In many infectious diseases, the immune system’s reaction to a virus, bacteria, or other pathogen can cause greater harm to the infected individual than the pathogen itself. Sepsis is a deadly example of this phenomenon. Triggered by an infection, the immune system overreacts, releasing chemicals called cytokines that make blood vessels become leaky. That can ultimately reduce oxygen delivery to vital organs, which may cause organ failure. Sepsis kills more than 10 million people a year.

The Covid-19 epidemic is something like sepsis: the reaction by the media and government is likely to produce more harm to societies around the globe than the virus, possibly for many years to come.

I’m not trying to downplay the impact of this virus, officially known as SARS-Cov-2. Fever, cough, and shortness of breath are the primary symptoms. They can appear two to 14 days after exposure, though many people infected with the virus don’t experience any symptoms at all. Based on the data we have so far, the virus appears to be more deadly than the influenza (flu) virus.

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Most people who develop Covid-19 and seek medical attention won’t be tested for it, at least not early on, because of the shortage of testing kits and confusion around where to send people who are showing symptoms. Mixed messaging from the government, media reports, and even employers complicates testing for the virus.

As I write this, about 5,700 people have died worldwide from Covid-19 and that number is growing daily. The CDC reports that adults over age 60 and people who have severe underlying chronic medical conditions, like heart disease or lung disease or diabetes, seem to be at higher risk for developing more serious complications from the virus.

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Ever since China decided to restrict personal movements, public events, and business activities of its people, media outlets worldwide have revved the fear-based headline machine into overdrive. There are hourly updates of new cases, possible deaths, and official briefings, as well as prognostication about future calamity. Inept government official briefings have not helped the situation. President Trump finally on Friday declared a national emergency over the coronavirus crisis, the first time such a declaration has been issued for an infectious disease since the H1N1 pandemic in 2009.

Many streets in cities around the world are empty. Flights to and from affected parts of the world have been grounded. Business conferences have been cancelled. Museums are closed. Company headquarters are shuttered. Grocery and drug store shelves are being emptied of cold and flu remedies, hand sanitizer, disinfecting wipes, and anti-inflammatory over-the-counter medications. People are stocking their homes with food, water, and toiletries, preparing for a long quarantine period that may never come.

The disruption in normal daily routines with social distancing and self-quarantines will cause lasting economic consequences given supply and demand-side shocks. With businesses closed and people avoiding public places, less money and fewer goods and services are exchanging hands.

This is a replay of what occurred in China during the SARS coronavirus outbreak in 2003. Essentially all public venues were closed, including shopping malls, indoor sports facilities, and movie theaters. More than 80% of luxury hotel rooms were vacant. Tourism to other countries was dramatically reduced. It is difficult to tell how many lives were saved with the actions to reduce the pandemic.

The World Bank, however, estimated that the SARS pandemic, which lasted one year and killed fewer than 1,000 people, reduced the global economic output by $33 billion.

Facing the Covid-19 outbreak, central banks and governments around the world are already bracing for what could be the largest economic decline since the 2008 global recession. The stock market is plunging across the world — the main index in the United Kingdom dropped more than 10% in its worst day since 1987, and in the U.S. the Dow and S&P 500 also hit their steepest daily falls since 1987.

I believe that most economic losses won’t come from direct sickness or death due to the novel coronavirus, but from what a 2008 World Bank report calls “uncoordinated efforts of […] private individuals to avoid becoming infected.” A slowdown in economic activity driven by fear of the novel coronavirus will cause layoffs and a recession. Without jobs and steady income, individuals and families will have a harder time paying the required deductibles, copays, and premiums required to obtain health care. Hoarding behaviors will compromise scarce resources. Lack of affordable options results in less medical care, which will increase the number of avoidable illness and death over a longer time frame.

