How I Was Able to Convince My Family That COVID-19 is a Real Threat (USA) : China_Flu

My parents are in the high-risk category for COVID-19 and as such, I am really worried for their health in the event they get sick. They are both retired and thus have the ability to completely stay home except in the event of an emergency, but of course they were resistant to that idea and thought I was being ridiculous. In an effort to prove to them that this virus is a real threat, I wrote the following and included lots of sources. I hope it can be of some help to others in a similar situation. I am American and so some of the information is specific to the U.S. Also, I must warn you all that I have mixed in a bit of political commentary. I also must thank this sub as I clearly incorporated a lot of information that I’ve gotten from here.

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I am concerned about COVID-19 and the effect it may have on the older members of our family. I feel as though the media and government are misleading people into thinking that the virus is less of a threat than it is in reality. So, with that said, I would like to address a few things:
*Note: This ended up being way longer than I expected. If you can’t read the full thing, the main takeaways are that COVID-19 is more dangerous than you might think and you should all do whatever you can to avoid catching it.

1. N95 Respirators ARE effective at protecting you from COVID-19

You may have heard the media or even the U.S. Surgeon General say that masks are not effective protection from the virus for the general public. That is absolutely false. This study from the Zhongnan Hospital of Wuhan University (aka the epicenter of the outbreak) provides empirical evidence that the N95 respirators can actually prevent you from contracting the disease. If you’d like a more detailed explanation of their findings, this article is quite helpful. I do want to point out that this paper has not been peer-reviewed yet, but they decided to publish the data before the review process (which takes many months) finished considering that this information will undoubtedly save lives. 
So, if the N95 respirator masks are actually effective against COVID-19, then why does the government keep discouraging the public from using them? Well, there simply aren’t enough masks for everyone, and the shortage is so bad that even healthcare workers don’t have enough. The U.S. government has failed in its job to protect its citizens and is grossly under-prepared for the impending crisis. Here’s a recent example which I think foreshadows the chaos to come. A few days ago in Washington, state authorities sent an urgent request for 233,000 respirators and 200,000 surgical masks to be released from the federal government’s Strategic National Stockpile. The federal government said they’d send help – but could only send less than half of what the state requested (93,600 N95 respirators and 100,200 surgical masks). The federal government did not provide a reason as to why they could only provide less than half of what was asked for. It couldn’t possibly be because we don’t have enough masks, right? Of course it is. While testifying to the Senate a few days ago, the Secretary of Health and Human Services Alex Azar recently said that “we currently have 30 million N95 respirators in the strategic national stockpile,” and that we need “approximately 300 million for health care workers.” A HHS spokesperson, when contacted by CNBC after the hearing, confirmed that the U.S. has 42 million N95 and surgical masks in its stockpile and will need roughly 3.5 billion if a pandemic erupts here. I don’t know about you all, but I find it incredibly unsettling that the United States has only 1 percent of the 3.5 billion respirators that we will need to fight a severe influenza pandemic. 
It’s not our fault that the U.S. government ignored the writing on the wall when this outbreak began in December and subsequently failed to produce enough masks for the country’s healthcare workers. While the situation is incredibly unfortunate, we should not suffer because of their lack of foresight. If I had written this email a few weeks ago, this would be the point at which I recommended you all go out and buy a supply of N95 respirators, but that’s pointless now considering they’re completely wiped out of most stores. If you choose to try to buy some, I’d like to ask you all to make sure you are buying the correct masks, which leads me to my next point.

2. Don’t Buy a Fake or Useless Respirator

Pandemic panic fosters a breeding ground for opportunists with no scruples, and as such, you have to be wary of fake masks (relevant OSHA video). Moreover, a normal surgical mask is not effective against COVID-19, the reason being that they do not create an effective seal on your face. An N95 respirator, when properly worn, does protect you from the virus. In the FDA’s own words, “The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95 percent of very small (0.3 micron) test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks.” If you decide you want to purchase an N95 respirator, I am working on a guide to purchasing one and how to properly use it. I’d be happy to send it to whoever wants it.

