2019 Novel Coronavirus
2019-nCoV (first named); COVID-2019 (later- named disease); SARS-CoV-2 (final name of the virus causing COVID-2019):
DON’T PANIC
February 27, 2020 update Part 4
Paul Herscu ND, MPH
Herscu Laboratory
This is the fourth piece of writing on this current
epidemic. Please read Part 1, Part 2, and Part 3 for context and also, please read my other
writing on this site for a larger context on the overall topic of public health
and epidemics. For this epidemic, I will keep the sections consistent. Also,
please be aware that I am keeping the same sequence of comment topics, for ease
of read from one installment to the next.
LASTLY, I am going to deliver a presentation next week, Saturday March 7, 2020 at 3:30 PM at Bastyr University in Kenmore Washington (just north of Seattle). This topic is part
of a broader course we teach there, and I will discuss how to understand and deal with epidemics
in general and this one in particular. Due to the current environment, this
lecture is open to all. Join us if you can. Details & RSVP here.
2019 Novel Coronavirus (2019-nCoV; COVID-2019):
Comments I shared here over the past weeks remain true and
are seen in the writings coming from across the globe. I want to focus on why
this is of utmost importance to you!
Official Numbers: My previous comments about the Chinese
government’s handling of the numbers is echoed across the globe. China mishandled the epidemic and misrepresented the numbers at first. I
know it sounded sort of odd when I started with that, but at least we all agree
on this fact now. And the main reason this is important is that reality helps
model what the likely progression is. More on this specifically during next
week’s talk, but the point here is that public health authorities agree that
China misrepresented the truth. And to the more official numbers from the WHO as of today, inside China we hear 78,191 infected,
with 2,718 deaths, or a mortality rate of 3.47%. If this were the case, that
would be REALLY bad for all of us. However, I think this number is still wrong,
maybe by as much as a factor. From the WHO, as of today, there are 2,918 confirmed
cases in 37 countries outside of China,
with 44 deaths, or 1.5% mortality rate. A really bad number for sure, but MUCH
less severe case fatality ratio than a horrific epidemic would have. I think
the fatality number will settle around 0.2% to 0.5%, unless the numbers
released are way off, again much less than what China is reporting. More on
this below.
While I am still not sure what the current Ro
number is for real, for reasons mentioned below, it does seem like we can start
to draw proper epidemic curves and I still think it looks like we might just miss
another scary global epidemic here during this wave. Let me say, right now,
here, that I believe there is good news finally, though not yet reported yet. And
not yet immediate.
As before, knowing the real number of infected is essential
in order for descriptive analyses to lead to mathematic modeling of how average
or how highly infectious this epidemic is. With this information in hand, better
predictions from those infected outside
China can be made. I mentioned that the mortality rate and disease burden outside China is the one that really
matters to science and to us as it is more likely going to come from more
accurate reporting. Though now, we must add Iran to the country whose numbers
are suspect and should not be used.
Under the Better Late than Never part that I wrote about last time, the main
point I made was that if China handled it properly, gave us the real numbers,
we would have only had a tiny outbreak and that would have ended it, not just
locally but globally in a permanent fashion. Again, more on this when we
discuss epidemics next week. But this is not possible when they do not share accurate
numbers. (And just to add to this, we see exactly the same behavior in Iran, with
again troubling numbers and problems caused by secrecy). Proper numbers lead to
proper epidemic curves that help us model and understand an epidemic. It would
take into account even the asymptomatic, i.e., those who may not be counted, or
those who have very mild symptoms, and therefore may not seek treatment, or are
scared to tell authorities that they are unwell, in which case reported numbers
are also inaccurate. This is where epidemic curves come in handy as they help us
‘fill in’ the missing data.
Yes, there is much we do not
know yet, but looking at the epidemic curve from the data available today, things
are looking better than they had a couple of weeks ago inside China. Below is what
the epidemic curve looks like, from the WHO data from outside China. From prior
epidemic maps this is signaling that this first wave of the epidemic and its
growth is soon going to collapse in Wuhan. It is most likely to end, sooner
rather than later. That’s the good news. Last week I said I think others will
follow the same observation in 1-3 weeks’ time. It is now a week since and
pretty much everyone is saying that the Wuhan numbers are in fact clearly
dropping. The only caveat is this: Can China maintain their hygienic closed
model or will it spread beyond the outbreak areas. (It will!) And when it does
spread, will they have the political will and science-backed policy to do what
is necessary to stop a new outbreak from taking off in a similar fashion that
Wuhan had or will they repeat the same mistakes? Will Iran needlessly go
through this nightmare? The answers to these are political, not scientific, and
therefore I have no idea, but I hope they choose wisely.
