Mixed Messages About COVID-19

Don’t let mixed messages about COVID-19 leave you confused or get in your way of preparing your family for this new pandemic.

Do you feel like you are getting mixed messages about COVID-19?

Don’t stockpile things, but be prepared.

Don’t wear a mask, but avoid other people so you don’t get sick.

It’s just like a bad flu, but states are declaring states of emergency and countries are restricting travel.

Mixed Messages About COVID-19

Are you confused yet?

Are you wondering why we continue to see new cases?

Have you forgotten that we were warned that SARS-CoV-2 would likely become a pandemic?

“With the inexorable spread of 2019-nCoV, we are again upset about the way officials and reporters are talking about containment. We think it is crucial to try to prepare the public for the very high likelihood that containment WILL FAIL, if what we mean by “containment” is that we might be able to stop a pandemic.”

Risk Communication about Containment – 2019 Novel Coronavirus

Shouldn’t we have been able to stop it if we had warning?

Although ideally we would have contained SARS-CoV-2 before we started to see community spread, the more realistic goal has been slowing down its spread.

Containment measures can help to flatten the curve in a pandemic, buying everyone some more time to get ready.

Slowing down its spread will help prevent everyone from getting sick all at once so that doctors and hospitals don’t get overwhelmed.

Wait, is everyone going to get sick?

That’s probably another thing about COVID-19 that has you confused.

And the answer is almost certainly no.

There likely won’t be constant exponential growth and like many other respiratory diseases, this one will hopefully end at some point.

We shouldn’t expect exponential growth of COVID-19, which means that everyone isn’t going to get it over the next few months.

It is also very important to understand that most of the people who do get sick will have a mild illness.

So if we can’t stop it and most cases are mild, then why are we declaring emergencies, closing schools, and canceling some large community events?

“That this disease has caused severe illness, including illness resulting in death is concerning, especially since it has also shown sustained person-to-person spread in several places.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

It is because we are still learning about this new virus and we already know that it can cause severe, even life-threatening disease, in some people.

Why are we trying to slow down the COVID-19 pandemic?

So what should you do?

“Call your doctor: If you think you have been exposed to COVID-19 and develop a fever and symptoms of respiratory illness, such as cough or difficulty breathing, call your healthcare provider immediately.”

Prevent the spread of COVID-19 if you are sick

Be prepared.

There is a lot of good information out there from the CDC, WHO, and your local and state health department to help you get prepared for COVID-19.

Most importantly, be smart and do all of the common sense things that we always talk about that can help keep you from getting sick, like washing your hands and not touching your eyes, nose, or mouth, etc.

And if you are in a high risk group, or have frequent contact with someone in a high risk group, you should likely be a little extra careful to help reduce your chances of getting COVID-19. That’s when you might take the extra steps of avoiding crowds and limiting contact with others, etc.

“Stay home: People who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home, except for getting medical care.”

Prevent the spread of COVID-19 if you are sick

What’s next?

As testing becomes more widely available in the coming days and weeks, you can almost certainly expect to hear about more and more cases in more and more parts of the United States.

Don’t be surprised.

Be prepared.

More on Mixed Messages About COVID-19

What is the COVID-19 Mortality Rate?

Do we know how deadly COVID-19 really is?

Knowing the COVID-19 mortality rate would help folks get a better understanding of just how concerned they should be about this new disease that is quickly spreading around the world.

New modeling from the CDC puts the COVID-19 case fatality rate at 0.1 to 1%.

Unfortunately, the widely different numbers we are hearing might contribute to some of the confusion people already have about the SARS-CoV-2 virus.

What is the COVID-19 Mortality Rate?

In general, the mortality rate for a disease is “the measure of the frequency of occurrence of death in a defined population during a specified interval.”

Defined population?

That’s not how many people have the disease. That’s literally how many people there are in the place you are talking about.

Instead of mortality rate, right now, what we really want to be talking about is the case fatality rate.

“The case-fatality rate is the proportion of persons with a particular condition (cases) who die from that condition. It is a measure of the severity of the condition.”

Mortality Frequency Measures

Still, differences in defining the “population” or cases has lead to differences in reports of case fatality rates from the CDC and WHO.

“There is now a total of 90,893 reported cases of COVID-19 globally, and 3110 deaths.”

WHO Director-General’s opening remarks at the media briefing on COVID-19 – 3 March 2020

The WHO reports a case fatality rate of 3.4% for COVID-19, which they get by simply dividing the 3,110 deaths by the 90,893 reported cases.

“This crude CFR is high: for comparison, the CFR for seasonal influenza is 0.1%. However, as I will show below, this number is not a one-size-fits all, and is influenced by many factors. Please do not look at 3.4% as an indicator of your risk of dying from COVID-19!”

SARS-CoV-2 coronavirus case fatality ratio

The CDC, on the other hand, is using a method that factors in the idea that there are likely many more mild cases that haven’t been officially reported. That gets them a much lower case fatality rate rate of 0.1 to 1%.

Only more testing will get us a more accurate case fatality rate for COVID-19.
Only more testing will get us a more accurate case fatality rate for COVID-19.