3. Covid-19 is more dangerous than the flu

I’ve seen a lot of unscientific drivel from people who love to claim that the flu is more dangerous than COVID-19, or that COVID-19 is “just another flu.” It’s not.
The CDC estimates that from October 1st 2019, through February 29, 2020, there have been 34,000,000 – 49,000,000 flu infections, 350,000 – 620,000 flu hospitalizations, and 20,000 – 52,000 flu deaths. If we assume that the numbers are on the higher end of the range, that amounts to a mortality rate of 0.1%. This figure has been corroborated by many experts, including Christopher Mores, a global health professor at George Washington University, who calculated the average, 10-year mortality rate for flu using CDC data and found it was 0.1%. 
Instead of trusting me to accurately compare the seasonal flu and COVID-19, I will just copy/paste the information directly from the World Health Organization (W.H.O):

The speed of transmission is an important point of difference between the two viruses. Influenza has a shorter median incubation period (the time from infection to appearance of symptoms) and a shorter serial interval (the time between successive cases) than COVID-19 virus. The serial interval for COVID-19 virus is estimated to be 5-6 days, while for influenza virus, the serial interval is 3 days. This means that influenza can spread faster than COVID19. 

Further, transmission in the first 3-5 days of illness, or potentially pre symptomatic transmission –transmission of the virus before the appearance of symptoms – is a major driver of transmission for influenza. In contrast, while we are learning that there are people who can shed COVID-19 virus 24-48 hours prior to symptom onset, at present, this does not appear to be a major driver of transmission.

The reproductive number – the number of secondary infections generated from one infected individual – is understood to be between 2 and 2.5 for COVID-19 virus, higher than for influenza. However, estimates for both
COVID-19 and influenza viruses are very context and time-specific, making direct comparisons more difficult.
While the range of symptoms for the two viruses is similar, the fraction with severe disease appears to be different. For COVID-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection,
requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than what is observed for influenza infection.

Those most at risk for severe influenza infection are children, pregnant women, elderly, those with underlying chronic medical conditions and those who are immunosuppressed. For COVID-19, our current understanding is that
older age and underlying conditions increase the risk for severe infection.
Mortality for COVID-19 appears higher than for influenza, especially seasonal influenza. While the true mortality of COVID-19 will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%, the infection mortality rate (the number of reported deaths divided by the number of infections) will be lower. For seasonal influenza, mortality is usually well below 0.1%. However, mortality is to a large extent determined by access to and quality of health care. 

In my opinion, the most noteworthy part of this information is the fact that the fractions of severe and critical infection for COVID-19 are higher than what is observed for influenza infection. As the WHO data stated, 80% of people experience mild/no symptoms, 15% experience severe infection, and 5% experience critical infection.
The Report of the WHO-China Joint Mission On Coronavirus Disease details the findings of the Joint Mission consisted of 25 national and international experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the United States of America and the World Health Organization (WHO). The report stated the following:

Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio 50% of the lung field within 24-48 hours) and 6.1% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. 

As you can see, the classification of mild also includes cases of pneumonia. You might think that catching  a mild case of COVID-19 would be no different than the average common cold, but that is not the case according to Dr. Bruce Aylward, who headed the WHO Joint Mission that produced the aforementioned report. The New York Times interviewed Dr. Aylward who said the following (I’ve put his responses in red): 

What were mild, severe and critical? We think of “mild” as like a minor cold.
No. “Mild” was a positive test, fever, cough — maybe even pneumonia, but not needing oxygen. “Severe” was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator. “Critical” was respiratory failure or multi-organ failure.
So saying 80 percent of all cases are mild doesn’t mean what we thought.
I’m Canadian. This is the Wayne Gretzky of viruses — people didn’t think it was big enough or fast enough to have the impact it does.

While the younger members of our family would likely have a milder case of COVID-19 (which would still suck) and ultimately be okay, the older members of our family are at greater risk, according to the Joint Mission Report:

Individuals at highest risk for severe disease and death include people aged over 60 years and those with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer

