Science Vs - Coronavirus: Fears and Facts

Episode Date: March 4, 2020

The new coronavirus continues to spread around the world, and it’s already killed several people in the U.S. People are starting to worry that this will turn into a full-blown pandemic. So how many of us could ultimately get infected — and is it time to prepare for the worst? To find out, we talk to epidemiologists Dr. Cécile Viboud and Prof. Marc Lipsitch. Here’s a link to our transcript: https://bit.ly/2IjUqW0 and our Hand Washing Song: https://player.gimletmedia.com/7osxva Selected references: CDC’s FAQ Page: https://www.cdc.gov/coronavirus/2019-ncov/faq.html NEJM Editorial: https://www.nejm.org/doi/full/10.1056/NEJMe2002387 Big report from the Chinese Center for Disease Control and Prevention: https://bit.ly/32S4e2H This episode was produced by Michelle Dang, Wendy Zukerman, Meryl Horn, and Rose Rimler. We’re edited by Blythe Terrell, with editing help from Caitlin Kenney. Fact checking help from Michelle Harris. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Emma Munger, and Bobby Lord. Translation by Lisa Wang. A big thanks to all the researchers we got in touch with for this episode, including Dr. Catharine Paules, Dr. Miriam Haviland, Professor Matthew R. McKay, Dr. Jason McLellan, Daniel Wrapp, Professor William Arthur Petri, Professor Li Min, Professor Xiaokun Li, and Professor Raina MacIntyre. And special thanks to the Zukerman family and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Bumble knows it's hard to start conversations. Hey. No, too basic. Hi there. Still no. What about hello, handsome? Who knew you could give yourself the ick? That's why Bumble is changing how you start conversations.

You can now make the first move or not. With opening moves, you simply choose a question to be automatically sent to your matches. Then sit back and let your matches start the chat. Download Bumble and try it for yourself. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan 11?

I'm here, astrophysicist and co-host, ready for anything. That's right, I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm here, astrophysicist and co-host, ready for anything. That's right, I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan Eleven. I'm Steve Strogatz. And this is... Quantum Magazine's podcast, The Joy of Why.

New episodes drop every other Thursday, starting February 1st. Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet. We're back with an update on the new coronavirus because, well, things have escalated. In the last few weeks, new cases of this virus have been going up and up. As of right now, there are about 90,000 cases and more than 3,000 dead. And this virus has spread fast outside of China, with more than 70 countries now affected. And we're starting to feel it here in the U.S. Tonight, the governor of Washington declaring a state of emergency after the first known

coronavirus death in the U.S. The virus has killed at least nine people in this country. We just keep hearing about more and more infections. There are now at least 100 cases of coronavirus in 14 states around the U.S. Not just one or two or three or five. There will be many who test positive. And people have started stockpiling. Food, hand sanitiser, face masks.

Yet in the face of all the worry and panic, President Trump is saying, calm down. Because of all we've done, the risk to the American people remains very low. When we did our episode back in January, things were pretty different. Since then, it seems that the virus has taken hold in the US. Now that we're finally testing more and more people, it's expected that even more cases will come through.

Also, just this week, the World Health Organization put out an estimate of how deadly this virus is, with headlines saying it's killing 3.4% of people who get it worldwide. And there are reports that 40 to 70% of adults around the world will get infected. Today on the show, we're going to take you inside these numbers to tell you how much you can trust them and just how worried you should be. To start, we called out, well, why don't you introduce yourself? Sure. So my name is Cecile Vibou.

