Here Comes Covid-19
February 28, 2020
By Geoff Frost, UBC Physiatry Resident
Pandemics are scary. I’m not going to try and convince you otherwise. I grew up in Toronto during SARS, and I remember the visceral fear my otherwise steady as a rock father displayed. I remember the news reports, I remember my parents thinking of pulling me and my siblings from school. SARS was an unknown danger, stalking amongst us, lurking on every surface, waiting to pounce. I’ll admit, I was a teenager, I thought I was invincible. I wasn’t that interested in skipping school for some virus. But I should have been scared. SARS carried a case mortality rate of around 10%. In clear language, one out of every ten people that contracted SARS died. Toronto was the epicentre of SARS in North America, the case mortality in Toronto was 17%, much higher than the global average. Teenage me had no idea how inhospitable my hometown had become. I cannot imagine doing something that carries a one in ten or one in five chance of ending fatally. Yet by wanting to go to school, I essentially shrugged in the face of those odds.
And now here comes Covid-19, commonly called Coronavirus. Covid-19 carries a case mortality rate of around 3% as per the latest WHO figures. Yet it has infected many more people than SARS ever did. The death toll stands at 2858 as I write. SARS had a cumulative death toll of 774. The difference lies in the spread. A 3% case mortality rate means 1 in 33 patients will pass away from the virus. That’s much lower than the 1 in 10 of SARS. What makes Covid-19 so deadly is its spread. 3% of 83652 (the current number of confirmed Covid cases) is a much bigger number than 10% of 8096 (the total number of confirmed SARS cases). So gun to my head, I would take a bout of Covid-19 over a bout of SARS any day. But therein lies the rub, and really, the fear. I don’t have a choice*. None of us do.
As has been pointed out in the past, the elegance of a pandemic is that it levels the playing field. Viruses do not care if you are rich or poor**. Bacteria are agnostic to your religious beliefs. Fungi are blind to your skin colour. Covid-19 has brutally forced this reality onto us. The initial reaction to Covid-19 was denial, followed by rushed quarantine. In the haste to keep infected individuals from others, unintended casualties arose. The story of a young child passing away from neglect after their care giver was quarantined struck me deeply as a Physiatry resident. I treat patients with disabilities every day. I cannot imagine tolerating one of my patients eroding away due to abandonment.
Quarantine has a real cost, in terms of time, lost earnings, even physical health. Yet quarantine is the most effective way to eliminate the threat an infected person poses to others. When we cannot eliminate the infection, we eliminate the vector. Take the infected person out of the group, and virus’ long march stops dead.
But what if you are the person that won the Covid-19 lottery? Preaching the benefits of quarantine when it is nothing more than a theory for me is easy. What if I had to spend two weeks on a cruise ship, then another 14 in quarantine on a military base, as many passengers of the ill-fated cruise ship the Diamond Princess? Would I take that that news well?
I honestly do not know. The numbers from the Diamond Princess are staggering. 621 of the 3711 passengers and crew are now thought to have Covid-19. All after one passenger spent five days on the ship. With a mortality rate of 3%, we can assume 18 people that embarked on the trip of their lives will pass away.
So I understand the anger and anguish of those disembarking from the Diamond Princess. One American was recently interviewed, and stressed the unfairness of the whole situation. She had a business to run, she explained, and simply could not afford to take another week off work. I sympathize with her. The process of being forced to sit in a small cabin while an unknown virus runs amok up and down the decks is terrifying. To then be forced to spend an additional fourteen days awaiting freedom and salvation because you happened to be in the wrong place at the wrong time seems… unjust.
Yet this is the way. And this way works. The spread of Covid-19 seems to have halted in China. Unfortunately, the virus seems to have escaped Chinese territory long before effective quarantine was enforced. So now hot spots abound, in France, Italy, California. The list is only growing. As it grows, more quarantines will be enforced. More time away from work and family. More individuals reduced to statistics with nary a care for the wreckage it causes.
There is no doubt the globally we have yet to hit the nadir in this crisis. The virus will continue to spread. In countries with weak public health systems, it will be devastating. In countries with good healthcare systems and strong reactions, like our own here in Canada, we may get off lightly. Sensible precautions are necessary. Honesty is essential. The enemy is known, but evasive. As a group we will overcome this and thrive. For each individual deeply affected in the midst of the crisis, I can only offer my most heart felt condolences.
* - I used this phrase loosely for dramatic effect. In reality, you do have a choice. Good and frequent hand hygiene, maintaining a social distance of 1 metre, practicing food safety, and practicing covered coughs have all been recommended by the World Health Organization to either minimize your chances of catching or spreading Covid-19. Check out: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public for more details
** - You could make a clear-headed argument that being rich affords you a better lifestyle that would make you less susceptible to catching Covid-19 and allow to access better healthcare if you were to catch it. These are all fair arguments, but again, for the sake of dramatic license, I have not enmeshed an understanding of the social determinants of health into our tale.
Geoff is a fourth-year Physiatry resident at UBC. He currently serves as the Director of Communications at the Resident Doctors of BC and is the host of the Pulse Podcast. Geoff is a professional engineer in Ontario, and prior to entering medicine, he worked as a biomedical engineering entrepreneur.
Want to learn more?
Healthlink BC: https://www.healthlinkbc.ca/health-feature/coronavirus-covid-19
BC Centre for Disease Control: http://www.bccdc.ca/health-info/diseases-conditions/coronavirus-%28novel%29
