In a press briefing on March 11, WHO director-general Tedros Adhanom Ghebreyesus called the event a pandemic. He also said, “WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.”
A Belgian doctor, Dr. Philippe Devos, published on his blog a piece expressing concern about the inaction and unpreparedness of the Belgian authorities in the face of the alarming contagion just next door in northern Italy.
First he explains the concepts of speed of transmission and of contagion ( R0 (pronounced “R naught”) contagion value of the disease). It’s important to understand these in order to grasp why Covid-19 is such a big deal and why precautions need to be taken urgently by everyone.
R0 represents the number of people who will catch the disease if you put one sick individual in a room of 100 people: the R0 of seasonal flu is 1.3, of coronavirus 2.2, of rubella (German measles), 6. Incubation period is estimated at 6 days, so after 6 days there’ll be 3.2 people sick in the room of 100; at day 12, 7.6 people infected, and at 18 days, 24% of the group. So it spreads quickly, and is about 1.7x more contagious than seasonal flu.
How many people get the flu in an average year in your country? (Here’s the CDC’s estimates for flu in the US 2019-2020.) Then multiply that by 1.7. That is if nothing is done. “We don’t even talk about containment for seasonal flu — it’s just not possible. But it is possible for COVID-19,” Ghebreyesus said on March 2nd.
“… unlike influenza, where countries have fought back, where they’ve put in place strong measures, we’ve remarkably seen that the virus is suppressed,” said Mike Ryan, executive director of the WHO’s Health Emergencies Program.
The contagion factor and speed of transmission are important because, according to the numbers coming out of European affected areas, 13.8% of patients develop pneumonia requiring oxygen and hospitalization, and 6.1% of patients also develop organ failure requiring intensive care. In the case of Belgium, 500,000 people get the flu every year. Times 1.7 for Covid-19 and you get 850,000 infected cases. 13.8% means 117,000 people hospitalized and 52,000 needing intensive care. But there’s only 30,000 beds for adults in Belgian hospitals, of which about 1,400 cater to intensive care (respitators, dialysis machines, etc.). You do the math.
If they all get sick at once, or very soon after each other, even the best medical system will soon be swamped and will need to divert medical supplies and personnel away from other, less urgent areas, and at some point triage will have to be put in place.
Another doctor, a corona virus specialist and also very concerned at the lack of action by the Belgian government, wrote an open letter to the Belgian Prime Minister. “You can either take drastic measures now, or later,” he wrote.
Other factors to consider are the doubling time, which he reckons at 3.3 days, and the CFR (case fatality ratio = death/(death + recovered) which was 37% in Italy, 24% in S Korea and 9% in Iran. (According to today’s figures on the Johns Hopkins website (7,330 deaths, 80,237 recovered), that gives a worldwide CFR of 8.37%.
Another measure is the crude fatality ratio, the number of deaths / total number of infected cases. This is what WHO Director-General Tedros Adhanom Ghebreyesus was referring to on March 2 when he said, “Globally, about 3.4% of reported COVID-19 cases have died”. (Previously, it had been caculated at 2.2%).
While governments in many countries seem to be practising the 4-stage strategy, Dr. Devos suggests the most effective measures can and should be taken by individuals (see also the advice for teens at the top of this post):
- keep your distance from others
- don’t shake hands or kiss on the cheeks
- wash your hands with soap and water or antiseptic gel after any contact with bodily fluids
- use disposable tissues
- cough and sneeze into your elbow
- if you get sick, stay at home and receive as few visitors as necessary.
“the risk is … to the whole society, yet the solution depends not on society but on the individual.”UPDATE: Armageddon ou Foutaise? Dr. Ph. Devos
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