Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-2019– the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill

Spreadability

When it comes to how COVID-19 spreads, this fact has been glaring for many weeks, but recent graphics may bring home this point quite dramatically:

There is a glaring difference in contagion in the West v the East

By this I mean that the across East Asia, the COVID-19 epidemics have been stopped, not slowed, stopped.

Not one nation in Europe or in N America has stopped their COVID-19 epidemics, not one.  Some are slowing, but not many are doing that.

This article website from The Financial Times (FT) is worth saving.  It shows graphs of how the virus is spreading in every country, and how deaths are rising across every country.

https://www.ft.com/coronavirus-latest

Here is the data on the rate of new cases appearing as of March 24, 2020:

Let’s take a look at this critically important graph.

First of all, let’s look at the x-axis, the horizontal dimension.   It tracks the number of days since that nation’s 100th case was proven.  As time goes on, every nation saw more cases appear.

Now look at the y-axis, the vertical dimension.  It tracks the number of cases a country has confirmed on a given day after it hit 100 cases.  Notice the numbers on the y-axis rise very rapidly.  The number of inches vertically is the same for the first 100, then 1000, then 10,000, then 100,000 cases.  It is called a semi-logarithmic scale, and when used, it tells us a straight line upward is not an even rise, but an exponential rise, meaning every so many days, the number of cases doubles.

This graphs offers highly useful dotted lines, one shallow line shows the line that would indicate a nation’s number of cases double every week.  And there are steeper and steeper lines to indicate what a line showing cases doubling every 3, 2, and 1 day look like.

So, if a nation has no new cases, it will have a flat line at the number 100, notice no country has such a line.

If a nation doubles their cases every week, you will get a line like Japan’s which followed that pace until 21 days after they reached 100 cases.

If a nation doubles their cases every 3 days, you will get a line like the United Kingdom which is still doubling every 3 days.

Now, what nation is doubling their cases of COVID-19 more rapidly than any other nation on the planet?  Sadly that would be us, the United States.

You can see it, our line emerged as the most rapidly growing line about 16 days after we hit our first 100 cases.  We are very close nationally to doubling our cases every 2 days!

China had a rate of rise even faster than ours for about 10 days after they hit 100 cases, but their choices and actions, slowed the spread from 10-16 days after they hit 100 cases, and since then they have had no doubling of cases at all, some days  no new cases.

Take a look at the jumble of lines, and ask yourself, out of all the lines, which are the only ones that have a flat enough slope to be flatter than the doubling every week line?  Only 5 nations have a line that flat or flatter, and all five are in East Asia:  China, Singapore, Hong Kong, and Japan.

Not one nation in Europe or North America has a rate of rise less than once a week.

Why is the progress in stopping the spread of this killer virus so dramatically different in East Asia and the West?

The best source for an answer to this critical question comes again from the World Health Organization, and specifically from one of its top officials, Dr. Bruce Aylward.

I featured his report a few days ago in Real Answers, today you get to hear him, he appeared on Morning Joe, and no matter if you are Republican, Democrat, or Independent, it is important to hear Dr. Aylward.

Here is his interview, it is where I saw these charts:

https://www.youtube.com/watch?v=UyG9Y3O1W8E

One clarification, when Dr. Aylward mentions isolating cases, he means isolating known infected people OUTSIDE their home in special isolation centers, which seem to be in use as an idea only in East Asia, at least so far.

His interview confirms once again that the necessary elements to stop the virus from spreading are:

1. Population wide screening for symptoms and testing all who have symptoms or have been in contact for COVID-19
2. Placing everyone found to be infected in a room away from home and anyone else for 14 days.
3.  Social distancing where necessary.  Some highly successful East Asian nations have applied this strategy only where the virus is active regionally, even by neighborhood.  This approach can ONLY work if testing is truly done to all screened.

In the US and much of Europe, we practice only #3, social distancing, of these 3 key strategies.  The only exceptions I know of outside of Asia are Iceland, one village in Italy (Vo), and apparently San Miguel County in Colorado (contains Telluride).

Severity

Two points to be made on severity

The Young Adult

We want to clarify, young adults do get sick with COVID-19, and can have critical severity that is even fatal, but the percentage of young adults who require hospitalization and even critical care still remains low compared to those over 60.

The Range of Severity by Regions Across the World

See the graph below also from the FT article.  Now it shows regions in the world, not nations.  And, it reports number of deaths, not number of cases.

A striking observation is the difference between NY, WA, and CA in the US.

The state of NY is the fastest growing region in the world, approaching doubling deaths every 1 day (!), the state of WA is doubling deaths every 3 days, and the state of California every week (!).  We do not know how California achieved slowing nu to nearly East Asian levels, it may relate to the strictness of early measures around its hot spot, San Francisco, but we do not know.

Note the lowering number of deaths in Daegu, the epicenter of COVID-19 in S Korea, and in Wuhan, the world’s first epicenter.

The Testing Controversy

It’s more a variance of recommended strategy than controversy.

One recommended strategy says test everyone.  This is clearly one of 3 essential elements (see above) to the unique success of East Asia in stopping the epidemic.

No nation can hope to stop the epidemic without trying to test everyone, to aim to diagnose every case.  Because only if this is done can enough infected people be isolated from everyone, meaning outside the home, for 14 days, the only way to really stop the spread.

The other recommended strategy is to test only the most ill cases.  This is the current strategy in the United States.  It rests on two assumptions.  The first is that we failed to test when we had only hundreds of cases, the virus is to widespread to diagnose the likely 100,000 or more who actually have it now.  The second is that we simply do not have enough test material to test all screened and found to maybe be infected.

As long as the US has too few tests to test widely, and if it is true our cat is out of the bag, then it makes sense to use our tests for the sickest amongst us, those requiring oxygen and therefore hospitalization.   That is true now, it why the Cleveland Clinic and UHCleveland have limited tests to only those at greatest risk, and it is why I support this strategy, for now.

But.

I still do believe our mighty nation has the ability to make enough tests to test widely, unless, and only unless, the technology limits production to fewer than can achieve population wide testing.  But, if technical details permit, as they do in E Asia, then we could choose to produce plenty of tests, and shift our practice to screening everyone for symptoms and testing all those at risk of being infected, including all contact, health care workers, and those with symptoms.  And, this new approach in the US would likely also only make sense if we had facilities to isolate infected cases away from everyone.

BOTTOM LINES

1. COVID-19, if allowed to, spreads wildly, with cases doubling up to every two days.
2. Just as dramatically, the disease’s spread CAN BE halted.  
3. We know this from the example of very different nations that all happen to be in E Asia.  Only one of these five nations are living under dictatorship, the other four are free societies, but they chose to stop the epidemic.
4. I find it so painful to report that our nation, the United States has the highest rate of spread in the world right now.   That means we have chosen to let this virus spread faster than anywhere else.  It is especially painful, knowing what the choices we could make to change this tragic fact.
5. Who should be tested?  It depends on your country’s approach to the COVID-19 pandemic.  If it takes on universal screening for risk, and isolates all infected outside the home, and can produce enough tests, then testing as close to everyone makes sense.  If not, then tests will need to be reserved for the critically ill, our current situation.

As I write up these updates, it becomes more and more imperative to be willing to see that this pandemic is not an act-of-God, it’s spread and impact will only reflect what simply human beings decide to do in each nation.

Like a child getting a report card, we may squirm when we see our grades, but our performance in this pandemic is being reported and no matter how tragic and uncomfortable the data they only reflect choices we make.

Here is to hoping that today, very, very soon, our United States of America decides to act in ways nations that have already stopped their pandemic.

To your health,
Dr. Arthur Lavin