Versión en inglés: "Coronavirus. Buy time!"

This text was written on March 9th, 2020, by Dr. Margarita del Val, Ph.D., Senior Scientist in Madrid, Spain, at CBMSO, Centro de Biología Molecular Severo Ochoa (CSIC-UAM), when the coronavirus case count in Spain was 1,204, with 29 deaths. As of March 16th, 2020, the number of casualties in Spain has increased to 330. A mere week later, 11 times as many.


I am a virologist and immunologist, but I am not an epidemiologist.

In my opinion, the key to understand what is happening with the coronavirus is to move forward from the individual level to the level of epidemics, as our whole society is the one suffering.

Perhaps due to my daily work with viruses and vaccines I don't understand why there are no explanations for the reasons forcing us to take these quite drastic contention measures. To sum it up, if you don't want to read any further: These measures are necessary not only to protect each one of us, but particularly to protect any vulnerable person and especially those who actually take care of us; they are taken to ensure that health personnel and services are not saturated nor they get sick; they are taken so the nurses, doctors, hospital staff, ambulance drivers and any health care takers are able to take care of all of us. Yes, it is very important not to alarm the population, so we don't look for medical attention unless we need to, but even within the given situation and recent events some people are wondering why prevention, contention and social distancing measures are being taken.

In my humble opinion, these are some of the reasons to understand the measures:
First, mortality seems to be higher to that observed with the regular flu, although the most vulnerable group -those older or with additional health concerns- is quite similar, thus talking about flu is somewhat close. By the way, seasonal flu is not as trivial as we normally believe. Just for the last two winters there were between 6.300 and 15.000 casualties in Spain linked to the flu. That is many more than deaths caused by traffic accidents.
As with the flu, we need to pay special attention to those potential coronavirus patients older or with chronic medical conditions: the mortality in China associated to coronavirus doubles up approximately within each decade (you can look up the exact numbers if you wish), reaching up to 14,8 % in those 80 years and older. Calculate for younger decades.

So, yes, probably at the individual level we don't need to over worry. True, we don't go to the doctor nor contact the hospital if we have flu symptoms and, yes, we do not offer high risk to transmit the flu to others if we have contact with some sick person or have visited places where flu is currently happening. We just have to read and follow the instructions recommended by the health experts, relax and do not oversaturate the medical centers due to panic.

BUT (and I don't want to alarm you): in the case of coronavirus, there are some differences at the collective level that justify this level of precaution, these quarantines, these social and economic impacts. This comes from the complete meaning of the word, "epidemic" (now, unfortunately, moved to "pandemic"). The impact of an epidemic is at a society, global level, not just individual.

COVID19 is a new virus and science knowledge is very limited, thus can predict very little about it. Of course we scientists should work hard and try to understand it as quickly and as much as possible. Please support us. Now and always we are in for the long run.

We still don't have an appropriate antiviral nor a vaccine against COVID19, while we have vaccines against the flu. They can be improved, but we have them. Also, we don't even know if science will be able to produce vaccines, it is possible but we are not sure until we have them in hand. Remember that, while we have vaccines against a few infectious diseases, we don't have against agents like HIV, malaria, dengue or tuberculosis, despite the constant scientific efforts and resources invested globally.

Coronavirus seems to be more contagious than flu, perhaps because, although not perfect, as a population we have some past immunity against this virus. We have no immunity against the new one, nothing. And we notice this difference with every point of contagion.

Each winter, about 1% of the population gets sick with the flu. That is, sick enough to go to the doctor. And only about 0.1% of the population each year gets hospitalized with the flu. So, yes, with a little bit of luck we will not have a serious flu in our lives. Do not confuse flu with many other, less serious infections with similar symptoms.

That 1% of the population with flu takes over the health system in winter, that is when saturation reaches maximum, almost complete levels.

In contrast and theoretically, a significantly higher percentage of the population can get infected with coronavirus in a few months, unless we put in place quarantines and contention measures. Not all of them -us- will have symptoms, but the overall amount is very difficult to estimate.

We CAN NOT allow free circulation of coronavirus because up to 17% of people will get sick, either serious or in critical condition. Those are actual statistics from China. In the worst case scenario, the number of acute sick patients will be 150 times more than that the number with flu. Our current health system can't take care of such elevated number of patients.

Therefore, we need quarantines, monitoring of contacts, and any other contention measure that manages to reduce the speed at which a significant percentage of the population will get the virus. We need to slow down the spread of the virus as quick as possible, so that overall infection takes 100 years or more! We need to slow down the spread to have time to develop a vaccine or an effective treatment. We need to slow it down to see if the infection goes down or even disappears in the summer, as it happened with SARS when high contention methods were used, similar to those employed today. We need time to see if vulnerable patients can get better and survive.

