April 2, 2020
REMAIN CALM, ALL IS WELL
Blog by Dr. Steven Bacall, DC
Because we care about your mental health, we wanted to help you make a little sense of our current situation. So here are a couple of quick thoughts on the coronavirus that might help put things in perspective for those of you who are having a hard time managing your anxiety and fear of being infected with the virus and subsequently suffering from COVID-19.
First, let’s take a look at some regular seasonal flu numbers and how the government arrives at them. According to the CDC, from September 30, 2018–May 18, 2019, clinical laboratories in the US tested 1,145,555 specimens for influenza virus; and of these, 177,039 (15.5%) tested positive. Note that that means out of every seven people who thought they had the flu, only one actually had the seasonal influenza virus (this is a discussion about the seasonal flu that we’ll have at another time). The important figure here is the 177,039 actual positive cases. From this number, the government, through lots of mental gymnastics, estimated the number of flu cases for 2018-2019 was 35,500,000 with 34,000 deaths attributable to the flu. The estimated number of cases is 200 times the actual “confirmed” cases with a fatality rate (estimated deaths divided by estimated cases) of about 0.1% (one-tenth of one percent). It is important to note that the 34,000 deaths figure is also an estimate. The actual number of deaths directly attributed to the flu by the CDC is usually in the low several thousands. These are fairly typical numbers presented by the government in any given year. The numbers for 2017-2018 according to the CDC, for instance, were 45,000,000 cases and 61,000 deaths leading to a fatality rate 0.13% (or just over one-tenth of one percent).
As of this writing (April 1st), there are approximately 200,000 confirmed cases and 4,300 deaths attributed to the coronavirus here in the US. Remember that with the seasonal flu, the government multiplies the confirmed cases about 200 times to come up with their estimated cases and then uses that number as the denominator to determine the fatality rate (for 2018-2019, that would be 34,000/35,500,000 = 0.1 or one-tenth or one percent). With the coronavirus, however, they are presenting the fatality rate based only on confirmed cases, thereby making that number look much more problematic (4,300 deaths divided by 200,000 confirmed cases = 2.15 fatality rate). It doesn’t take a rocket scientist to figure that there are, at an absolutely conservative estimate, at least 10 times more (forget the 200 times used by the government for the flu) people infected than “confirmed”. Estimates range from 25% (NYT) to as high as 60% (Nature) of all people infected show little to no symptoms. Testing is reserved for those with significant symptoms. And it just makes sense to realize the number of confirmed cases in no way represents the actual count. So if we multiply our confirmed caseload of 200,000 by 10, we get 2,000,000 people infected (with perhaps as many as half of them having no symptoms at all). If we then take the number of deaths (4,300) and divide it by a conservative estimate of cases (2,000,000) we get a fatality rate of 0.2% (two-tenths of one percent). While this number does indeed represent a fatality rate twice that of the seasonal flu (that would be the headline you would see), in real terms it still represents a risk of dying from COVID-19 of two-tenths of one percent. Nobody reading this would make the effort to cross the street to save two-tenths of one percent on their next purchase. And this number is based on an estimate of 2,000,000 infected people; that number could easily be much higher, which would lower the fatality rate even more.
Look at it a different way. Even if you take a high estimate of how many Americans will be infected, say 50%, that leaves you with a 2% chance (using the current fatality rate, which I have suggested is overestimated) of dying from a virus you have a 50% chance of catching. That leaves you with a 0.01 (one-one hundredth of one percent) chance of dying from coronavirus. And this doesn’t take into account the large percentage of people who are dying from this virus who have comorbidities (other pre-existing illnesses). Studies are showing that as many as 50% of fatalities are in people with three or more comorbidities, with the other 50% having one or two comorbidities. Now add that into the calculus of risk and you get…well you do the math. Also realize that the estimates I am presenting apply to the percentage of people being hospitalized as well. Those numbers are probably closer to one-tenth of what you are currently seeing.
Please remember, the information you are getting from the media is sensationalized. It is designed to keep you tuned in and anxious because that’s what sells. All coronavirus, all the time!! The social isolation and distancing has been implemented to protect the medical system, mainly hospitals, from being overwhelmed (to “flatten the curve”), which is a good and necessary thing, more than to protect the average American from dying from this virus. This is a virus; it isn’t going away and it will spread. The numbers will increase, perhaps alarmingly over the next several weeks. Everyone reading this will know someone infected (although you may never actually know because of minimal/no symptoms). I am not suggesting in any way to take this cavalierly or to not bother washing your hands or keep an appropriate distance from others. And it is certainly prudent to protect those more susceptible. Many people will get sick and sadly some will die (for some perspective, the CDC says in 2018 about 69,000 people died from drug-related causes, and that number is pretty steady year to year). But for the vast majority of Americans, if you’re afraid to go outside because you think you’re going to “catch it” or you’re questioning whether you can talk to your neighbor through a closed window, or you think this is the end of the world as we know it, you are letting fear get the better of you. While the fear response is a natural and instinctive function of the human brain (if this were 50,000 years ago and a saber-toothed tiger was chasing you, you better be scared and run!), in today’s world we must use our rational brain to regulate our primitive brain. The psychological damage done to people may, in the end, prove to be worse than the physical toll. Please take a deep breath and recognize the reality of the numbers.
Next time we’ll dive deeper into this comorbidity issue and what you can do to make you and your family healthier and more able to defend against this virus and those to come. Here’s a hint, stop eating garbage and start eating real food. But for now, remain calm, all is well. All is well.