We have learned to live with the flu, which can cause up to 80,000 deaths a year in the U.S. and between 300,000 and 650,000 worldwide. It doesn’t invoke widespread fear, dread, and hysteria. Life goes on. People go out in public, eat at restaurants, drink in bars, fly in planes, take mass transit, attend sporting events, and congregate in other large indoor settings.

We cope with it by washing our hands with soap and water for at least 20 seconds, avoiding close contact with people who are sick, and covering coughs and sneezes.

Flu, of course, is a known quantity, whereas Covid-19 is new and not yet well understood. Unfamiliar infectious diseases are scary. Plus we don’t have a vaccine for coronavirus, as we do for influenza. We do have antiviral medications, which might be effective against coronavirus, but it is too early to tell.

It is impossible to run a test to compare the state of the world with the public health measures that are being undertaken with what would have happened without them. Yet we should take a hard look at the costs and benefits of the actions taken. For example, the decision to close schools to limit the spread of coronavirus has myriad costs to children and their families and should be considered only after other options have been considered.

What’s the appropriate response to Covid-19? I believe we should counsel individuals to continue going about their daily lives while taking proper and prudent precautions until we learn more about its long-term public health risks of this disease. We should try to balance the public health and safety concerns with disruptions in daily activities. Quarantining individuals who have been exposed to the virus or who have underlying health risks makes sense, as does adhering to prudent measures like staying at home if you feel sick, washing your hands regularly, covering your mouth when coughing and sneezing, and avoiding large social gatherings. All of these can attenuate the spread of the virus.

But we must be measured in our actions so we don’t end up causing more lasting harm than good as we try to protect ourselves and our communities from a new — and scary — infectious disease.

Darren Schulte, M.D., is the CEO of Apixio, a health analytics company.

  • The best article i’ve seen since the outbreak emerged.
    How can these eminent scientists continue to fuel the flames of sensationalism. ‘Deaths of between 250,000 and 500,000’ in the uk based on one model … damn, lies and statistics!!
    Unprecedented global economic repercussions with the global approach of ‘we’re doing more than you’. Any common sense comments being drowned out.
    There is a new virus, however we should be looking at the positives, it doesn’t affect people up to 60 as much as seasonal flu that’s good. Sadly people with underlying health conditions will always be more susceptible to viruses that’s well known. Let’s keep things is perspective….saying ‘if we can save just one life’ (Klopp) sounds very noble but helps nobody, people die each day anyway …. harsh but true.
    Another headline just reported….29 deaths Uk covid 19 , however deaths in Uk today not due to this virus are 1700…. 0.02%.
    Numbers will increase, that’s the nature of the beast, all of the sensible precautions mentioned before are useful. More draconian ones less so, more hardship, stress, mental health issues will only lead to increased health issues in the future…. and therefore more deaths.
    Maybe the eminent scientists can model that …..

  • This is an excellent article! I keep seeing the numbers, the graphs, the predictions and the demographic analyses, and for the life of me can’t see how these warrant the absurd, unquestioned lock-down of the entire world.

    Just saw another article about Italy, apparently the nation hit hardest: “Italy’s Corona Virus Death Toll Surges Past 2,500.” Surges.
    The number of flu deaths in Italy:
    2014 = 7,000
    2015 = 20,000
    2016 = 16,000
    2017 = 25,000
    Seems like they should be quarantining against the flu every year instead.

    Is no one considering the cost to charities and food banks? Look it up, “charities lack funds because of corona virus.” Underfunded hunger and poverty relief organizations is the real pandemic.
    Because a child already dies from hunger every 10 seconds, countless children will likely die not because of COVID, but because of our hysterical reactions to it and the resulting economic turndown.

    That’s just one of countless sectors reeling because of efforts to “flatten the curve” against a virus that affects ZERO children and hardly any adults.

    Why on earth couldn’t we measure our response to what we know?
    For everyone: practice good hygiene, wash hands regularly, don’t go out if you feel sick or have any symptoms or have been exposed to someone who has. And sure, cancel huge gatherings.
    For the elderly: stay inside/away from others until this virus is behind us.

