The similarities to the influenza virus or flu are important; but more important right now are the differences, and those differences can be stark.
As ‘social distancing’ fast becomes national policy to avert the worst potential ravages of the coronavirus, the Wall Street Journal’s Peggy Noonan makes a good point about the commonplace advice, “Don’t Panic!”, and the much-used qualifier, “out of an abundance of caution.”
Now it’s time to lose the two most famous phrases of the moment. One is “Don’t panic!” The other is “an abundance of caution.”
“Don’t panic” is what nervous, defensive people say when someone warns of coming trouble. They don’t want to hear it, so their message is “Don’t worry like a coward, be blithely unconcerned like a brave person.”
One way or another we’ve heard it a lot from administration people.
This is how I’ve experienced it:
“Captain, that appears to be an iceberg.” “Don’t panic, officer, full steam ahead.”
“Admiral, concentrating our entire fleet in one port seems tempting fate.” “We don’t need your alarmist fantasies, ensign.”
“We’re picking up increased chatter about an al Qaeda action.” “Your hand-wringing is duly noted.”
“Don’t panic,” in the current atmosphere, is a way of shutting up people who are using their imaginations as a protective tool. It’s an implication of cowardice by cowards.
As for “abundance of caution,” at this point, in a world-wide crisis, the cautions we must take aren’t abundant, they’re reasonable and realistic.
Reason and realism are good.
Point well made and point well taken, Ms. Noonan. I should, therefore, offer up my own mea culpa.
In Obesity Is a Much More Dangerous Public Health Problem Than the Coronavirus (March 10), I wrongly downplayed the risk of the coronavirus and criticized the resultant “public panic (or at least [the] media panic).”
I was not entirely wrong. For the vast majority of us, obesity is a much more dangerous public health problem than the coronavirus.
And the media does have a tendency to sensationalize and distort public health problems—especially, when these problems (or at least the tardy and weak response to these problems) can be attributed to President Trump and his administration.
However, as I made clear in my last piece, Social Distancing’ Will Stop the Coronavirus and Save Lives (March 13), the risk posed by COVID-19 is very real, albeit much less real to any one of us than to the healthcare system in general.
Case in point: Italy’s healthcare system, which is being overwhelmed by the sheer volume of COVID-19-infected patients who require care.
Similarly, in The Coronavirus Is a Public Health Problem, But It Is Not a Death Sentence (Feb. 29), I compared the coronavirus to the influenza virus or flu, and noted that “despite the surprisingly high number of flu-induced deaths or fatalities, there is no widespread fear or panic over the influenza virus.”
Influenza v. Coronavirus. Again, this is true, but it misses the point: While the coronavirus and influenza virus are similar, there are important differences—differences that legitimately can and should cause much greater public concern over the coronavirus.
The most significant differences appear to be the fatality rate and the incidence of severe and complicating illness.
The fatality rate for both the coronavirus and flu are low; however, the fatality rate for the coronavirus is significantly higher, and not just for the elderly, but for younger age groups as well. Ditto the incidence of severe and complicating illness.
Tomas Puyeo, who has done an extensive analysis of the coronavirus, says “countries that are prepared” will see a fatality rate of roughly .5 percent (South Korea) to roughly .9 percent (mainland China excluding Wuhan, where the virus originated).
“Countries that are overwhelmed” by the virus (Italy, for instance) will have a fatality rate of between three percent and five percent, roughly, he notes.
Scott Gottlieb, a medical doctor and former head of the Food and Drug Administration (FDA) in the Trump administration, appears to concur with this estimate.
Here in the United States, Gottlieb told CBS News’ Face the Nation, “the fatality rate [from the coronavirus] might not reach one percent,” but it’s also not gonna be as low as we routinely see for the seasonal flu (.1 percent) or a mild flu outbreak (.05 percent).
While these obviously are small percentages either way, the differences are significant—and they can have large and dramatic effects on our healthcare system, especially when dealing with a U.S. population of more than 327 million people. One percent, of course, is 10 times .1 percent.
Severity. Which means that the fatality rate for the coronavirus could be 10 times what we see for the flu.
“And it’s not just older Americans, as tragic as that is,” says Gottlieb. “If you look at 40-year-olds, the case fatality rate has been anywhere between .2 and .4 percent. So that means as many as one in 250 forty- to fifty-year-olds who get this [virus] could die from it.”
Moreover, as Julie McMurry, MPH, observes at FlattenTheCurve:
Mortality is not the full picture: Italy reports that 10% of cases need not just hospitalization but also ICU care—and they need that care over a period of 3-6 weeks. This is unsustainable.
Even if these figures are inflated because they reflect the experience of other countries with less capable and less advance healthcare systems, the fact remains that, as National Public Radio’s Fran Kritz and Pien Huang report, relying upon data from the World Health Organization and China:
[For] about 1 in 5 patients, the infection gets worse. About 14 percent of cases can develop into severe disease, where patients may need supplemental oxygen.
And 6 percent of cases become critical and may experience septic shock—a significant drop in blood pressure that can lead to stroke, heart or respiratory failure, failure of other organs or death.
“The bad news is the other 20 percent get the illness severe enough to require hospitalization,” reports NBC News’ Elizabeth Chuck.
These patients may not be reflected in the mortality rates for the coronavirus. However, their condition is quite serious and imposes a real burden on the healthcare system.
And that is the point. If too many people contract the coronavirus too quickly and it spreads too rapidly, we risk overwhelming our healthcare system such that it cannot cope with the volume of patients who require care.
We then could be in the unenviable position of northern Italy—which, as I have reported, is now forced to ration care and make heart-wrenching decisions about whom to treat and whom to let die.
Acknowledging Error. I offer up this mea culpa because, as I’ve explained, my intent here at ResCon1 is to pursue the truth regardless of the consequences. That means acknowledging my own errors in reporting and analysis, even as I criticize others for theirs.
As a classical (19th Century) liberal or modern-day (20th Century) conservative, I believe that truth is best served by a free and unfettered marketplace of ideas, where open competition and public scrutiny enhance knowledge and understanding.
Indeed, none of us has—none of us can have—a monopoly on the truth. And this is especially true when it concerns a rapidly unfolding story about a new and challenging topic such as the coronavirus.
For this reason, we must acknowledge our mistakes and strive to do better. It is in that spirit, that I readily acknowledge my own mistakes and misperceptions.
Feature photo credit: Peggy Noonan as shown in the Wall Street Journal.