Yesterday morning the US Centers for Disease Control (CDC) gave a media briefing, led by Dr. Nancy Messonnier, Director of the National Center for Immunization and Respiratory Diseases. The transcript still isn’t up, but you can listen to the audio here if you have 30 minutes. After it was over, I was thinking “OK, nothing here to get excited over, not really any new data.” Then the news reports started coming out and I started getting messages, headlines like this NBC article: “Americans should prepare for coronavirus crisis in U.S, CDC Says” and pull quotes like “It’s not so much a question of if this will happen anymore but rather more a question of exactly when,” an official said. I thought “wow, did I miss something?” so I listened again. Nope. So what’s going on? Is it time to panic, get masks, and start drinking?
Maybe not. Let’s start with the pull quote. What Dr. Messonnier said in full was “It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness.” In my view that puts a whole different spin on things – the “how many people will have severe illness” is the key. Certainly we should prepare – especially health care providers need to dust off their pandemic response plans (and, recall that Pandemic doesn’t mean people dropping dead in the streets, all it means is widespread). Schools and businesses should probably think about what they would do if – and at this point, it’s a very big if with decreasing probability – things get bad. Check ready.gov for some good advice and checklists. Most of these things are stuff you should have already done to prepare for earthquakes, hurricanes, etc.
This points up a huge problem with how complex, scientific topics are covered by the media. The details matter. You can’t just grab a pull quote (and especially cut off the quote halfway for a headline!) and covey the nuance people need. It stokes fear and uncertainty – and that has consequences. Just look at what the stock markets are doing (some of which is justified because of Chinese supply chain disruptions, but risk taking on a life of their own).
Another problem is that Dr. Messonnier was discussing a lot of “what if” scenarios that got reported as active plans. Things like closing schools, businesses, etc. are certainly things that would be done in the event of a bad contagious outbreak. That kind of control measure can do a lot to limit the spread of a disease. But the economic impacts are severe – and those actions have consequences that results in people dying. Doing nothing can cause misery and kill, doing too much can cause misery and kill. It’s a hard balance to keep, and is far more difficult for decision makers to keep when there is bad reporting that scares the population and the political class, and stampedes them in to making bad decisions based on fear, not facts.
The terminology can be a problem in science, and specialties matter a lot. Here’s an example. A couple weeks ago I talked to a Doctor who works for one of the agencies responsible for looking at COVID-19. He said they were seeing mortality rates of 10% or so. That would be catastrophic. In looking over the data yesterday, I was calculating a mortality rate for those infected (to plug in to a financial impact model) at well under 1/100th of that. So I checked in again, and he still said 10%. In talking it through I figured it out – he was talking about cases with respiratory involvement, which makes sense because as a Pulmonologist he only cares about those patients. So when you hear things like mortality rates, the first thing to ask is “based on what denominator – total population, those infected, symptomatic, hospitalized, or what?” That’s the kind of question and perspective reporters should be asking, but aren’t.
So what’s the bottom line right now? Don’t misunderstand this – there is still some uncertainly around COVID-19, and as noted above some precautions such as those currently recommended by CDC are sensible, but the numbers are starting to line up (link to PDF of summary spreadsheet) along the lines of a severe influenza strain, something like the 2017-2018 flu season. In that, the population mortality rate (fraction of the total population who died), taking in to account vaccination, is around 0.03 percent, the fraction of those who became symptomatic (got sick) who later died was around .14%, those hospitalized who died between 5 and 8%.
COVID-19 is almost certainly already here and spreading, we just don’t know it yet. Testing is very limited both here and elsewhere. And normal cold and flu strains, which are still going around and likely masking some COVID-19 cases, cause a lot of death and economic impacts. But in perspective, it is shaping up that COVID-19 is in that realm of impact, and is not the devastating pandemic that will like hit us someday if we aren’t careful. In that sense, it is a good wakeup call (as if SARS and other outbreaks weren’t enough of a warning) and maybe we will listen this time.