Skip to main content

“I am a Canadian, free to speak without fear, free to worship in my own way, free to stand for what I think right, free to oppose what I believe wrong, or free to choose those who shall govern my country. This heritage of freedom I pledge to uphold for myself and all mankind.” ~~ John G. Diefenbaker

J. EDWARD LES, MD -- COVID-19? Rampant misinformation, relentless spin, and wacky thinking amplified by social media hasn’t brought clarity, suffice to say


In the winter of 2017 two 17-year-olds with a 3-D printer created a little spinny thingy called the Fidget360 and promoted it on social media.

Fidget spinners quickly went viral.  And because there was no patent, dozens of companies hurried to produce knockoffs.


By May of 2017 the little gadgets accounted for 17% of all online toy sales and had spun their way into every nook and cranny of the globe.  Every kid I tended to in the emergency department of my hospital was spinning one of the plastic gizmos—and more often than not, so were their parents.

But then—just as quickly as it started—it was over.  By September of 2017 fidget spinners had vanished, consigned to trash bins and forgotten corners of toy rooms and closets.

There’s a word we use to describe this sort of phenomenon, where something spreads quickly throughout an entire country, continent, or the whole world and affects an exceptionally high proportion of the population before burning itself out.

That word is pandemic, of course.  We use it to describe massive outbreaks of disease, typically, not outbreaks of fidget spinners.

It’s a scary term—one that conjures up images of the Spanish flu, which wiped out up to 100 million people in 1918 (five percent of the world’s population); or of the bubonic plague, which ravaged the globe in the 14th century, killing half of Europe’s people and knocking the world population down to 350 million from 475 million.


... we must acknowledge that stopping this virus is like trying to stop the wind. We must acknowledge what any seasoned epidemiologist can tell you: viral pandemics burn themselves out—but only after millions of people get sick and recover, freshly equipped with powerful antibodies to the virus ...


Not all pandemics are as lethal as the Black Death or the Spanish flu, mind you.  The H1N1 influenza pandemic of 2009, for instance, killed approximately half a million people—a big number, but roughly on par with the death toll extracted by the seasonal flu each year.

Another pandemic—COVID-19—now threatens the world.  This time the viral assassin is a novel coronavirus that originated in China.

How much danger we are in remains a matter of intense debate.  Death toll predictions run the gamut from the ridiculous to the obtuse, from epic eradication of mankind on the scale imagined by novelist Stephen King in The Stand, all the way to: “Nothing to see here, folks, keep calm and carry on.”

Rampant misinformation, relentless spin, and wacky thinking amplified by social media hasn’t brought clarity, suffice to say.  U.S. President Donald Trump labeled the coronavirus a Democratic conspiracy.  Paranoid wing-nuts blather on about Chinese bio-weapons.  Some people blame a vengeful God; others warn shrilly (and wrongly) of the risk of mail from China or of the danger of eating in Chinese restaurants.

I wrote about the coronavirus outbreak on February 20, seemingly an eternity ago.  At the time I wasn’t overly stressed—just a bit fidgety.  Twelve thousand people were infected and 250 were dead, pretty much all in the epicentre of Hubei province in China; but it seemed like a drop in the viral bucket compared to the seasonal flu, which takes out up to 600,000 people globally per year.

Plus, after initially dismissing the virus as a threat, the Chinese had reacted with unprecedented measures, locking down Wuhan and a slew of other cities, cordoning off Hubei province, shutting down mass transit, closing airports, and confining 60 million people to their homes—berating those who dared to venture outside with government drones.

It seems to have worked for the Chinese.  Epidemiologic data show that the virus continued to spread post-lockdown, but primarily among families already infected pre-quarantine.  Community spread was stopped in its tracks.

The number of cases in Hubei province ultimately crested at around 67,000, with 2900 dead.  (Just a smattering of new cases are being reported.)

By the time the Chinese instituted their draconian quarantine measures, of course, the viral dandelion had gone to seed: infectious spores of coronavirus had already blown around the world.

Still, the worst-case scenario for Canada, I surmised, surely couldn’t be worse than what Hubei endured.

Applying Hubei’s experience—a population infection rate in that province of only 0.11% (67,000 divided by 60 million) and a case fatality rate of 4.3%— to Canada’s population of 37 million would mean roughly 41,000 cases and 1750 dead in Canada.

Bad enough—but seasonal influenza kills 3500 Canadians every year; traffic accidents kill 2000 people.

So not a huge deal, right?

But here’s the problem: Canada is not China.  Neither is the U.S., or any of the other countries where coronaviral spores have taken root.

In one sense, at least, that’s a good thing: our air is much cleaner, and far fewer of us smoke cigarettes, leaving us with lungs presumably less hospitable to invading coronavirus.

