Turns out that national TV personality and news correspondent Dan Bongino and his wife have been big fans of my Coronavirus series. As a result, Dan interviewed me yesterday on his podcast which is out today at this link: https://bongino.com/ep-1203-coronavirus-facts-vs-fiction-interview-with-dr-centeno
We had a great 30 minutes separating Coronavirus facts from fiction. Here’s the video:
Stay safe out there!
Dr. Centeno interview with Dan Borgino Fact vs. Fiction: How Serious Is the Coronavirus?
Is this serious?
Yes, of course, we need to take it seriously. Having said that, there’s no reason to have an abject panic.
What’s the difference in severity between this and influenza or variants like H1N1?
When it comes to the elderly (approx. 75-85), H1N1 or standard influenza causes a lot of damage. Mortality rates in that group can be very high.
The mortality rates for the Coronavirus outside of Wuhan China is 0.4%. The German data show 0.2%. The cruise ship data was at 1%. So about 1% or less.
If you look at the mortality rate for the flu in the elderly, it is about 0.5-1%.
But this is a different animal. It affects younger people. It can require ventilators.
Diamond Princess creates an interesting case study because it’s in a closed environment.
The cruise started in Wuhan, China, the epicenter of the Coronavirus outbreak. Then docks in Japan. We know 1 or more than 1 were infected. You have 4000 people in a closed environment with shared spaces.
More people should have gotten sick if this was as dramatic as it’s being made out to be, correct?
Everyone was tested. 17% of all on the ship contracted it after a month. If you look at the flu, normally if tested everyone in the population in an area that’s affected, it’s 20-40% of the population will test positive for the flu.
This is a novel virus with no natural collective immunity to this?
In 1918, the Spanish Flu, the older people had some collective immunity to that. Younger people didn’t. This is the opposite. Younger are doing ok, older are being affected.
Why the disparity between older and younger?
Older people have immune systems that start to fail and go south, so they tend to overreact to things like this and not resolve the inflammation as quickly as younger people can. Talking really about the mean age of death in Italy right now at 81.4 years.
How long does the virus last on surfaces?
Washington Post had quoted an article that was a review of a bunch of other articles. If you really dig into those articles, it says that other coronaviruses (not this one) survive for about 2-3 days on plastic (the longest that they survive for; they survive much less on other surfaces).
Just today an online prepub service said they tested this virus and it lasted 2-3 days on plastic (longest lasting surface, everything else was less). It’s still alive at 9 days, but it’s up to 10,000x less by then. So, 9 days is quite an exaggeration.
Are both Coronavirus and the Flu aerosolized?
Yes, that’s the primary way the flu is spread. So, Coronavirus is not more spreadable than the flu because it is aerosolized. They both are.
How likely is it that the US could be like China?
We need to look at this. We’re at the end of the prime viral respiratory spread. If you look at the last 36 years of CDC data and look at the peak month for the flu, it starts in December, goes about the same in January, it peaks in February a little bit in March; then by April and May, we’ve never had a peak. We’re at the end of that. The US got into this later in these months where the virus is harder to spread. Why? Because it’s aerosolized and when the temperature goes up, viruses don’t survive very well in water droplets. So that’s why you don’t see summer flu peaks because the weather is too warm. Same with this virus.
It’s really about the heat. Such as that one study on plastic, once they turned up the heat the virus died.
Are we going to crash?
We have to prepare, need ventilators ready, ICUs ready, testing dialed in, quarantine off those people who need to be quarantined. But the U.S. is really in at a pretty good time, unlike Italy and China.
What about younger people with conditions like lupus or COPD?
If you have COPD you’re at higher risk. The more treatment required the higher the risk.
If you’re in your 30s and have type 2 diabetes probably less risk. If you’re in your 60s probably more risk.
The Italian health system had said that in the first 104 cases that they did post-mortems on, not only were they elderly, in addition, more than 2/3s had at least 2 chronic life-threatening conditions. So, these weren’t healthy people, but on the edge in a day to day basis.
Is this really a total Armageddon? What’s really gone on in Italy? Do we have the same concerns in the US?
They got in a situation where they weren’t prepared and they’re running out of ICU space and ventilators. About 50% of patients will have mild to moderate cold symptoms. Then another 30% will have some symptoms and think they have the flu. Then 15-20% that get more ill that might need some help. Then looking at the Italy data probably about 3% are going to need ICU care. That’s a lot of people if this thing spreads quite a bit.
But if you look at S. Korea where the fatality rate is 0.65% or Germany where it’s 0.2%, they are able to keep up with all that. So. if you can properly ventilate all those people, most of them will do fine.
Italy got too far along that curve and don’t have enough ventilator or ICU care to really deal with the whole thing.
Is the death rate largely contingent on how you keep the initial cases manageable?
Yes, this is about the appropriate response. If you can get a lid on it, I think you can control it. What do we need? Testing, ICU space, ventilators, health care workers that are protected. For example, in Colorado, they’ve made testing easy with drive-through testing.
Is the response (frenzy) commensurate with the threat? Will it help to see people recover?
Recall in war time Britain, “Keep Calm and Carry On.” We don’t need to create the panic. It would be a good thing for people to see people like Tom Hanks recover. To see that for the most part this is not going to kill you. But it does need to be taken seriously. Need to still be prepared with social distancing, washing your hands, shutting down community events.
Can you get Coronavirus from a box from China?
We need to think about how that works. Porous surfaces seem to be the worst at transmitting a virus. A box, or paper, is one of the hardest for it to survive. Coming from China it would be very unlikely for that to cause transmission. Could it happen if a local 1-day delivery scenario. Maybe, but if a 2-day scenario that virus is probably going to be dead because of that porous surface. Then add heat on top of that, it helps to mitigate it.
Is there a possibility that this could become a seasonal threat like the flu?
It’s possible. The 1918 pandemic did that. It goes into the Southern hemisphere, they’re going into their winter soon. More people are flying around these days. But by the time the US is done with this and sees what it takes to get a lid on this, we’ll be even more prepared next year.
If you get this virus in 1 variant are you immune to other variants of it? Do you get any immunity?
It doesn’t seem like anyone knows yet. My sense is you could develop immunity but that might be to only one type. Really too early to answer that one.
What are the symptoms of this? What’s the difference from the common cold? Influenza? What one thing would concern you most?
For example, with the cold or flu, you get a runny nose or a lot of congestion; there’s that big component. If you have a cough, in addition, it’s usually a productive cough. That’s not the case here. This is a dry cough and a fever that if it gets severe can move into shortness of breath. So, we’re talking about a dry cough and a fever. So, if you see someone with the sniffles they probably have a cold, not coronavirus. But if have a dry cough and a fever and develop any shortness of breath, go see your doctor. If just have a dry cough and fever go see your family doctor and they can decide if you need to be tested. If it’s positive, obey the strict quarantine.
Have you seen any data about any over the counter mitigation measures that might help?
Take supplements for good health but haven’t seen anything that shows it helps coronavirus. There was one pre-publication paper (not enough time to get this stuff to publication). There were some Chinese physicians using culture-expanded umbilical cord stem cells on a woman on her death bed. Within 3 days she was back walking around. That concept has a lot of promise; that you may be able to do an IV infusion of mesenchymal stem cells that can help to control the inflammation. The problem there is the regulatory approval for that in this country might be much more difficult. But if this gets bad, we might see those types of trials ongoing.