I am writing this message, which I would never have wanted to write, for 3 reasons:
1- Because the situation we currently have with the covid-19 coronavirus in Spain is very serious -much more than most people believe-, due to the characteristics of this virus (which I will detail later and it is important to know), since the “measures adopted”, even those currently being considered, are practically equivalent to letting the infection continue to spread at the same speed.
2- Because neither rulers, nor politicians -of any party-, nor health authorities nor the media are making the population aware (and this is extremely urgent) of the characteristics of this virus, nor of the measures that, given those characteristics, we have to take each one to alleviate its enormous potential for damage..
3- Because there are two basic measures - which are the most effective given the characteristics of the virus - that are not being taken and that we can - and must - take all forcefully. (And that we must demand that the authorities take them as central measures, just as the countries that have managed to contain or considerably slow down the spread of the virus have done).
This is not a message of opinion, criticism, or biased or false information. I will present and explain a summary of the scientific information available, indicating the sources (their links are at the end of the message). There is also a brief analysis of some measures based on their effectiveness, emphasizing the two essential -and most effective- that we are not taking..
Despite the fact that all the information that I am going to transmit is public, I have spoken with several doctors from our health system and they have acknowledged with great concern that they did not know it, and that the very dangerous and completely uncertain message that we have all heard that "it's like the flu".
This is not a criticism of doctors, quite the contrary. Their job is not to collect health information, since they receive it from the health authorities, which in this case neither the doctors nor the civilian population have transmitted it (out of optimism, ignorance, excessive focus on reassuring ...?)
The reason I do not care, what interests me is what we can do from now on. And, as we are going to see, the lives of hundreds of thousands of people depend on that, in Spain alone..
(All the data on the virus and measures are logically extrapolated to other countries, but in the comments I will focus on the Spanish case).
The virus data:
The latest estimate of the WHO (World Health Organization), provided on March 3, is 3.4% That is, of every 100 infected by this coronavirus, an average of 3.4 dies.
To compare it with the happy flu, the mortality of seasonal flu is 0.05% (other estimates lower it to 0.02%, but in the flu I will use the highest of those available so that no one thinks that I want to compare the coronavirus with a "weak flu").
0.05% vs. 3.4% What does that mean? That the death rate of the coronavirus is 68 times higher than that of the flu. Or, in other words, that one in every 2,000 infected people dies with seasonal flu, and one in 29 infected with the coronavirus.
Its high mortality indicates that it is an extremely aggressive virus. That 1 in 2,000 who dies from seasonal flu is practically always someone with previous pathologies.
With the mortality of 1 in 29 infected with coronavirus, although logically the ratio increases in very old people and with pathologies, people of all ages die, doctors who treat patients, etc..
Another important fact about aggressiveness
The rate of infected people who worsen until they become serious or critical patients is 15-20% (if you look at the links and do the math, you have to take into account that Iran does not report critical cases).
That is, 1 in 29 dies, but 1 in 5 or 6 infected becomes seriously ill. And another big difference with the flu (the famous paracetamol and 7 days at home), is that 15-20% of those infected who become seriously ill develop bilateral pneumonia (unlike SARS and MERS in which it is basically unilateral) that compromises your breathing capacity, and that you are seeing that can last 6-8 weeks.
It is not easy for any organism to pass such a test. In addition, it is being seen in autopsies, as was seen in SARS, that covid-19 pneumonia causes pulmonary fibrosis, which at least in some patients who do not die but have been serious would leave sequelae for life.
In summary, 3.4% mortality and 15-20% of seriously infected.
They are very high data, but by themselves they do not tell you the impact it can have on a country. For that we have to examine its contagion potential, which we are going to see is very high.
The common flu has a reproductive index of 1.3; that is, each infected in turn infects 1.3 people. The average reproductive index of covid-19 is estimated around 3. That is, in two reproductive cycles, which we can estimate in two weeks, the number of infected with influenza barely doubles, while that of infected with coronavirus multiplies by 10.
10 more times every two weeks, this information is very important.
+ Incubation period
It is an essential piece of information, but first we must know another essential one: this virus is also spread during the asymptomatic phase, while there are no symptoms. That is why temperature controls are of very little use, or saying that when someone is unwell, do not mix with other people.
