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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.


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.


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.

  • There are good arguments/positions on both sides of this pandemic. The biggest problem I have seen is the lack of reliable, scientific information from all levels of government. The public is receiving enough information to cause concern/panic, but not enough to generate rational decisions. Here are some EXAMPLES of information people need in order to make safer decisions:
    1) When an individual is infected, what are ALL the ways they can infect others?
    2) What are the TRUE recovery rates of CURRENT & KNOWN cases? (Any good news?)
    3) Once an individual is infected, what are the most common effects to the individual in the road to recovery?
    4) What are good safe alternatives (vs shutting down) in a crowd based event?
    5) What is the likelihood of getting infected in a room full of people if an infected person is in it.

    It is human nature to “fill in the blank spaces” when not enough good scientific information is presented. The current news media IS too quick to push out bad and scary news that tends to promote fear mongering. If you hear daily that “x” number of people have become infected or died, how do expect people to act. The media would serve the public much better by reporting scientific FACTS, good news (recoveries) with the bad, calming citizenry during periods of disaster, stop giving OPINIONS they are not qualified to deliver, and being more of a “port during a storm”.
    Yes, I also value human life above economics, as what is the price for a life? However, decisions must be balanced against the future quality of life for everyone? Being totally healthy in a country with a completely
    scrapped economic system will not be safe or pleasant for anyone.

  • Seems sensible article to me,Ive just had a row with a younger friend here in UK because im over 70 and wont self isolate.Yes im over 70 but im fit,active have normal blood pressure,have never smoked,weigh same as at 20 and have no underlying health problems.

    I like many of my generation lived through polio outbreak,remember that,way worse than this virus,But the world didnt shut down did it,no of course not.And what happens once all this self distancing and isolating comes to an end,people will lose all natural resistance to anything and if you live alone as many do,no socializing will affect peoples mental health.This cant possibly go on indefinitely surely,the world as we know it will disappear,society will be wrecked,possibly never to recover.

  • It’s math based on the numbers we see in China. If we do nothing it spreads to 40-70% of 327M people. With a 3.4% case fatality rate that’s millions. If we socially distance we may slow or stop the spread. Minimally we prevent overburdening the healthcare system. Read about the Spanish flu. Some cities did nothing and were overrun. Other cities shut down and fared better. Do what you want, but if you have the ability to socially distance, you should. It’s the ethically correct thing to do. Writing an article like this is counterproductive, sounds like
    Darren Schulte is concerned about his stocks and 401k.

    • China has begun releasing their data, and finding that the fatality rate for those 14-64 is 0.5%. However they are also thinking it could be lower (possibly 0.1%), because they believe that the majority of people who got the disease never realized they had it.

  • Thank you for writing this. I work for a major medical organization and they are completely overreacting. “Elective” cancer surgeries are being cancelled. People are losing their jobs. My kids school has been closed for 6 weeks! Think of the lost time/lost education. We keep hearing from the media about how terrible the situation is, but I look around and I look at the statistics and I can’t help but wonder why the reaction is so strong when the actual amount of deaths is so low. People will accuse you of saying that you value the economy over human life, but it’s not that simple. Reacting to the situation in an appropriate way is the right way to go. What is happening now seems to be an over reaction.

    • Well you have to associate death with a collapsed economy as well. The 2008 financial crisis was linked to at least 10,000 suicides. Plus if people have no money, they can die from not being able to afford the necessary medical help or medications.

  • What about Tuberculosis kills about 4,000 people per day worldwide. COVID-19 kills what a hundred. Oh, but we know about TB and we don’t know about COVID-19. What I know is the numbers would tell me that TB is much more serious a problem than COVID-19. So is pneumonia.

  • Are people even looking at the statistics?? They prove an over reaction. What I don’t see is a chart showing the age breakdown for how many deaths so far In the United States. So many of the people who have died are elderly. This mass hysteria doesn’t happen during flu season. I’m flabbergasted that so many are buying into this shutdown that is a complete over reaction. Why aren’t more people coming out in the media saying what is obvious and in plain sight?

    • Swine flu has a case-fatality rate similar to the flu but the people it kills are not just the sick and elderly. It killed everyone of any age group. It was and is a serious disease different from flu. The current reaction would not be appropriate for H1N1, but some mitigation more than the flu was warranted.

  • This knee-jerk reaction is the stupidest thing I’ve ever witnessed. I’m wondering how long the media can keep duping people and keep ramping up the hysteria without the people catching on. Oh no…a cold virus. Any more dangerous than the flu? Doesn’t look like it to me. The numbers don’t add up. The response does not add up. Nothing the government does makes any sense. If we did absolutely nothing, the numbers would get lost in the normal flu season deaths. Remember Chicken Little and the boy who cried wolf? This will be the problem for the next 20-30 years. If anything real ever does happen, people won’t forget this.

  • I can’t believe that this article was written by an MD. It’s just basic math at this point. Given an estimated case fatality rate 17 times higher than flu and an infection rate of 40-70% we’re looking at 4-7 million dead in the US alone. You value a $33 billion loss to the economy over those lives. You value preventing a recession over the negative impact this will have on our hospitals and emergency services. This isn’t fear driven histeria this reading about history of previous pandemic and looking at the data provided by China which is at least a month ahead of the curve.

    • Andrew, this comment is fear driven hysteria. 4-7 million people dead in the US alone? 80% of cases are mild and most people who get this are already recovered. This type of reaction and lack of knowledge is the problem. This will cause more damage than the virus itself.

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