I'm an infectious disease epidemiologist. Cecile works for the National Institutes of Health and as an epidemiologist, she's tracked a lot of scary diseases. Just a few years ago, the Zika outbreak, a few years before that, the Ebola outbreak in West Africa. 17 years ago, the SARS outbreak. It's a testament to my age, but yes, I was present for all of this. The first thing we want to talk about is the fatality rate of this coronavirus. The World Health Organization just said that worldwide, it's 3.4%,

which would be a lot worse than, say, the seasonal flu. But the thing is, the fatality rate of this coronavirus, so far, it's really different for different countries, which Cecile says is a clue to how this might go. You have to realise that most of those differences are driven by differences in surveillance. So some countries capture only the very, very severe cases and primarily deaths, for instance, Iran, while other countries test a lot more for COVID. And so they find a larger spectrum of cases. And so their estimate of case fatality rate is lower.

Right. So if you're just testing the people who are severely ill and have a higher chance of dying, then the fatality rate is obviously going to be higher than if you're testing anyone who perhaps has mild symptoms. Exactly. And that's what people are still struggling with now to try to get a good handle on exactly what the severity of this bug is. So, for example, in China, where the virus has been infecting people for months and surveillance has ramped up, so they're catching people with milder illnesses, studies are coming out estimating the fatality rate is lower than 3%. Yeah, so estimates are still a little unclear, but we think it's around 0.7 to maybe up to 2%. 0.7 to 2%.

And this suggests that these initial figures from the World Health Organization, they may keep going down as we get better data, as there's more testing, and as we start capturing more and more cases, especially mild ones. For now, Cecile told us that this 3.4%, it's an incredibly rough estimate.

Okay, so next question. Who is most at risk of dying if they get coronavirus? While adults of all ages have died, this is especially risky for older people, those in their 70s and 80s, as well as people who are already sick with things like heart disease and diabetes. And something else rather odd is cropping up in the data. More and more studies are also surprisingly suggesting that being a male is also a risk factor for severe disease, and that's not entirely clear why. So it's a 50-50 gender breakdown for the risk of being a case. It's

just the fatality risk that's higher in male. So that's still being investigated. What new research is telling us, though, is that for most people, if they get infected, this virus won't be too dangerous. Last week, China's government published a big report that looked at more than 40,000 confirmed cases of coronavirus, and they found that 80% of them were what they called mild. A mild case would be, so you're coughing, you're sneezing, maybe you have fever. Some people in that mild category also had pneumonia that cleared up without too much trouble.

So 80% with mild-ish cases. The rest though, they ended up being quite sick and 5% were in critical condition. So those are some of the best numbers we have right now. But research is starting to suggest that these figures could change quite a bit. And that's because even though we are getting better data from people with milder symptoms, what's still not properly captured here is people that barely have any symptoms at all. It is conceivable that there is a large iceberg of very mild patients that we haven't really seen yet and been able to test. And when we do, and if we do, then the case fatality rate

could decrease a lot. It's also possible that there are people who will get this coronavirus and never have any symptoms at all. So, for example, a curious case report was recently published. A healthy 20-year-old woman living in Wuhan travelled to a different city in China to meet some family. A few days later, five of her family members were sick. They were infected with coronavirus. She tested positive. She had the virus. But a month later, she still hadn't shown any symptoms.

It's early days. That's just one woman. We are waiting for more studies on this. And amidst all these unknowns, though, one thing we do know is that people can spread this virus early on in their infection. Producer Rose Rimler and I talked to Cecile about it. I guess if I was like rating the scariness of a virus, the idea that it could spread and infect more people early on before people really realize they're sick would make a virus more scary to me. How do you feel about it?

Yes, that's right. It's a virus that's more difficult to control. Yeah, and it feels like it's spread to other countries fairly quickly. Is it inevitable that more and more countries are going to see widespread infections? Yes, I think more and more countries will see infections. More and more countries. And while Cecile doesn't sound particularly stressed,

others are raising the alarm bells. Because things look pretty different now than what they did a few weeks ago. In January, the US had just a handful of cases in people who had visited China. In fact, there was only one case of a person giving the virus to someone else in the US. But now, scientists are seeing people infected that seem to have no connection to China or countries with other big outbreaks. And that suggests that people are walking around in the US infected with this virus and spreading it around. This is exactly what experts were worried would happen. And now it looks like it's here. Several people in the US have already died. And this raises a