The comments about the bad news
are becoming more and more real though. As I mentioned before, this virus has
escaped the region, and became too big to contain. Yes, we should isolate those
that are ill, to slow down and limit
its spread, but if the numbers that China reported are partially true, and if
there are numerous people who are asymptomatic or partially so that they do not
even know to self-isolate, then it is not likely to have the virus disappear because
of its easy contagiousness. Also, we are still not completely sure which animal
vectors are involved with this virus so cannot have clear impact there to
actually get rid of it completely. In other words, what is likely is that this virus
is with us, for the duration, with ups and downs, with bigger epidemics and
smaller ones, but following us the way influenza or the common cold does. It is
just that we, as humans seem to have always known the flu and the common cold
as part of reality, and this time, this virus we are seeing at its very
genesis. Biologically, evolutionarily interesting, but nevertheless sad. So,
that’s the first bad news. I mentioned this before, but now WHO and CDC are saying
the same thing as are many infectious disease researchers.
The second part of bad news that
I mentioned is that if this infection does come back, after this first wave is
over, then unless something changes we will see deaths every year. Not in the
hundreds of millions but still. What is frustrating is that proper monitoring
and open intergovernmental cooperation may have stopped this in its track. Iran
should really pay attention here and learn from the mistakes China made.
Relatedly, the comments on
vaccine development and mandatory immunization for health care workers is ever
more likely. Vaccine research is in full swing at an accelerated rate.
Lastly, my hope to have
scientists work on virus coevolution to make the virus less lethal has not
gotten any traction yet, though I really hope it does. It may be that vaccines will
help with this infection. But it is also possible that COVID-19 vaccine may not
work out very well, and it would be prudent to have a second option such as
this. Methods learned here could modify other bugs that are pathogenic to us
and in so doing add an additional method of disease prevention. More on this interesting
topic next week.
But as I mentioned from the first, personally, I
believe that these mortality prediction numbers will be much lower than
currently thought by the numbers out of China.
The Physical Crisis
Regarding the actual disease, when it shows itself in a severe form we see:
A. the direct damage of the virus upon the organs, such as
the lungs
B. the cytokine storm that threatens the life of the
patient
C. the after-effect of the cytokine damage, which is
potentially the most dangerous
B. The plasma exchanges are still occurring. Sadly,
filtering out part of the cytokines is still not occurring which is sad and
this delay may be causing unnecessary deaths. I think the sooner the better
here.
C. Here, I still believe both checking the level of serum
C1-INH in the most ill patients and then giving those with a relative
deficiency of plasma C1INH more C1-INH is a workable, affordable, targeted solution. I hope they
will soon start to measure C1-INH in severely ill patients, using it as a sort
of biomarker for treatment and prognosis. IF
ANYONE KNOWS PEOPLE TREATING THESE MORE SEVERE PATIENTS PLEASE PASS THIS
SUGGESTION ALONG.
The role of those practicing in naturopathic, homeopathic,
and integrative medicine settings in general and during the time of 2019 Novel Coronavirus (2019-nCoV; COVID-2019), February 19, 2020:
The main point I made earlier is still relevant. Follow
WHO/CDC guidelines as to best practices. They are mostly reconfirming that
these are the most effective methods to slow down and stop the progression of
this disease.
Regarding the masks in use and copper. For the past 4
decades, in fact before medical school, I was enamored by the anti-germ
properties of copper and when I used to teach on medical history, I highlighted
the use in ancient times of copper in makeup and pipes to limit germs (though
they did not know it at the time.) A few years ago, I began to write on the topic, highlighting the benefits of copper to
limit and end transmission of germs. The issue of epidemics will not go away, always
replacing one bug with another, but copper seems to work impressively well
against them all. The point I made in different writings is that it is very
simple intervention and has already been tried for years to change surfaces
towards copper infused products and paints. These have been added to curtains
in hospital wards as well as surgical masks. This would cut down transmission
by a lot. But more on this whole topic next week when discussing transmissions.
The role of those practicing homeopathic in general and
during the time of 2019 Novel Coronavirus (2019-nCoV) in February 19,
2020:
I want to start by saying that the comments I made last
week are still the most important ones for us. Good public health measures that
you can take will slow down and eventually stop this epidemic. Follow WHO/CDC
guidelines here. They will help to keep you safe. Every organization has the
same comments. Keep to them, and share them with your patients. They are
important to you and to your family. But onward now.
