Here’s What We Don’t Know 

I resisted writing about the new strain of coronavirus, COVID-19, because it’s either that or politics at the moment, and wouldn’t it be nice to read about something – anything – else?! But the COVID-19 landscape is rapidly evolving, and it feels untrue to the core of my doctor-self to not address the flurry of texts I have received. Besides, dealing with this particular virus feels a whole lot like parenting: it’s easy to lose your bearings on what are appropriate reactions, particularly while in the thick of it. 

So I am going to do what I did a few newsletters ago, just after the virus made its debut in China: I am going to give you a snapshot of the current situation. The big difference? This time I’ll frame it as what we don’t know, because that might be the most important piece of the story. At least the most honest. Our lacking info sits at the heart of current confusion, so identifying it and unpacking it may be the best use of our energy at the moment. 

·         We don’t know precisely how many people have COVID-19 currently. Experts estimate that an infected person will pass the virus to 3 or 4 other individuals. But given limited availability of testing, we don’t actually know who has the virus in the first place. There are likely many completely asymptomatic people walking around who neither look nor feel sick. And there are people sick with other illnesses who may – or may not – have COVID-19. One thing is for sure: as lab tests become increasingly available this week, many more folks will be tested... and some of these tests will come back positive. This is going to create its own form of predictable confusion, because it won’t be clear whether the disease is spreading rapidly or whether it is just being diagnosed in people who have had it for a little while. But that said, the CDC is working hard to keep an accurate tally. Check out this link for numbers updated at noon daily or this one from John’s Hopkins, currently considered the best moment-to-moment data resource. Take a look at this article about a Biogen leadership conference in Boston to see one example of how COVID-19 spreads.

·         We don’t know COVID-19’s death rate. That’s a really important fact, too. Last week, the World Health Organization (WHO) issued a statement that the best estimate of the COVID-19 death rate is 3.4%, which is extremely high. By comparison, the death rate for influenza is 0.1%. But the 3.4% death rate is calculated based upon the number of known cases of corona virus, which, as explained in the bullet above, is itself a very fuzzy number. The death rate also requires that we know how many people have died of corona virus, and while we have a better sense of this figure, it too is still fuzzy because not all cases were tested pre- or even post-mortem. Case-in-point: two people in the Seattle long term care facility at the epicenter of that state’s outbreak died several days before their deaths were attributed to coronavirus, and if there hadn’t been other deaths in the same facility presumably no one ever would have tested the bodies.  

·         We don’t know if you should cancel your spring break trip. Unless you are traveling to a level 3 country, that is, which means a country that has enough COVID-19 spreading around at the moment that you’ll have to self-quarantine for 14 days after returning home… if you can get home. So I would cancel those plans. The currently list of level 3 countries is on four long: China, Iran, South Korea, and Italy, but undoubtedly this will change in the days and weeks to come. I’ll add that many of the texts and emails I have received ask about other countries in western Europe and also Mexico. My answer has been that right now no one knows if return travel will remain an option, so if you really want to go hang out on that beach, think about bringing 14 extra pairs of underwear. 

·         We don’t know if your kid’s school is going to close. Right now, in most parts of the country, the answer is not likely. That’s partly because kids aren’t getting sick in the same numbers as adults, a fact likely related to all of the other corona viruses that kids get in preschool and the early grade school years – it looks like these recent infections protect them. That said, schools may close if the adults who run them and teach there begin to get sick. They may also close if a parent of a student is infected or just in an effort to minimize spread among large groups of people. Viruses love big groups.  

·         We don’t know if you can get coronavirus through prepared foods, swimming pools, or from your pet, though all of these look pretty unlikely at the moment. The WHO has a great myth-busters resource page, though, worth checking out. Hopefully they will add more info over the days to come. 

·         We don’t know how long you are going to need to wash your hands and wipe down surfaces… but we do know those things work! A study done in the past few weeks looked at how COVID-19 spreads on surfaces. In Singapore, researchers went into quarantine spaces and tested surfaces in the anterooms and bathrooms of three patients living in isolation. Here’s what they found: before anyone did routine cleaning, the virus was identified on basically all surfaces tested, yes, including the toilet. But after cleaning, the virus pretty much disappeared. So cleaning works. And a big PS: samples of the air in these rooms contained no virus.   

If you are looking for some elegant articles invoking bigger-picture thinking, read this one by Bill Gates or this one by my friend and fellow doc Joon Yun. Or read anything by STAT’s Helen Branswell. There are lots of great resources out there, but there are also lots of unfounded theories and swirling fears. Choose where you get your information carefully and above all else, use basic common sense.