The Morning Jolt

Health Care

Coronavirus Chronicles

President Donald Trump gives a news conference on the coronavirus outbreak at the White House in Washington, D.C., February 26, 2020. (Carlos Barria/Reuters)

Today’s Morning Jolt is all about the coronavirus. A fact that doesn’t help anyone score any partisan points, and thus will be largely ignored, disregarded, or forgotten: The U.S. Centers for Disease Control, the Department of Health and Human Services, and the broader Trump administration could make all the right choices regarding how to handle the coronavirus, and it could still be a serious and disruptive problem.

Reasons You Should Not Be Too Worried about the Coronavirus in the United States

The Associated Press fact-checkers point out that the Democratic accusations that the administration is unprepared are based upon a budget proposal that was never enacted: “Trump’s budgets have proposed cuts to public health, only to be overruled by Congress, where there’s strong bipartisan support for agencies such as the CDC and NIH. Instead, financing has increased. Some public health experts say a bigger concern than White House budgets is the steady erosion of a CDC grant program for state and local public health emergency preparedness — the front lines in detecting and battling new disease. But that decline was set in motion by a congressional budget measure that predates Trump.”

All across the United States, since 9/11, hospitals and first responders have been training and running drills to deal with bioterrorism and mass-casualty events. This means for roughly eighteen years, everyone in the medical profession has been thinking: “If the worst-case scenario happens, what is my role in responding? How do we contain it, treat the sick, and minimize the danger to everyone else?”

What’s more, the outbreaks of the past years — swine flu, H1N1 flu, SARS, MERS, and Ebola — have given doctors, clinics, and hospitals good dress rehearsals for something on this scale:

“For the whole country, this is not our first rodeo with new germs,”  Dr. Amy Compton-Phillips, executive vice president and chief clinical officer of Providence St. Joseph Health, said. “Ebola was our wake-up call that we needed to be ready for the next pandemic. So we, as well as other hospitals, put in place the ‘just-in-case’ scenario planning.”

That scenario is something that hospitals across the country have been rehearsing for weeks as cases of the new coronavirus, which causes a disease called COVID-19, rise around the world. And while not every U.S. hospital will get notice that a possible coronavirus case is coming through its doors, many say they have been bracing in other ways: They are holding daily briefings with state and local health departments, stocking up on personal protective equipment for health care workers and working with engineers to control air flow in their hospitals to make sure they are best positioned to stop the virus from spreading.

“We’re already acting as if it’s here,” said Dr. Michael Phillips, chief epidemiologist at the NYU Langone Health System in New York City, which has yet to see a confirmed case. “We’re already thinking about what we should be doing, how we make sure our health care workers are safe. Are we messaging them enough, but not over-messaging them?”

Much like other viruses, the amount of danger the virus presents is probably connected to your age and overall health condition:

The sample’s overall case-fatality rate was 2.3%, higher than World Health Organization official 0.7% rate. No deaths occurred in those aged 9 years and younger, but cases in those aged 70 to 79 years had an 8 percent fatality rate and those aged 80 years and older had a fatality rate of 14.8 percent.

No deaths were reported among mild and severe cases. The fatality rate was 49% among critical cases, and elevated among those with preexisting conditions: 10.5% for people with cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6% for hypertension, and 5.6% for cancer.

The latest China-based study, which was not peer-reviewed by U.S. scientists, found that men had a fatality rate of 2.8% versus 1.7% for women.

Some of those numbers sound scary, but keep in mind, this means that if you’re 80 years old and catch it, you’ve still got an 85 percent chance of surviving.

As noted earlier, the Chinese numbers may be significantly affected by smoking rates in that country. Roughly half of all Chinese men smoke, while very few Chinese women smoke.

If you’re a nonsmoker who is in good health and takes basic preventative steps such as washing your hands, you’re probably going to be fine . . . at least, based upon what we know so far.

Reasons You Should Be at Least a Little Bit Worried about Coronavirus

Even if the United States is about as prepared as any country can be for a severe viral outbreak, a lot of other countries are not. And even the most technologically advanced, economically prosperous, and well-run countries are going to find this a serious challenge.