However, we are not going to quarantine entire Canadian cities and provinces (it’s too late for that now anyway).

We’re not going to close airports and shut down mass transit.

We’re not going to chase our citizens with drones.

We’re not going to mandate that entire populations stay in their houses for weeks or months on end.

And we’re certainly not going to be as good at keeping infected patients alive—not because we lack the know-how, but because we lack adequate space, supplies, ventilators, and personnel.

The WHO’s Bruce Aylward, commenting on the case fatality rate observed in China, had this to say about the regime’s efforts:

“That’s the mortality in China — and they find cases fast, get them isolated, in treatment, and supported early. Second thing they do is ventilate dozens in the average hospital; they use extracorporeal membrane oxygenation (removing blood from a person’s body and oxygenating their red blood cells) when ventilation doesn’t work. This is sophisticated health care. They have a survival rate for this disease I would not extrapolate to the rest of the world. What you’ve seen in Italy and Iran is that a lot of people are dying.”

Canada may do better than Italy and Iran.  But our hospitals are already stuffed to the gills (and people won’t stop suffering from heart attacks and strokes and trauma and cancer just because COVID-19 is kicking around.)

We can’t, like the Chinese, build enormous hospitals almost overnight specifically for coronavirus patients.  (We can’t even build a pipeline in this country.)

Does all of the above mean we’re screwed? Not at all.

Certainly, we can’t do what the Chinese did.  Nor should we try.  The Italians are trying, and their country is descending into unmitigated chaos.

We must adopt a radically different strategy.

First, we must acknowledge that stopping this virus is like trying to stop the wind. We must acknowledge what any seasoned epidemiologist can tell you: viral pandemics burn themselves out—but only after millions of people get sick and recover, freshly equipped with powerful antibodies to the virus. 

The resulting collective population immunity—called herd immunity—prevents the virus from hopping from person to person to person with epidemic speed, and the pandemic dies out.

There are no other options. 

Well, there are two, but neither are on the near horizon: complete eradication of the virus (as mankind did with smallpox), or the development of an effective vaccine.

We must let this pandemic burn itself out. But equally importantly, we must control how that happens.


Those most vulnerable to the deadly effects of this virus — the elderly and the medically compromised — must self-isolate, while we allow the virus to do what it does among the rest of us.

That doesn’t mean we shouldn’t continue to protect ourselves sensibly, just as we do from the flu: wash your hands, cough into your elbow, stay home if you are sick, learn the “Ebola handshake”, and stay away from hospitals and clinics unless truly necessary.

But we must not close the schools, the airports, the theatres, the restaurants.

We must not allow the economic infrastructure of the world to be destroyed, and society completely upended, by a viral pandemic that targets primarily the elderly and medically compromised.

The novel coronavirus has an R0 value of 2.2, which means that each person can infect 2.2 others.  The case fatality rate across all of China was 2.3% (it’s higher in Wubei province and outside of China—it’s over 4% in Italy, for example).  Those numbers, ominously, aren’t much different from the Spanish flu.


... we must shout this message of self-quarantine from the rooftops, loudly and repeatedly, so that the elderly and medically compromised understand that if they do not comply, they stand a high risk of dying ...


Knowing that most of the world cannot replicate China’s totalitarian lock-down to control viral spread, epidemiologists estimate that between 30-60% of the world could end up infected with coronavirus.

Wait a minute, you say:  Hubei province had a population infection rate of only 0.11%!!  That’s a far cry from 30%!

Sure.  But the Asian elephant in the room is that China, by its draconian quarantine measures, prevented community spread—which also very effectively prevented the development of herd immunity.

When Wuhan and her 15 sister cities are re-opened -- when the stranglehold on Hubei province is released -- when the airports re-open and the trains start running and commerce restarts -- we will see an enormous second wave of infection in China.  It cannot be otherwise—the virus is not gone.  Because the Chinese prevented community spread from continuing for two months, most of their population is not immune—there is no herd immunity.

It was the second wave of the Spanish flu, remember, that killed most of the people in that pandemic.  And China is on the cusp of a second wave of COVID-19.

We must not allow this to happen globally with COVID-19.

If epidemiologists are correct even at the low end of their estimates—30% of the world’s population infected and a case fatality rate (also at the low end) of 2.3%—that means 53 million dead: roughly 255,000 of them in Canada (73 times the death toll of the seasonal flu).

Horrific stuff.  But the Achilles heel of the coronavirus is that it primarily kills old people.  And we can exploit that.

The Spanish flu killed across demographics, disproportionately killing those in the age categories of 20 to 40, over 65, and younger than five. The high mortality in healthy people was a unique feature of this pandemic – as was the case with the 2009 H1N1 pandemic.

