Chronic Diva

COVID-19

By now, all of you reading have been in the thick of quarantine, social distancing, and working from home. Some of you have been furloughed from your jobs; you are home, juggling home-schooling, conference calls from the kitchen table while your children are trying to do schoolwork in the living room as your youngest ones are scrambling around the house without their nappies on while belting out their finest renditions of “Let it Go!” If you are one of the brave nurses and doctors working in the hospitals; if you are in emergency services or work in the healthcare industry, you are on the frontlines, battling the unseen enemy. You are witnessing the effects of this virus up close, and personal, putting your life on the line every day, despite having a family or people you care about back home. Money is an issue; healthcare has been an on-going issue in this country and above all, on everyone’s mind every hour of every day, is COVID-19.

I’ve been seeing questions on my Facebook feed nearly every day from all my friends. Is there a need for all this “locking-down?” Why is there so much chaos around COVID-19? How are COVID-19, H1N1/Swine Flu, Bird Flu/H5N1 and H7N9 different/same, and why wasn’t there this severe of a reaction to those pandemics? Didn’t a lot of people, if not more, die during those pandemics? Is this just political? But I’ll get a mild cold, what’s so bad about that? These are very good questions. Questions are what prompted me to start blogging in the first place. There’s a lot of information out there, but the information isn’t something everyone can understand when it’s a subject we’re not familiar with, and disease is something I am familiar with. As I’ve talked about in my blogging, but not necessarily to any of you who might be new at reading this, before autoimmune disease and chronic illness took over my life, I was studying to pursue a career in Public Health. I am rather obsessed with diseases; so, when this outbreak began in Wuhan, China, I was already following it and I knew it was going to be bad. The difference between what you will read here and somewhere else is that I won’t make it overly complicated. I’m not writing for a doctorate. I like being able to translate things in a way everyone can understand and relate to. Here we go.

The first thing we are going to tackle: How are COVID-19, H1N1/Swine Flu, Bird Flu/H5N1 and H7N9 different/same? As I write this, according to Worldometers, the U.S. currently has 123,750 cases of coronavirus, there have been 2,227 deaths, and 3,231 recovered. Globally, there have been 663,740 deaths, 30,879, recovered, 142,183; the mortality rate, according to the WHO, of 3.4% (as of 3.3.20). Now, with seasonal influenza, the CDC estimates in the United States from October 1st, 2019 to March 14th, 2020: 38,000,000 – 54,000,000 flu illnesses, 17,000,000 – 25,000,000 flu medical visits, 390,000 – 710,000 flu hospitalizations and 23,000 – 59,000 flu deaths.

Coronavirus vs Seasonal Flu

Seasonal flu aka influenza happens every year worldwide. It’s not a notifiable disease so it doesn’t have to be reported to authorities, which means the CDC numbers are estimates. Most with mild symptoms don’t even go to the doctor. Current estimates put CFR at 0.1% (Case Fatality Rate). There’re an estimated 3.5 million cases of severe flu each year and 250,00 – 500,00 deaths worldwide. In most industrialised countries deaths mostly occur in people who are 65+, otherwise, it’s dangerous to pregnant woman, children under 59 months and people with chronic medical conditions. Getting your annual vaccine reduces transmission and serious complications in most developed countries, however, it is still an accepted part of every winter.

“How the coronavirus compares to the flu thus far: 1.) It has resulted in fewer deaths so far. 2.) It has a higher CFR. 3.) No vaccine. 4.) It is more widespread.” Corona Virus Compared to Other Outbreaks

Corona Virus vs Bird flu (H5N1 + H7N9)

There have been multiple outbreaks of bird or avian flu over the years; most recently in 2013 + 2016. These are typically from two different strains; the H7N9 virus and H5N1 virus. The H7N9 epidemic in 2016 made up a third of all human cases reported but was still limited compared to both the coronavirus and other outbreaks/pandemics in this list. There have been 1.233 lab-confirmed cases of bird flu since the first epidemic. While the rate is very high, the spread from person to person is limited, which in turn reduces the number of associated deaths. FutureLearn

“How the coronavirus compares to the bird flu thus far: 1.) It is more widespread. 2.) It is more easily spread via human to human contact. 3.) Has lower CFR 4.) Has resulted in more deaths overall 5.) Has moved further from the source.” Corona Virus Compared to Other Outbreaks

But I’ll Get a Mild Cold? What’s So Bad About That?

