Don’t Panic! Points for Thought About COVID-19 Outbreak

A week or so ago I wrote a post providing a lot of research and numbers highlighting why I think society as a whole is over reacting to the current pandemic. I still feel this way. However, I also know that many people disagree with me and I want it to be made clear, that is okay. I will not hold it against people it they truly feel that the measures being taken currently are what is needed and are the best course of action. All I ask, is that anyone who reads this considers the information I am presenting. Simply repeating unsupported media headlines or saying “anything is better than the risk because we don’t know enough” is an appeal to ignorance, clearly uninformed and speaking from fear, not logic. I usually try to keep my posts organized in an essay-like structure. This post will be more disjointed and point oriented because as I said it is intended to be notes to consider and think about. There are of course many counter points and conflicting reports. Some of these I’ve left out simply because they don’t need to be mentioned due to the fact they are constantly repeated on every media source we’re exposed to. In other cases I’ve found information from more reputable sources and I am more inclined to trust in that. For a couple of points I have tried to cover the other side of the argument too. I am appealing to people to read all of this (it will be long), think about it carefully, do your best to suppress cognitive dissonance and please share this so others can do the same. If you read, understand and acknowledge all of this but still feel the measures being taken are the best possible solution I will respect that.

The last thing I want to address before jumping into it is that I do not think this is “nothing”. This is a virus causing deaths which can be controlled. I firmly believe that some preventative measure are required and it should be faced with concern. However concern is not the same as fear and I do not believe that the extreme measures stemming from fear are in society’s best interest. In my opinion more moderate measures such as a strong emphasis on basic hygiene and illness prevention, seclusion for those at high risk (elderly or compromised immune systems) or likely/confirmed to be infected (travelers, those exposed to someone infected ect…)  and most importantly responsible use of media by the press and government (no fear mongering!) would be the best solution both immediately and long term. People are falling strongly for the false dilemma fallacy in which options are presented only as two opposing extremes. Either everything has to be done or nothing should be done, when in reality most often the best solutions lie somewhere in the middle and there is an array of ways to deal with a problem. This is the biggest point of my argument and it pisses me off to no end when people see me disagreeing with extreme measure so they throw me in with idiots on spring break who think there is no threat at all.

With that said, let’s get into it. Again, these are disjointed points to think on, but I have made an effort to keep similar topics/ideas grouped together.

– First I would like to look at some numbers. These are based on the latest (as of the time I’m typing this) numbers from the WHO situation reportTotal confirmed cases worldwide: 332 930. Confirmed cases in Canada: 1384 Total deaths worldwide: 14 509 (4.36% mortality rate). Total deaths in Canada: 19 (1.37% MR). Those numbers are good and relative information to know (as I am Canadian, for people from other countries who may read this, all the information is on the provided link). However the more interesting numbers are from China and Italy. In my opinion these are two particular anomalies.
Let’s start with China. Confirmed cases in China: 81 601. Total deaths in China: 3276 (4.01% MR). The first thing which will jump out is all of those numbers are significantly higher than Canada. In fact they are significantly higher than most of the world. But consider this…an article in the South China Morning Post traced the first confirmed case as far back as November 17. Think about that carefully. The virus was not recognized as something new until New years. That means the virus was being spread and affecting people for a month and a half before it was even recognized. That means there were no warnings, no preventative measures and no idea at all how to treat it during that time. Without a doubt that alone had a huge impact not only on the initial numbers but the spread and rate of infection. There’s no way to tell the exact effect it had but it is easy to assume that had it been recognized earlier and dealt with, the numbers would have been noticeably different. On top of that we can add China’s high population density of 153 people/km2 (for comparison the U.S. population density is 36 people/km2) which makes pathogens much easier to spread.
Next we’ll look at Italy. Confirmed cases: 59 138. Total deaths: 5476 (9.26% MR). Not only has Italy had an abnormally high number of infections, but the mortality rate is by far the highest in the world. This is the example being used by many people of “look at how bad it could be!” However as I said I consider this to be an anomaly as it is a clear stand out from even the next few most affected countries. Italy’s average age is 47, the highest in the EU (for comparison the entire EU’s average age is 43, China’s is 38 and Canada’s is 41). As well Italy has 11.6 million smokers, that is about 18% of their population (Canada’s rate is around 15%). These are both well known to be extremely significant factors in severity of this coronavirus and no doubt are strong contributing factors to the death rate. The country’s population density is also extremely high at 206 people/km2. Combine that with Italy’s well known culture of close and physical socializing (families all living in close proximity, strong emphasis on family bonds and togetherness, kiss on the cheek greetings ect…) and it is easy to imagine how quickly any virus must spread. Finally, Italy was one of the first countries to start seeing cases of the virus just a month after it was identified. Like China, this left them largely unprepared.
Of course in both these cases, and all others for that matter, there are plenty of contributing factors. However I highlighted the ones I found to be significant factors which set these two places apart from most other affected areas.

