I have been contacted by my many clients and subscribers with concerns about the current COVID-19 outbreak, and how they should respond to it.
Unfortunately, the media feeding frenzy over the novel coronavirus that first emerged in Wuhan, China in December 2019 has caused widespread panic among people who personally have little to fear even if they should become infected, and distracted attention from what what should be done to protect those who are at risk due to advanced age and/or pre-existing health conditions.
Coronaviruses: A short primer
Coronaviruses are a large family of viruses, whose members can infect and cause illness in humans and some other animal species, including bats, camels, civets and snakes.
Human coronaviruses are generally associated with the common cold and other mild illnesses. However, elderly people may develop severe complications, including pneumonia, from coronaviruses that circulate widely in the population, causing mild illness (or none at all) in younger, healthy people.
There have also been several instances of animal coronaviruses evolving to infect humans, causing severe diseases.
Severe Acute Respiratory Syndrome (SARS) was caused by a coronavirus which infects bats and civets. It emerged in 2002 and killed 774 people, with a case fatality rate of 15% (that is, out of every 100 people diagnosed with SARS, 15 died).
SARS was highly contagious, with an reproduction number, (“R0”, pronounced R nought) of approximately 3, meaning that each infected person spread the virus to an average of 3 other people.
According to the World Health Organization’s “Consensus document on the epidemiology of severe acute respiratory syndrome (SARS)”,
“More than one third of early cases, with dates of onset before 1 February 2003, were in food handlers (persons who handle, kill, and sell food animals, or those who prepare and serve food).”
Middle East Respiratory Syndrome (MERS) emerged in 2012, caused by a coronavirus that infects bats and camels.
Dromedary camels are the major reservoir for the coronavirus associated with MERS, and the majority of cases “reported direct or indirect contact with dromedaries“.
Despite its high case fatality rate (around 35%), its low human-to-human transmission rate (R0 < 1) has limited the number of deaths attributed to it to 858.
Emergence of COVID-19
Cases of pneumonia associated with a novel coronavirus initially dubbed SARS-CoV-2, now renamed COVID-19 (coronavirus disease 2019) were first reported in people with a history of exposure to a large wet market in Wuhan city, Hubei province, China, in December 2019. A wet market is a market in which large numbers of animals, including many species of wild animals, are caged in unsanitary conditions, and slaughtered on-site for their purchasers’ consumption,
Bats appear to be the source of this novel coronavirus, but it is not yet clear whether the virus was transmitted directly to humans from bats or through an intermediate host – that is, an animal of another species.
The novel coronavirus is related to the SARS and MERS viruses, but is genetically distinct (about 79% similar to SARS-CoV and 50% similar to MERS-CoV).
COVID-19 basics
Transmission
The virus is passed from person to person primarily by respiratory droplet transmission. This occurs when an infected person sneezes or coughs, sending out droplets of virus-containing fluid from their nose and mouth which land on furniture, doorknobs, light switches, mobile phones and other surfaces. It is not yet known how long the coronavirus can survive outside its human host, but it may be several days.
If another person touches surfaces on which respiratory droplets have landed, and then touches their own eyes, nose or mouth, they may become infected.
Direct contact with infected body fluids, contaminated hands, surfaces or objects can also result in infection.
This is why frequent hand washing with soap and water, and avoiding touching one’s face (or anyone else’s!) are recommended as the primary strategies for minimising the risk of infection.
It is unlikely that COVID-19 can be spread through aerosol transmission (that is, mixing of the virus with droplets in the air, which cause infection when a person inhales). This means you almost certainly can’t ‘catch’ the virus by just breathing the air in public places, even if an infected person has recently been there.
R0
Estimates for the reproduction number of CoVID-19 have varied widely, from 1.3 to 6.5, but currently the R0 is estimated at 2.2, meaning that the virus is more contagious than MERS or seasonal influenza, but less so than SARS.
Incubation period
In a study of 1099 patients with laboratory-confirmed COVID-19 in mainland China, through to January 29, 2020, the median time from first exposure to the virus to onset of symptoms was reported as 4 days.
A much smaller study of 181 confirmed cases outside Hubei province (the new virus’ ground zero) estimated the median incubation period as 5.1 days, and found that
“97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection.”
