purpose. I will get into this later, but I COVID-19 is not especially dangerous based on the data I analyze. What is unusual is 1) it can have up to a 14 day gestation period before systems appear. 2) sickness lasts longer than a typical flu 3) most importantly, it seems to be more contagious than the flu (spreads faster). These 3 factors are why the social distancing is critical at this time.
Having a person be contagious a long time before showing symptoms just means the virus can spread more. By the time a person finds out they are a carrier, the virus has spread far beyond that person. A 14 day period of slowing down the hidden spread with reduced social contact is a reasonable step. By the end of 14 days, in theory, every person who has a severe case will be known and will show symptoms. Those households can continue isolation and treatment, and the majority of people will know they are ok to resume life. I say in theory because it will not be perfect (it will still spread), but it will let the data catch up more closely with the reality. With any virus, our numbers and data always trail the reality.
The longer recovery time is important because it means the average extremely sick person will use more medical resources (bed, respirator, oxygen, etc.) than a typical flu case. From what I have read, the symptoms of COVID-19 for those people in the top 20% of severity can last 2 weeks or more. This is longer than the normal flu timeframe (all of us and our ancestors have had the flu so we have some innate ability to fight it). This means for the immunocompromised (elderly, sick), they could need medical attention for longer, using up limited hospital space for that timeframe. Those are beds others could need but they will not be available.
The final and most important factor is how contagious COV19-19 is as a virus. The measure scientists use to determine how easily a virus spreads is known as the "basic reproduction number," or R0 (pronounced R-nought). This is an estimate of the average number of people who catch the virus from a single infected person. The flu has an R0 value of about 1.3.
Researchers are still working to determine the R0 for COVID-19. Preliminary studies have estimated an R0 value for the new coronavirus to be between 2 and 3 according to the JAMA review study published Feb. 28 (1.4 - 3.5 in various other studies). This means each infected person has spread the virus to an average of 2 to 3 people vs. 1.3 for the flu. It's important to remember that R0 will not be a constant number. Estimates can vary by location, depending on such factors as how often people come into contact with each other (ex. China is densely populated), the weather and temperature, the efforts taken to reduce viral spread, plus the spread of COVID-19 will naturally slow down as more people in an area have had the virus and developed immunity.
Why is the R0 factor so important? Let's take a flu and have it spread at 1.3 people per sick person through 10 transmissions (each starting point would produce 1.3 to the 10th power or 13.8 total patients). Now let's assume COVID-19 spreads at double the R0 rate at 2.6 (2.6 to the 10th power is 14,116.7 patients). The higher R0 will spread exponentially faster. This will send the high risk patients to the hospital all at once, meaning many will not get the care they need, increasing the mortality rate unnecessarily. It can also mean the hospital staff can get sick in rapid sequence, compounding issues of the increased patient load with a corresponding decrease in medical capacity and quality. This appears to be the main risk and issue where it has gotten bad.
By slowing down the virus, we are slowing down natural immunity from being created (and the corresponding decrease in the R0 level) and actually dragging out the viral outbreak, but we are allowing our healthcare system to take care of those in need over a longer time in a sustainable manner.
I mentioned that I do not see COVID-19 as especially deadly, which will contradict much of what the news and even medical sources spread. I have heard as high as a 3.6% death rate vs. 0.01% for the flu. My calculations were showing around a 0.7% rate, which is still much higher than the flu. Something didn't make sense to me given the fact WAY WAY more people have died from the flu this year than COVID-19 and the people dying of COVID-19 were older on average (and no kids). This would indicate a LESS deadly virus. Then I realized the issue. COVID-19 rates are being calculated on actual people dying divided by actual people tested. We know tons of people have had COVID-19 without getting tested (we have a severe lack of tests worldwide). We also know that China has skewed the numbers (original location, high smoking population, late response, huge population) with a higher death rate than the world has seen recently. Still, none of the reports or numbers I read ever used ESTIMATED total COVID-19 cases in the denominator of that equation. The .01% flu number presented is actual deaths divided by ESTIMATED people that had it. The denominator is not JUST the people that tested positive. If I look at this year’s numbers, and divide the actual people that died of the flu by the people that actually tested positive in the US, the death rate of the flu would be 10% (22K deaths divided by 222,552 tested positive at time I found the data)! That would make COVID-19 about 1/3 as deadly as the flu. I am not saying this is the case. I don't think we have enough tests and time to know where COVID-19 will land. I just think the data points to the rapid spread of COVID-19 being the main issue, not the severity of the illness itself.
