Coping with COVID-19, part 1: Country and society

It’s been just 11 days since my last article on COVID-19. In this short period of time, the Israeli government imposed a 14-day mandatory quarantine for travelers, effectively shuttering the tourism and aviation industries, Italy has gone into full lockdown, and numerous countries around the world have begun ‘social distancing’ measures to address the rapid spread of the coronavirus.

I have recently returned from Vancouver, Canada to begin my own 14-day quarantine in Jerusalem, and I reached out to Israelis around the country, and folks around the world. I asked how you were feeling, what you wanted to know about COVID-19, and what you were most worried about in the current crisis. In this article, I will focus on the global and national effects of COVID-19; we will save the individual impacts for a separate article.

Again, it’s important to note that I have no specific training in public health or epidemiology – I am a scientist, so my perspectives are based on the same news articles and books everyone else has access to, just with a bit of scientific skepticism added to the mix. And in this challenging time of misinformation, hoaxes, and internet get-rich-quick schemes, perhaps this is something we all need right now – you can be the judge of that.

If the seasonal flu goes around every year, how is COVID-19 any different? Although influenza and COVID-19 share similar symptoms, COVID-19 is about 10 times more deadly than the seasonal flu. This is partly because these are different viruses, and partly because it seems that very few people have immunity to COVID-19. This also makes COVID-19 much more infectious. Unlike the seasonal flu, COVID-19 is droplet-borne, which means it can remain in the air or on surfaces after an infected person coughs or sneezes. Plus, asymptomatic carriers can shed the virus and infect others for days before showing symptoms, if at all. These factors give COVID-19 an R₀ (the average number of people an infected person will infect) twice as high as influenza, meaning that it will spread farther, faster.

Since only a small percentage of people show symptoms, why are we so worried? This is basically a numbers game. We are mostly worried that hospitals will not be able to cope with the massive influx of patients, meaning that quality of care will decline for vulnerable patients. For a simple model of this situation, let’s assume only 30% of the population of the USA gets exposed to COVID-19. That’s 110 million people. If just 1% of those people need emergency care (1.1 million people), the hospital system will simply not be able to cope; there are only about 330,000 available hospital beds in the USA, and around 70,000 ventilators (needed to help the sickest patients to continue breathing). With the doubling time of the virus somewhere between 3 and 6 days, estimates suggest we could arrive at this point in mid-May. Other OCED countries like Canada, the UK and Israel have similarly over-stretched healthcare systems and would face similar outcomes.

One of the challenges of using these models is that epidemiologists and virologists don’t know all the numbers yet. Even with our best estimates, I hear frequently how difficult it is to grasp the magnitude of this crisis, so I will break down what we do know and what we don’t. We have a pretty good idea of the doubling time of COVID-19 (around 3-6 days), and we know the fatality rates for different age groups. However, we don’t know what percentage of people are immune to the virus, what percentage get infected but show no symptoms, and what percentage show only mild symptoms that could be confused with the common cold. Estimates for each of these categories range from 20-80% of the population and we may never know the true figures as no country has instituted population-wide testing. These are critical numbers for epidemiologists to estimate the impact of COVID-19 and to make accurate predictions. Despite the lack of data, epidemiologists have still created a best and worst-case model for disease spread. The CDC estimates that up to 70% of the US population could become infected and 200,000 to 1.7 million could die without any preventative measures.

What lessons can we learn from hard-hit countries? Right now there seem to be two case studies: Italy and South Korea. Italy reported 4 cases in early February and now has 25,000, with hospitals triaging ventilators and hundreds dying without enough medical care. Only recently, the entire country has been put on lockdown as a last-ditch measure to stem the number of cases. Inefficient testing practices and lax public health measures are some of the reasons Italy has had trouble flattening the curve. By contrast, South Korea recently ran a pandemic-preparedness drill and are much better prepared. The South Korean government initiated drive-thru testing and has tested more than 300,000 citizens. They have instituted quarantines and social distancing for more than a month, and have used an app to triage and monitor patients. This allows South Korean hospitals to keep beds open for the most high-risk cases. As a result of these highly proactive measures, as well as some population demographic differences like smoking frequency and percentage of elderly folks, South Korean hospitals have not been overwhelmed and the death rate is much lower than in Italy. Israel, following the South Korean model, has closed their borders, instituted social distancing and quarantines, used apps to search for new cases, and currently has a much lower case burden than many other Western countries thus far.

And there is good news on the horizon. Reports out of China and South Korea, after more than a month of social isolation and quarantines, show dramatic results in flattening the curve of new cases. In the scientific and medical communities, labs are working around-the-clock to characterize the virus, screen and validate COVID-19 vaccine candidates, and test anti-retroviral medicines. Israel, South Korea, the United Kingdom and the United States have all announced in the past week that they are very close to developing a working vaccine. There is hope that we will not have to wait for herd immunity to reduce the spread of the virus.

What can you do? Right now, social distancing, hand-washing and other preventative measures are critical. We have a very short window of time when there is still a chance to flatten the curve. Otherwise, our hospitals will reach capacity and have to start rationing equipment or turning patients away. Nearly everyone online is saying this right now, but it matters, so I will repeat it as well. How we react as a society and how well we self-isolate before the case-load reaches the exponential proportions seen in Italy will have a tremendous effect on our healthcare system’s ability to cope with new COVID-19 cases.

Although we may feel alone in this crisis, each of us has the power to make an impact for the public good, and the potential to save lives by self-isolating, social distancing and hand-washing. We all have a moral duty to help curb the spread of COVID-19.