-Healthcare workers can easily have their risk of infection mitigated by a large amount if given the proper support in the forms of staffing and supplies. An in depth study by the WHO of healthcare workers in China found that most of those who were infected fell into one of two categories. The first group were infected before preventative measure such as extra PPE and screenings were put into place. The second large group were infected at home by friends or relatives. Very few of them were found to be infected while working with proper protective equipment. Do not take this as demeaning the risks healthcare workers are taking. Many places, Ontario specifically are still not providing the resources healthcare workers need. They are still put in higher risk than most other people, they are still over worked and they still deserve the utmost respect. This highlights the need specifically for the proper protective equipment which will prevent the virus spreading to them from patients not just immediately, but to be prepared in the future as well.

-The virus does not spread like the wildfire the media has made it out to be. The same WHO report showed that the most common way of the virus spreading, by far, is confined and prolonged person to person contact. This means in the large majority of cases it was found to have been transferred within the home as opposed to in public. Community transmissions are a minority of cases because the virus simply does not spread well between people more than a few feet apart for a short amount of time (This will be expended upon a little later). The CDC also reports that people are most contagious when the symptoms are worst and that those who are infected but not exhibiting symptoms pose little risk of spreading it. This means that the paranoia of going out in public, of not letting more than one person go shopping and wearing masks and gloves (which are very needed by our healthcare workers) everywhere you go is all largely unfounded unless someone is symptomatic in which case they should be isolated anyways. (EDIT: since writing this there has been more research done on this subject. Here is an article about it. According to this researcher’s findings though people are less likely to spread it when not symptomatic most transmissions come from those people because they are being the least careful)

-The SARS-CoV-2 virus is surprisingly easy to kill. To start with the CDC reports most common household disinfectants are enough to sanitize surfaces from coronavirus. This means you don’t have to mix extra strong batches or buy any over the top products. For most people bleach is probably the easiest, cheapest and most readily available method. A small dilution is all that’s needed [Side note, it’s concerning how many articles have to stress to safe use of chemicals such as bleach. Please don’t be an idiot, read directions and use common sense.]. The only specification made for laundry, even that of someone infected was to use the warmest setting when possible (so don’t worry about burning any velveteen rabbits). Additionally though the tests were done on SARS and MERS strains of corona virus UV light was shown to be very effective at killing the viruses. This means that the sunlight can be an effective method of reducing the spread as the natural UV light will help to kill cells living on outdoor surfaces (yay for ozone holes!). The School of Medicine at the University of Maryland has also predicted a reduction in spread as we head into the summer due to seasonal changes. Both of these points can also be supported by looking at other types of viruses such as the flu which are greatly reduced in summer (it should be noted part of that reduction can also of course be contributed to people spending more time outside and less time in confined spaces).