Of course, it should not be mixed, but it should not have been mixed either during the incubation phase in which the virus is transmitted even if the patient has no symptoms. The measures to be taken are very different -and much more anticipatory and generalized- when we have a virus that is transmitted in the symptomatic phase.
Well, we already know that covid-19 is transmitted even if the infected person has no symptoms; For when? During the incubation period, that gives us another bad news. It is estimated that it is triple that of the flu, which shows its face before. Covid-19 incubates from 2 to 14 days, and there are reported cases that raise the incubation period in exceptional cases to 27 and even 37 days. The average from symptoms to infection, which we are interested in making calculations about the virus, is just under a week.
In summary: very high contagion potential (which also has the entire population available to infect because no one has immunity to this new virus, nor are there vaccines - it is estimated that it will not be possible to have them before at least mid-2021-); very fast growth rate; asymptomatic and very prolonged period of contagion.
This combination of factors has several consequences:
- We can expect (and we are seeing that this is the case in Italy or Spain for not imposing restrictions) a growth of the order of magnitude of x10 every two weeks. 10 times more (cases and deaths) every two weeks, it means 100 times more in a month ...
- With the reproductive index or ratio of around 3 and how elusive it is, especially without proper measures, it can infect a large percentage of the population in a short time. And that gets worse because there is still no immunity, as we have said. Various estimates consider that it has the potential to infect 40-70% of the world's population in one year. If we place ourselves in an intermediate point, 50% of the Spanish population is 23 million people, which for a 3.4% mortality is equivalent to 780,000 deaths in Spain alone. And the number of serious cases would be between 3.5M and 4.6M seriously ill.
- Worse still, the reality is that the health system would collapse much sooner, and a high percentage of severe cases would go untreated, increasing the mortality rate. There would also be a large number of patients who would require treatment to survive other pathologies and would not receive it, and the number of deaths would indirectly increase..
The death rate of the virus is a more or less fixed fact (although it increases if you cannot attend to patients).
The high potential for infection during the asymptomatic period (and also afterwards, of course), is another fact.
But there are two factors that are in our hands, and that reduce the infection rate, the more the better the application.
They are extremely important, and I appeal to the civilian population on them, because the official measures so far in Spain, despite the fact that we have known all the data that I have mentioned for more than a month, go only in the line of pursuing cases that They have manifested and closed meeting places that have the consequence that people go to another place to continue interacting. (Not to mention that on March 8 in Spain they summoned a million people to congregate in the streets of all of Spain, how outrageous!)
As an example of a measure that is inadequate in isolation, in Italy schools closed and parks and shopping malls filled with children and grandparents (which increases the rate of contagion between them; and with 80 years the mortality is 22% , almost 1 in 4).
The measure is insufficient -although necessary- and misdirected, and the population of Italy (and that of Spain) is not used to obeying government orders as in China. Finally, the population does not do what it has to do because it does not know what to do (in addition to not knowing the severity of the virus). No one has told / convinced / demanded what to do.
These are the two measures that if we take en masse and demand that governments, health authorities and companies demand and apply them, we will notably change the evolution of the epidemic in the country:
We cannot affect the mortality of the virus, for that the financing of the studies of treatments and vaccines is in the long term, but we can interfere in its contagion rate.
Its ratio of 3 patients per infected and the growth of x10 every two weeks occurs with the natural rate of personal contacts that we currently have.
That ratio and that growth would drop drastically if we all reduced our interactions to the really essential minimum (minimize the number of people you see, no physical contact -kisses, handshakes, hugs-, avoid meetings or public gatherings no matter how small they may be. , avoid or postpone family celebrations, avoid attending places of entertainment, playgrounds, shopping centers ...
Virtually everything can be postponed or not vital. It involves a considerable effort and sometimes a considerable sacrifice, but the result, which I will quantify after mentioning the following measure, is undoubtedly worth it).
In Spain it is heard that "the mask is useless". That hardly reduces the risk of contagion, that it can be misused ... In a virus that is transmitted during incubation, and in such an exponential way, the mask (or handkerchief) is our most powerful tool to slow down infections.
Of course, it should not be seen only as that the effectiveness of a person putting on a mask (the mucous membranes of the eyes are also a route of entry for the virus ...) can reduce the risk by 90%, but rather pose it as the need for me to wear masks and the person I deal with as well.
