Nagging Questions I Have About Coronavirus...
Updated: Apr 25, 2020
More than a month after the lockdown started, I’m still confused by the threat and our response
I’m not an epidemiologist.
I’m just an average person who's trying to make sense of a world that’s making less sense every day. And the more I learn about COVID-19, the less sense it makes. Just to be clear, I’m not saying that this virus is a hoax; this virus is very real. Nearly two hundred thousand people have died, which is a grave human tragedy.
But some things aren’t sitting right with me about the society-stopping panic it’s triggered. What I’m saying might sound like heresy in the midst of the greatest public health crisis in modern history, but there are some common sense questions I have to get off my chest.
A few weeks after the first confirmed COVID-19 case in Washington, my state went into lockdown and I went into low-level panic. I self-quarantined with my family, agonized over trips to the grocery store, and severed all physical social contact. I tuned in to CNN every morning, anxiously awaiting updates from Dr. Fauci and Dr. Birx. Being in quarantine gave me a lot of time to think, and thinking led to questions.
Early on I heard that COVID-19’s mortality rate was around 3.4%, making it ten times more deadly than the flu. Yet I was also hearing that in South Korea the rate was only 0.6%.That was still grim news because it meant that millions of people in the U.S. could die.
But the discrepancy in mortality rates nagged at me. How deadly was this virus? How freaked out should I be? I knew that getting an accurate rate depended on knowing how many people had been infected, and that could only happen with testing. The problem was that a ridiculously small number of people had been tested.
South Korea, which had conducted more testing than any other country, had screened less than 1% of its population. The numbers in the U.S. were even lower because the CDC had botched its attempt to create a test. It seemed weird that we were preparing for all-out battle against a contagion without a realistic sense of how lethal it was. But as pictures of overwhelmed hospitals went viral I pushed the thought from my mind.
Lack of testing wasn’t the only problem; the criteria used to screen potential carriers was problematic. The first confirmed case in Washington on January 21 wasn’t actually the first confirmed appearance of COVID-19 in the U.S.; it was just the first confirmed “travel related”case. Why? Because the CDC had instructed doctors to only test people with symptoms if they had traveled to Wuhan, China.
It didn’t take an expert to see the flaw in this protocol. If a person traveled to Hong Kong, shook hands with someone from Wuhan, then hopped on a plane to the U.S., they would be a COVID-19 carrier — but doctors would never test them because they hadn’t been to Wuhan. Could there be more infected people than we thought? Was South Korea’s mortality rate only .6% because it had tested more of its population? Since experts weren’t raising these questions, I didn’t give them serious thought. But I couldn’t shake the feeling that the world was locking down without a lot of hard data.
I also heard that COVID-19 was scary-contagious. It could hang in the air for 30 hours and survive on surfaces for days, yet 86% of people infected exhibited only mild, flu-like symptoms -- and up to 25% exhibited no symptoms whatsoever.
This opened the door to more questions. If the virus was highly contagious but most cases were mild or asymptomatic, that meant there were probably a lot of people who had been infected without realizing it. Again, I wondered, wouldn’t this lower the mortality rate? Why was no one mentioning this? Was I the only one asking this question?
It turns out I wasn’t. In a March 24 op-ed in the Wall Street Journal, two professors at Stanford University argued that WHO’s projected toll of two million deaths was “deeply flawed” because “the actual number of infected Americans might be underestimated “by orders of magnitude.” Drs. Eran Bendavid and Jay Bhattacharya claimed the “real fatality” rate could be closer to 0.06%, significantly lower than South Korea’s.
It sounded outrageous, yet given what we were learning about COVID-19 it made sense. If the virus could be carried with mild or no symptoms, then it could have hit U.S. shores earlier than we thought, silently infecting the country. But just how early could it have arrived?
Officially, COVID-19 had been brewing in Wuhan since late December. But was it possible that the Chinese government had struggled to contain the outbreak before making the news public? And given the traffic between the U.S. and China during the holidays (when Asian-Americans likely visited their families), could the virus have surfaced in the U.S. shortly after the Wuhan outbreak, but been mistaken for the flu?
Quietly percolating cases from China weren’t the only reasons to suspect the number of infections might be higher than expected. In early April, researchers discovered that the first cases in New York were “seeded” by travelers from Europe — not China — in mid-February. A highly-contagious virus had been circulating for weeks in the most densely-populated city in the country — but we didn’t know because doctors were only testing travelers from Wuhan, despite the fact that China was a major international travel hub.
The Coronavirus mystery deepened in late March. I stumbled upon an article Dr. Fauci had written in The New England Journal of Medicine a month earlier. After culling data from China, Fauci concluded that because the number of mild or asymptomatic cases was several times higher than the number of reported cases, the mortality rate could be “considerably less than 1%.” He even speculated that “clinical consequences” of COVID-19 might ultimately be “more akin to those of a severe seasonal influenza.”
I was baffled. Was the most trusted face in the war against Coronavirus telling us we might be dealing with something no more lethal than a severe flu? I didn’t recall Dr. Fauci saying anything like this in press conferences.
On April 4, the World Economic Forum echoed the conclusion reached by the Stanford doctors, arguing that “we could be vastly overestimating the death rate for COVID-19” because many people “are or were already infected with the virus,” whether or not they have symptoms.
