Corona Virus Pandemic; a Review and Perspective

May 1^st is a traditional spring holiday in many European countries. This year’s May 1^st is different than any in my memory because the corona virus pandemic is in the minds of most people in the world. (Photo of Porto Rafti, Greece)  

Since its beginning in December 2019, in Wuhan city in Hubei province of China, nearly 3,450,000 cases and 250,000 deaths due to Corona virus have been reported in 210 countries.  During this period, confirmed cases in select countries, are as listed in round numbers; U.S. 1,100,000, Spain 250,000, Italy 210,000, UK 180,000, France 170,000, Germany 165,000, China 84,000, Netherlands 40,000, Sweden 22,000, Ireland 21,000, Austria 16,000, Japan 14,300, S. Korea 10,800, Greece 2,600, and Taiwan 432.(Wuhan and Yangtze river) 

During the same time the deaths per million of inhabitants in the above-mentioned countries are: Spain 532, Italy 467, UK 409, France 364, Holland 267, Sweden 260, Ireland 240, USA 194, Germany 80, Austria 41, Greece 14, S. Korea 5 and Japan 3 and Taiwan 0.3.  Interestingly, while China enacted strict quarantine of the 60 million inhabitants of the Hubei province, Japan let individuals and businesses continue as in pre Covid-19 period but instituted lockdown when the cases spiked.  S. Korea instituted extensive testing early and reported no new cases as of yesterday.  Sweden also allowed its citizens continue their lives and businesses as in the pre Covid-19 epoch with minor exceptions such as not permiting gatherings of more than 50 people.  The vast majority of the remaining countries enacted lockdown schemes of different severity.  

There is no doubt that the total number of individuals infected maybe 10 times higher to the reported due to the large number of asymptomatic patients and also because the tests have a false negative rate as high as 30%.  Mortality statistics from France show deaths 30% in excess of normal levels, over the same time period.  

The Covid-19 shutdowns and lockdowns have been based on the premise that the disease would kill 240,000 million Americans or up to 2 million as the Imperial College of London predicted.  Some models predicted death rates as high as 1-3% while the World Health Organization (WHO) estimated a death rate as high as 3.4%. 

Thee newer studies though refute these dire predictions.  The study from Stanford University tested 3,300 individuals for presence of antibodies in their blood that would show if they had previously been infected with the novel coronavirus.

The researchers found that between 2.5% and 4.2% of individuals tested had antibodies against the virus. That translated into 50 to 85 times higher number of  infections comparing to the known cases.  This suggests that the large majority of people who are infected by the corona virus remain asymptomatic. The authors also estimated that the death rate due to the Covid-19 is somewhere in the range of 0.12% to 0.2%.

A study from China that was published in BMJ found that 130 of 166 new infections (78%) were asymptomatic.  

A study from New York published in the NEJM examined 215 women entering two hospitals to give birth. Of expectant mothers who tested positive for active infections, 88% were asymptomatic at the time of admission.

If the findings of the three studies are true one may wonder why do we lockdown, if the disease is so widely spread and has infected large number of people worldwide.  

The IHME of the University of Washington projected 82,141 deaths from Corona virus in the U.S. by August 4, 2020. While the CDC estimates that in 2019-2020 season in the U.S. which just ended, there were 39 to 56 million flu cases and 24,000-62,000 deaths.

The more I look at the number of confirmed cases and deaths due to the pandemic the more I realise that certain unique patterns from different countries begin to evolve.  I think we should all learn from the Swedish, S Korean and especially Taiwanese experiences.  The deaths per million of inhabitants in Sweden are 260, in S Korea’s are 5, while Taiwan’s is a mere 0.3 per million.  It is axiomatic that we study how Taiwan’s tamed Covid-19, with sound hygienic practices like wearing masks and/or avoiding congested places, washing our hands and coughing or sneezing into our elbows and the most important early diagnosis of an impeding endemic. If more countries can replicate those, we can achieve death rates as low as that of Taiwan while waiting for a vaccine and/or drugs against the virus to be developed.

Corona virus

Some maybe wondering why I post about the Coronavirus in a blog devoted primarily to traveling.  Because viruses travel along with humans.  The reason they named the novel virus Corona virus is because under electron microscopy it looks like the crown royals wear.  Corona viruses and Rhinoviruses are the etiologic factors of common cold.  Most of the colds in the winter are due to Corona viruses while those in early fall, spring and summer are due to Rhinoviruses.   The novel Corona virus was recently renamed to Covid-19 belongs in the family of viruses that humans and other mammals harbor in our bodies. 

Covid-19 emerged in Hubei province in central China in late December 2019 and subsequently spread in 59 countries around the world.  As of March 6, 2020 at 12:15 UCT/GMT the World Health Organization (WHO) reported 100,242 infections and 3,408 deaths.  China the epicenter of the epidemic has reported 80,559 infections and 3,042 deaths.  South Korea has reported 6,593 cases and 42 deaths while Iran is next with 4,747 cases and 124 deaths and Italy follows with 3,858 cases and 148 deaths. The overall death rate is 3.4% but this is not an accurate estimate as it does not take into account the mild or asymptomatic cases that are not recorded.

Interestingly according to the Centers for Disease Control and Prevention (CDC) there have been 30-40 million million flu cases, and between 15-40,000 deaths in the 2019-2020 flu season in the USA alone, a disease that can be prevented but individuals decide not to get vaccinated to their and other people peril.  

The most common symptoms of Covid-19 infection are fever, headache and coughing as the virus tend to affect the lungs.  

Although it is impossible to avoid completely exposure in an epidemic there are several precautionary measures that people should take such as covering their nose and mouth when sneezing or coughing.

The simplest and most effective measure in the dissemination of the virus is washing hands with soap and water if we believe we’ve touched surfaces contaminated by nasal excretions. 

Wearing masks is a sensible way to prevent exposing others and maybe avoid viral exposure to ourselves.  Other reasonable precautions are avoiding contact with live animals that are known to harbor the virus such as bats, and finally avoiding eating uncooked meat. 

As in every epidemic people should exercise reasonable precautions while in the same time excessive measures should be avoided.  We should remember that similar epidemics have taken place in the past.  The MERS viral epidemic had a mortality rate of 10% while the SARS had a mortality rate of 5%.  The Corona virus mortality is estimated to be between 1-2%.  (Doctor Schnabel of Rome, is coper engraving by Paulus Fürst of a plague doctor in 1656)

Needless to say, that the mortality rate of the above-mentioned epidemics was negligible when is compared with the Plague or Black Death which is estimated to have killed 25 million individuals that represented one third of Europe’s population. The plague may have reduced the world population from an estimated 475 million to 350–375 million in the 14th century. (Image Saint Sebastian interceding to God for the Plague stricken. By Josse Lieferinxe exhibited at The Walter’s Art Gallery, Baltimore, Maryland, USA)