Guest Post by Howard Wetsman

Why you’re hearing about this now

How it started

About two months ago, the world first learned that there was yet another cluster of respiratory viral illness in China. This is not an infrequent story, as traditionally the flu seasons start in Asia and travel east across the Pacific. What made this story unusual were two factors. The first was that the number of cases that presented in serious condition were larger than normal. The second was that we were quickly told that the cases centered on a wet market in Wuhan. What happened then was unusual as well.

Because Wuhan is the location of China’s only level 4 biolab (the US has a few) and because wet markets sell all kind of animals for consumption that people in the US wouldn’t eat, we got two competing narratives. The first was that the people got sick eating something they “shouldn’t” and how irresponsible they are. Second was that China made a bioweapon in their lab and it escaped. Both stories get us focused on the people who got sick first and not the virus. Neither story need be true to explain everything we’ve seen.

Viruses

To be clear, viruses have been attacking mammalian cells for millions of years. It’s been a constant war lasting much longer than humans’ quick history on this planet. On our side, we have a sophisticated immune system honed by our genetics and experience. But the viruses have sophisticated tools as well. Viruses mutate rapidly and can pick up genetic material from other viruses in the same host. This is their advantage in the war; they change rapidly so that the defenses we built up don’t continue to work.

The first thing to understand about viruses is that they aren’t, strictly speaking, alive. They cannot reproduce or utilize energy on their own. If you put a virus on an inanimate surface, it would eventually just degrade. How long it takes to degrade is variable depending on how much protection the individual virus has and how well the environment fits the virus’s protections. This virus, SARS-CoV-2, has been reported to be able to last on surfaces up to 9 days, though heat and humidity lower that considerably. Surfaces can be decontaminated easily with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite.

A virus becomes dangerous once it gets inside a cell it can use to reproduce. Viruses come in a couple of different flavors. Some use DNA for their genetic material like we do, and some use RNA. Those that use RNA can be double stranded or single stranded. SARS-CoV-2 is a single stranded RNA virus which makes the RNA less stable outside the body and may explain some of why this virus has been so hard to test for. The material the test is measuring has a tendency to fall apart before it can be tested.

The Numbers

You’ve been hearing or will be hearing in the news about two numbers. The first is R0, pronounced ‘R zero’ or ‘R naught.’ It is the average number of people who are infected by a person with the illness. You can imagine that if everyone with an illness gives it to 10 people, it will spread rapidly. If everyone who gets it only gives it to less than one person, the illness will die out. From the beginning of this SARS-CoV-2 story, the R0 has been elusive. Currently, most experts are saying it’s somewhere between 2 and 3.

The R0 isn’t just a property of the virus. It can be affected by us as well. If, for instance, a disease is spread by sneezing in people’s faces and we refrain from doing that, the R0 will be lower. That’s why you’ve seen the Chinese government enact such strict travel regulations. They are trying to lower the R0 below 1 so it will die out. With this virus, it isn’t as easy as telling people not to sneeze in your face when they are sick. It seems that people can be contagious even before they feel ill and, perhaps, after they feel well again. This makes it harder to know who to avoid and while you’ll be hearing more about ‘social distancing’ in the future.

The other number you’re hearing about is the CFR, or Case Fatality Rate. This is as it sounds. It is the number percentage of people who have the illness who die of it. Even this number though isn’t hard and fast. The CFR will depend on age, co-morbid illnesses, and other factors having nothing to do with the virus. You can imagine that an 80 year old man with diabetes in a city with no available ICU bed is going to have a tougher time surviving than a 25 year old healthy man who can be hospitalized if he needs it. Currently, estimates are that the CFR for this virus is between 1 and 2%. To put that in perspective, the seasonal flu has a CFR of around 0.1%, 10 to 20 times less lethal than SARS-CoV-2.