-Michael Levitt, a biophysicist and Nobel prize winner became a viral figure of hope throughout China after writing a letter to friends in which he analyzed the statistic and correctly predicted the decline of the pandemic in the country with surprising accuracy. What was special about the way he looked at the data was that he considered not the rate of infection its self, but the rate of growth of the infection. In other words instead of just considering how many new cases were reported every day, he looked at how much that number grew by each day and found that that rate was shrinking. For example imagine a hypothetical data set. The first day in the set sees 20 new cases. The second sees 30 and the third day sees 40. At first glance the infection rate is growing by 10 more cases each day. But upon closer examination we see that between the first two days there is a 50% growth of the number of reported cases. Between the second and third day there is only a 33% growth. Typically at the beginning of an outbreak that number increases day by day (two people infect two people, infect two people…), but sees a reduction towards the end. Infections will continue even after the virus is under control. When dealing with exponential gains the important factor is the rate of growth and that data showed that the spread was actually slowing down. Levitt has predicted a similar situation across the rest of the world again based on the data we see.

-There is a lot of incomplete data. As time goes on we are getting a better look at the whole picture and (as I hope I’m proving in this post) things are looking more up each day. The unknowns are what cause a lot of fear and part of the problem is simply not enough people are being tested. Much of our data is based only on reported cases which means only people who show symptoms and either get themselves tested, or end up in hospital and have to be tested. As testing becomes more widely available infection rates are climbing while the rates of severe cases and deaths are rapidly dropping. Despite this we do have one small but very in depth data point which can be very valuable in extrapolating for other areas. The Diamond Princess cruise ship made headline when it was completely quarantined due to detection of COVID-19. The decision was made to test every passenger for the virus and so far this is the only case of an entire population being tested. The ships carried 3700 crew and passengers. Of them, 712 people tested positive for the virus. That alone is interesting because a cruise ship is relatively confined in a small space for a long period of time. Yet even under those circumstances only about 19% of the population was infected. Of those people, 7 died (the linked article claims 8 however the WHO report cited earlier states 7). That is less than a 1% mortality rate, significantly lower than most other places which suggests that there could be many more cases not being reported (the study showed 17.9% of cases showed no symptoms) which in turn would also lower the worldwide MR. Other parts of the study also reaffirmed points I’ve touched on earlier such as it being more likely spread in confinement. Finally, this point has no data I could find to support it, so this is conjecture, however it is reasonable to assume that the average age of the passengers was high due to the trend of cruise ships to have a lot of seniors on them. If that were the case then as stated before it would have a significant effect on the MR.

Among all the lack of information and dismissal of data I’ve also found there is a lot of information being partially conveyed or largely misunderstood. The next few point will attempt to address some of these issues.

-Stories started circulating a couple of weeks ago that the virus has been found to be airborne and can remain in the air for hours on end. Around the same time other articles told people that the virus can last for hours and even days on some surfaces. Both of these, while technically true were taken out of context (and were form the same study even though I did not see them ever reported together) in an attempt to scare people more. The study was not a real world scenario. Researchers artificially misted the virus into the air to see how long it would survive under ideal conditions. This replicates how it could be diffused into the air by medical ventilators used to help people breath but in reality it was found that when coming from humans the virus ended up in large droplets and fell to the ground after just a couple of feet. It does not remain airborne. This is why putting some distance between yourself and someone is is coughing (or yourself and everyone else if you’re the one coughing) is a very effective preventative measure. It also again highlights the need for proper equipment such has masks for healthcare workers. In the case of life span on surfaces the tests showed that traces of the virus can be detected after the stated time spans. However what most articles failed to mention that even on plastic, the surface which showed the longest possible time, the half life of the virus (the time it takes the number of viable celled to be cut in half) was under 7 hours. Though it is still not known exactly how much of the virus is required to cause an infection, this still means that the chances of infection decrease rapidly and there is nowhere near the need for the concern the articles imbued into people. (Plus, as stated earlier, it is very easy to disinfect)

-Gloves only work when you use them properly! I don’t know how many people I’ve seen out wearing masks and gloves. The masks as I’ve already stated are completely unneeded and should be used for those who need them, not paranoid idiots getting groceries. Gloves in theory could help, but I have yet to see anyone use them appropriately. In fact, as a cook, this is something which has bothered me for a very long time because so many places mandate food handler to wear gloves simply because it gives the perception of being “safer” but like the moron getting groceries they are not being used properly. Gloves are meant to be used when contacting one contaminate, then removed, hands washed, and a fresh pair of gloves put on. Gloves are an additional level of safety, not a replacement for hand washing, especially if they are not removed correctly. Wearing the same pair of gloves all day long (whether it be shopping or serving food) collects all the contaminates in one place and transfers them to everything you touch! There is a much easier, cheaper and effective method to prevent contamination. Go to a bathroom, bring a small bottle of sanitizer or use the automated ones in a lot of public places. You’re only fooling yourself by wearing gloves and possibly creating a bigger problem.