The government of Japan just closed all the public schools in the country for a month:

Prime Minister Shinzo Abe on Thursday asked all elementary, junior high and high schools nationwide to close from Monday through the students’ spring break, which typically ends in early April.

“Efforts have been made to prevent the spread of infection among children in each region, and these one or two weeks will be an extremely critical period,” Abe told a meeting of key Cabinet ministers on the coronavirus outbreak crisis.

The Japanese also reported that a woman who had the virus and appeared to recover had tested positive a second time.

Hong Kong is closing schools for two months.

Saudi Arabia halted travel to Mecca.

Milan, Italy, is not completely shut down, but the cathedral, opera house, schools and universities, and many bars and restaurants are shut down.

Joint military exercises with South Korea are being scaled back.

The quarantine of Wuhan began January 23. It’s still in place.

As I was discussing earlier, China has roughly 60 million men over age 60 who are regular smokers. If the coronavirus spreads throughout that population and kills just five percent of those, we’re looking at 3 million deaths.

Besides the severe economic consequences, I don’t think anyone really knows how the Chinese people would respond to a public-health crisis and disaster on this scale.

Beyond all of that, the United States and most Western countries are probably reasonably well prepared for this. Poorer and less developed countries probably won’t be well prepared. Any regime that has a history of being less than fully honest about the country’s problems is in for some serious trouble ahead.

If you thought Iran had problems before, take a look at the situation now:

“We think that this virus has been in Iran for the past three to four weeks and has circulated throughout the country. Right now in Iran we are facing a coronavirus epidemic,” said a senior medical doctor at the Masih Daneshvari hospital in Tehran, the country’s top pulmonary public hospital and the main facility overseeing coronavirus patients.

Since it first announced the presence of COVID-19 last week, Iran has so far reported a total of 245 cases and 26 deaths, a far higher fatality rate than seen elsewhere. The doctor, who requested anonymity to speak freely, said the official tally vastly underestimates the true number of cases. “We didn’t have a way to test people earlier and don’t have the capacity to screen everyone,” he said, in a telephone interview. “Let me put it this way, if in general two out of 100 corona patients die, in Iran, if we now have 20 deaths that means we have 1,000 infected patients.”

An anesthesiologist at one of Tehran’s top private hospitals, who also requested anonymity for fear of retribution, said she believed officials are victims of their own inaction in tackling the disease. “The reason these government officials are contracting the virus is because, they always want to hide the truth; so they don’t use any protective measures when going from this hospital to another just so they project this image that there’s nothing serious going on. It’s only natural that they have been exposed to the virus.” Speaking in a telephone interview, she claimed government officials held back information out of fear of low voter turn out in last week’s parliamentary election.

No matter how much we may detest the Iranian government, this situation still means suffering for innocent Iranian people. This is an erratic, paranoid, fundamentalist regime that is eager to find scapegoats. It is not difficult to envision scenarios where things go very wrong very quickly in Iran.

Why We Can’t See a Problem Like the Coronavirus Clearly

Ross Douthat picked up on something I couldn’t quite articulate as well as he did. We live in a U.S. media environment that can hype the dangers of everything from sharks to fracking to micro-aggressions to Russian-generated Facebook posts. Think of all the times your local news has run quick commercials like: “This common home appliance may be trying to kill you. We’ll tell you which one at eleven.”

But up until recently, a lot of our media voices were doing the opposite of fearmongering. For a few weeks, the dominant tone of the coverage was, “Actually, you’re in much more danger from the regular flu.” As our MBD observed: “Because most reporters are terrible at vetting information when it requires numeracy, they want to file many, many, many articles about how the seasonal flu was a greater threat than the coronavirus. Meanwhile, trade shows and global production lines began to shut down, when the flu never causes them to shut down.”

ADDENDUM: More coronavirus discussion, along with a lot of talk about the state of the Democratic primary, on this week’s edition of The Editors.

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