I’ve often heard people explain away the deaths of younger people with COVID-19 by saying “Oh, well they had an underlying condition!” An underlying condition does not mean they are some immunocompromised bubble boy – hypertension (high blood pressure), which is rather common, counts as an underlying condition. The WHO Joint Mission also reported that the mortality rate increases with age, with the highest mortality among people over 80 years of age (CFR 21.9%). The CFR is higher among males compared to females (4.7% vs. 2.8%). By occupation, patients who reported being retirees had the highest CFR at 8.9%. While patients who reported no comorbid conditions had a CFR of 1.4%, patients with comorbid conditions had much higher rates: 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer. 
However, we must keep in mind that “the number of coronavirus cases not just in China but worldwide has probably been under counted because many people with the infection do not suffer serious symptoms and may not seek medical treatment. It is possible that only those who have tested positive are being counted as “confirmed cases.” Until the case definition is expanded to include people clinicians think may have COVID-19 but who were not tested for it, they said, the total estimated number of cases will remain lower than the likely reality. But, if the number of cases widens to include those with mild symptoms who have not been tested, then the mortality rate will go down.” That doesn’t change the fact that “with the flu, the population has a partially built-up immunity, whether through receiving flu shots or already having been exposed to the illness.” COVID-19, however, is “a brand-new virus in a completely naive population on Earth; we’re all susceptible to it. Everyone is potentially infectable with this virus, even with a high transmission rate and the low case fatality rate, that still becomes a massive number of ill and fatal cases.” There is also no vaccine for COVID-19, nor is there any treatment for COVID-19 beyond supportive care. 
I’m sure you’ve all heard about the retirement home in Washington which has been linked to the majority of COVID-19 cases in the United States. Tim Killian, a public liaison for the center, gave a press briefing regarding the virus for the first time on Saturday, March 7, in front of the facility. “Our experience with this so far has shown that the virus is volatile and unpredictable,” Killian said. “We’ve had patients who, within an hour’s time, show no symptoms to going to acute symptoms and being transferred to the hospital. And we’ve had patients die relatively quickly under those circumstances…We know very little about how fast this may act.”
Here is a recent update from Chinese scientists who have performed autopsies on the patients who died of COVID-19. “The influence of COVID-19 on the human body is like a combination of SARS and AIDS as it damages both the lungs and immune systems,” Peng Zhiyong, director of the intensive care unit of the Zhongnan Hospital of Wuhan University in Wuhan, told the Global Times.
4. There are probably way more people sick than the numbers reflect

This is getting way too long so I’m not going to elaborate very much here. The point is that the government doesn’t have enough tests, so the CDC hasn’t been very generous in terms of testing people. As a result, there could be people in your area spreading the virus without knowing that they have it. Here’s another example, just for fun.

5. Lessons from the Spanish Flu of 1918

John M. Barry, a historian and expert on the 1918 Spanish Flu epidemic (about 50-100 million people died), wrote an article about two years ago explaining why the outbreak was so deadly. His conclusion was that governments officials, desperate to keep morale up during WWI, didn’t tell the truth. And because the government lied, more people died. Sound familiar?
Here is a really interesting video from Dr. Dena Grayson who is a pandemic disease expert, MD and PhD in biochemistry and molecular cell biology. Dr. Grayson helped research and develop BCX4430, a broad-spectrum antiviral drug that is active against Ebola, Marburg, Yellow Fever, Zika, and other deadly viral diseases. If you don’t watch the video, her main message is that she predicts COVID-19 “will die down a little bit in the summer months, but come fall, we will see a large increase of cases, much as happened with the 1918 Spanish flu. The vast majority of infections and deaths occurred during that 2nd wave.”

6. Stock up & Stay Home

The CDC has recommended that people who are at higher risk for the virus (e.g. older adults & people with underlying conditions) stay home as much as possible. Here are their general recommendations, which I urge you all to take seriously:

  • Have supplies on hand

  • Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time.

  • If you cannot get extra medications, consider using mail-order for medications.

  • Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.

  • Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.

  • Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.

  • If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.

  • To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.

  • Wash your hands after touching surfaces in public places.

  • Avoid touching your face, nose, eyes, etc.

  • Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones) **Please note: Coronaviruses can survive on surfaces for up to 9 days**

  • Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.

  • If COVID-19 is spreading in your community, take extra measures to put distance between yourself and other people

  • Stay home as much as possible.

  • Consider ways of getting food brought to your house through family, social, or commercial networks

7. Wash Your Hands & Don’t Touch Your Face

I know most of you can’t stay home, nor will you be able to buy a mask. What you can do is wash your hands. Putting some soap on your hands and rinsing them off is not sufficient. Refer to the image below for proper hand-washing technique. You should be washing your hands for at least 20 seconds.

Hand Washing Technique
If you don’t wash your hands for a full 20 seconds, enjoy the coronavirus!

My intention in writing this is not to scare you, but to inform you both. I have tried to include as many reputable sources as possible so you all know I’m not making this up. Maybe you guys will think I’m nuts, but I hope you guys take this virus seriously if you are considered high-risk. I truly hope everyone stays safe and healthy.

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