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My Take on COVID-19

The Doctor is in!

I have a bit of free time since the Quarantine started -let’s call it what it is!

 We have had talks with our kids about how this is an unprecedented time in human history and they are seeing things that they and we have never seen before.

In the last week we have launched what will be a worldwide recession and have seen just about anything happen as people prepare for and respond to the current situation.  Even to the point there have been grocery store brawls over toilet paper and individuals trying to sell hand sanitizer on Amazon and eBay for $50 a bottle – crazy.

This is affecting us all.  Our hospital and other hospitals across the nation have suspended elective surgical cases, we are screening people at the doors and keeping the febrile away unless they have other issues (respiratory and coronary and diabetes). Currently hospitals are at some of the lowest census’ in history as we sit in the calm before the storm.  The storm we predict will be similar to what is seen in Italy, which makes sense right?  They are a developed country, an educated country, they are similar in socio-economic distribution to the USA, and they were grossly unprepared and not serious enough about this problem.  Therefore we are preparing now to prevent Italy 2.0 from occurring in the US.

Schools nationwide are closed, churches are closed nationwide, entertainment in every live form has been suspended.  Sports: professional, collegiate, high school and club sports have been suspended.  Dining, plays, concerts… anything that physically unites groups of people have been suspended.  People are relational, we are not meant to be isolated.  In isolation we succumb to anxiety and depression.  Community in part helps to keep us sane and that is exactly what we are giving up right now, community.

As a physician many have asked me my opinion and I am willing to give my opinion.  I do have a bit of an analytical mind and I feel I can dig into what is being presented so I can formulate an opinion that is fairly well informed and it makes sense to me (okay to smile).  So this is science based opinion, accept it for what it is. 🙂

I want first to address the virus itself.  COVID-19 is a respiratory virus that first began affecting humans in Wuhan, China.  Primary symptoms:  fever, cough and shortness of breath.  Current mortality rates of 3.4% (translation of 100 people who get ill from it 3-4 will die) this mortality is certainly related to underlying disease (COPD, Coronary Artery Disease, Diabetes…) It is spread by droplet: coughing, sneezing, transmission of sputum.  Incubation period 2-14 days: you could get exposed and not be symptomatic for up to 2 weeks.

Now let’s look at Influenza.  It spreads across the world annually.  It starts away form the equator where is is cold and spreads throughout the cold months, in equatorial areas it can happen anytime in the year.  Primary symptoms:  fever, runny nose, sore throat, muscle and joint pain, headache, coughing and feeling tired.  Current mortality rates: 0.1% (pandemics of 1957 and 1968) and 20% (1918 pandemic) again mortality is linked to underlying disease.  It is spread by droplet: coughing, sneezing, transmission of sputum.  Incubation period  1-4 days: you generally know pretty quickly if you are affected and spreading it.

Everyone has heard the comparison and seen the experts argue and now people are quieting arguments and battening down the hatches to prepare for what comes next as we do widespread testing and the numbers of confirmed cases start to sky-rocket.  I want to address the question of –  will we be the next Italy?

  Does our current quarantine prevent us from following in their footsteps?  To answer that question I want to look at the demographics of Italy as compared to the US.  Population distribution by age, and population distribution by density.

Age:  Please see the graphics. They are top heavy.  They have a knot in their population that centers around age 40-70, then they drop off above and below, the graphic is most like a diamond.  This means the majority of the population is over 40.  As for the US, our population is not top heavy, we have a near equal distribution from 7 days to 70 years, then it tapers off as the aged die.  We don’t have a ‘majority’ of our population.  With this in mind we already know that those with underlying disease are most susceptible and the young are generally not affected, that does not mean they don’t transmit it.  Given this population curve I would expect Italy to have a higher proportion, by population, of the disease and higher mortality associated with it.

Population density:  Please see the graphics, darkest areas have the highest concentration, lightest the least.  In a disease that is spread person to person by droplet it would stand to reason that higher density populous areas would be more affected.  A quick look reveals that Italy has a population density of 532 per sq mile.  The US has a population density of 90 per sq mile.

In my opinion, (informed and researched but still my opinion) we will not follow Italy’s trajectory.  First for the above reasons I don’t think we will follow their trajectory. Second because we have been put into quarantine.  Will the quarantine be effective? Yes – in 3 weeks we will see that we did not follow in Italy’s footprints and we did not see the severity of the disease and we did not see the 3.4% mortality rate.  Will the quarantine be the reason for our success? No.  We will be successful in surviving this and saving lives but it will not be the quarantine that did it.  It will be because of our differing demographics, it will be because we practice droplet precautions.

Our economy will recover, hospitals and schools will re-open, churches will congregate but we will show the world we have solidarity…. Solidarity in our response, possibly over reaction, possibly too careful (is that a thing?)

We will have to see.  Considering that our entire economy is built as an on demand and right on time production economy the shortages and the supply line disruptions we are currently creating will take years to recover from.

Possibly we will face more deaths from the depression and anxiety of isolation than we do from the contagion.  Time will tell.

So what do we do now? Love the ones you are with.  Take care of the sick, the poor, the orphan, the widow.  Spend time with the ones you love.  Stay sane.  Wash your hands.  I’ll see you on the other side.

Kent C. Bowden, DO, PCOS


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