But, over all, WE NEED to gain time so our health system does not collapse. Because even in the critical cases, this virus has less effects and is less lethal with good medical assistance: oxygen, hydration, anti fever and anti inflammatory medication, antibiotics in case of bacterial complications, vital support.... This is well know to the MDs for all the other pneumonia cases, but we don't know yet for this virus and perhaps it causes particular secondary and side effects. Within "ground cero" in Wuhan, China, mortality has been 8-30 times higher than for other provinces in China. When asked "why [in Wuhan] the [fatality] ratio was so much higher than the national level, the National Health Commission of China official replied that it was for lack of resources" (meeting NHCC and OMS, Feb 20, 2020). This happened even when, with contention methods, "only" 1 in each thousand persons got infected in Hubei. We need to reduce those numbers and adjust to the contention measures! We need to help all those doctors, nurses and technicians so they are able to do their job!

Because we need to put a stop to this epidemic, any health personnel that gets exposed to coronavirus without knowledge and without protection must be put in quarantine. That already happens for other pneumonias and measles, for instance, and now also for COVID19. If they get infected they need to be in quarantine to avoid spreading the virus to vulnerable patients, thus the number of health personnel able to care for all of us will get drastically reduced.

Because we have to stop the spread of the virus, coronavirus infected patients must be isolated, either at home or at the hospital, depending on the severity of the symptoms and the resources available. Many patients with mild symptoms will be able to go through the sickness isolated but at home but, because of the needed isolation measures to be used with the critical patients, the health system will be unable to take care of a -mere- 0,1% of the population getting really sick if, for instance, we have the expected and normal levels of patients with severe flu.

Lets take flu as a point of reference. In that case we will have 600-1,000 hospitalized cases per million. Last March 8th, International Women's Day 2020, the Italian northern region of Lombardy reached close to emergency health levels with 350 coronavirus cases per million of inhabitants. That is why it was necessary to adopt drastic measures to limit free circulation of people. And that is in one of the "best" health systems of the world, according to the World Health Organization. In Hubei, China, where they reached to 1,200 cases per million, they had to build 16 hospitals in a few days, and recruit thousands of health personnel from other China provinces.

We need to put a break to the epidemic. Data from Italy and Spain shows that every 7 to 10 days the number of cases increases ten times. Do the numbers and estimate how we are going to get to the end of the month if we don't comply with the contention measures and don't follow the hygiene and isolation recommendations. This is so new, so uncertain, that we can't risk not to take control. We need to act.

That is why we need to respect all high contention measures, quarantines and isolation recommended by our Health Authorities. Because, even doing this and being more prepared than ever to contain a pandemic, we are also more globalized and interconnected and the possibilities to expand and extend a pandemic are much greater.

So, in addition to follow exactly all the recommended measures, we need to act with common sense and limit our own contacts. Because the question is not only if I will get infected, but whether I can pass on the infection to other persons. Remember, this is an epidemic. Thus, cancel even congresses and meetings of health professionals. Thus, avoid unnecessary travels and risk exposing the virus to many people from very different places. Thus, avoid big groups, celebrations and meetings. That is why if they close your kid's school you don't send them with their grandparents as kids will put grandparents at severe risk. That is why if they cancel classes in your university or high school you stay home and don't go out partying. That is why when they close your workplace because there is a coronavirus case in your department you don't go out for a drink or to visit your mother or just shopping a little. They sent you home, not to protect you, young, strong and healthy, but to prevent you from being a source moving the virus around to more vulnerable people in a couple of contacts between multiple friends. Even you, if you get appendicitis and suddenly there is a shortage of resources, they won't be able to attend you. It is the only sensible thing to do.

Not to mention if or when this spreads to other countries with less resources.

Hopefully, in the future this virus will become milder and produce a not so strong seasonal sickness, like the flu or other respiratory diseases that happen every year. However, to get to the future we have to pass through the pandemic, and this has to spread as slowly as possible. We need to gain time. Any delay with the spread of the virus and the extent of the epidemic is essential and will help both us and our health care personnel. Yes, it is possible and those delays are on everybody's hands (by the way, go wash your hands). We have to accept and follow the easy tasks, but also the hard ones.

Besides being an attempt to explain the situation, this is a call to sensibility and responsibility once we have the data, not so many, that we have about this virus. Responsibility is not limited to not feeling afraid but, moreover, to think about others, particularly those closer to us.

Well, this is my opinion.

Best to all and keep safe,

Marga del Val

Written by Margarita del Val (CBMSO, CSIC-UAM), Madrid, Spain, in response to a question in a scientific forum about the need to inform why extreme contention measures are being taken to stop and prevent contagion with coronavirus COVID19.
Translated by Maria Teresa Sáenz (Department of Biological Sciences, University of Pittsburgh, Pittsburgh PA, USA).

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