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I’ve been countering a lot of claims that COVID is “just a bad flu.” It’s not but I can understand why we would wish it so as we see the pain and suffering in NYC - or out of fear if not of getting sick then of facing destitution which is very real for many Americans. 1/
This is a great summary to explain why COVID is so much more dangerous. I’ll summarize below. 2/…
First the R0 (Rnaught) “Data from China show that each coronavirus case seems to infect about 2 to 2.5 additional people. That's higher than the flu. The average patient spreads the flu virus to about 1.3 others.” 3/
Fauci recently cited a lower R0 in NEJM and of course our hope is to get below 1 through social and physical distancing. Of course without testing we don’t know the real R0 but NYC Italy and Spain show clearly we are not close to or below 1. 4/
Transmission is very different - typically presymptomatic with COVID and after symptoms appear for flu. “analysis of data from China found that 13% of cases were likely caused by people spreading the coronavirus before they started coughing and feeling achy...” 5/
“... flu is most contagious in the three or four days after symptoms begin, according to the CDC, and presymptomatic transmission doesn't seem to be a major driver of new cases.” Add to this that Covid also possibly transmitted in fecal matter... 6/
So far - COVID infects more people as it is transmitted (the R0) and it is transmitted before symptoms appear (whereas the flu knocks u out keeping u home making it less likely u will transmit). That’s a terrible combination leading to exponential spread. 7/
So we have more cases - what about the burden on hospitals. “Data from China show that 20% of COVID-19 patients serious enough to go to hospital...10 times more often than flu. the prelim data for 2018-19 flu season rate of hospitalization is far lower: 1%-2%” 8/
So many more cases in hospital and with longer stays: “Once patient with serious case of the coronavirus is hospitalized, average stay is 11 days, according to a study based on January data from Wuhan — about twice as long as the five- to six-day average stay for flu.” 9/
So in sum highly contagious virus that is contagious many days before u know u r sick. On average 8-9% in US get the flu in any season. “Imperial College of London predicted a worse-case - 81% of the U.S. population infected over next few months, if no actions were taken” 10/
Mortality from this level of infection in such a short time frame would be staggering. “seasonal flu kills 1 in a thousand people (0.1%) who get sick from it. COVID-19 is currently estimated to kill at least 10 people per thousand infected (1%).” 11/
We have no idea what the morbidity will be for those who recover but permanent lung damage is possible. 12/
Aggressively infectious virus. U don’t know when u r contagious. Spreads exponentially. High mortality - and - not discussed in this article - higher transmission rates and higher mortality shown for doctors in Italy and Spain without adequate PPE. 13/
So very quickly - as we are seeing in NYC where they are “running out” of ICU MDs and RNs - you have a huge number of people infected and no one to care for them. The Imperial College model doesn’t account for this. It would be catastrophic on an unimaginable scale. 14/
It’s not “just the flu.” We need excellent clear leadership to move forward. Many have already written clear plans we can follow. Adequate PPE. Sharing across state lines. Testing testing testing including antibody so maybe we can stage our way back to work ...15/
In surgery we are taught never to avoid the reality in front of us. If we have a very challenging case or a complication we must address it head on unflinching. If the road ahead is tough because of mistakes we’ve made we own them and move forward learning from them. 16/
What I’ve written above is terrifying. We’ve made mistakes and lost many opportunities to do better. But we can beat this if we work together as nation. Our medical teams are showing us the way in the front lines banding together across disciplines and sacrificing 17/
Stay home. Be passionate in ur support of efforts to get our medical colleagues PPE. Push ur representatives to demand testing. Stop wishing and searching for a different reality - we are in this one. Let’s face it together and beat it soundly. 18/
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