What we’re hearing about this virus can be very deceptive. Such as Only those 65 yrs and above are having serious symptoms that have been leading to death. Because we’re also hearing now, as the virus spreads farther and faster, that more young people within the ages of 22-49 are also experiencing serious and fatal symptoms. Example: A young boy, 17 years old just passed away in Louisiana. No underlying symptoms. A young person, under the age of 18, passed away in Los Angeles County. Reminding everyone of the very real danger of this virus to those young and without any underlying ailments. What does this mean or could this mean? It’s still rather puzzling. But what is clear it the critical role of the immune system and the part it plays in whether or not you can and will recover from COVID-19.

It all begins on the entry of the virus. Very different symptoms emerge depending on where in the body the virus takes hold. This is how your immune system reacts. Novel coronavirus gains entry into a cell by latching on to a specific protein called the ACE2 receptor that sits on the cell’s surface. These are most abundant in the lungs, which is why COVID-19 is considered a respiratory illness. The second-highest number of ACE2 receptors are in the intestines, which could explain why many people experience diarrhea. The goal of the innate immune system is to contain and prevent the virus from replicating. The adaptive, virus-specific immune system sweeps in as a second wave defense to handle what’s left, having virus-specific antibodies and T-cells that the body develops that can destroy the virus more quickly. It’s these antibodies which provide immunity and protect people from becoming re-infected with the virus after they’ve already had it.

In some people, whose environments expose them to huge amounts of viruses, such as those in the healthcare industry, you will have instances where the virus will replicate and spread rapidly before the immune system has had the chance to beat it into submission. These folks can acquire a more severe infection even if they are young and healthy. The more virus the body is flooded with the more difficult it is for the immune system to manage. Older people will be less effective at fighting the virus as the immune system naturally declines with age and therefore will be more vulnerable, as will people who are immunocompromised because of another illness or medication. A suppressed immune system can result in the delay of antibody response. This delay allows the virus to swim through channels unchecked and unchallenged, to spread from cell to cell. If it takes up residence in your lungs it can progress to pneumonia, as more cells become infected. This is partly the virus, but even more so, due to the immune system itself in a seek and destroy mode as it tries to get rid of those infected cells.

The Difference Between Swine flu/H1N1 and COVID-19 and the Differing Reactions

Between Spring of 2009 and Spring of Spring of 2010, we saw the emergence of H1N1 infecting as many as 1.4 billion people across the globe; killing between 151,700 + 575,400 people according to Centers for Disease Control. CDC Flu Pandemic The 2009 pandemic was caused by a new strain of H1N1 that originated in Mexico in the Spring of 2009 before spreading to the rest of the world. By June there were enough cases that the World Health Organization declared the Swine flu outbreak a pandemic. In the U.S. between April 2009 + April 2010 the CDC estimates there were 60.8 million cases of Swine flu, with over 274,000 hospitalizations and nearly 12,500 deaths- that’s a mortality rate of about 0.02%. Here are some of the differences that brought such different reactions between the two.

 

• The 2009 Swine flu primarily affected children and young adults and 80% of the deaths were people younger than 65. It seems while this is unusual, with even the seasonal flu causing the most deaths in people over 65, in the case of swine flu older people seem to have built up immunity to the group of viruses H1N1 belongs to. So not as many were affected. LiveScience I often hear this butchered a lot in the explanation and the understanding, so I am hoping to explain it in a concise way that eliminates the confusion and mysticism surrounding it. There is typically some herd immunity to the seasonal flu. This means that many people are immune to the infection because of vaccines or their immune system has already fought the infection so that the few people who aren’t immune are somewhat Herd immunity is NOT a guarantee for everyone to be protected. Now, with COVID-19, there may be some groups of people who have immunity to the virus, but it’s an area that is still being researched. So far, COVID-19 is most deadly for those over 60 who have underlying health conditions. However, even as I write this, we are seeing those numbers change and we are seeing the vulnerability of those between 22-49 with no apparent underlying illness. FutureLearn