Everywhere I looked, there was growing evidence that the novel Coronavirus was considerably less fatal than most people assumed. Yet around the world, countries were bracing citizens for the end of the world as we knew it.
It’s been more than a month since the lockdown started in the U.S. At the peak of the crisis, hospitals were pushed to their maximum. Cities secured overflow shelters and hastily constructed tents to house patients. Yet even as authorities “scramble[d] to build makeshift medical centers” in hardest-hit New York, there were enough beds to serve patients in need. In fact, temporary overflow hospitals in New York City remain underused. Other states anticipated severe shortages that never materialized. In April, California sent 500 ventilators to assist other states, even as it braced for a “surge” in cases. Comfort and Mercy, the naval ships sent to New York and Los Angeles to assist with hospital overflow, never held more than twenty patients.
Based on the high mortality rate we were hearing and the highly contagious nature of the virus, it’s easy to see why states prepared for a public health apocalypse. But this isn’t the first time a virus has pushed our resources to the limit. The 2017–18 flu season was one of the deadliest in history, claiming 80,000 lives. Overwhelmed hospitals cancelled elective surgeries and set up triage tents. It was an unprecedented health crisis that claimed more lives than COVID-19 has in the same period of time, and it severely strained hospital resources and staff — but it didn’t trigger a lockdown. In fact, it barely made front-page news.
Since the end of March, the White House has dropped the number of projected deaths significantly — from 2.2 million to 100,000–200,000, then to 82,000, and now 60,000. The consensus is that the curve is flattening due to widespread implementation of social distancing and lockdowns. But an evolving Coronavirus timeline throws the effectiveness of these measures into question.
On April 22, doctors discovered that a Santa Clara woman died of Coronavirus several weeks before doctors detected the outbreak in California. Moreover, new research indicates that “hidden outbreaks” had been spreading in cities long before testing indicated a problem. On March 1, there were 23 confirmed cases in New York, Boston, Chicago, San Francisco, and Seattle, but researchers now believe 28,000 people may actually have been infected in just those five cities by then. A recent Stanford University study points to a similar conclusion. In a representative sample of Santa Clara residents, between 2.5% and 4% were estimated to have COVID-19 antibodies, or 50 to 85 times the number of known cases. Similar rates of infections have also been found in Europe.
This begs several questions: how effective were social distancing and lockdowns if they were implemented a month after a highly-contagious virus had already infected tens of thousands of people in only a handful of cities? How many millions of people might have been infected throughout the country before the lockdowns started? Is it more likely that the curve has flattened due to these state-mandated measures, or because the virus had already worked its way through much of the population earlier than we knew?
The Stanford study also poses a question more people will likely ask in the coming months as the infection timeline continues to shift: if policy makers had known from the outset that the “COVID-19 death toll would be closer to the seasonal flu than the millions of American deaths” projected by early models, “would they have risked tens of millions of jobs and livelihoods?”
Policy makers aren’t psychics; they can’t know exactly what they’re dealing with from the outset. But even Dr. Fauci had reason to question the early models and suspect the practical effect of COVID-19 might be akin to a severe seasonal flu. Yet his findings were never made public. Instead, we were consumed by images of death and overwhelmed hospitals, and in the end, those images spoke louder than journal articles or common sense.
As the death toll mounted, we never thought to wonder why China and Italy seemed to be outliers, suffering mortality rates far higher than other countries. If we had looked deeper, we might have seen that Italy has the oldest population in Europe, with 23% being over the age of 65. Or that the majority of victims in both countries were men who smoked at extremely higher rates, putting them at greater risk for a virus that attacks the lungs.
In New York, which has had 14 times as many deaths as California, nearly 20% of residents are over the age of 65. The state is also home to the most densely-populated city, where 1 in 5 residents live in povertyand a “chronically inadequate health care” system services minorities. Blacks and Hispanics comprise 51% of New York City’s population, yet account for 62% of Covid-19 deaths.
We could have asked harder questions before shutting down the world’s largest economy, but we didn’t. And now we’re facing the consequences. 26 million people have filed for unemployment, and 1 in 3 Americans is expected to be out of work due to the crisis. In Los Angeles, more than half of residents are unemployed. Since the lockdown began, calls to suicide hotlines have spiked and domestic violence has increased dramatically. Due to a widespread lack of jobs globally, as many as 265 million people now face acute starvation by the end of the year.
Many intelligent and educated people are raising these issues now, but their voices have been muted against the rising tide of panic and fear. 800 experts in public health, law, and human rights recently presented an open letter to the White House in which they advised of the danger of ongoing lockdowns that "disproportionately affect the most vulnerable segments in our communities" and cautioned that "[i]nfringements on liberties need to be proportional to the risk presented by those affected."
No reasonable person would argue that COVID isn’t a threat; any novel virus or disease should always be taken seriously. But I’m wondering if our reaction has been disproportionate to this threat. I wish we had received more consistent and complete information about Coronavirus early on. I wish we had all asked harder questions early on. And I question whether a more balanced approach — self-quarantining the most at-risk citizens and social distancing — might have been just as effective in controlling the spread of a genie that was likely already out of the bottle.
If we had asked more questions, our response might not have taken such a vicious toll on the vast majority of people who will never succumb to this virus.