Then there is the large study on COVID-19 case fatality rates that did include suspected and asymptomatic cases, Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. They found an overall case-fatality rate (CFR) of 2.3%.

“Epidemiologists think and quibble in terms of numerators and denominators—which patients were included when fractional estimates were calculated, which weren’t, were those decisions valid—and the results change a lot as a result.”

COVID-19 Isn’t As Deadly As We Think

What do these numbers mean to you?

They might be easier to understand if you compare the case fatality rate of COVID-19 to some other diseases.

DiseaseCase Fatality Rate
Rabies99.9%
H5N1 bird flu60%
Ebola50%
MERS34%
H7N9 bird flu25%
SARS15%
Yellow fever15%
Tetanus13%
Diphtheria5-10%
1918 flu pandemic1-3%
COVID-19*0.1-3%
2009 flu pandemic0.1%
Seasonal flu0.1%
Measles0.1%
A high case fatality rate doesn’t tell the whole story. It is also important to understand how likely it is for a disease to spread and get a lot of people sick. And a reminder that many vaccine preventable diseases are quite deadly!

Fortunately, COVID-19 is near the bottom of the list, and as we get more and more data, it seems like the official case fatality rate will continue to drop.

Still, since it is spreading at pandemic levels, that means a lot of people will get sick and could die, especially those in high risk groups.

Older people and people with severe chronic health conditions are likely at higher risk COVID-19 infections.
Older people and people with severe chronic health conditions are likely at higher risk for COVID-19 infections.

*How many? It’s too early to tell, as we really don’t know what the real COVID-19 case fatality rate is yet.

“Practice everyday preventive behaviors! Stay home when sick. Cover coughs and sneezes. Frequently wash hands with soap and water. Clean frequently touched surfaces.”

Preventing COVID-19 Spread in Communities

That makes it important to take steps to try and slow down the spread of SARS-CoV-2, especially to people who are at high risk.

More on the COVID-19 Fatality Rate

Should You Be Tested for COVID-19?

A limited supply of test kits has meant that few people have been tested for the SARS-CoV-2 virus, but that will likely change as more test kits become available and more people get diagnosed with COVID-19.

Breaking News – criteria for COVID-19 has been expanded to include more symptomatic patients. (see below)

As SARS-CoV-2 infections continue to spread, many people are probably wondering if they should be tested if they think they have COVID-19.

“Call your healthcare professional if you feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19, or if you live in or have recently traveled from an area with ongoing spread of COVID-19. Your healthcare professional will work with your state’s public health department and CDC to determine if you need to be tested for COVID-19.”

CDC on Should I be tested for COVID-19?

While it might sound like a good idea, especially if there are any COVID-19 cases in your state, getting tested for SARS-CoV-2 isn’t as easy as you might think it should be…

Should You Be Tested for COVID-19?

What’s the biggest problem with getting tested for SARS-CoV-2?

Since this is a new infection, a new test had to be developed to detect it.

And that test is not widely available. In fact, most testing has been done at the CDC so far.

“The California Department of Public Health announced today that new CDC test kits used to detect Coronavirus Disease 2019 (COVID-19) now available in California can be used to do diagnostic testing in the community. California will immediately receive an additional shipment of kits to test up to 1,200 people.”

COVID-19 Testing Kits Arrive at State Public Health Laboratories

More and more local and state health departments are now getting a limited supply of test kits though.

The CDC is now shipping its laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to qualified state and local public health laboratories.
The CDC is now shipping its laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to qualified state and local public health laboratories.

Still, even if you should be tested, it won’t be a test that your pediatrician has on hand.

But what happens if you think that you have COVID-19? Can you get tested?

Unless you are hospitalized and have severe symptoms, the criteria for possible COVID-19 from the CDC, which might lead to testing, has included:

  • Fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath), AND
  • Any person, including healthcare workers, who has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset.

If a patient is hospitalized with COVID-19 symptoms, then a history of recent travel from affected geographic areas (China, Iran, Italy, Japan, and South Korea) is added to the criteria.

Only those with fever and severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza) would be investigated for SARS-CoV-2 even though no source of exposure has been identified.

Those who meet the criteria can get tested if necessary, as can many others under the latest expanded criteria.

“Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness.”

Evaluating and Reporting Persons Under Investigation (PUI)

In general, your provider will obtain the samples (nasopharyngeal swab AND oropharyngeal swabs) and send it to a local or state health department or the CDC for testing.

And if there is any doubt about whether or not someone needs testing, your provider will call their local or state health department for extra guidance.

But why would you want to get tested if there is no treatment for COVID-19?

“For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar coronaviruses.”

COVID-19 Frequently Asked Questions and Answers

Testing can help identify folks who really need to be quarantined, keeping them from getting others sick. That can be important, as many people might not be able to quarantine themselves for 14 days unless they are sure they are sick with SARS-CoV-2.

What to Know About COVID-19 Testing

A limited supply of test kits has meant that few people have been tested for the SARS-CoV-2 virus, but that will likely change as more test kits become available and more people get diagnosed with COVID-19.

More on COVID-19 Testing