Matthew J. Edlund M.D.

The Power of Rest

Coronavirus Hype or Hope?

With so many contradicting public messages, it's hard to determine what's true.

Posted Apr 09, 2020

 CDC
CDC model of SARS-CoV-2.
Source: CDC

Which of these contentions is true:

  • It’s going to disappear. One day—it’s like a miracle—it will disappear.
  • Peak cases in the U.S. will occur in the next four weeks.
  • We have it totally under control. It going to be just fine.
  • This epidemic will peak in the summer, recur in the fall, last 18-24 months and will continue endemic in different populations much longer.
  • Hydroxychloroquine is a miracle drug that will save thousands of lives.
  • There’s no proof hydroxychloroquine helps at all.

Feel whipsawed? Don’t fret. Answers will be forthcoming eventually. But you need a little analysis.

South Korea has had 200 deaths, following a severe point outbreak in a religious group in Daegu.

New York City recently has that many deaths a day that go uncounted as people die in their homes, never tested for COVID-19. So let’s look at coronavirus peaks: are they like Mt. Fuji, or more a packed mountain range like the Himalayas?

1. From peak to peak. Turns out there are many peaks. There are peaks of listed cases. There are peaks of deaths. There are peaks for active versus recovered cases. Plus the methodology of testing is different in every country.

Still, if you aggregate data on case and case death numbers on sites like that of Johns Hopkins and Worldometer, which list data nations publicly declare (some are clearly withholding,) some points become evident:

  • a. Peaks in Asia are not like those in Europe or the U.S. In Korea, there was almost a V, Mt. Fuji type of increase in new cases over three weeks and decrease over three weeks. They still have 40-100 cases a day, but the number is steady. South Korea appears to have the epidemic under control.
  • b. The time it takes to get to maximum incident cases have been running much longer in Europe than Asia. In places like Italy and Spain the “peak” is not a sharp point but a mountain range lasting 10-14 days or longer, which took four to six weeks or more to reach. Peak deaths occur later, as the incubation period can extend two weeks and the course of illness (the severe kind) far longer.
  • c. The longer it takes to get to strict social distancing, the longer it takes to peak cases. This results also in a “flatter” more mountain rangey looking peak that lasts, as well as an expectable longer period to a trough. It appears the longer it takes you to get to peak, the longer it takes to come down
  • d. Most countries may experience an ongoing series of regional “peaks.” Large point outbreaks in Milan and NYC are followed by other outbreaks in places like Rome and New Orleans. Rural areas in the U.S. which have been notably slow to emplace social distancing, a policy that correlates with the national political divide, will get hit later, probably with longer times to peak and trough.

Many people who are infected are asymptomatic, based on data from Iceland and Italy. This highly transmissible virus spreads through unwary folks who feel just fine, who don’t realize that breathing and talking spread infection to potentially everyone. So you will witness rolling regional peaks throughout the U.S. And these regional peaks will last longer than anyone wants.

2. Will hydroxychloroquine be a SARS-CoV-2 wonder drug? You won’t know till you’ve done a proper double-blind clinical trial. Here are a few reasons:

  • a. There are not dozens or hundreds but thousands of unconscious biases when studying treatment efficacy, as the great epidemiologist David Sackett demonstrated. Here’s an example: In the early 1980s, when I was a resident at the Harvard School of Public Health, the Nurse’s Study (still ongoing) “showed” that taking hormone replacement treatment decreased heart attacks in women by 50%.

    A 50% decrease in the major killer of women? That’s a no brainer. I told my mother. “No way I’m taking hormones.” Mom was right. When proper clinical trials were done it turned out HRT increased the number of heart attacks and strokes, breast and other cancers. Hormone replacement therapy increased extra deaths.

    How did the Harvard researchers, some of the smartest guys in the room, get it so wrong? From a few of the many hundred forms of volunteer bias, in turn one of the many kinds of biases that alter results. People who volunteer for studies are different from those who don’t. In this example, people with much healthier behaviors in terms of eating and exercise disproportionately also took HRT- they felt it would improve their health. In the modeling done by the researchers, the variables they included, like HBP and weight, didn’t catch a lot of that volunteer bias.
  • b. Count up the number of biotech companies with “promising” or “fabulous” new compounds that no longer exist. It’s a very long list. The companies died because when double-blind trials were done, their stuff was too toxic or just didn’t work.
  • c. About 90% of big pharma drug trials end in failure. Do you think pharmaceutical executives routinely spend billions of dollars for stuff they don’t think will work?
  • d. Hydroxychloroquine has a lot of toxicities, especially in the often rapidly collapsing COVID-19 patients. They include prolongation of the EKG’s QT interval which people working in ICUs tell me scares the bejeesus out of them.

I’d love it if hydroxychloroquine, or remdesivir, or some variant of laetrile worked. But without properly done double-blind trials, you are literally flying blind.

3. Hope. Hype is often more efficient than hope. When people are desperate, they want answers, fast. Even if they’re wrong. It turns out SARS-CoV-2 spreads almost as fast as fake news. As President Lincoln said, you can fool all of the people some of the time. You can’t fool Mother Nature.

But you can do stuff you know works. Taiwan, as of this writing, has had five people die of COVID-19—five, in a population of 23 million with extremely close links to mainland China where the epidemic started. Five.

Singapore is doing OK, too. So is South Korea, despite its vicious point outbreak in Daegu. Those countries learned the lessons of preparation and communication from the original SARS epidemic.

If they’re succeeding, why can’t we?

The answer is we can and will, if we creatively copy what they did. Test, trace, track. Rigorously practice social distancing. Try taking temperatures as people go to work. Stop getting caught up in issues like hydroxychloroquine.

My bet is that if Americans were offered the chance to help with tracing and tracking COVID-19, millions would volunteer. More Americans have recognized that my health is yours, and yours mine. That going out and bantering as usual with the neighbors endangers not just their families but every family, not just in your community but in every community in the world.

This is a global pandemic. It will be defeated when it is defeated in every country. We’re social animals. We move around.

Viruses take advantage.

People can get a lot accomplished when they plan and prepare and cooperate. We have plenty of tools to vanquish the virus. It’s time to cooperatively use them.