Covid-19: Science-Driven Q&A
A summary of key findings from scientific studies.
“We thought this was only a respiratory virus. Turns out, it goes after the pancreas. It goes after the heart. It goes after the liver, the brain, the kidney and other organs… Its ferocity is breathtaking and humbling.”
— Dr. Eric Topol, cardiologist, Director of the Scripps Research Translational Institute
Is Coronavirus worse than the flu?
Covid-19 is at least ten times as fatal as influenza. Analysis from the University of Washington estimates Covid-19’s infection fatality rate to be 1.3%, compared to 0.1% for seasonal influenza. Columbia University estimates a 1.46% infection fatality rate for Covid, based on New York City data. Analysis from a University of Wollongong epidemiologist found an even higher fatality rate, suggesting Coronavirus is 50–100 times as deadly as the flu. Covid-19 patients are also five times as likely to require intensive care than flu patients.
This virus is more than four times as contagious as the flu, with an R0 score of 5.7 compared to the flu’s R0 score of 1.3, based on CDC data. R0 measures the average number of people that contract a contagious disease from one person with that disease. About 146,000 people have died from Covid in the U.S., while about 61,000 people died from influenza in 2017–2018, which was the worst flu season since 2011. Far more people are susceptible to contracting Covid-19 than the flu. Due to the lack of a vaccine, between 50–80% of the U.S. could get infected with Covid, according to a study in The Lancet. Meanwhile, the flu tends to affect about 8% of the U.S. population every year, based on CDC data.
Unlike the flu, Covid-19 causes excessive blood clotting, which leads to heart attacks, coronary-related kidney damage, and severe strokes, even in young people with no previous history of cardiovascular disease, according to a study in Nature. It also causes testicular damage, based on research in European Urology Focus.
The virus’ lingering symptoms can be debilitating, with 45% of patients experiencing memory loss, 29% experiencing heart palpitations, and 26% experiencing blurry vision, according to an Indiana University survey. Even young, fit individuals experience long-lasting effects that baffle their doctors, people like Karyn Bishoff, a 30-year-old firefighter. She used to work out five times a week. Now, she can’t walk more than two blocks without needing several days to recover. Her symptoms continue to worsen and she says she fears for her life. Karyn’s story is shared by countless other so-called “long-haulers” who are suffering from poorly understood long-term side effects.
What areas are the riskiest?
The highest risk areas are crowded, enclosed spaces with poor ventilation and long exposure times. A preprint paper on MedRxiv estimates that transmission is 18.7 times more likely indoors than in open-air environments. The worst case clusters in the U.S. have occurred in cramped, indoor spaces like prisons, jails, meat-processing facilities, and nursing homes. AC units in poorly ventilated areas may increase the risk of transmission. Scientists believe AC units may explain why a restaurant in China saw an outbreak despite customers staying 1-meter apart.
Confined spaces are risky even if they’re not crowded. Small respiratory droplets (aka “aerosols”) can travel far distances and cause infection upon inhalation. This is known as airborne transmission, and it’s especially likely in confined areas. Researchers believe it explains how a tour bus passenger in Hunan, China infected another passenger who sat 4.5m (~14ft) away and entered and exited through a different door.
Restrooms also pose a high risk, especially those with poor ventilation. The CDC successfully isolated viable and infectious Covid-19 particles from infected patients’ feces and said there’s a potential for fecal–oral or fecal–respiratory transmission. A study published in Nature looked at two hospitals in Wuhan, China and found that virus particles were mostly concentrated in the air near the unventilated toilet areas in the patients’ rooms. A study in JAMA found viral particles near the toilet, sink, and door handle of an infected patient’s isolation room. Additionally, research shows that toilet flushes create plumes of infectious particles (droplets and aerosols); closing the toilet lid before flushing can reduce this effect, but most public restroom toilets lack lids.
Though outdoor gatherings are generally safer, many are high risk. According to the CDC, the riskiest gatherings are those that lack the space for proper distancing (6-foot separation) and have a large number of attendees traveling from outside areas. Gatherings in areas with above-average infection rates are especially high risk. The CDC says you should wear face masks around outsiders (people who don’t live in your household), regardless of whether you maintain distance or are outside. Face masks are especially critical in situations where distancing is not possible. Since shouting and singing produce far more infectious droplets than talking, it’s imperative that singers wear masks (safest bet is to avoid singing). Hosts should keep music levels down to reduce the risk of guests shouting to one another.
Here are some tips from aerosol expert Jose-Luis Jimenez, one of 239 scientists who asked the World Health Organization to take airborne transmission more seriously:
“Avoid indoor bars, restaurants, salons and churches that are not well ventilated or do not have air filtration systems… go to places where service is offered outdoors… air flow and UV sunlight during the day destroys the virus quickly.
If you are in closer proximity with people on a city street, you might want to wear masks. Imagine that the people you cross are smoking cigarettes. You don’t want to inhale or smell the smoke they exhale without a mask.”
