COVID19 Pandemic: Putting it into Perspective: Incidence and Fatality Rates

Every day it seems there is bad news about how COVID19 is rapidly spreading in the United States. However, is what is reported in mainstream media the real truth about COVID19 or is it a way to sell more print because it’s spun in a negative way. Is the data twisted to make things look worse than they really are?

Many lessons should be learned from the huge amount of evidence that is being produced on this COVID19 pandemic. TrueMD even has a COVID19 tracker at the top of its menu bar to help people follow the disease process better and become informed about it and how to react to the data.

Are we really doing the right thing with all this social distancing and continuing to shut down the economy? Suicide rates, rates of depression, domestic violence and divorce rates are rising rapidly. Divorce rates in Italy have increased 40% over the time of the quarantine. Unemployment rates dove down causing many people to lose their jobs.

Many businesses, especially restaurants, have gone bankrupt due to the shutdown, and many hospitals are about to do the same due to low volumes and low revenues. Are we putting a dent in the spread of the virus to justify all this shutdown and social distancing? The data should help us to evaluate this.

COVID19 Cases are Rising Rapidly but Not Fatality Rates

 

Recently a physician in Florida set it upon himself to organize the data from COVID19 trackers in an understandable graph. As seen below, the incidence of COVID has escalated rapidly over the last few weeks. However, fatality rates have actually been steady or even slightly dropped during that same time. This graph is for Florida but is similar to other areas in the US.

The reasons for the rapid rise recently are many. Firstly, this is the time when those who did protesting a few weeks prior would have started to show symptoms of COVID19. The incubation for COVID19 is about 2-3 weeks before it shows symptoms. Social distancing has been shown to be beneficial and those protestors did not demonstrate adequate social distancing during their marches. They then went to bars and other high population density places and spread the virus further over the ensuing weeks.

In addition, and probably more importantly, the incidence of testing has increased markedly over the last 4 to 6 weeks due to more availability of the tests, paid for by the government and insurance, and faster results of the newer tests. More availability means more tests are going to be performed, especially if somebody or some other entity is paying for it.

It’s also questionable whether the data reflects actual new cases of COVID19 or is it just a reflection of the number of positive tests for COVID. Many people do multiple tests for the virus once they get it to see if they become negative for COVID19, helping them return to work after being quarantined. If these multiple tests per person are included as new cases this would skew the data making it rise even faster.

Are We Really Preventing You from Getting COVID19?

The data over time has been very disappointing regarding whether we are really doing anything to significantly stop the spread of this virus. However, we are probably slowing the rate of spread. News stories are fear mongering people into being so afraid of this virus that many people won’t even venture out of their houses due to this fear. Unfortunately, a study in New York showed that many people who did this still got the virus, demonstrating the infectiousness of the virus.

A recent study demonstrated that the virus may be primarily spread by respiratory droplets.[1] Their graph tells the story that whatever we do and whatever restriction or requirements we do, the virus infectiousness continues to progress. We are not really stopping the progressive increase in COVID 19 cases, as their graph exemplifies below, although it may be slowing it’s spread.

This graph shows that the rising accumulative incidence of COVID is not stopping as is the accumulative incidence of confirmed fatalities from COVID, no matter what we do, whether it’s requiring social distancing or masking. However, if one looks at high population density areas, social distancing has slowed the spread of the virus.

One thing we must realize is that the goal of social distancing was never to prevent the spread of the virus but was to help slow the spread to allow the healthcare system to be able to provide ICU and other health services to patients with the COVID19 virus as they acquired it. Thus, although the graph appears to suggest there was little help from social distancing, in populated areas it did slow it down to achieve this goal. In other words, the slope of the line probably would have been much steeper.

Do Masks Prevent the Spread of the Virus

One of the best studies for this was in the same paper by Reni Zang as the above graph. He and his coworkers found that in New York City and Italy, the rate of spread seemed to decrease when they instituted mandatory facemask wearing, which they initiated in mid-April. According to the article, wearing a mask decreased the rate of spread 3% per day in these areas while in the rest of the U.S. there was a <0.3% increase in the spread, although many of those people also wore masks electively.

However, the study also mentions possible other factors that could have caused the decrease in COVID19 in those area besides the facemasks. The primary one is a marked decrease in pollution which we have seen happen even in the DFW area. High pollution actually increases the infectious rate of the virus by allowing the virus to attach onto the polluted microparticles in the air and spread the virus more efficiently  and more prevalently.

Thus, was the 3% reduction from wearing facemasks or from the decrease in pollution? As we now, NYC is very polluted, as is Milan. IT. Both saw marked decreases in pollution during the shutdown. Taking this into consideration, the 3% decrease of COVID19 attributable to wearing a facemask is probably much lower than 3%. In addition, the 0.3% increase in other areas of the U.S. not requiring facemasks is close to being not statistically significant and could be within the range of error.

Most prior studies[2] and logic tell you that masks do not protect you from getting viral infections. The pores in the masks are not small enough to filter the nanoparticles of virus so they simply pass through facemasks just like they do through air. This was even confirmed by Dr. Fauci at the beginning of the pandemic who did not endorse using masks, and even now it is not endorsed by the FDA to prevent you from getting infected by viruses. All it does is to decrease excess spread of the virus from infected symptomatic people when they sneeze or cough. However, even they still can spread it so they should be quarantined and not expose others to the virus.

There is a concern about asymptomatic spreading of the virus, and many people wear masks because the person next to them could be an asymptomatic carrier and spread it to them. However, the WHO has stated that transmission of the virus by asymptomatic people is rare. Although the news downplayed this and said the WHO “retracted” this statement,[3] the WHO continued to confirm “They’re following asymptomatic cases. They’re following contacts. And they’re not finding secondary transmission onward. It’s very rare.”

This has been refuted by others, but the WHO evidence is pretty convincing in a unique way. They actually tracked people who had positive test for COVID, symptomatic or asymptomatic, using their cell phone’s tracking device. They also tracked those who came in contact with them and found that asymptomatic people rarely transmit the virus to others.

Conclusion

The fear of COVID is driving people to be less social, to be afraid, and to change their life by giving them more stress from job loss, domestic abuse, and an increase in divorce. The incidence of COVID19 is rising rapidly, but this may be due to more testing and duplicate testing in addition to less social distancing from protestors and others several weeks ago.

Remember, the goal was never to prevent the ultimate spread of the virus, which will happen regardless of what we do as noted in the graph cited. The goal is to slow the virus so healthcare facilities are adequate for treatment of the severe cases.

Although incidence of COVID19 is rising, death rate is staying low and is decreasing slightly. Thus, the fear mongering produced by the news is not founded when it comes to severity of the disease. In the next blog, I will discuss more about putting COVID19 into perspective and what the government should be doing.

 

[1] Renyi Zhang, Yixin Li, Annie L. Zhang, Yuan Wang, Mario J. Molina. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proceedings of the National Academy of Sciences Jun 2020, 202009637; DOI: 10.1073/pnas.2009637117

[2] Cowling BJ, Fung RO, Cheng CK, et al. Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS One. 2008;3(5):e2101. Published 2008 May 7. doi:10.1371/journal.pone.0002101

[3] https://www.thedenverchannel.com/news/national/coronavirus/who-asymptomatic-spread-of-covid-19-very-rare-leading-expert-disagrees

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