Well-Being

Understanding Scary Public Health Announcements

  1. Note: This post is intended to help evaluate ongoing public health concerns, not to provide up-to-date statistics on the Wuhan coronavirus, for which most information dates from last week (February 3 to 9). New York Times articles have been updated with new information and headlines since publication.

WHEN A new virus strikes, look at rates of infections and deaths as well as total numbers; consider the intent behind official announcements; and put the new bug into a context of related viruses.  Generally ignore early, alarming headlines to give the numbers time to shake out.

For the Wuhan coronavirus (also known as 2019-nCoV), headlines remained unnecessarily alarming in almost all media reports until last Thursday when the impeachment acquittal took over. In Tuesday’s Science Times, “Deadly New Contagion” was the six-column, front-page headline, and the words “experts…fear” appeared in the first sentence.

To assess new bug risks, keep track of statistics on numbers of cases, hospitalizations and deaths that work together to create risk: For example, as numbers of cases rise, the death rate can become much lower—while rates of hospitalization indicate virulence. Also relevant is the period when an infected person can spread the disease, more worrisome if before symptoms appear.

Another NYT story on February 4, buried deep in the paper version and difficult to locate online, offered the most useful information, such as the crucial context of the behavior of similar new viruses: “The highly transmissible H1N1 ‘swine flu’ pandemic of 2009 [around the world] killed about 285,000, fewer than seasonal flu normally does, and had a relatively low fatality rate, estimated at .02%.

For anyone unsure of the definitions, however, the article’s headline made 2019-nCoV sound like the plague: “Rise in Cases Suggests Epidemic is Pandemic.”

In general, epidemic refers to rapid spread; and pandemic, to cases over a wide geographic region of one or more countries.  For the Centers for Disease Control, pandemic indicates that an illness has caused death and has spread person-to-person beyond its original source—live animals in the case of the Wuhan virus.

But rates of spreading through a population can be unreliable.  What at first looks rapid can turn out to be problems of poor early reporting compounded by underreporting of mild cases—especially from China, which earned a reputation for delayed response with another coronavirus, Severe Acute Respiratory Syndrome (SARS).

Because the median age of 2019-nCoV sufferers to date is 49-56, total case counts likely miss many children because they develop milder and often symptom-free illness.  “Cases among children have been rare,” according to the NYT report from The Journal of the American Medical Association.

For the Wuhan virus, one concern has been the risk of similarity to SARS and Middle East Respiratory Syndrome  (MERS), its “slow-moving viral cousins.” As numbers of 2019-nCoV cases increased, however, the numbers of deaths created a much lower rate than that for the cousins: 10% for SARS (9,893 cases) and more than 30% for MERS (2,500 cases).

As of last week, the 2019-nCoV fatality rate hovered around 2% (about 800 deaths in 37,500 people infected, with 99% occurring in China), though if true infection numbers are closer to 100,000 as suspected, the rate would plunge. However low the death rate, though, rising numbers of cases means higher total numbers of deaths: in some years, seasonal flu has killed tens of thousands (61,000 in the 2017-18 season) in the U.S. alone.

Comparing coronaviruses brings up the best if remote possibility that ongoing measures to isolate sufferers such as quarantines and travel bans could consign 2019-nCoV to the same fate as SARS, its outbreak halted and microbes eradicated, never to be seen again.

A more likely alternative is that 2019-nCoV will join four currently circulating (endemic) coronaviruses that cause about one-fourth of all colds. “We don’t pay much attention to them because they’re so mundane, especially compared to seasonal flu,” Columbia University epidemiologist Stephen Morse told Statnews.

During some winters, however, these four have caused serious symptoms, creating the possibility that if the Wuhan coronavirus infects enough people regularly, it might boost incentives to develop good treatments and even vaccines.

Among official warnings, the World Health Organization declared the Wuhan virus a “public health emergency of international concern”— a designation designed simply to mobilize international resources for containing the virus—on January 30 after the first reported person-to-person transmission of the virus.

For similar reasons, on January 31, the CDC, which is “closely monitoring” the situation, posted the statement by Health and Human Services Secretary Alex M. Azar II’s of a “public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to 2019-nCoV.”

Prompted by the WHO announcement, the U.S. State Department issued a “do not travel” warning for China, the highest-level travel alert that applies also to Afghanistan and Syria.

The WHO “dashboard” offers easy-access, up-to-date statistics with useful charts—revealing last week at least a temporary leveling off of new cases.

Immunity is a final important variable for assessing dangers from new viruses. ”Exposure to the four endemic coronaviruses produces immunity that lasts longer than that to influenza,” said flu expert Richard Webby at St. Jude Children’s Research Hospital.  But coronavirus immunity wanes with age, so that risk of reinfection can be higher in older people.

Crying wolf, in the proverbial sense, is the biggest danger of media over-hype—alarming people too early or unnecessarily, which makes it harder to get their attention when threats get worse or more serious emergencies arise in the future.  If this is happening with the Wuhan virus and the loudest alarms have already sounded, people could miss worse news or new precautionary advice when it comes.

Mary Carpenter

Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.

 



2 thoughts on “Understanding Scary Public Health Announcements

  1. Lauren says:

    Hear, hear, Mary! Thanks for putting this in perspective. It is also of note that of the relatively few fatalities, most, if not all, have been individuals with already compromised health from other conditions or age.

    1. Mary Carpenter says:

      Thanks so much Lauren, very good point: Risk of death from what’s now called COVID-19 increases with age, with high risk among those who are over 80 and/or who have pre-existing medical conditions.

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