Should you wear a mask?
Covid-19 is primarily spread through respiratory droplets. These droplets result from exhaling via the nose or mouth, talking/singing, coughing, and sneezing and can travel up to 2 meters (~6 feet). Masks are incredibly effective at containing your respiratory droplets so they don’t infect others. They also greatly reduce your own risk of getting sick.
Research from the New England Journal of Medicine shows that wearing a face mask reduces the amount of speech-generated droplets by more than 99%. Masks also dramatically reduce the amount of virus particles present in whatever respiratory droplets end up escaping. A study in Nature found that wearing a mask nearly eliminated the presence of the virus in respiratory droplets. States that used a mask mandate saw statistically significant drops in their case rates in each five-day period where the mandate was in place, according to a study in Health Affairs. An article published by The National Academy of Sciences estimated that masks prevented 78,000 infections in Italy from April 6 to May 9 and over 66,000 in NYC from April 17 to May 9.
In addition to preventing your respiratory droplets from infecting others, masks drastically reduce your own risk of infection. A recent meta-review published by The Lancet concluded that wearing a surgical face mask reduces your odds of infection by 67%. Homemade masks offer some protection but are probably a third as effective as surgical masks, based on research with influenza. Some simple tweaks can make them nearly as effective as surgical masks, but they need to have a snug fit. Eye protection can reduce your odds of infection as well, according to a study in The Lancet.
A study published by The National Academy of Sciences concluded that wearing masks and maintaining distance are both essential strategies for containing the spread of Covid-19. The authors found that, even without social distancing, masks significantly reduced infection rates. Social distancing without masks, on the other hand, failed to adequately protect the public.
According to the CDC, masks must cover the mouth and nose to offer protection. Masks that allow for easy breathing using a mesh or valve system are unlikely to offer protection, according to the Minnesota Department of Health:
“Any masks that incorporate a valve that is designed to facilitate easy exhaling, mesh masks, or masks with openings, holes, visible gaps in the design or material, or vents are not sufficient face coverings because they allow droplets to be released from the mask.”
How to make a homemade face mask
The best mask materials have low porosity, like high-thread cotton sheets or coffee filters. Silk and flannel can make good filters too. Masks with two fabric layers provide nearly the same protection as surgical masks, and there may be a benefit in using at least two different materials (aka “hybrid approach”), provided both are good. A study published in the Journal of Medical Virology found that a combination of one cloth layer and four paper towel layers could be 95% as effective as a surgical mask (assuming proper fit). Extremely porous masks, such as those made from transparent or mesh-like materials, have no protective benefits.
Make sure your mask covers your nose, which produces a substantial amount of respiratory droplets. If you want to minimize the number of infectious droplets you spread to others, your mask must cover your nose, according to the CDC.
Improper fit can reduce protective benefits by about 50%. To provide the most protection, your mask should have a tight fit around your nose and mouth and have minimal leakage.
Is herd immunity the answer?
Sweden is the only country in Scandinavia to avoid a lock-down and try to build herd immunity. Their strategy has been a massive failure. The country has more cases and fatalities than all of its Scandinavian neighbors, and in May it had the highest death rate (deaths per capita) in Europe.
Anders Tegnell, the Swedish epidemiologist who designed the country’s response strategy, admitted that the country should’ve imposed greater restrictions. He said Sweden “failed” to protect its elderly population, noting that 50% of Swedish deaths occurred in care homes for the elderly. Sweden’s alarming death rate isn’t a side effect from better testing protocols. In fact, the proportion of its population getting tested is one of the lowest among all European countries.
Based on Covid-19’s R0 of 5.7, more than 82% of the population would have to be immune in order for the population to achieve herd immunity. If we use a more forgiving R0 estimate of 3, more than 67% of the population would need to be immune. Immunity can only come from vaccination or natural infection.
Without a proven vaccine, the U.S. can only achieve herd immunity if 67% of the population contracts the virus naturally. Based on estimates of Covid’s fatality rate, that means 2.9 million people in the U.S. would die by the time the country achieves herd immunity.
Additionally, we still don’t know if natural infection causes lasting immunity. Many patients never beat the virus, seeing symptoms that continue to accelerate, even if they are young and had been fit. Those who appear to beat the virus at one time can later experience severe flareups. Research published in The Lancet shows that 15% of adults and children experienced “secondary attacks.” The Korean CDC encountered cases of the virus “reactivating.” If natural infection doesn’t reliably lead to lasting immunity, herd immunity is literally impossible without an effective vaccine.
Antibody levels decline rapidly after a person has been infected. A preprint paper on MedRxiv found that after the first three weeks of symptoms, 60% of patients had potent levels of antibodies; after another six weeks passed, just 17% of patients had potent antibody levels. This may make achieving herd immunity even more challenging. T-cells appear to help the body develop immunity, but scientists don’t know how many patients will build lasting immunity this way.
Do lockdowns work?