huge question. How bad is this going to get? How far will this virus spread? Well, there's some big and scary numbers that are making the rounds. 40 to 70 percent of the world's adult population could be infected. 40 to 70 percent of the world's population likely to be infected this year. One expert has predicted that 40 to 70 percent of the world's population will be infected within the next year. Yeah, it felt like this figure was everywhere. It was in the Wall Street Journal, the Atlantic, CBS. It was reported in Israel, in New Zealand, in Taiwan. And the expert who came up with it is Harvard epidemiologist Mark Lipsitch. Hello.

Hello. Is this Mark? Yes. We got you. This is Wendy. Yes. You're a tough man to find. Yeah, you. This is Wendy. Yes. You're a tough man to find. Yeah, it's crazy right now.

Mark is a professional disease tracker, and he told us that with just a little bit of information, he can predict how big an epidemic will get. I've been doing this for long enough that I can tell you a reasonable guess at the size of the epidemic that it would cause without thinking very hard, because that's, you know, it's one of the things that I'm good at doing. Fun at a cocktail party, I imagine. Yeah.

When Settlers of Catan is finished. Right. So here's how Mark plays pandemic and how he came up with that 40 to 70% figure. The first thing he needs is called the reproduction number of the virus. You may remember this from our last episode. It's kind of like the estimate of the virus's contagiousness. So in this model, Mark figured that the reproduction number for the coronavirus was 2.2,

which meant that if, say, Mark got infected... On average, I will infect, say, 2.2, which meant that if, say, Mark got infected... On average, I will infect, say, 2.2 people. That's one of the popular numbers that's going around. Then he plugs that number into an equation that's used by lots of researchers in the land of pandemic modelling. And it describes, theoretically, how many people would have to be infected before the virus can't infect anyone else.

Kind of runs out of steam. Now this model, by the way, it only looks at infections in adults and that's because we don't have numbers on how many kids are infected. Mostly because kids aren't getting really sick from this virus, from what we know. So Mark takes that estimate and then he tweaks it based on what we know from real life pandemics, like the Spanish flu in 1918, which killed millions of people. But he looks at other pandemics too. Less famous pandemics of 1957 and 1968 and 2009. So Mark did all of this modelling and voila,

he landed at his estimate, that 40% to 70% of adults around the world could get infected with this coronavirus. And while this seems really surprising, to Mark it made sense. Because from what we know about brand new viruses like this coronavirus, if they hit a population that has no immunity to it, that means everyone is susceptible. And so then, so with this 40 to 70% figure, so that means I have a good chance of getting this? Yes. Yes, all of us, over 20 folk, have a pretty good chance of getting it. Okay, so that might sound really scary, but there are a few things you have to know about these numbers.

The first is that they include people who get the virus without having scary symptoms, or possibly people who have no symptoms at all. So the 40% to 70% is an infection number, not a sick or dead number. Another issue? That number that Mark relies on to give his estimate, the reproduction number, it's changing as we're getting different data. In some last-minute fact

checking, Mark told us that it's actually creeping downward, which now means that he's estimating that 20 to 60 percent of adults will get infected. So this isn't an ironclad calculation here. It's an estimate that Mark first did for the Wall Street Journal. This was not a formal process. This was a journalist asking, what do you think? We are not at a point where anybody can give an answer that is based on firm assumptions and firm conclusions. We just don't know the numbers. We reached out to a bunch of epidemiologists about it.