-I, and many others have raised the point before that there are other diseases out there, such as the seasonal flu, which have very high death tolls annually and nothing special is being done about them. I often get the retort that “this isn’t a cold or flu”. Firstly, I addressed  the nature of the virus in relation to colds and the symptoms in my previous post so I will not go over that again. More importantly however is that I am not claiming this to be a flu virus. The comparison is made to emphasize that this is an over reaction, not to say they are the same. The WHO reports 14 509 deaths worldwide from the SARS-CovV-2 virus. According to the CDC the flu has killed and estimated 23 000 people this season in the United States alone including 149 children, which is the highest number on reports excluding the 2009 pandemic.

-I’m sure everyone has seen the graphs about “flattening the curve”. Not only has the image gone viral, but it has become quite a catchphrase among celebrities, politicians and assholes who want to showoff how much more considerate they are than you on social media. But it is clear (mostly through those same assholes) that few people actually understand the details of this concept. I’ve seen multiple posts scolding people and telling them that the longer they ignore social distancing and flattening the curve, the longer they have to put up with it. In reality, the opposite is true and it is obvious both through common sense and actually looking at the graphs. The concept is not, and never was meant to get this over with quicker. In the end, the same total number of cases are projected. The difference is that when they all happen at once there are not enough resources to deal with them all. This results in many not receiving treatment and a higher overall MR. Instead they are spread out over more time, but not as many all at once. Without social distancing we would build herd immunity quicker which would cause the virus to die off. So yes, there is a logical reason behind it, but if you’re going to preach and call people out, know what the fuck you’re talking about first.

-I’ve seen a number of people complaining that we should just be using one term and that having “coronavirus” and “COVID-19” and “SARS-CoV-2” all floating about is just confusing and over complicated. All it takes it a second to google the terms, but instead I’ll explain it for you. “Coronavirus” is a name given to a family of viruses which are not new and are in fact fairly well known. There is a good chance you’ve actually had one before. The SARS outbreak in 2002-03 was caused by a caronavirus, but more commonly many colds are caused by them (see my previous post for more about this). SARS-CoV-2 is the particular strain of caronavirus we’re currently dealing with, whereas COVID-19 is actually the name given to the disease caused by SARS-CoV-2 and not the virus its self. For a more in depth explanation on this please see the WHO website.

Now that I hope we all have a better understanding of the virus side of the situation and why I feel the threat is not nearly as severe as many people are panicked into thinking. To understand why I think the over reaction will do more harm than good we need to take a look at the economic and social side of things because it is not simply a case of selfishness or being bored at home. I believe there is strong evidence to show that the extreme measures being taken could in the long run cause more damage than they are saving. It’s no secret or surprise that the world economy is already taking a nose dive into recession with countries shutting down boarders, ordering business closed and other such measures.

-I want to start this by acknowledging I did find a study suggesting that the economic strain is evened out by the savings of an out of control pandemic when it comes to quarantines. This could be good news and I hope it turns out to be the case as these implementations have already done significant damage to the US, Canadian and world economy. However it should also be noted that it was a small study, only based on Toronto, and it was looking at the SARS outbreak which was treated much more mildly than this one.

-In Ontario, the information regarding EI benefits is slowly coming out, but is largely still vague and unclear. As far as things look now it seems like ,while people laid off can still collect EI, it will only be a fraction of their pay. Short term this shouldn’t be a problem for many people however if this shutdown is extended as some people think it will be, that loss of income will become harder and harder for everyone to deal with. It is also all money coming directly out of the pocket of the government which will be collecting a fraction of the taxes it usually would.

