On February 21, the WHO announced cases of Coronavirus (COVID-19) that have no clear epidemiological link to China.
This is very concerning. Until now, we've thought it impossible to contract the virus without travel to China or a clear link to someone who traveled to China. Indeed, CDC guidance to hospitals is to suspect Coronavirus only when a patient has symptoms of the disease AND travel to China or contact with a known Coronavirus patient. This guidance was last updated February 12, and now it's wrong.
Suddenly, any patient with a fever or cough is a potential carrier of the virus.
Let's imagine what might happen from here.
In the next 10 days, we hear about clusters of COVID-19 cases around the United States, simliar to the episodes that are unfolding in Italy right now. These cases have no clear connection to China.
In March, you find out on social media that an acquaintance of yours, who lives near one of these affected areas, is hospitalized from COVID-19. This acquaintance is a healthy 56-year-old man with no medical problems, matching the demographic profile of the typical patient hospitalized in Wuhan, China during the early outbreaks of the disease.
We know that about 20% of people who contract the virus develop severe or critical disease, ranging from shortness of breath to multi-organ failure. For comparison, the figure is closer to 8% for influenza (1). Given that 1 in 5 develop severe disease, it's not surprising that someone you know ends up in the hospital.
COVID-19 claims the lives of only 2% of those infected, and the majority of those are older people or those with underlying health conditions. After 10 days and a successful GoFundMe campaign, you're shaken but relieved to find that your friend makes a full recovery and is released.
Cases of Coronavirus climb around the United States. It's not clear how the virus is spreading from place to place.
There are no mandatory quarantines, but people are keeping to themselves. The President gets on TV and tells Americans to avoid all nonessential travel, and to work from home when possible. Restaurants and stores are closing early or not opening at all. When you do go out, everyone is wearing masks. Business trips, vacations, classes, parties are canceled. Life is a lot more boring than it was in 2019.
A few weeks later, you start not to feel well yourself. You have a fever, a cough, and maybe a little bit of trouble breathing. You tell yourself this probably isn't Coronavirus — it's probably influenza (the flu) or a bad cold. You haven't been near anybody sick. You figure you'll wait it out at home.
Two days pass. You still have a fever. You feel awful, the worst you can remember feeling. You think, "What if I have pneumonia?" and then "What if I do have Coronavirus, and I'm 1 of the 5 who needs to be in the hospital?"
You know the CDC is telling people who think they might have Coronavirus to stay away from hospitals. You call your primary care doctor, but no appointments are available for weeks.
You wait one more day.
You wake up in the middle of the night, fatigued and short of breath just lying in bed. You know something is wrong. Urgent care is closed. You're not sure what to do. You think of your friend who was hospitalized for 10 days. You head to the ER.
In the ER
You arrive at the emergency room, and it's a zoo. In a typical flu season, it's common to wait 6 hours to see a doctor at your local ER. Today, the wait for a doctor is 48 hours. Every patient with a fever and a cough is a potential Coronavirus case, and it's causing confusion and overwhelming hospital resources.
You're asked to wait in the cafeteria, because the waiting room is full. Everyone is wearing a mask, coughing. Healthcare personnel are dressed in what look like biohazard suits.
You feel like you're the sickest one in the ER. You see people on their phones, looking comfortable, chatting with each other. "Why are they here?" you think. You sleep on the floor of the hospital cafeteria, miserable.
You're finally taken to an exam room. Reassuringly, a doctor tells you your vital signs and chest X-ray are currently normal. You're surprised to learn the hospital can't actually test you for Coronavirus, only central CDC labs can.
You're treated with an antiviral medication called oseltamivir, and an antibiotic called moxifloxacin. Since there is no known specific treatment for Coronavirus, the ER doctor chooses to treat you with these medications, which are normally used for the flu and pneumonia, thinking it might help and probably won't hurt.
You later learn these are the medications that were given to Coronavirus patients in Wuhan. There are no randomized controlled trials demonstrating the utility of these medications for treating Coronavirus. You were given the medications anyway.
You spend 2 nights in the hospital and recover. You never learn whether you actually had Coronavirus.
May and beyond
You're feeling better. It's starting to get warmer outside. You remember that President Trump infamously said that the Coronavirus would dissipate with the warm weather, like the flu does.
Indeed, fewer cases are reported each day, but the absolute numbers are still climbing, and it's far from business as usual. You're thankful not to be in an area of the United States that's under quarantine. Nonetheless, with ongoing recommendations against nonessential travel and with many stores and restaurants still closed, the quiet streets feel like a perverse, never ending version of Christmas Day.
You hear on the news that a vaccine and definitive antiviral treatment are undergoing clinical trials, but they're not expected to complete until late 2020.
You worry it will take another year, until summer 2021, for things to return to normal.
Could this really happen?
This is, of course, a fictional account, but it's based on facts we know now about Coronavirus.
Coronavirus is not Ebola, and it's not The Andromeda Strain. It's not causing people to drop dead or turn into zombies. Instead, current data suggest that COVID-19 is like a version of the flu that spreads slightly more easily and causes slightly more damage. But a virus that's "slightly" worse can cause a big impact — socially, financially and medically.
What you should do now
Imagine the worst and hope for the best. Prepare to shelter in place, as you would for a hurricane. Keep food, water and medical supplies at home. Have backup power for your cell phone. Obtain personal protective equipment, including gloves, masks and faceshields. Anticipate economic disruption, if COVID-19 negatively impacts the economy or your ability to perform your job.
See ready.gov/kit for a detailed list of what to keep in an emergency kit.
Continue to monitor the WHO and CDC websites, and this blog for further updates.
And of course, wash your hands, cover your mouth, and do not travel while sick.
(1) About 20% of COVID-19 patients have severe disease. Recognizing that the prevalance of COVID-19 is based primarily on laboratory confirmed disease, we can calculate a comparable figure for influenza: 3,775 lab-confirmed influenza hospitalizations, compared to 174,037 positive flu tests, or 7.9%. (https://www.cdc.gov/flu/weekly/index.htm)
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