Some agreed that Mark's estimate was possible. Some said it was more like an educated guess. And others, like Cecile, thought it was more like a worst-case scenario. Yes, yes, that's a good term for it. And the big reason that Cecile thinks this is because those high-end figures, 60 to 70 percent getting infected, they don't take into account the control measures that a place like the United States might take in preventing the virus. Things like telling people to stay at home if they're sick,

getting people to work from home, or even closing schools. I think most countries, the large majority of countries, will put interventions in place so that, you know, we won't see 40 to 70%. The truth is that we don't know how bad this will get. There's just too many unknowns here. But even if it doesn't get so bad that, say, half of us are infected, things may get worse in the US before they get better. And what do you think would have to change for the situation in the US to get quite scary?

So, you know, I think if hospitals start to be... ..there starts to be an influx of really sick patients in the hospital that they can't cope with. And so what if it does get really bad? This coronavirus starts spreading through the community. Hospitals start getting overwhelmed. We're told not to go to work. A press briefing from the CDC last week said that, quote,

disruption to everyday life may be severe. So what would that actually be like? Well, for this, we don't need a model. We can go to the place that's been hit hardest by this virus, a place where people are living through these severe disruptions. And that's coming up after the break. Welcome back. So experts say that we're likely to see more and more cases of this coronavirus in the US.

And some people will get really sick. That'll be especially scary if you're older or have existing health problems. On top of that, though, a lot of us could be told to stay at home and to avoid public places. That'll be to keep the virus from spreading. And so we wanted to know, what's it like to live like that? Hi, good morning. Good morning. This is Chan. She asked us to call her by her last name.

Me and Jackie Chan have the same last name. Chan is an electrical engineer who lives in Wuhan, in an apartment with her parents. When the virus really started spreading in January, everyone was told to stay home. So she's been at her parents' place ever since, basically in quarantine. I basically work from home.

If I need to do any shopping, I do online shopping, and then I go downstairs and I pick things up. I still got to go out sometimes, though. For example, I went out to walk my dog. And when you go outside, what are you doing that's different now than before? So everyone is pretty careful. And when I go outside, we all try to keep our distance from each other. When we come home, we use alcohol to disinfect. So it's, I'm okay. How many people have you seen in the last month, including your family and friends? Like how many people have you seen in the last month, including your family and friends? Like how many people have you spoken to and, you know, had a laugh with in the last month?

Face to face? Yeah. 对,面对面。 Probably no more than five. My parents and then the people who are getting the groceries. Wow. We're all okay. We're all okay.

It's just my dad loves to work. And he can't go outside. And he also can't work from home. So he's probably really bored. How do you entertain yourself? Aside from working, I watch TV shows and movies and I'll also make some desserts. What's the most extravagant dessert you've made while in quarantine? Have you heard of shachima? No. It's like fried rice flour. It tastes very good. Chen told us that for some people in Wuhan, things are harder.

Some have to go to work. And obviously, for those who have been infected and hospitalised, it's really different. And do you know anyone who's gotten sick? So directly around me, the people who are close to me are healthy, but I definitely hear people say this person or that person has been infected. And because I watch the news, it's still scary because infection rate seems to be quite high. And while some in China, like Chan, who aren't infected, are sitting tight and waiting for this to be over, those on the front lines,

the doctors, have been throwing everything they have at this coronavirus. Most experts are saying that a publicly available vaccine is still at least a year away. It just takes time to make sure that it's safe. So in the meantime, scientists have started scores of clinical trials to find the best treatment for really sick people. They're trying antivirals, traditional Chinese medicine and even faecal transplants. So, is any of it working? Well, one antiviral called remdesivir can kill coronavirus. In a petri dish.

A clinical trial with the NIH is currently underway. A drug used for malaria is also showing quite a lot of promise in China. But probably the most surprising thing that we came across is research into this kind of infamous drug called thalidomide. Yeah, this is the drug that was used to help with morning sickness in the 1950s but ended up causing birth defects in babies. Well, researchers at Wenzhou Medical University recently announced that 10 really sick coronavirus patients

got a lot better after given thalidomide, along with other standard treatments. And they've just started a clinical trial. How on earth could it work? Well, we know that one of the things that happens in severe cases is that our immune system can go nutso, and this can damage our organs. Both thalidomide and that anti-malarial drug, they might damp down that immune response.

