Commentary: COVID-19: To panic or not to panic? That is the question

By Bruce C. Nisbet, MD

SARS, MERS, Ebola, H1N1, Influenza, Coronavirus:  Is the hype and fear dominating the United States real or overblown?

I write this opinion piece as a practicing emergency physician who has a solid understanding of data and statistics. I am not an epidemiologist and the prevalence and knowledge of “COVID-19” are changing rapidly. By the time you read this, some of the coronavirus statistics may be out of date, yet other facts I provide will, at the very least, put COVID-19 into perspective.

Coronavirus is certainly concerning and should command the attention of the CDC and State Public Health agencies. Hospitals should be prepared with appropriate containment efforts and plans in place to minimize potential exposure to others. The following thoughts do not argue against these measures.

When it comes to coronavirus, there is much we don’t know, and the unknown can sometimes lead to irrational fears and a loss of any sense of relative risk or probability. 

For example, what percentage of infected patients die from the disease?

The number of 2% has been cited out of data from China. Given the Chinese government strictly censors what information can be released (try googling Tiananmen Square within China) and that a couple of journalists who were critical of the government’s response to COVID-19 have allegedly gone missing, data from China cannot be trusted. We also know little about health care delivery in China which causes further questions on whether the reported 2% mortality rate would be reproduced in developed western countries.

The fear of COVID-19 magnified greatly when it was discovered that it could be spread within the community between people who apparently had no obvious reason to get it (i.e., hadn’t traveled from a COVID-19 hotspot).

However, if we are indeed missing all these cases of community transmission — missing them because we aren’t testing these people — then the mortality rate would be much improved.

For example, let’s assume that in a certain state there are 100 positive patients and 2 deaths. The “case fatality rate” would be 2%. Testing then becomes easily available and 10 times as many people test positive under this greatly enhanced surveillance. However, these additional positive tests are in people whose symptoms are mild and none die and so the state remains with only 2 deaths.  The mortality rate then becomes 0.2% which is quite similar to the flu.

If in a typical year, worldwide around 500,000 people die from influenza related illness each year. That’s not a typo. In the U.S. between 10 and 50 million people contract influenza in a given year with it resulting in around 25,000 flu-related deaths per year. Given these statistics, why aren’t there gargantuan efforts made to limit its spread when the first cases arise in Asia in the fall?

I believe the answer is because COVID-19 is new and viewed as “foreign.”  We are used to the flu so we don’t actually see it as foreign, even though it originates in Asia each year and then spreads worldwide with devastating impact. Sociologists should have a field day analyzing this. Much of the media coverage is fueling panic and irrational behavior.

Let’s consider this: Current deaths from COVID-19 in the US stand around 20.  No doubt this could increase significantly, but bear the following in mind:

Each year in the US:

• Approximately 47,000 people commit suicide

• Smoking causes about 480,000 deaths

• Overdoses account for around 70,000 deaths

• Approximately 40,000 people become newly infected with HIV

• Approximately 40,000 people die in car accidents

• Approximately 30,000 gun-related deaths occur (60% by suicide)

There are many other social/health issues that are massive issues in the U.S. — homelessness, teen pregnancies, drug addiction, sex trafficking to name but a few —- but we are used to these issues and numb to them even, though the magnitude of suffering they cause will dwarf COVID-19. There will also undoubtedly be serious health consequences from the economic downturn, some of which is reasonable, (for example, eliminating travel to endemic areas such as Italy and China) and much of which is not.

People will lose jobs, housing, health coverage with probable resulting increases in depression, drug addiction, and suicide. Unfortunately, this effect may not be able to quantify and will likely go either unreported or underreported.  Conversely, the tally of affected COVID-19 cases will be prominently displayed and obsessively reported.

COVID-19 might get much worse and the death toll will rise, but will pale in statistical comparison with the above list.  Let’s not lose sight of that.  Let’s not panic.

Bruce C. Nisbet, MD is a practicing emergency physician and chairman of the Emergency Department at Saint Francis Hospital, Wilmington.