Coronavirus: Seeing Through the Fog of Fear

With nearly every news website, broadcast, blog, social media outlet and publication wallpapered with coronavirus coverage, information—and, sadly, misinformation—about it abounds. That slew of coverage is seemingly spawning fear, which makes focusing on facts currently known about the outbreak all the more urgent, in our view. Now, we aren’t epidemiologists or physicians. Neither of us studied medicine. We don’t even play doctors on TV. But part of what we do is analyze media—our team covers dozens of outlets daily from around the world. That means we have collectively read hundreds of articles on the subject—and found some significant overlap across various experts about what is true and what isn’t. While there are still some significant unknowns about the outbreak, we thought rounding up our findings may help readers. Now, of course, all this could change—and some statistics surely will—but we hope to provide you as good a basis for seeing this as possible now, given extant fear over the issue. Without further ado, here we go.

How Many People Have the Coronavirus?

Most outlets cite the total number of identified cases in response to that question. As of March 6, Johns Hopkins University’s dashboard (which you can view here) cites 101,781 coronavirus diagnoses—260 in America. However, there are a few caveats to this. One, that doesn’t deduct the number of patients who have recovered or, tragically, died. Hopkins counts 55,866 patients as having recovered from the virus. 3,460 have died. Hence, these data show 42,455 persons currently known to have coronavirus globally—238 in the US.

Of course, these numbers are likely understated. Limited testing worldwide means officials only identify those patients with the most severe symptoms. When Elisabeth got swine flu in 2009, she was not part of the official tally because she stayed in bed and had fever dreams instead of checking in at a clinic. That the disease is likely more widespread than data suggest may seem frightening, but it brings us to another critical point to consider: The coronavirus death rate is likely overstated—potentially by a lot.

How Deadly Is the Coronavirus?

Interviews with professionals uniformly agree on this point. If you use basic math and simply divide the number of deaths by the total number of identified cases, you may think the death rate is 3.4%. But the trouble with this is, again, identification. As Tom Frieden, former director of the US Centers for Disease Control (CDC), put it, the 3.4% rate “is certainly an overestimate.” The reason: Limited testing means many mild cases went unidentified. At a panel discussion Friday on Capitol Hill, Johns Hopkins’ Dr. Tom Inglesby stated that roughly 80% of known cases were mild. So mild that patients recovered with no hospitalization or medical intervention. (Some 15% did need hospitalization and 5% critical attention.) Many others likely didn’t even know they had it.

This means we don’t have the right denominator to calculate the death rate. In South Korea, where testing has been more aggressive, Dr. Inglesby noted the death rate was 0.6%. Frieden told Bloomberg reporters he expected the death rate to eventually hover around 1%. Now, that is speculation to an extent, but it is educated speculation that seems logical given the backdrop. That puts the death rate higher than influenza, which CDC estimates killed an average 0.14% of people who contracted it from the 2010/2011 flu season through 2017/2018.^[i] But it is far lower than mortality rates tied to 2003’s Severe Acute Respiratory Syndrome and other similar outbreaks.

Who Is Most at Risk of a Severe Form of the Coronavirus Illness?

Older people—and, particularly, those with pre-existing health conditions. Again, these data are likely overstated, but there are some demographic findings worth noting. World Health Organization (WHO) data show those over age 60 are at an elevated risk, with those over 80 particularly vulnerable. The table below is about a week old, but it contains the latest available data, and the general gist likely still holds.

Exhibit 1: Global Coronavirus Fatality Rate by Age

Source: World Health Organization, as of 2/29/2020.

The US experience echoes this: Of 14 fatalities in America, most stem from a single nursing home in the Seattle area. Moreover, many of the younger people who have died had major pre-existing conditions—another point global data show.

Exhibit 2: Pre-Existing Conditions Exacerbate Death Rate

Source: World Health Organization, as of 2/29/2020.

Dr. Lisa Lockerd Maragakis, also of Johns Hopkins, echoed this point, noting that high-risk groups cluster among the elderly—which is normal for virtually any illness. As she put it, this “happens every year with influenza.” So, this is a sign older readers should take caution—we won’t get parental here and tell you to wash your hands, because we figure you already do that. But if you do feel ill—fever, cough, and shortness of breath are common symptoms, although gastrointestinal issues can be too—take action.

Because the Number of Cases Seems to Increase Exponentially, the Coronavirus Must Be Highly Contagious.

This viewpoint has gained popularity thanks to the likes of Bill Gates, who went on to call the coronavirus the “once in a century pathogen we’ve been worried about.” But how does the coronavirus’s contagion compare with other infectious diseases?

