posts » COVID-19: an epidemiologist's view

COVID-19: an epidemiologist's view

Over the last few days and weeks, I have had increasingly frequent discussions about COVID-19, with people asking my view due to my training in both medicine and, more specifically, epidemiology. Now, at this point I need to state that I am not an infectious disease epidemiologist. But I did have some training about infectious disease epidemiology when I did my masters at the London School of Hygiene and Tropical Medicine, and I also work with the emergency services in France, so I've probably got more experience/knowledge/understanding than many people.

Anyway, tldr: my advice is that you should probably isolate yourself now - even if you think you don't have the virus. And if you want, you can find out more about why below.

First off, for those who like reading, Tomas Pueyo has published an excellent article on called Coronavirus: Why You Must Act Now. I highly recommend you read it. It deconstructs the numbers in ways that anyone (at least, with some basic numeracy) can deal with. If you want more graphic descriptions, here are two threads on twitter by Italian doctors describing the situation in their hospitals:

If you want more (detailed) info, there are lots of articles and resources online you can read after you have read the Pueyo one mentioned above. Indeed, the main graphic that is used in that article comes from an article published in JAMA (the journal of the American Medical Association) on February 24, 2020 entitled "Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention" and written by Zunyou Wu, MD, PhD and Jennifer M. McGoogan, PhD from the Chinese Center for Disease Control and Prevention, Beijing, China. They also have an interesting timeline in the article providing a comparison with the SARS outbreak in 2002-2003 - this is useful and actually important to know about as SARS comes from the same coronavirus family, hence potentially has things to teach us. It's just a shame the global effort into coronaviruses was wound down after that outbreak, otherwise we might not be in the situation we're in now. For instance, spread on airplanes occurs.

I also note that illness does occur in children - being a paediatrician, this is of interest because up until now it has been thought that children basically do not show symptoms from COVID-19. However, this is clearly not true - a report published today in the NEJM describes six children infected and affected in Wuhan in January. Interestingly, "None of the patients or their family members had had direct exposure to Huanan Seafood Wholesale Market ... [and one patient who lived outside Wuhan had] illness onset on January 2, 2020. The patient and her family were residents of the Yangxin area of Huangshi and had not traveled outside the city in the month before illness onset." So there is clearly evidence that "patient 1" was very unlikely to have been the first person to get the virus.

Ok, Enough for now - I will possibly write more in the coming days (time-dependent) but in the meantime there is a pad where some links of interest are being gathered: feel free to add/edit!

And, my final summary: it is going to be pretty bad for a few months. Most (all) health care systems will struggle to cope, and privatised ones will cope a lot worse than centralised/state managed systems.