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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.

    • WHat do we do when people who are REALLY dying forego medical treatment out of fear? Let’s say a person has pain in their arm, feeling heartburn and fatigue and they decide it isn’t worthy of going to the hospital because those arent COVID19 symptoms. Oops those are actually HEART ATTACK symptoms, but because of FEAR they didn’t go to the hospital and they DIED. I guess the over 600k who die from heart attacks EVERY year arent quite as important?
      Yes, there are limited resources in the healthcare system. Covid 19 isnt even top ten killer

  • Go about your daily life, but also avoid large gatherings… Like an office building or worse, corporate complex with many companies…

    I just don’t think should be business as usual, that’s how we got into the this situation.

    • No, unsanitary practices in a wet market in China is how we got into this situation. Maybe we should take a look at that situation, rather than bringing the world’s economy to a grinding halt?

    • @Katy – Nobody is certain of that. So far that’s one of the operating theories. If you disagree that people should take part in large gatherings, but people are making their own decisions in the vast majority of cases on canceling trips – which led to the airlines shutting down a bunch of flights. You lament the world’s economy, but the Fed doesn’t have any problem injecting $1.5TRILLION into the trading/financial services sector. So where is the money for the rest of us? I have relatives with compromised immune systems – flattening the curve is the only logical and humane thing to do. You sound a lot like Boris Johnson.

  • Thank you! We need more reasonable voices in the face of the constant hype by the media and, even more, by social media. As someone with some experience in infectious diseases, I fear the panicked response to this virus (including the healthcare demands from the mildly ill) more than the virus itself. It’s hard to find a news site these days that isn’t packed with COVID-19 stories, ignoring most other news. I also suspect the news of mandatory shutdowns is helping fuel the panic by convincing people their exaggerated fears are warranted.

    The panic will eventually run its course – as you say, people live their everyday lives in blissful ignorance of the high death rate from the flu, bacterial infections, etc. in the elderly and compromised populations, until it hits someone close to them. But what COVID-19 will do to the economy, that’s another question. Unfortunately, this is a situation that requires long term thinking, realistic assessments of the realities, and a willingness to look at the pros and cons of the options and balance the needs. But most people think in the short term and, if the political pressure is loud enough, politicians will give them what they demand now and “Do Something!” even if it means more harm in the end.

  • 1. Unlike influenza, COVID-19 leads to a severe infection in 15%
    requiring oxygen and 5% are critical infections, requiring ICU. These fractions of severe and critical infection are higher than what is observed for influenza infection. = demands on health care are much higher
    2. It is not clear if there are seasonal variations (like flu) that will let us “catch a breath” and prepare for “COVID seasons”
    3. We don’t know if we develop an effective vaccine – that will “solve” the problem.
    4. We do not know anymore, who is exposed to the virus to quarantine them – that’s why social isolation is important as less than ideal, but the ONLY measure to flatten the curve.
    5. Yes, I hope that COVID experience will change our attitude to “going to work with a bit of cold” and we will become very very very quick to isolate ourselves with any viral illness.

    So for now, I think every healthcare professional, especially physicians should support stopping travel, cancelling mass gatherings (including conferences) limiting socialization and school closure, etc.

    • According to WHO 650,000 people die from the flu every year worldwide and according to the CDC 80,000 people died from the flu last winter in the U.S. — are you saying these 80,000 didn’t require hospitalization or oxygen before they died? And what about the countless number of people who “almost” died from the flu? They didn’t require oxygen and/or hospitalization? Yet somehow life continued with absurd shutdowns and panic because the flu isn’t some new thing with a scary name that triggers fear and irrational responses in people with OBC tendencies.

    • @Overboard – You’re missing the point here. Let’s take Italy for example:

      Italy has an ageing population so their flu mortality rate is already kind of high, but so far this flu season there have been 2 million cases of flu and only 240 deaths. Contrast that with the novel coronavirus which has infected 31,000 Italians (known) and more than 2,500 deaths.

      This should serve as a wake up call to those who think this is nothing more than a seasonal flu. The death rate in Italy is sky high, nearly 10% of cases.

      Take the social distancing seriously, don’t panic and wash your hands/don’t touch your face.

  • An “M.D.” with no actual medical experience in the last 10+ years. A “healthcare analytics company” that actually just does manual offshore risk adjustment. Probably not the best source of facts. Move along everyone, nothing to see here.

  • There’s a key difference between COVID-19 and the common cold or influenza, besides novelty: its ability to cause interstitial pneumonia, which it has done repeatedly in Italy (to quote in translation a recent post by one of their ER doctors: ‘stop calling this a bad flu’). It is a balancing act, and of course we want the cure to be less damaging than the disease.

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