We asked Cecile from the NIH about this. I think we have to keep an open mind, right? It's a new virus. I mean, drugs that we didn't necessarily think could have an effect could very well have an effect, as long as you can prove it through, you know, regular, randomised control trials. So even though we don't have a slam-dunk treatment yet, if this gets bigger in the US, which at this point seems likely, At least we won't be starting from scratch.

You know, where do you think this is on the scary scale? I think it's concerning. I, yeah, I don't have a, you know, a quantitative scale of scariness. It's a little difficult. Such a scientist response, isn't it? Such a scientist response. Okay, let me give you the scale. 10 is, ah! Zero is, do-do-do-do-do-do-do-do-do-do. Where are you at now? I think maybe I'm on a seven. What does seven mean to you? A seven means that I keep watching the news. I think it's good to be prepared.

Have you started, you know, buying up the chickpeas, the cans of chickpeas? Just a little bit, just enough for a week. So, you know, not anything really scary. And I don't think anyone should buy the entire store. Cecile says that a big reason she's buying this stuff is because if she does get sick, she doesn't want to have to run off to the store and possibly infect others. And this advice to have some stuff at home, it's in line with other recommendations that we're hearing.

They're also saying that if you're on meds, try to get some extra if you can. And if the virus does hit your area and you're older meds try to get some extra if you can and if the virus does hit your area and you're older or already have a chronic illness you may need to take extra care when it comes to wearing masks well for people who are infected they should be wearing masks but if you're healthy the research is pretty mixed about whether it'll do anything. So, this virus, it can be scary, and the situation might get worse.

But there's no need to freak out. We can prepare for this. Plus, freaking out, it's not an effective antiviral anyway. But you know what you can do? Is you can wash your hands properly. We told you about this last time, and that advice has not changed. And you need to lather up for a while, for at least 20 seconds, according to the CDC,

which is way longer than most of us normally do. And so to help wash our hands, our sound engineer, Peter Leonard, actually came up with a song. We know this is a serious situation, but just maybe this little ditty will help you wash your hands. That's Science Versus. Now, Wendy, I'm going to tell you how to wash your hands in just the right way, the CDC commands.

First, turn on the tap and stick your hands under, then turn the tap off. You don't want to waste water. Now, soap up and don't skimp. That's your weapon. Then you've got to scrub your hands for at least 20 seconds. You don't wanna waste water Now soap up and don't skimp, that's your weapon Then you gotta scrub your hands for at least 20 seconds You need some help? Let me show you how 20 seconds starts now

Go! Lather, lather the back of your hands Between your fingers, under nasty nails Lather, lather, lather your palms together Wash of those hands Are we done yet? No! Lather, lather your palms together

Wash of them hands Can you show me now? No! Lather, lather the back of your hands Between your fingers, under nasty nails See? 20 seconds. So dry off your hands, reduce the threat. See? 20 seconds. It's longer than you think. If you just want to hear that song, you know, while you're washing your hands, we'll link to it in our show notes. And as always, you can also find this episode's transcript with all of our citations right there as well in our show notes.

This episode was produced by Michelle Dang, me, Wendy Zuckerman, Meryl Horn and Rose Rimler. We're edited by Blythe Terrell with editing help from Caitlin Kenny. Fact-checking help from Michelle Harris. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Emma Munger and Bobby Lord. Translation by Lisa Wang. A big thanks to all the researchers we got in touch with for this episode, including Dr Catherine Powless, Dr Miriam Havilland, Professor Matthew R McKay, Dr Jason McClellan, Daniel Rapp, Professor William Arthur Petrie,

Professor Li Min, Professor Zhao Kunli, and Professor Raina McIntyre. And a special thanks to the Zuckerman family and Joseph Lavelle Wilson. I'm Wendy Zuckerman. Back to you next time.