GELFAND’S WORLD--It’s hard to know whether to join the people of Costa Mesa in panicking over the new version of coronavirus or whether to treat it as the newest Ebola – that is, something that kills a few thousand people but is put under control before the rest of us seven billion folks are bothered – something that will come back from time to time, but be put under control with each event.
Meanwhile, a few pedants are reminding us that seasonal influenza is killing Americans by the tens of thousands with little comment either by the press or the government.
We had an informal discussion the other night after a neighborhood council meeting. Three board members – a molecular biologist, a marine biologist, and an employee of the CDC – considered the question as to whether the danger from the new coronavirus is worse than the risk from the plain old seasonal flu. The answer we came up with is a qualified Maybe.
The reason for that maybe can be explained in a few words and one question: Exactly how contagious is this new virus? The worst case scenario is that people carry it for several days without developing symptoms, and during that period they are infecting other people. If that were to be the case, and if the mortality for symptomatic cases is actually between two and three percent, then there is a potentially serious problem. As the news agencies are saying, it could become a pandemic. If, say, one-tenth of this country came down with a symptomatic case (i.e.: fever, trouble breathing) and one percent died, then, that would mean a death toll in the hundreds of thousands. If you adjust the (intentionally conservative) numbers I just plugged in and imagine a death toll of about 3 percent (as the international numbers right now are showing) then we are looking at more than a million dead.
On the other hand, if the virus isn’t that contagious, and people don’t pass it on until they already have a cough, then it is obviously a lot easier to control. Public health authorities are controlling the active cases strictly, using hospitalization and quarantines. They are going a little less strictly on the merely-potential cases, including people who have just arrived from mainland China.
The authorities are reacting strongly to any and every suspected outbreak. In the meanwhile, we are getting a different story from sources such as our own county public health people. In short, we’re getting distinctly mixed messages.
Just to get the fear juices flowing, let’s consider a different virus that is about as contagious as any microbe can be. We’re talking about the measles here. It is so contagious that before there was an effective vaccine, pretty much every American was exposed to the measles, mostly fairly early in life. You can catch the measles by walking into an empty elevator that an asymptomatic measles carrier was in previously. In the pre-vaccine days, several hundred thousand American children got measles each year.
The anti-vaccination people like to point out that for most of us, getting the measles was simply a rite of passage in childhood. What they don’t usually mention is that about one in a thousand cases resulted in death as an immediate result of the illness, and that a similar fraction died, years later, from persistent infection of the brain by some still lingering measles virus.
So here is the nightmare scenario for public health professionals: a new virus that is as contagious as the measles and as lethal as the new coronavirus. A worldwide pandemic would result in the deaths of more than a hundred million people. Even this is not at the level of the bubonic plague epidemics that struck medieval Europe, but it would resemble the Spanish Flu that hit the world in the immediate aftermath of WWI.
Reassuring words and a logical twist
At an emergency preparedness meeting the other day, I heard a presentation from a representative of the county’s public health agency. What did I hear? Well, there wasn’t much about the coronavirus per se. We did learn that this class of viruses got the name because the virus particle has little knobby things sticking out all over the surface, so it resembles a crown or the corona around the sun. We didn’t hear much about the biology of the virus, or even much about the particular parts of the body it attacks. We just heard that we should wash our hands and get a flu shot.
Now this is a very peculiar sort of prescription for dealing with the coronavirus, because it has nothing to do with the subject under consideration. The argument goes something like this: Lots of people in this country get influenza each year, and several thousand of them die. One way to lessen the risk of getting the flu is to get a flu shot. (It isn’t perfect, but this year’s shot knocks the risk down by about half.) This has nothing to do with coronavirus of course, but since the audience was hearing about a virus, you might as well tell them something useful about protection against another virus. Not exactly logical, but it seems to be the current party line.
We were also warned several times about scratching our eyes or touching our mouths or noses unless we had just washed our hands. Again, this had almost nothing to do with coronavirus, and it is even less likely to be adhered to by most people.
If you want to see the county’s official party line, click here. The hand washing advice begins to make sense for those who have been in contact with sick people, but the county representative didn’t really make that clear.
When I listened closely to the county presentation, the main story came clear – right now, there aren’t any infectious people in this area. The government is doing its best to find and quarantine anybody and everybody who has even a slight chance of carrying the virus. It would have been just as useful to advise us to ignore the whole subject unless or until some real risk begins to present itself.
By the way, I don’t usually take issue with items appearing in these pages, but a piece on the coronavirus last week concluded with these words: “If you don’t want to get sick or spread disease, wash your hands and get a flu shot. Same as any other year. It’s not rocket science. It’s basic epidemiology.” Well, no. There are lots of ways to get diseases, everything from inhalation of virus particles floating through the air to your own genetics, and the flu shot is at best about half effective. If nobody around you has the coronavirus, it doesn’t matter whether you wash your hands or not. The advice isn’t wrong, but it’s incomplete.
The conclusion reached by our little discussion group of biologists and a CDC person is that we just don’t know enough as yet to reach solid conclusions. That’s one reason the world’s governments are reacting so strongly. They know that if they do nothing, a lot of people will get sick and some will die, and they fear that the epidemic could get out of hand even if they do everything possible.
So there we are – uncertainty is always a part of that grey area on the edge of science where you are only beginning to understand things. Maybe the disease would run its course without any governmental intervention at all (maybe it’s not that contagious), but nobody knows for sure.
Human acceptance of the inevitable and a logical fallacy
Before the measles vaccine, parents put up with measles as an inevitability. There was a term for measles, mumps, and chickenpox – childhood illnesses. Since there wasn’t any way to avoid these diseases, people accepted their incidence and hoped for the best. Since most children survived without a lot of residual symptoms, it wasn’t quite the panic that something like a polio epidemic would cause, where a significant fraction of children ended up with difficulties in walking or breathing. Still, there was the odd case from time to time of a child dying from the measles. It was inevitable. Nothing people could do. And there was a 998 chance out of a thousand that your child would do OK.
Applying this same approach to a disease where there now is an effective vaccine is fallacious at best. Why accept a mortality of even 0.1% if we can knock it down to zero?
We don’t have this choice at the moment when it comes to the new coronavirus or Ebola or childhood leukemia. So we go through life trying to ignore the fact that they (childhood leukemia, anyway) are real risks and we are just plain lucky that we and our children haven’t gotten them.
But when an effective vaccine against all influenza viruses becomes available, we should all get it. Then those nearly-inevitable tens of thousands of deaths from the flu will be another historical fact that we can look back on in wonderment. Not many people remember having the whooping cough nowadays either.
Something completely different, or From the Balcony
The Los Angeles Opera just completed its world premiere of the opera Eurydice. L.A. Times critic Mark Swed gives the whole story here. From the standpoint of the naïve audience member, I would add that full bore grand opera as presented at the Music Center (and Long Beach) is several cuts above the usual pop music scene. It’s just not comparable. The trained voice is different on so many levels and mixing operatic voices with the classical orchestra creates a sound that you are not going to hear otherwise. Adding a story with some depth (or if not depth, then emotion) makes the experience something that you don’t get otherwise. Eurydice was put together by a young composer and deals with the story of Orpheus and Eurydice from the female point of view, as written by a female story teller. It was musically beautiful and definitely worth attending.
(Bob Gelfand writes on science, culture, and politics for CityWatch. He can be reached at [email protected])