-Governments all around the world are already promising billions of dollars to help people affected financially by the coronavirus. In Canada, the federal government has promised $27 billion in aid, and the Ontario government another $200 million. Those are significant numbers coming out of the pockets of governments who will be collecting a lot less income tax, and sales taxes. How are they going to deal with these deficits in the long term? Stimulus spending must be done carefully because it can end up doing further damage to the economy if mishandled. In fact, former head of the US Council of Economic Advisers Edward Lazear argues that stimulus is not what we need. This spending could be causing long term economic damage and could be avoided (or at least greatly reduced) with more moderate preventative responses to the outbreak.

-The Canadian governments have also announced the deferral of payments for things such as taxes and rent. These are useful for the immediate future for those who live paycheck to paycheck and have now lost that paycheck. However a deferral just means it is delayed. Those bills will have to be paid eventually and the money which could be made during this time is still lost.

-The only ways the governments will make up the money both being lost due to the shut down and spent on stimulus is by cutting spending or raising taxes (or a combination of both of course). There is a good chance that cuts will come out of the healthcare budget as that is constantly a target, the same with education. Cutting education hurts the economy. It becomes a feedback loop. The more is cut, the more it hurts the economy and repeat. On top of that if we refer back the science based portion of all this I would argue that it is clear a better understanding of science and critical thinking skills are vital when dealing with something like a pandemic. In this case again, less education would translate to poor handling of future situations like this one and further damage to the economy.
Over the last little while the Ontario healthcare budget has been notoriously cut a number of times and it has landed us in the middle of a pandemic, grasping for resources and workers. Cutting it further will only leave us even more unprepared for the next crisis. If we had been increasing the budget instead of constantly cutting it we’d have more available beds, more nurses, more of the equipment vital for them to safely do their jobs. In turn hospitals would not see the heavy burdens from this virus, we would not have to flatten the curve as significantly and these extreme measure would have even less reason to be implemented.

-We are planning too far ahead without enough information. Doug Ford guessing schools won’t reopen two weeks from now, the COC withdrawing athletes from the Olympic games 3 months from now, governments declaring a state of emergency over what they think will happen and people stockpiling enough toilet paper for a coming apocalypse (I hope no one needs me to cite a source for that one). Again, people and governments are using an appeal to ignorance to justify these long term policies instead of being patient and waiting for the data to come in. Or better yet actually examining the data and evidence we already have. I will admit the actual postponement of the Olympics can be justified due to the time needed for planning and rescheduling. However so many other things happening right now are decisions which can be made in a practical manner on a much shorter time frame and don’t need to be set in stone before we know they are necessary and don’t need to cause further fear and panic.

-Mental health is already a big issue not just around the world, but especially in Canada. The Canadian Mental Health Association estimated that in 1998 mental health cost the Canadian economy $14.2 billion (yes, as in Carl Sagan billions). 3.8% of all hospital admissions in 1999 were related to mental illness. With the strong push for better care and raising awareness for mental health over the last few years coupled with inflation, those numbers have no doubt risen. With this already being such an economic and social burden, what effect will a recession have on those stats? Rates of alcoholism, depression and suicide have been shown to be affected by economic downturn. In fact, more than one study has shown “an association between economic recession and increased suicide rates”. Beyond the economic factors, quarantines have been shown to result in PTSD symptoms and also higher rates of depression. What will the toll on the healthcare system be if the mental illness rates climb after this pandemic?

I do try to look on the bright side of things, especially considering all these policies have already taken effect and there is little to be done about it now. With that in mind I’ve though about a few ideas this pandemic has highlighted in society which can be worked with moving forward.

-Our healthcare system needs better funding. I touched on this earlier but want to reiterate. The fact that 1384 reported cases of a virus across the whole country (keep in mind, those are all  the reported cases. By the worldwide average at least 80% of those were not even severe) has overloaded our hospitals is a huge red flag that there is not enough money being put into them. Our national healthcare system can be fantastic, but it needs the finances to back it or the whole system fails. Not only do we need to be more prepared for viral outbreaks in the future, but even day to day we have to remember that the better care people get the more often and the quicker they can get back to work and keep driving our economy. The investment is worth it.