 

• Flu viruses are spread in respiratory droplets and airborne particles. Although the COVID-19 virus is primarily spread through respiratory droplets, it is in some cases shed in feces. It is yet unknown how important the oral-fecal route of this infection maybe, but you can’t be negligent in your hand washing. Wash your hands often and wash your hands for as long as you can make time for, following up with lotion to combat dryness.

 

• Symptoms with COVID-19 may be mild, and some persons may not experience any symptoms at all. The incubation period is between four and fourteen days which means a person could be carrying the virus for up to two weeks before experiencing the illness. Comparably, symptoms of Swine flu are similar to those caused by other viruses: fever, cough, headache, body ache, sore throat, chills, fatigue, and runny nose. Symptoms show up between 1-4 days after contracting the virus. LiveScience

 

• Still learning the full breadth of symptoms with COVID-19, clearest data seems to show that first signs are: fever, dry cough, shortness of breath. Other symptoms include headache, sore throat and abdominal pain, diarrhea. These have been reported but are less common. As with flu, COVID-19 can cause respiratory issues that lead to serious problems, such as pneumonia. CDC COVID-19

 

A Few Differences in the Way the U.S. Has Responded to the COVID-19 Pandemic vs the Swine Flu Pandemic

• “We were better prepared (at least in the U.S.) years ago,” said Steffanie Strathdee, the Associate Dean of Global Health Sciences at the University of California San Diego’s Department of Medicine. LiveScience

 

• With both pandemics, the genetic sequence of the virus was released to the public at incredible speed so that countries could create diagnostic testing ASAP. On April 24th, 2009, just nine days after initial detection of H1N1, the CDC uploaded the genetic sequence of the virus to the public database and had already begun development of a vaccine. Similarly, on January 12th, 2020, five days after the novel coronavirus was isolated, Chinese scientists published the virus’ genetic sequence. But that is where the similarities stop. It’s been a fairly bumpy ride for COVID-19; nothing has happened as fast or as smoothly. Making it a very dark and uncertain time for everyone involved.
• The 1st COVID-19 case was identified on January 20th by the Department of Health and Human Services. Eleven days later it was declared a public health emergency by the Department of Health and Human Services, on January 31. With Swine flu, a public health emergency was declared just two days after the first confirmed case in 2009.

• Within four weeks of detecting H1N1 in 2009, the CDC had begun releasing supplies from their stockpile that could prevent and treat influenza and most states in the U.S. had labs diagnosing H1N1without verification by a CDC test. None of this was seen as the COVID-19 threat blossomed. Instead, we saw an administration balk at the idea that it would be a threat to the American people at all, and shake their heads that it would come near to being the same kind of problem as China or Italy.

To make things worse, the continued hiccups and theme, surrounding the COVID-19 diagnostic tests continued. On February 5th, the CDC began sending diagnostic kits for COVID-19 to about 100 public-health laboratories across the country. Most labs received faulty kits which caused a major delay in combating the virus. Testing had to continue exclusively at the CDC headquarters until the agency could develop and send out replacement kits. This meant that COVID-19 continued to spread undetected for weeks.

The FDA commissioner announced on February 29th, that the agency would allow labs across the country to test for COVID-19 with their lab-developed tests without prior approval as long as they took basic steps to validate the tests and submitted an “emergency use authorization” (EAU) app before 15 days. LiveScience

• This is the first pandemic of the social media age. Talk about misinformation! It spread faster than the disease as has the blame for the disease which has led to an incredible amount of hate on social media. Only unity to fight the disaster will ultimately win against it.

