”…everyone can get it. No one has immunity. ‘Everyone’ is a lot of people.”
COVID-19: a Primer
In recent weeks, most of us have had our lives upended in amazing ways. Changes came with a rapidity we never imagined possible—though many still were too slow in arriving. There were delays in risk recognition, in testing, and in treatment. People became ill because they were on that cruise ship or in that city before the risk was fully—or even partially—appreciated. Too many people ignored the advice of public health agencies and gathered for Mardi Gras or spring break or a choir rehearsal or a funeral. Some became ill. Some died.
The virus and the disease: These changes were wrought by the emergence of a novel coronavirus, SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). SARS-CoV-2 causes the disease COVID-19 (COronaVIrus Disease-2019). Because SARS-CoV-2 is a novel coronavirus—one never before seen humans—everyone is susceptible; no one is immune.
SARS CoV-2 is not the first or only coronavirus to infect humans. There are four others which circulate widely in the population; they cause the common cold. One day, SARS-CoV-2 may circulate similarly, and have similar impact. Right now, since no one has immunity, it’s wreaking havoc: everyone is susceptible to the virus, and each person it infects is capable of infecting multiple other people.
Disease severity: For about 80 percent of the people who develop COVID-19, the disease will not be severe. Indeed, in perhaps a quarter of these people (estimates range from 15 percent to 40 percent), there may be few—if any—symptoms. These folks are unaware they have the disease and place no direct burden at all on the health care system: they feel fine; they are not seeking any care.
Many more people among the 80 percent will have symptoms consistent with those of a cold, or seasonal allergies. In the absence of worsening symptoms, these individuals aren’t likely to burden the health care system either. They treat their symptoms—or simply “outlive” them—and carry on with their usual lives. Or as usual as those lives can be, depending upon the restrictions in place where they live and their level of compliance with those restrictions.
Both the symptom-free and mildly symptomatic people ARE a problem, however, in terms of illness transmission: those unaware they are infected nonetheless can infect others. Even those who develop symptoms—and sequester themselves to avoid transmitting the disease—likely spread the virus during the days before their symptoms appeared.
That’s why social distancing is essential: we simply cannot know who has COVID-19. So, we must stay away from most everyone.
All those precautions: If most people who develop COVID-19 won’t become seriously ill, why are we taking such extraordinary precautions? There are a few big reasons:
The novelty of the virus: Since no one has had it, everyone can get it. No one has immunity. “Everyone” is a lot of people.
The capacity of the health care system: The arrival of a very large number of even somewhat-ill people would overwhelm the health care system, flooding doctors’ offices and clinics and emergency rooms.
The 20 percent of people who will develop severe disease: COVID-19 can be a serious disease for about 20 percent of those who contract it. Even 20 percent of “everyone” is too large a burden for the health care system to manage—there simply are not enough health care providers or hospital beds or equipment (e.g., ventilators) or supplies to support these people through the course of their disease.
Who develops severe disease? Most (but certainly not all) of those who develop severe disease are older (age 60 or above) and/or have underlying medical conditions, such as diabetes or heart disease, which make them more vulnerable. Those with multiple chronic conditions are more vulnerable than those with just one. There also appears to be a “dose response”: people exposed to large quantities of the virus (e.g., health care providers) are more likely to develop severe disease. People who smoke and those who are immunocompromised are also at somewhat greater risk of developing severe disease. Men are at greater risk of serious disease than women.
Sexual orientation alone is not a risk factor for developing a severe form of COVID-19. But to the extent that LGBTQ people are among those who are at greater risk—i.e., are smokers or immunocompromised or have underlying medical conditions—they too are at increased risk of severe disease. Since a disproportionate number of LGBTQ people may smoke or have other risk factors, a disproportionate number may be at risk.
Staying informed: Seeking out information on COVID-19 is good. Understanding how the disease is transmitted, what steps we can take to minimize the risk that we will become infected or will infect others, and learning how to care for ourselves or others who are infected are all important.
But, seeking out information also can be risky. As with anything new (or even not-so-new), much of the information available on COVID-19 is inaccurate. Inaccuracies run the gamut from misinformation to disinformation, so it’s important to stick to reliable sources.
A recent post on Harvard University’s Health blog offers tips on identifying reliable sources, e.g., avoid publications that are promoting or selling a product related to the information they’re supplying; and rely on organizations whose mission is to inform and protect the public. You can read the whole post here:
Here are some sources we find reliable, and use regularly ourselves:
LOCAL GOVERNMENT: Delaware’s official site: coronavirus.delaware.gov/ The site includes everything from case counts to links to the Governor’s declaration of a State of Emergency (and subsequent orders related to same); links to information specific to various groups—e.g., schools and businesses; testing guidance; and telephone numbers through which you can seek more information.
Sussex County’s government operations site: sussexcountyde.gov/coronavirus
Municipalities, e.g., the city of Rehoboth Beach: cityofrehoboth.com
FEDERAL GOVERNMENT: There are multiple sites at which you can access national information on everything from case counts and helpful hints to links to additional resources:
The World Health Organization (WHO) who.int/emergencies/diseases/novel-coronavirus-2019
Johns Hopkins University maintains an online map of all COVID-19 cases reported throughout the world: coronavirus.jhu.edu/map.html
Johns Hopkins: hopkinsmedicine.org/coronavirus
The Kaiser Family Foundation: kff.org; coronavirus appears on its homepage
The Commonwealth Fund: commonwealthfund.org; click on the coronavirus link on the homepage.
Our World in Data has videos, charts, and narrative pieces about coronavirus: ourworldindata.org
MEDIA: A graphic depicting where media sources fall politically (right, left, or center) and how reliable they are (lower, higher) is available at: mediabiaschart.com. It’s useful in factoring that information into your assessment of what you hear/read from that source.
The publishing company Elsevier has made thousands of publications related to coronavirus available free of charge in its novel coronavirus information center: elsevier.com/connect/coronavirus-information-center
The New England Journal of Medicine is making its coronavirus coverage available free of charge at: nejm.org/coronavirus
The New York Times offers free access to much of its coronavirus-related news to anyone registering with their email address: nytimes.com/news-event/coronavirus
The Washington Post also provides free access to its coronavirus coverage; go to washingtonpost.com and click on the “coronavirus” link on the homepage.
Local print media (e.g., capegazette.com; delawareonline.com) offer community-level information and perspectives.
National Public Radio (npr.org) offers wide ranging coverage, including a daily podcast running about 15 minutes.
Network television: Mainstream networks (e.g., PBS, NBC, ABC, CBS, BBC, CNN) are more likely to offer balanced coverage; FOX News skews sharply right; MSNBC skews left.
Local television stations (e.g., WBOC.com; WRDE.com) provide local coverage.
Marj is an epidemiologist and wordsmith who has devoted her life to minutiae. She reports that yes, the devils are in the details.