Because your mask (or handkerchief) will be stopping 99-100% of the droplets in which the virus travels (and to that is added mine that would retain 90% of what happened).
Basically, and this is what you have to understand, my mask protects above all the other and the other protects me. In any environment or interaction, everyone should wear it, and the contagion rate would be greatly reduced..
I have mentioned two measures that require some sacrifice. Worth the effort? What can we get with them? We can reduce the rate of spread, flatten the growth curve. And, in practical terms, what does that imply? Let's see.
We have talked about the potential for deaths and serious victims in 2020-2021 at the current rate of expansion (of the order of magnitude of 800,000 and about 4 million).
Starting from the current situation, and seeing the growth rate mentioned, which is the one that occurs in countries like ours in which the virus is not contained, in a couple of weeks we will be seeing in Spain that the death toll exceeds the hundred daily.
That is inevitable because "it has already happened"; That is, on average, the deaths within three weeks will correspond to people who have been infected today (for the average week of incubation period, plus the average period between the onset of symptoms and death, which is 14 days). From that point on, evolution will be maintained or slowed down if we take the two measures mentioned TODAY.
But if we do not adopt them radically, in April we can see more than a thousand deaths per day. And from the one hundred daily (and the sick that that implies), the health system cannot cope. Let's not wait for others to take action by looking at each day's data or making optimistic estimates.
TODAY we already know that we are going to exceed a hundred deaths a day and that the health system is going to reach the limit. But TODAY we have the last chance that from that point on, in three weeks time, the curve will flatten out a lot ... or to surpass the thousand daily deaths (and thousands of seriously ill) in April.
Having tens of thousands of deaths a month and hundreds of thousands of patients is just around the corner if we do not take the measures with absolute firmness.
By the way, flattening the growth curve has another great advantage: we would be buying time for effective treatments to emerge that reduce mortality and severity rates, and in the long term a vaccine that reduces the rate of infection. In addition, we could avoid the total collapse of the healthcare system, which would otherwise occur in April.
The government has taken some measures. But it's not enough. It can only be so if each of us reduces our interactions to the really essential minimum, with the spirit of sacrifice that the situation requires, and wears a mask or handkerchief at all times and demands that the same be done in our environment (both the government and the Companies should lend strong support to this, but it is time for each of us to make the effort and sacrifice whatever it takes, knowing everything that depends on the sum of our individual decisions..
With a hesitant attitude, what comes to us, and very quickly, is a human and economic loss of a magnitude comparable to that of the civil war.
It is key to understand that what is showing up now in terms of deaths is what happened three weeks ago, on average. And that what is happening now is what we will see in deaths in 3 weeks, which will be 10-15 times higher.
If we do not take some measures now because we fear damaging the economy, we will have to take them a couple of weeks later in a much more forceful way, when the reality is 10 times worse and the negative effects on consumption and employment are much more intense and much more that if we take the measures now, whatever they are.
To be forceful now, even by paralyzing most of the economic activity, is to save our economy in the medium and long term. The only country in the world that controlled an outbreak in a situation similar to what we will have in 3-4 weeks was China, which completely paralyzed Hubei for at least two months (they are still locked up, but the cases are decreasing a lot), They arrest anyone who goes out into the street without a mask and no one thinks of going out if it is not essential. Only then did they do it.
But that situation in Spain has already been generated TODAY, and we are very far from officially taking the measures that China took, so only the sum of individual actions decided, minimizing interactions and always everyone wearing a mask (or handkerchief ...) would achieve a true effect.
Let's not forget that we do not have a contagion rate close to 1 like the flu, that with a few measures you can lower it from 1 (which is when an epidemic begins to contract). Unfortunately, the ratio of this bloody virus is 3, and only very exceptional measures can lead to that longed-for 1.
In the case of Taiwan, which was worse than us a few weeks ago and it seemed that the virus was going to explode due to its proximity to China, they keep schools open but both children and teachers always wear masks from the beginning (example of a “hard” measure that prevents cases from multiplying and soon it is necessary to take much more extreme measures).
South Korea is also a similar case, but we have already left them behind in the growth rate of the epidemic, they serve as a reflection of what we could have done.