Pandemic

You’re going to hear the word pandemic and a lot of argument about whether this illness is a pandemic or not. I hope you’ll see here that it really doesn’t matter. An epidemic is when an illness spreads rapidly across a wide area, and a pandemic is when that area is the whole world. At least that’s roughly what the words used to mean. In 2009, we had an epidemic flu that was declared a pandemic by the World Health Organization (WHO) through a formal process they had. This time though, they have decided that they don’t want to use the process anymore and won’t be declaring this a pandemic because they don’t want to use the term anymore.

But the disease is rapidly spreading and affecting, as I write this, about 60 countries in all areas of the world. So, let’s let go of the word, and just say what it means. The virus has not been contained to one country, one region, or even one continent. The horse has left the barn. Don’t forget to close the door!

But as I’m an American, this concept of pandemic and the decision of the WHO brings me to ask, “What about the CDC?”

Well, the CDC does use the term pandemic but mostly when talking about influenza and the influenza virus. They have a method of categorizing pandemics by severity. In the technical appendix and for reference, the 1918 Spanish Flu pandemic is listed as a CFR of 2.04% and a R0 of 2. The 1957 pandemic flu had a CFR or 0.3% and a R0 of 1.68. The 1968 pandemic flu had a CFR of .05 and a R0 of 2.01, and the 2009 pandemic had a CFR of .048% and a CFR of 3.3. Below is their picture. Note that the numbers are their scaled scores, not the CFR or R0.

So is SARS-CoV-2 just the flu?

Well, yes, and no. It is a viral lower respiratory infection and has a similar clinical picture to flu. But “the flu” isn’t just “the flu.” As you can see in the picture you can have flu pandemics that you don’t remember from a decade ago and you can have flu pandemics they are still writing books about a century later. Just comparing the numbers from the CDC, a R0 of 2 and a CFR of 2% is a memorable experience.

So what do I do?

First, don’t panic. Even if SARS-CoV-2 produced damage in China like the 1918 Spanish Flu, it doesn’t mean it will here.

First of all, there are differences between people that are genetic and the expression of the protein this virus uses to get into the cell is one of those things that can be different in different people. You can see below that people who express the G allele and have more ACE2 expression are fewer in number and the percentage varies by continent of origin. While EAS population is 40% GG, the AFR population is only 5% GG.

But Italy and Iran seem to be having a growing problem as China and Japan did, so this idea of different populations being differently affected may not turn out to be true. So what can you do if it will be as bad here as in China?

Hopefully, as I write this, the CDC and FDA will start allowing commercial labs to test for this virus. At this point, only the CDC could test limiting testing to very few tests a day for a country our size. Once we start testing we’ll get good numbers in the next few weeks on just how many cases we have.

It may be that people are sick with something else and only think it’s SARS-CoV-2 because it’s in the news. It could be we have lots of cases already but they are still asymptomatic. We have no way of knowing right now, so the thing to do is wait.

We have a head start because of the Chinese experience. They’ve been working for 2 months on this, and we will benefit from their experience. There are anti-viral medications that weren’t available in 1918 and that they didn’t use in China at first. These can greatly affect the lethality of this illness. We’ve had time to prepare, though we may not have used it well, and, as of today, we still have some time to plan.

If you want to do something now then, act as if. Act as if in a couple of weeks you may find out we have a problem here in the US. Sit down today and make a plan. Just spend 10 minutes today, sitting quietly with pen and paper and think about what you want to do. And by the way, my friends in China tell me that even when they were self-quarantined, they could get deliveries of food. So there’s no need to run out and empty the shelves. Just talk to your families, consider your resources, consider your area, and consider your options. Make a plan thats right for you and your family just in case you need it.

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Howard Wetsman is an addiction psychiatrist and founder of GenEd Systems. He blogs at TOCDr.com and maintains a channel on YouTube where he has released his serial Ending Addiction. If you want to know more about genetics, check out GenEd Systems and learn along with them as they grow.

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