By reducing person-to-person contact and indoor hangouts, lockdowns have prevented millions of infections. One study published in Nature estimated that the U.S. lockdown prevented 60 million infections (~780k deaths) in total, and found that a no-lockdown approach could have caused early cases to grow exponentially at roughly 38% per day. Another study looked at 11 countries in Europe and found that lockdown measures likely averted 3.1 million deaths.
What about the economy? Though lockdowns prevent mass casualties, they definitely reduce economic activity and disrupt supply chains. A modeling study published in Nature found that shorter, stricter lockdowns minimize the impact on supply chains. The duration is the key variable; the shorter the lockdown, the less economic damage. Shorter lockdowns need to be more strict in order to effectively reduce virus spread.
Does hydroxychloroquine (HCQ) treat Covid-19?
A peer-reviewed systemic review published in Clinical Drug Investigation found that HCQ’s efficacy and safety are “not satisfactory.” The review considered 663 articles, 12 clinical studies, and involved 3,543 patients. It stressed that, without stronger evidence from randomized clinical trials, researchers can’t draw a conclusion about the role of HCQ in the treatment of Covid-19.
A preprint in medRxiv found that HCQ did not provide improvement in clinical, progression, mortality, or viral clearance, and that HCQ resulted in a higher frequency of adverse events.
Is Covid-19 a hoax?
Given the diverse body of evidence supporting Covid-19’s severity, it’s unlikely that this pandemic is a hoax. A conspiracy of this magnitude would mean that nearly every level of society has been compromised, including clinicians, hospitals, local/national health departments, academic journals, news outlets, and epidemiologists.
It would also mean that investors have been fooled. Stock market participants have shown a clear preference toward companies that are most likely to profit in a world affected by Covid-19; stocks in industries that benefit from lockdowns have been the best performers, industries like online retail, distance learning, digital media & games, diagnostics/testing, packaged foods, and recreational vehicles. Meanwhile, stocks in “return-to-normal” industries have been the worst performers, industries like lodging, department stores, and office/retail real estate. Markets are pretty smart; institutional funds and banks try to risk their money only on the smartest bets they can find. The bond market predicted all ten U.S. recession since 1955, with only one false signal.
If all that were true, you would have no way of researching the topic yourself. You would be unable to trust clinicians, hospitals, local/national health departments, academic journals, news outlets, epidemiologists, or market prices. You would have to place your faith in non-experts with no proven track records of forecasting or analytical ability. Your beliefs would reflect someone else’s thoughts and reasoning, not your own. By delegating your thinking to someone else, you would be reducing your own individuality.
Why do people believe Covid-19 is a hoax?
The likeliest explanation is that people are in denial, which protects them from the pain and sadness that result from accepting the pandemic’s severity. We are dealing with an unprecedented loss; in the U.S., 146,000 have died from Covid-19.
If we choose to believe that the loss never occurred, we protect ourselves from the pain of accepting reality. Denial acts as a defense mechanism. Peter K. Gerlach, MSW explains denial and how it can break:
“Denial is a type of unconscious reality distortion which protects us from experiencing painful awareness… Denials are not conscious choices, so they will rarely respond to willpower, logical reasoning, or confrontations.
Breaking or dissolving denials is a paradox — we must become aware of our unawareness. Yet people do this if and when their illusions clearly cause a major trauma, like an arrest, divorce, [or] death.”
Arguments and evidence won’t convince people who are in denial. They’re unlikely to change without seeing their denial cause a traumatic experience, like the death of a loved one.
A tragic example of this is Tony Green, a former pandemic denier from Dallas, TX. He believed the pandemic was a hoax created by Democrats to soil Trump’s reelection campaign. He hosted several family members at his residence without any precautions (like masks), partially to mock pandemic fears. Most of his family got seriously sick, he had to go to the hospital, and one of his grandparents soon died:
“That night my father-in-law became ill. Two days later, my father-in-law’s mother got sick. The new mommy and daddy got sick, too. We all tested positive for COVID-19. Only the newborn was spared. My father-in-law and I both went to the hospital on June 24. The virus had attacked my central nervous system, and the staff stopped me from having a stroke. My father-in-law’s mother was admitted a day later. On July 1, she died of COVID-19/pneumonia.
You cannot imagine my guilt at having been a denier, carelessly shuffling through this pandemic, making fun of those wearing masks and social distancing. You cannot imagine my guilt at knowing that my actions convinced both our families it was safe when it wasn’t.”
After seeing the tragic consequences from his denial, Green now recognizes the severity of the pandemic and feels immense guilt for his actions. Sharing heartbreaking stories like his may be the most effective way to wake people up to the severity of the Covid-19 pandemic.
It’s also possible that foreign meddling contributed to the popularity of pandemic conspiracy theories. According to an AP report, Russia may have spread conspiracy-related rumors about the pandemic to cause chaos and erode the public’s trust in institutions. This behavior isn’t unprecedented, given that Russia used disinformation campaigns to try to influence the 2016 election.