Sometimes, I do not know if in order to reassure (which seems serious to me because what we need is maximum awareness that leads to maximum involvement of measures that individuals have to take), I have seen an extensive article by someone -young- who has how the coronavirus is happening in a mild way.
I have already commented that 80% study mildly. With the contagion of 50% of the population, 18 million would attend in a mild way (it is better for them, because no one could take care of them), compared to the 4 million serious ones (a large part could not be treated either) and the 800,000 dead.
Taking out an article like that and not talking about what happens to the other 20%, it seems to me that it is like interviewing someone who smokes two packs a day and complains that they are in good health. Once again, dangerous false confidence. Fear is bad, but if you need an entire society to sacrifice itself in an exceptional way, then it is necessary.
It is not about generating more fear than that corresponds to reality, but exactly that, instead of taking action and saying "nothing happens", because then people do exactly that, nothing. They continue with the same life, and without adopting more precaution than washing their hands a little more because of that virus that "is like the flu".
I am not forgetting frequent hand washing or other extremely important measures. They are the essential base on which we have to add trying to bring interactions and meetings to zero and whenever we talk or are close to another person, both with a mask.
I also want to comment on the phrase, very dangerous because it can generate false confidence, of "with the heat of summer the virus will die." The virus does not die with heat (it is very comfortable at 37º inside us), but it is true that the drops that fall on surfaces evaporate earlier and then the virus dries up and dies.
It is one of the reasons why infections decrease in summer in some viruses. Not in others, and in this one we still don't know, although we see that there are cases in countries where it is now summer. However, in a country like Spain where the epidemic is growing rapidly and there will be a large number of cases in the summer, infections will continue to occur although it may be at a lower rate..
But let's not forget the enormous contagious power of this virus, with its long contagious incubation period without symptoms. Hopefully it will give us a little respite in the summer but, if we don't contain it now, in the summer it will still be something much bigger than we can handle..
The masks and the rest of the material to avoid contagion have to be available in the first place for the health personnel. I would like to think that since January the government has controlled all the factories and material stock, and increased production to the maximum so that the health personnel, who are going to be our guardian angels for the next few months (or a couple of years) , have the best protection.
That is why I insist that a handkerchief is worth if you do not have a mask (and these can be disinfected and reused, especially if we are not health personnel). Another measure that I do not know if the government has adopted but it should, is the prohibition - with harsh penalties - of sale between individuals of this material to prevent hoarding and theft.
I want to conclude by commenting that both minimizing interactions and putting a barrier to contagion through handkerchiefs or masks are community measures, which each of us have to take but which help us all. And only together can we protect ourselves. If some of us fail, we are opening the gap and hurting everyone.
Awareness has to increase until seeing someone without a mask is like someone who goes with us in an elevator starts to smoke (with the difference that the coronavirus is much more dangerous than a little smoke). We must take these steps and put pressure on the government to try to enforce them in turn (and if we can't, continue on our own).
But it is not enough just to talk about the measures, I think it is essential to know the virus data so that people understand the reality of the current scenario (the x10-15 that we will inevitably see in three weeks) and the importance of the measures to avoid now May April be remembered as the month in which the gates of hell were opened in Spain.
I believe that the authorities, the media, companies, groups ... should support the dissemination of this information and the importance of adopting these measures TODAY, unanimously and with the utmost forcefulness. If someone has in his hand to achieve something in this way, do it, please.
Because if we see children and grandparents in parks or shopping centers without a mask because the schools are closed, if the university students are dedicated to meeting -and also without a mask- because they do not have class; If, in short, the interactions do not tend to zero and the inevitable minimums always with a mask or scarf, all the other measures will only have served to cause terrible damage by generating false confidence and the feeling that "something has already been done".
I have tried to mention all the basic information and explain it. I regret not having time available to answer questions or dedicate myself to disproving the many hoaxes that are circulating. I have to try to move forward with my work while taking care of my two children in the mornings, who have been isolated at home for a few days..
A hug,
Marcos Chicot
Some links. The first contains very extensive information in its different sections:
https://www.worldometers.info/coronavirus/
https://www.theatlantic.com/science/archive/2020/01/how-fast-and-far-will-new-coronavirus-spread/605632/
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