Epidemiologists measure contagion with a statistic called the reproduction number, denoted as “R0.” It estimates the number of people each patient is likely to infect. Bloomberg rounded up R0 estimates for the coronavirus and other infectious diseases from the WHO and CDC and found that while the coronavirus’s R0 of 2.8 makes it more contagious than the seasonal flu (1.3) or Ebola (1.9), it is much less contagious than smallpox (4.8) or the measles (15.0). A separate New York Times analysis estimates it is also far less contagious than chickenpox.

Yet even these comparisons may overstate the transmission risk. As WHO Director-General Tedros Adhanom Ghebreyesus explained on Monday: “We don’t even talk about containment for seasonal flu – it’s just not possible. But it is possible for Covid-19.” He elaborated: “We have never seen before a respiratory pathogen that’s capable of community transmission but at the same time which can also be contained with the right measures. If this was an influenza epidemic, we would have expected to see widespread community transmission across the globe by now and efforts to slow it down or contain it would not be feasible.” WHO officials have also observed that the coronavirus appears to be much less contagious than the flu in their respective incubation periods, i.e., before symptoms appear.

The Statistics Show the Coronavirus Is More of a Threat Than the Seasonal Flu.

This statement depends on how you define “threat” and which data you cite. As shown above, the documented R0 and fatality rate are higher for the coronavirus than the flu. Its fatality rate is far below 1% of infected patients, compared to 3.4% for the coronavirus. We deconstructed the latter above. But even if you take it at face value, it doesn’t mean the coronavirus is worse than your typical seasonal flu thus far.

The WHO estimates that of the tens of millions of people who contract influenza globally each year, there are between 3 and 5 million severe cases, with 250,000 – 500,000 fatalities. At last count, as mentioned above, the number of confirmed coronavirus cases is 101,587, with 3,460 deaths. That is between 0.7% and 1.4% of the amount of annual influenza casualties.

The Coronavirus Is a Bio Weapon Created by the Chinese Government.

As a general rule, whenever something bad or scary happens, you will get a conspiracy theory. This one is a 21^st century version of the conspiracy theory about Lyme disease being the US government’s botched attempt at germ warfare during the Cold War. It is also quite likely incorrect. Public health scientists who studied this virus’s genome have concluded it came from wildlife.

The coronavirus is what virologists call a zoonotic disease—it was transmitted from animals to humans. MERS and SARS, which were also coronaviruses, transmitted from bats to an intermediate animal to humans. Researchers believe this coronavirus did the same, potentially with a cute little scaly anteater called a pangolin the likely intermediate agent. Pangolins are endangered, and there is a global ban on selling them. But they have also long been used in Chinese traditional medicine, and poachers often traffic them into the country. They then sell at open-air markets like the one in Wuhan where the first cluster of coronavirus cases emerged. The pangolin may or may not yet prove to be the culprit, and it is possible that the virus may have leapt directly from bats to humans. But for now, all are operating on the working theory that wildlife sold illegally at the market was the initial infection source. It will take further research to confirm, but Occam’s Razor—which says the simplest explanation is almost always right—is always a good analytical starting point.

We also feel compelled to point out that if a government were going to create a bio weapon, it would probably go for something more virulent and deadly than a coronavirus, considering that this is also the family of viruses that causes the common cold. If this was indeed germ warfare, it was an epic flop, considering the mortality rate is low and likely to fall.

What About the Economy?

To turn to something much more in our wheelhouse: the virus’s economic impact. It is too soon to know exactly how the coronavirus will impact economic growth. There will almost certainly be some kind of hit, with most forecasts suggesting slowing growth. But, and this is key, it looks to be temporary. Already, various purchasing managers’ indexes hint at inventories falling while order backlogs rise—fuel for a rebound. In China, there are already signs of this. One Chinese online travel agency noted hotel bookings soared 40% in the week ending 3/1 from the prior, while flight demand skyrocketed. In a hard-to-refute sign the country is getting back to work, nitrogen dioxide pollution is back. The gas, a byproduct of utility output and factory emissions, largely vanished amid the twin impact of the Lunar New Year holiday and coronavirus-related shutdowns—which NASA captured in a recent image of the week. We aren’t cheering pollution, but it seems a pretty tangible sign of a rebound. Of course, there are many other pollutants—and China’s economy is mostly services these days, not factories. But it still seems relevant to note, in our view.

While we are on the subject of Chinese pollution, let us put to bed the notion that went viral (sorry) that an uptick in sulfur dioxide emissions showed China was mass-cremating coronavirus dead. As NASA put it: “In the model, the concentrations of SO2 are estimated from historical emissions sources that are transported around the globe by atmospheric circulation. Therefore … [the] simulations cannot account for variations in SO2 concentrations arising from a sudden change in human activity (like a quarantine).” We know, shocker, somebody said something wrong on the Internet.

Because the coronavirus outbreak is new, still ongoing and its eventual end is unknown, fear is running high. We hope to cut through some of that emotion by sharing the findings of our broad-based survey of media in one consolidated place.