This is Not the Flu

Critica Clarifies Its Message on COVID-19

         In our recent commentary about the novel coronavirus pandemic, we tried to make several points. First, we noted that despite the fact that flu has caused far more cases and deaths than COVID-19, the media rarely mentions the former but addresses the latter daily. Second, there is a known way to reduce the number of cases and the severity of flu that many people have not taken advantage of: the flu shot. Third, the US Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and other agencies have not done a good job of communicating risk or strategy to the public.

         All of these points remain valid for us, but they probably create the false impression that COVID-19 and flu are comparable illnesses. This is clearly not the case. Without in any way minimizing the severity of flu, it is important to understand that the virus that causes COVID-19, designated as SARS-CoV-2, is about 10 times deadlier than the flu. The mortality rate for flu is around 0.1%; for COVID-19 the most recent estimate is 1.4% and it approaches 15% for people 80 and older. Everyone should still get a flu shot. But saying that COVID-19 is no more serious than the flu and therefore all the measures governments are imposing are unnecessary is a totally misleading view.

Are Measures to Control COVID-19 Effective

         Many people do wonder whether the increasing number of restrictions being placed on our lives by government guidelines and rules will actually help mitigate the spread of COVID-19. Evidence and experience with previous epidemics indicate that they are. Three general types of interventions are now being employed to control the spread of the coronavirus that,  if rigorously carried out, will work to “flatten the curve” of expanding case rates.

         The first are travel restrictions. Governments have imposed bans on travel to and from areas where rates of novel coronavirus infection are high. A study published in the journal Science on March 6 showed, however, that travel restrictions are only “modestly” effective in preventing the spread of the virus. Now that the virus is already spreading within the U.S., for example, it is not clear that banning travel from European countries will be effective. It is still wise to avoid travel as much as possible because, as CDC notes, being in crowded areas like airports and train stations increases the chances of coming in contact with someone who is infected.

         The second approach is an attempt to prevent transmission from silent cases (that is, people who are infected with the virus but not yet experiencing signs or symptoms of the illness) to uninfected people. This is what “social distancing” and hygienic steps like increased and more effective handwashing are designed to do. One study showed that in China, about 10% of new infections were caught from people not yet showing symptoms. The median interval (the value in the middle between the highest and lowest) for getting infected and showing symptoms, known as the incubation period, for SARS-CoV-2 appears to be about five days, with almost all infected people showing symptoms by 12 days. As has been widely noted, this means that it is possible to have a “silent” infection for almost two weeks, during which time an infected person can infect others. Limiting contacts with other people, keeping a distance of six feet when there are other people around, washing hands frequently for at least 20 seconds, and avoiding touching one’s face are all ways of limiting the spread of COVID-19. Evidence suggests that things like proactive school closures—closing schools when a case of coronavirus has been confirmed in a community but not yet at the school—and other forms of social distancing can be effective in limiting the spread of viral epidemics.

Frequent and efficient handwashing is one of the most important tools we have to limit the spread of SARS-CoV-2, the virus that causes COVID-19 (image: Shutterstock).

         The third approach is testing as many people who may have been exposed to the virus as possible and isolating those who test positive for infection.  But, as has been widely reported, we are woefully short on test kits in the U.S.  That is why public health officials do not have an accurate estimate of just how many people are already infected with SARS-CoV-2; we only have good data on the number of people who are symptomatic and have come to clinical attention and of the number of people who have died. For every person known to be infected, it is now estimated that there are between five and ten people who are silent carriers, capable of spreading the virus to others without knowing they have it themselves. Although children are generally spared severe illness, they are just as easily infected by SARS-CoV-2 and capable of spreading infection. We need to test almost everyone if we’re going to get ahead of the virus, as was done in South Korea, and hopefully the loosening of restrictions on private labs performing tests will enable us to expand the number of people who get tested. The failure to rapidly adopt near-universal testing for the coronavirus in the U.S. is probably due to multiple factors and represents a failure of our public health system.