But that’s not the case with COVID-19: it kills mostly the elderly and the infirm.  The mortality rate in those over 80 is 15%; in those over 70, eight percent; and in those over 60 it’s just under four percent.  In Italy, where the death toll stood at 366 as of Sunday, the average age of those who have died is 81.

At younger ages the mortality rate drops off dramatically – the vast majority of younger people, especially kids, recover without incident, most of them with mild or no signs of illness.

But—and this is key—even though children (and healthy adults) may be completely symptomatic or have only mild symptoms after they acquire coronavirus, they still carry the virus: they are vectors, much like the rats that spread the bubonic plague in the 14th century.

We are not going to exterminate the children as we did the rats—but we can take real steps to mitigate the risk of viral spread.

We must sequester the elderly and the medically compromised away from the rest of the population.  They must avoid crowds and travel and children—and likely until August or later.

We cannot do this by decree—that will never work.  But we must shout this message of self-quarantine from the rooftops, loudly and repeatedly, so that the elderly and medically compromised understand that if they do not comply, they stand a high risk of dying.

At the same time, it is critical that we protect heath care workers and those who are medically at-risk in hospitals: we must enact systems of external triage (a.k.a. drive-through emergency medicine), external treatment sites, telemedicine, mobile treatment teams, and so on.

These measures are critical to reduce the death rate, to lessen the coming incredible strain on our health care system, and to buy time until we either have herd immunity or a new and effective vaccine.

To be clear, I’m not downplaying the risk of infection among the young and healthy.  Even in young and healthy people the coronavirus is potentially 10 times more deadly than the flu.  But the risk of serious illness from influenza among the young and healthy is extremely low—and ten times extremely low is still very, very low.

Our politicians and medical leaders have dropped the ball on this.  They’ve been fidgeting while this virus burns, spinning confused and garbled messages of half measures and wrong measures.

It’s time to stop the fidgeting, to do away with the spin, and to lead with strength and clarity.

  • We must not allow the world to succumb to chaos.


  • There is no need to panic.
  • We should remain calm and carry on.

  • But nor should we keep our head in the sand.


As Bruce Aylward put it: “Get organized, get educated, and get working.”

Comments

Popular posts from this blog

THE SIDEWINDER -- Just quit your constant damned whining and do something positive about it

  Living in a democracy is a wonderful thing, but it comes with responsibilities such as voting and being involved. When the dust settled on Saturdays (October 24 th ) BC election, less than two thirds of the eligible voters * took the time to vote - but the loudest bitchers will probably be among the more than one third of voters who sat on their asses and complained about how all politicians are crooks, etc. How many of you constant whiners have ever done anything close to becoming involved; or do you just like sniveling to hear your own voice? Are you one the arseholes who likes to take advantage of everything our democracy has to offer, without ever contributing anything? And I don't want to listen to your crap about paying taxes, blah, blah, blah. There's more to making democracy work than simply voting and then sitting back and let others carry the ball for you. Too many people seem unwilling to get involved - and follow-up - to make sure elected po

The stats clearly demonstrate the need for professional and impartial advice at the time of purchase, renewal, and refinancing of mortgages

REPRINTED WITH PERMISSION : Canadian Mortgage Trends   Canadians need guidance with their mortgages ... t hat’s the takeaway from a national survey released this week by Rates.ca, which found half of Canadians aren’t aware of the mortgage options available to them. Not only that, but Canadians are lacking in some other basic mortgage trivia, with an astounding 9 out of 10 respondents not knowing that mortgage interest is charged semi-annually: 28% think interest is compounded monthly; 17% think it’s bi-weekly; 17% think it’s annually; 28% just have no idea. Should we be concerned? Dustan Woodhouse, President of Mortgage Architects, and a former active broker who has written multiple educational mortgage books, thinks so. “ Sounds about right. We know about what we pay attention to, i.e., The Kardashians ,” he wrote to CMT. “ The material concern in this is how easy it makes it for the government to over-regulate the industry, with c

AARON GUNN -- He is, at his core, an ideologue, meaning the facts of any particular issue don’t actually matter

Ben Isitt - City Councillor and Regional Director Victoria City Council and its resident-genius Ben Isitt is back with another dumb idea. Introducing a motion to ban the horse-drawn carriages that have coloured Victoria’s downtown streets for decades, calling them “an outdated mode of transportation”. Are you serious?   No one is actually commuting by horse and carriage. They are here for tourists and residents alike to interact with world-class animals and discover the magic and history of our provincial capital. It’s part of what gives Victoria its charm. And the truth is these horses are treated better than anywhere else in the world. They probably live better lives than many British Columbians.   And talk to anyone who works with these horses and they’ll all tell you the exact same thing: this is what the horses love to do. This is what they were bred for and trained for. This is what gives their lives purpose and meaning. But maybe we shouldn’t be su

Labels

Show more