-There is a severe lack worldwide of scientific literacy. I’ve pointed out the number of things people are mislead about, believe without fact checking or simply have no understanding of whatsoever. This is not only critical to dealing with pandemics in a practical way, but to the advancement of our society as a whole. Inspiring children to grow up with critical and creative minds, influencing government policies and being able to hold interesting and engaging conversation about how everything around us works all hinge on scientific literacy. School funding is an important part of it, but so is every person taking the initiative and interest to try and learn whatever they can and read past a headline.

-Bandwagons are bad. It seems that a lot of the governments reactions to what is happening result directly from what most people see, hear and believe in the media. I have to imagine that there are advisers and experts who see this data and tell our leaders what I’ve been saying. But in the end votes are all that count and when the majority of the population thinks extreme measures are needed that’s what the government is going to enact lest they be criticized for “not taking this seriously”. Remember, the number of people who believe something does not change the facts. Governments are our leaders and they need to be the voice of calming reason. They need to set an example of level headed behavior but instead they are falling for the same panic as everyone else making it difficult to convince anyone this may not be as bad as they think. When they should be dispelling rumors and giving context to data they are quickly marching towards martial law. This can not be allowed to continue.

-People who are high risk (specifically those with compromised immune systems) are being highly guarded right now, and with good reason. They are extremely susceptible to infections and even minor ones such as a common cold can lead to severe complications, even death. So why are we not always taking extra measures to ensure their safety!? As I’ve stated there are a lot of strong and highly contagious pathogens out there and it should not take a global pandemic to realize that some of them might get to the people they could harm the most. I’ll bet those flu numbers I cited earlier could be reduce significantly by this.

-It is great to see appreciation and understanding of the roles overlooked workers play in society. There is a lot of love for grocery store employees and truck drivers going around right now and many people did not realize before this how needed they are in our day to day lives. On the other hand, in my opinion, they are not “heroes” for working right now and I don’t think I should be tipping them for cashing out my food. Yes, this point is incredibly selfish but I’m saying it anyways. I’m out of work right now. I won’t get my full pay on EI. As much as I enjoy the time of doing nothing and spending with my family, I would also love to be able to make money so that we could enjoy time together without worrying about finances. So no, I will not be tipping those still collecting an income or calling them heroes, especially when I feel I’ve proven how little the actual risk they face is.

-This is serving as a great example and data point for human effects on the environment. NASA imaging has shown a drastic reduction in pollution over China since the lock downs began. With factories shut down and people commuting by car significantly less the constant haze of smog has been lifted from the countries biggest cities. Likewise the canals in Venice are clearing up for the first time in decades. It has been a long time since we’ve had such a plain and simple example of what we do to the environment around us.

If you’re still reading, thank you. I truly hope you take all this into deep consideration, consider it carefully and think critically. Is this pandemic as bad as you’ve been led to believe? Are the economic a social consequences worth how much these policies are helping? Are the measure you or someone you know taking really mitigating the risk? Consider for a moment that instead of full lock downs and declaring emergencies, our governments did away with the fear mongering and focused on the importance of washing hands, being responsible for yourself when you’re sick, simply taking a couple steps back from anyone coughing and when there are confirmed/suspected cases or especially vulnerable people requiring those individuals and the people around them to self quarantine while allowing society at large to continue functioning. Suppose our media acted more responsibly and instead of publishing catchy headlines and striking fear into people to keep them coming back they reported full facts in the context they were intended and only reported what is necessary instead of ensuring the word “COVID-19” is constantly on the screen (do we really need a special segment on how to clean our smartphones from COVID-19?). We could still flatten the bell curve but at the same time we could significantly reduce the long lasting economic effects and all live with a little less stress. If you still really disagree with me, that is okay. Please comment and let me know, I would love to talk about it and discussion is what’s needed right now. But if I’ve managed to sway you, or even if I’ve managed to make you second guess what you thought you knew then please share this. Please encourage those around you to do as I’ve asked you to. If we all take a step back, look at the big picture and relax, we can get through this much easier.

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