COVID-19: Drivers and Implications

Update: 3/27/2020

Here’s an article that recently appeared in the The Atlantic. Can the U.S. really pull back from individualism and focus more on a communitarian public health policy?

Here I’ve drawn on my medical sociology background and current media reports to paint a succinct picture of the current pandemic.

COVID-19 Virus

The 1918 flu pandemic probably originated in Kansas, USA (though there is some recent evidence that it could have originated in Asia or Paris). Epidemiologists estimate that among a global population of about 1.8B somewhere between 50m and 100m died from the 1918 flu, making it the one biggest infection killer of all time. The disease ran its course in about 24 weeks. Although the Plague of 1300 killed a far greater proportion of the population, far fewer people died from the Plague (Barry, pp. 4-5).

Today, the global population stands around 7.3B. According to the WHO, “. . . the crude mortality ratio (the number of reported deaths divided by the reported cases) for COVID-19 is between 3-4% (this figure will change as more information becomes known). As of 3/24/2020, 1:14:14 PM there were 407,485 confirmed COVID-19 cases and 18,227 confirmed deaths, resulting in a crude mortality rate of 4.5%–far higher than the 1918 flu pandemic. In contrast, the mid-range crude mortality estimate (calculated using the numbers reported in: 2. Influenza is already a major health challenge) for flu over the years is .04%. The major variables determining infection rates depends on how contagious the disease is, when public health measures are implemented, how effective those measures are, and the cooperation of the public with those measures. Mortality rates are dependent on these factors as well as the viruses’ virulence (strength), and the capability of the healthcare system.

Epidemics are unpredictable–they can erupt anywhere. However, we know that they are fostered by population density (7.3B people worldwide and concentrated in urban areas), proximity to and the eating of domesticated or wild animals (factory farming and people encroaching into wilderness areas risk infection), and a warming climate (tick and mosquito borne illnesses)–all greater factors now than in the past. Indeed, these factors are already changing the course of humanity.

The current evidence (with some regional exceptions) shows inadequate efforts to address these factors. This raises the importance of establishing sound healthcare systems around the world, coupled with a strong disease surveillance system to minimize the spread of an outbreak. Still, both of these are tall orders (as we currently see with the U.S. healthcare system). While Americans proclaim to have the world’s best healthcare, this is only true in terms of medical training, and the development of a wide range of medical technologies. However, the access to health care and these technologies, and the health care system in which clinicians work leave a lot to be desired when compared with other developed nations.

In reference to disease surveillance, as reported in The New York Times, some see this as a threat to our privacy. Clearly, there is a tension here with no straightforward answer. How better surveillance would best be implemented would depend on political initiatives. Nevertheless, there would likely be some loss of privacy with a strong disease surveillance system. However, with an ever greater likelihood of epidemics and pandemics, we must balance the risk of societal upheaval and excessive mortality, with some loss of privacy.