“As a group, homeopaths have not seen patients with this
infection. We have to wait until we do. If my assumptions are correct, as in
the past, then it is only a matter of time until homeopaths start to see actual
patients with this virus. If you recall my comments on the 4 different
responses of contending with the virus, asymptomatic, mild symptoms, severe
acute, and life threatening, I believe that homeopaths will eventually have
some patients with this infection. Most likely not the most severe forms but
clearly carrying and contending with the virus.” I made this comment before and
can say that at least for the lesser severe cases, thus far, this is still
true. The vast majority of people seem to stay within their chronic state
But for now, as help to the community I think it will be
most beneficial to everyone involved, the homeopath, the patient, and science,
to properly document both the diagnosis (via confirmed lab results) all the
treatments, the symptomatology, and outcomes. A case series or a pooled data
set will help us all. As we gather more natural history of current cases, a
better picture will develop.
DON’T PANIC. The bottom line as of now, is do the hygienic
measures that are within your control, that really, truly work. The most
important piece of the puzzle remains to limit person to person transmission.
This will not be enough to keep it from coming back, but it is the quickest way
to end this first wave. Primarily try to avoid those that are sick. If you are
sick stay home and keep your family away from you. Self isolate. And DON’T
travel if unwell. Everyone, wash your hands often, 20-30 seconds, with soap and
water. (Sing the happy birthday song twice, that is about the right amount of
time, which is easier than counting). Wait until we get the number outside of China to see how problematic
this epidemic will be, and take appropriate action. I believe these lethal percentages will begin to diminish in this first
wave.
I ended last time saying that within a week or two people
will start to lose interest as the outbreak will lose steam. I thought this first
wave will end without tremendous global tragedy, though of course very, very
sad for those who have lost their lives and the people they leave behind. The
very largest percentage of people, even in China will never meet anyone with
this disease during this first wave. I think this is still the case. But as I
said, it is likely that we are seeing the genesis of a new annual disease. I
can well imagine the second wave. And if that is true, we need to be able to
better deal with it. As it winds down in the northern hemisphere, it will give
us 6 months or so to develop a better strategy. Remember that in the terrible
influenza epidemic of 1918 more people died in the second wave than the first. A
friend asked me how many people are going to die of this virus in the USA from
now until November, 2020. I said I thought the most possible will be around
4,000-5,000 dead but that it is most likely to be much, much less, like in the
hundreds at most. But that is with really smart public health measures
continuing to be enacted.
I ended with a wish list before, which I would like to update:
1.
Get
the full real numbers. We are getting most of
these numbers from outside China, and outside Iran. The only number I am
missing is the number of asymptomatic people who carry the virus, see below.
2.
Specifically,
how many real cases in China? We may not get this number. Ever. But there is a
number that really interests me and is not that difficult to get, either in
China or in Italy. In those closed cities, if they test a sample size, what
percent of people are carrying the virus but are completely asymptomatic. And
of those what percent stay asymptomatic after 2 weeks, even though they carry
the virus. This is a very important number for public health preparedness.
Perhaps the most important number right now. But it is not being shared. Not
sure why. In my next update this is the number I am going to focus on the most.
3.
Of
those infected, how many become seriously ill? It seems as though this number
may be around 20% from the numbers from China. This number should drop, I
believe. Also, this number is much higher in Iran, much, much higher,
suggesting either a misrepresentation of the total exposed and ill, or else
incompetence in treating them and therefore dying. They have a pretty good
health care system, so I tend to think it is the same underreporting that we
saw in China.
4.
How many
closed cases? It seems as though over
a third are considered closed
cases, with 8% of those ending in death, which again, I believe is a number
that will drop significantly.
5.
How
many in the epicenter are completely healthy yet carry the virus? A good
epidemic curve will guess at this, but this is an easy number to get. Just test
a sample number of people in the epicenter that are considered healthy.
6.
Pass
along the suggestion to Cytosorbents. Someone
should still do this please.
7.
Pass
along the suggestion to test for and monitor C1-INH levels. Someone should still do this please. I think it
will save lives.
8.
As
work continues to develop a vaccine, begin work on modifying the virus itself. Someone should still do this please.
9.
As
work continues to develop a vaccine, begin work on germ to germ controls. Which
other virus or bacteria can fight with the virus to control it. Work in science
should not solely be placed in the vaccine solution. Someone should still do this please.
10.
Have
proper funding to test out methodically natural solutions that may currently
exist. PLEASE!!!
In any case, stay tuned!
In health,
Paul Herscu ND, MPH
