March Madness – an Update

“Hey Doc, can you believe that they’ve cancelled the NCAA men’s basketball championship? Cancelled! Done! Nada! What are we going to do about March Madness?”

Hmm…If you could spend a little time with me in the clinic, you’d see some real March Madness—up close and personal.

“Dr. Lesslie, I’ve heard that the Corona virus is ten times more deadly than the regular flu. Maybe worse. Where should we hide?”

No need to hide…not yet anyway. Probably never. At this point, we just don’t know how deadly this virus will prove to be because we don’t have enough information. What information we do have suggests that there are probably a lot of people infected, but currently not an overwhelming number of deaths. That’s good news. But let’s consider this “deadly” business and how this is defined.

We’re talking here about the “mortality rate.” This is a simple mathematical equation (I should have consulted my older daughter, Lori—our family math guru.) and it looks like this:

Number of deaths due to a specific disease / the number of cases of that disease = death rate.

An example would be 10 deaths due to X / 1,000 cases of X gives us a death rate of 1%.

Here are some examples of the death or mortality rates of some important and familiar diseases:

• Rabies (untreated) – > 99%
• Small pox (the most virulent strain) – 95%
• Ebola virus – 83-90%
• Chickenpox in newborns – 30%
• Anorexia nervosa – 16%
• Whooping cough – 3.7%
• Corona virus (very early estimation) – 3.48%
• Influenza A – < 1%

The rate for the Corona virus is a very rough estimate. Remember the equation. We have a pretty good idea about the number of deaths due to this infection (still very small) but we have no idea how many people out there have been or currently are infected. We know it’s much more than those who have tested positive, since just like with the flu, many people with mild symptoms don’t seek medical care and never end up being counted. The estimate for Influenza A takes that into account, and inflates the denominator (the number of cases). A best guess. As time passes, we’ll get a better handle on these numbers for the Corona virus and an idea of just how deadly this will prove to be. Right now, there seems to be no reason to panic.

“Hey, I don’t have any symptoms, but I want to be tested. Just for my peace of mind…and my wife’s.”

Well, let’s consider who should be tested. But before we do that, let’s think about why someone should be tested. I’m writing this on 3/15/20, and as of two days ago, the President and his health team announced that widespread testing would be available starting sometime next week. That sounds well and good, but I foresee a boondoggle. If the testing is free, and the criteria to be tested are subjective (a low threshold for testing), why not get it done? If you have no symptoms or very minimal symptoms and the test is negative, then what? Get tested again in a week? Ten days? Or if you have minimal symptoms and test positive, are you going to be willing to self-quarantine for two weeks? Remember, there’s no treatment for this infection, in contrast to the flu. Regarding the self-quarantine, all of us should be practicing that now, with no encouragement from the government. Mild cough, congestion, a few aches—we need to keep our distance from other people. A recently coined term is “social separation.” Sounds kinder, gentler. But the concept is a good one.

Now for the people for whom testing will be important. These are the folks with fever (above 100.4), congestion, cough, flu-like symptoms, and respiratory distress. But a drive-thru testing at a CVS or Target is not appropriate for these individuals. They should be in an emergency department or another facility capable of handling emergencies. Next week and the one following are going to be interesting.

“So just how good is the test anyway? I’m sure I had the flu a couple of months ago, but my test was negative. Is this going to be any better?”

That’s a good question, and we don’t know the answer. We do know that only about 2% of tests being performed turn out to be positive. That means that 98 out of 100 people tested have been negative. That indicates one or more things. The test might not be very sensitive (missing cases that actually are present—a false negative test), we’re testing too many people (our criteria for testing is too broad and not objective enough), or the infection is easily confused with other diseases—the garden-variety flu, colds, even allergies. This is something else we will learn over the next weeks and months.

In the meantime, we need to remain calm. Vigilant, but calm. It’s hard to do that, given the unprecedented response from many quarters. The NCAA championship gone, golf tournaments cancelled, schools being closed (South Carolina is set to close all state-supported schools as of tomorrow). This is an historic moment, and a huge opportunity for us to learn some important lessons.

March Madness. We have a whole new meaning of the phrase. Stay tuned.