All three of these approaches are effective means of limiting the spread of infection, or what epidemiologists call “flattening the curve.” They should all be pursued simultaneously because at present they are the only tools we have that are likely to have some benefit. Pharmaceutical companies and medical school researchers are now working to identify existing medications that might suppress coronavirus activity and be useful for people who are already infected, but it is unclear whether any such medications exist and unlikely that we can develop new antiviral drugs in time to have an impact on the current pandemic. The ultimate solution would of course be a vaccine. Chinese scientists published the complete genome of SARS-CoV-2 just two weeks after the first cases were reported to the WHO and there are now more than 35 candidate vaccines in various stages of development. But the most optimistic time frame for getting medications that prove to be safe and effective and approved by FDA is 12-18 months. By then, we hope this pandemic will have resolved.

The Infodemic

At the same time that we take measures to limit the spread of COVID-19, we need to improve our ability to get accurate information about the virus to the public. The WHO has called the COVID-19 pandemic an “infodemic” because of the vast amount of misinformation that is being promulgated on the internet. Although they are trying to control misinformation on their social media platforms, Facebook, Twitter, Google, YouTube, and others are said to be stumped by a surge of misinformed posts and videos.

Some of the recommendations for preventing or “curing” COVID-19 that appear on the internet are wrong, but probably not harmful, such as gargling salt water. Others, like drinking bleach and taking steroids, are both useless and potentially harmful. Myths that have been prominent on the internet include that products shipped from China can carry live coronavirus capable of infecting someone; that there is a vaccine already available; that facemasks will prevent infection; and that the virus was engineered and released by a variety of conspiratorial organizations, like the Chinese government, drug companies, and the U.S. Army. In fact, SARS-CoV-2 most likely originated in bats.

We know that the longer misinformation goes unchallenged, the more influential it will be. This is particularly important in view of a recent poll that showed that nearly half of Americans, including a majority of Republicans, believe the seriousness of COVID-19 is being exaggerated. Some scientists are now using social media to provide accurate information about the pandemic,  but scientists have traditionally been reluctant to challenge misinformation and when they do venture into this field it can take days or weeks before experts respond to a myth posted on one of the platforms. For their part, public health agencies often have to be careful with the statements they make for political reasons and therefore spend time carefully crafting their messages. That makes them ill-suited at present to be able to respond rapidly to a proliferation of misinformation, like the COVID-19 infodemic. Rapid refutation of myths and falsehoods must be initiated immediately after they appear online, but that repudiation must be done in accordance with evidence-based methods. Merely stating the facts, especially if done in a condescending manner, will not dissuade people from believing misinformation about any topic in health and science.

A solution that we have advocated is the creation of a core of online misinformation “first responders.” Scientists, including those working at Critica, have developed methods for the detection of misinformation about a specific topic almost as soon as it appears. In our plan, first responders trained by medical and scientific societies and by universities would be alerted immediately when a falsehood is posted and begin responding. We’ve developed an evidence-based protocol to guide those counteracting responses and maximize the chances that they will be persuasive. We plan to test the protocol in the coming months. We further recommend that organizations like the CDC and WHO, medical and scientific societies, and research institutions like the National Institutes of Health (NIH) and Wellcome Foundation all develop cohorts of first responders with expertise in their disciplines and trained in the Critica Protocol.

To these traditional first responders, we propose adding a cohort that responds immediately to online misinformation about science and health (image: Shutterstock).

COVID-19 is not similar to flu. Both are dangerous viral infections with the capacity to cause severe illness and death, but because of its high level of contagion and mortality risk, COVID-19 requires more drastic prevention and mitigation solutions. Proven public health interventions to prevent the spread of pandemic-level infectious disease are available; they are being implemented at different speeds by different states and countries and will hopefully be successful in controlling and ultimately ending the pandemic. In order to make these interventions work, it is crucial that the public receive scientifically correct, understandable information that guides them to the correct steps and behaviors. Given the dazzling speed with which misinformation proliferates on the internet, we call for the creation of a corps of science and health misinformation first responders.

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