    But no, every government official is apparently now in some horrid race, where whoever seeks to destroy COVID with the most monomaniacal obsession and using the most restrictive measures is declared the winner.

    • You hit the nail on the head. Not only will people die from charities being hog-tied, but from hunger & home loss following job loss, from infectious disease caught subsequent to anxiety & stress dampening immune systems, and from isolation exacerbating depression into suicide, especially among those with PTSD & the elderly with serious chronic illness.

  • I wholeheartedly agree the reaction to the virus is worse than its biological effects. The statistics quoted by many are inaccurate and do not reflect the true morbidity rates. The flu kills each year and we just deal with it. The coronavirus is just a “new” flu that is being politicized and causing unnecessary panic. The medical community needs to step up and propose the use of anti-viral medications like chloroquine to provide some reassurance to the anxious, easily panicked portion of the general public. Look just south to Mexico and their handling of this problem after learning their lesson over-reacting to the swine flu years ago. We can look to the last pandemic with H1N1 as another lesson learned. People died because of it but we did not overreact worldwide. Thank you for sharing this information to dispel some of the hype associated with this problem.

  • If up to 650,000 people are really dying from the seasonal flu each year, then I feel like the media could just as easily scare the world by constantly spotlighting every flu case and death .

    “Another 2000 dead from the flu today!”
    “Starbucks Employee Dies of the Flu!”
    “Another 10,000 cases of the flu have spread to California!”

    I don’t know what to think anymore. I thought the 3200 deaths in China was a crazy amount for 3 months. But the more I hear about how many people die from other diseases a day, the more I wonder if we’ve simply panicked.

  • Thank you for this article. I appreciate your matter-of-a-fact assessment of the situation in the context of the media, fear of the unknown, and the economic tradeoffs. We should wholly take this seriously as a possible threat, but also check our actions against the long-term. Keeping a balance is important during this time, and I don’t read a lot of news these days that stresses that.

    I also echo Bud’s question. I would like more data on those that have been infected / recovered / died.

    @Bud, I found this article interesting. Would love to see if Statnews endorses. According to it, 99% of deaths in Italy were in persons with 1+ underlying health conditions; 50% alone in persons with 3+ (!)

    https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says

    • This is critically important data that should be included in every article like “3 members of the same family wiped out by coronavirus.” I wonder, too, what those stats are for those in critical care, but who didn’t die? For instance, what % of those intubated were healthy seniors, healthy younger adults, healthy children?

  • As an “at risk” person, and a total layman, I agree with your summation. My being at risk factor is that I am a 69 year old male. I have no underlying health issues, in fact I am in excellent health. I’ve searched for and failed to find, any statistics that show how many people without health issues have died. I get lumped into the category of “over 60 OR “underlying health issues.” I wonder how healthy seniors would handle the disease. Appreciate any feedback.

    • Well if you read Rose’s link above. It states that after examining the medical records of about 18% of Italy’s coronavirus fatalities, only three victims had no previous pathology. Whereas 99% of the victims had underlying health conditions, with 50% suffering from at least three prior illnesses.

      That seems like a positive sign for you.

  • Excellent article. The data we have is crappy and we are making unprecedented disruptive decisions based on crappy data. In fact, a study out of France suggested an existing malaria drug all but eliminates the virus in 75-90% of patients, and that 86% of people who have this are walking around with symptoms so mild as to be undetectable. In other words, the death rate is not 3-4% of 40-70% of the population, but whatever the fatality rate would be (probably not 3-4%, anyway) times population infection rate ***TIMES the .14 of people who actually show symptoms when infected****. Still concerning, but a much smaller number. Meanwhile, what about the social costs of destroying our economy? the spike in depression, suicide, joblessness, malnutrition, unemployment, crime? We are destroying our economy for a disease that is likely to affect far fewer people than expected with far greater possibility of treatment than we even anticipated six weeks ago.

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