Now some really good news. A study released March 16th showed that treating COVID-19 with chloroquine is an effective antiviral therapeutic treatment against Coronavirus Disease. The virus was gone within 6 days when treating with chloroquine. Some HIV medicines and other malaria drugs are showing similar results. This is based on data from South Korea, which has been one of the most effective countries at treating COVID-19, and China, who has had the most time and cases. South Korea showed great results with oxygen therapy and just basic anti-oxidants and minerals (vitamin C, zinc - basically everything in Airborne) also. This is no different than any other virus. Protect your immune systems.
Below are the South Korean guidelines:
According to the Korea Biomedical Review, the South Korean COVID-19 Central Clinical Task Force guidelines are as follows:
If patients are young, healthy, and have mild symptoms without underlying conditions, doctors can observe them without antiviral treatment; If more than 10 days have passed since the onset of the illness and the symptoms are mild, physicians do not have to start an antiviral medication; However, if patients are old or have underlying conditions with serious symptoms, physicians should consider an antiviral treatment. If they decide to use the antiviral therapy, they should start the administration as soon as possible: chloroquine 500mg orally per day. As chloroquine is not available in Korea, doctors could consider hydroxychloroquine 400mg orally per day (Hydroxychloroquine is an analog of chloroquine used against malaria, autoimmune disorders, etc. It is widely available as well). The treatment is suitable for 7 - 10 days, which can be shortened or extended depending on clinical progress. Notably, the guidelines mention other antivirals as further lines of defense, including anti-HIV drugs. There is a light at the end of the tunnel. Hopefully this news will get out in the media and government and the hysteria can start to subside. Remember summer is coming and viruses tend to hate sun and heat. This will also slow the spread down naturally, which combined with the natural immunity building in the population, should make this a regular old virus on a go forward basis sometime in the near future. Most of us will (or have gotten it), and it will not be a big deal. Just be careful with your immunocompromised loved ones. There really is little to fear but fear itself for the majority of us.
Stay safe and stay strong!
ABOUT THE AUTHOR
Mr. Beans is a recognized expert in the field of healthcare management and medical cost containment and has extensive experience in entrepreneurship, technological innovation, organizational culture, and talent management. He is a frequent speaker at industry conferences and regularly featured in the business media for his knowledge and expert opinions on workers’ compensation, consumer-driven healthcare delivery, medical cost containment, state medical fee schedules and Medicare Set Aside administration. Mr. Beans is the President and CEO of Rising Medical Solutions, a business that he founded in 1999 to protect the financial wellbeing of the U.S. healthcare system through the application of proprietary technology that cuts medical fraud, waste and duplicate billings. Rising delivers “stakeholder first” (patient, provider, and payer) healthcare solutions nationally to the workers' compensation, group health, liability, auto insurance, and medical tourism markets and has been recognized as an industry leader. Rising has been included for multiple years in Inc. Magazine’s Inc. 5000 list, the Private Company Index top growth companies, and Crain’s Chicago Fast 50 list. Mr. Beans presently serves on the Boards of Transparent Health Network and Texting Base, Inc. He previously served on the Board of Aspen Holdings, a financial holding company whose primary business FirstComp Insurance was one of the fastest growing workers’ compensation carriers prior to its sale to Markel. Mr. Beans also served on the Board of Matrix Healthcare Services, a hyper growth Pharmacy Benefits Management company that was sold to Express Scripts. Mr. Beans graduated from the MIT Entrepreneurial Masters program and holds a Bachelor of Arts in Finance from Boston College. He is an inductee in the Chicago Area Entrepreneurship Hall of Fame, an adjunct professor at the University of Florida and a jujitsu black belt martial arts instructor.