• The plus side to the technology age is the speed with which research and vaccine development can occur. Potentially treatment and the first trial of candidate vaccine are already underway. This is very encouraging light at the end of this very, dark tunnel.

The Need for Lockdown

There are many reasons and needs for a lockdown. I could probably write an entire article just citing those, but we’ll stick to a few of the major ones.

• While the vast majority of those who contract the illness may only feel mild symptoms, there are going to be those over 60 who are at greater risk, those (younger or older) with underlying illness, who are going to be at greater risk, and those, who for no reason at all, may experience this virus worse than the rest. They are going to flood the hospitals. They are flooding the hospitals.
• This means that elective procedures are being eliminated. This means that people who may have accidents, sudden heart-attacks, car accidents or any other serious injuries that require hospitalizations, may find themselves in serious trouble. Why? First, there may not be enough beds. Second, you may be exposing yourself unnecessarily to the virus by going into the hospital. Remember what I said about doctors and nurses and viral overload? You don’t want this to happen to you while your immune system is down or in shock from an accident, illness or sickness.

 

• Asymptomatic spread. This is my opinion, as is the whole of this article, but I truly believe that the cases of asymptomatic spread could be making the epidemic more difficult to control because these patients would be spreading the virus with no visible symptoms themselves. “A study in Science, of the early days in the outbreak suggests that those with mild or no symptoms accounted for 86% of infections. With high numbers on their side, the hidden cases became the source for almost 80% of the diagnosed infections.” sciencenews

 

Are We Over-Reacting to COVID-19?

In my head that’s a pretty slam dunk answer- no! No matter what statistic is out there, for how many the flu kills each year globally as compared to COVID-19 when it comes down to it, we don’t social distance for the seasonal flu. Some don’t vaccinate for the flu because they are afraid it will harm them. Some don’t wash their hands regularly. Have you thought about how different the flu might be if you practised social distancing, washed your hands regularly, didn’t handshake, and got your vaccine? Maybe the numbers would be much lower and maybe it wouldn’t be an accepted part of winter. This pandemic won’t phase out handshaking; there won’t be a sudden new trend of elbow bumping or foot taps or knee bumps. No matter how cool you might be, we’ll go back to what we’re accustomed to doing. We need a vaccine. The moment we go back to doing what we normally do is the moment that this virus attacks us again because that is what it does. It should not matter that in some people COVID-19 only causes mild symptoms. What should matter, is that we still have so many unanswered questions about COVID-19. That should be enough to motivate communities to work together to slow its progress. Marketwatch Lastly, the seasonal flu has a fatality rate of less than 1%. “Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, estimates that the flu fatality rate is closer to 0.1%. But even accounting for the mild, yet undiagnosed cases of COVID-19, he said it would still make “it roughly 10 times more lethal than the seasonal flu.”” The scenario being played before our eyes right now is apocalyptic at best, and only going to get worse with no proven therapy, beds disappearing as more patient’s flood hospitals, medicine begins to deplete and nurses and doctors succumb to the illness. It’s a grim scene that can only be compared to war. This should be reason enough to motivate any person to lockdown and save humanity. Maketwatch

 

Resources

• https://about.futurelearn.com/blog/covid-19-how-does-coronavirus-compare-to-other-outbreaks
• https://www.marketwatch.com/story/coronavirus-vs-the-flu-its-just-like-other-viruses-and-we-should-go-about-our-normal-business-right-wrong-heres-why-2020-03-09
• https://elemental.medium.com/this-is-how-your-immune-system-reacts-to-coronavirus-cbf5271e530e
• https://www.wisegeek.com/what-is-the-cytokine-storm.htm
• https://www.cdc.gov/flu/index.htm
• https://www.vox.com/policy-and-politics/2020/3/14/21177509/coronavirus-trump-covid-19-pandemic-response

 Adding an excellent resource for terminology:

MDAnderson21TermsToKnow

** This is my opinion, based on my background and education and in no way reflects any medical advice. If you think you have COVID-19, please quarantine yourself immediately and seek medical attention. I do not claim to be a medical professional, so please do not take the information within to be medical advice.