This means that a person who has completed quarantine or been released from isolation poses no risk of infection to others.
Symptoms
The symptoms of COVID-19 infection are essentially those of any upper respiratory tract infection:
- fever
- flu-like symptoms, such as coughing or sneezing
- difficulty breathing, which may develop into pneumonia
- sore throat
- fatigue
The Chinese Center for Disease Control and Prevention (CCDC) analysed all COVID-19 cases reported through February 11, 2020 – a total of 72,314 patient records – and found that
- 1.2% were completely asymptomatic (i.e the person was carrying the virus but had no symptoms at all)
- 80.9% were mild
- 14% were severe (difficulty breathing, hypoxia, or >50% lung involvement on imaging within 24 to 48 hours)
- 5% were critical (respiratory failure, shock, or multiorgan dysfunction).
- The overall case fatality rate was 2.3%
- No deaths were reported among noncritical cases.
Dramatically higher asymptomatic carriage rates have been reported in Japanese nationals who were evacuated from Wuhan after the outbreak began. All evacuees underwent reverse transcription polymerase chain reaction testing on their return to Japan, and 31% were found to be carrying the virus without manifesting any symptoms, even 30 days after leaving Wuhan.
The authors of the study also pointed out that asymptomatic carriage is even more common in seasonal influenza, with 56–80% of people carrying influenza viruses without showing any signs of illness.
This should give you pause. A large percentage of people who come in contact with upper respiratory tract viruses, whether influenza or COVID-19, do not get sick; their immune systems simply deal with the virus and develop immunity to it without them ever knowing it had entered their bodies.
There is ongoing debate about whether asymptomatic carriers can transmit the virus, but given that respiratory droplets are its primary mode of transmission, it is unlikely that an individual who is neither coughing nor sneezing could pass the virus on to others.
Case fatality rate
Estimates of the case fatality rate have varied widely since the first reports of the new syndrome emerged from China (ranging from 5.8% in Wuhan to 0.7% in the rest of China), and vary depending on the definition of a ‘case’.
As Anthony Fauci, Director of the US National Institute of Allergy and Infectious Diseases and co-authors pointed out in an article published on February 28 in the New England Journal of Medicine,
“On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1% [my emphasis]. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS.”
As leading epidemiologist Dr John Ioannides has pointed out, in an article titled Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based measures, the case fatality rate on the Diamond Princess – an elderly cohort, at higher risk of complications from any respiratory infection – was only 1%, suggesting that the case fatality rate
“may be much lower than 1% in the general population; probably higher than seasonal flu (CFR=0.1%), but not much so.”
Of course, the death of any person, old or young, from a respiratory tract infection is a very sad event; the point is that such deaths happen every day, but normally without attracting any media coverage whatsoever.
Dr Ioannides also points out that Germany, which has adopted the most widespread population testing for COVID-19, has a case fatality rate of 0.2% – that is, 2 out of every 1000 people infected with this virus have died from it.
German pneumologist Wolfgang Wodarg, in an article title Corona-Hype: Without PCR-Tests there would be no reason for special alarms, underlines the fact that coronaviruses circulate widely in the population at any given point in time, but in the past have ‘flown under the radar’ because they are never tested for in general clinical practice:
“In view of the well-known fact that in every ‘flu wave’ 7-15% of acute respiratory illnesses (ARI) are coming along with coronaviruses, the case numbers that are now continuously added up are still completely within the normal range.
About one per thousand infected are expected to die during flu seasons. By selective application of PCR-tests – for example, only in clinics and medical outpatient clinics – this rate can easily be pushed up to frightening levels, because those, who need help there are usually worse off than those, who are recovering at home…
We are currently not measuring the incidence of coronavirus diseases, but the activity of the specialists searching for them. [My emphasis.] Wherever such the new tests are carried out – there about 9000 tests per week available in 38 laboratories throughout Europe on 13 February 2020 – there are at least single cases detected and every case becomes a self-sustaining media event.”
It’s worth noting that as of 23 March 2020, Germany, with its extensive testing program, had 24 852 confirmed cases of COVID-19 (a rate of 289 cases per 1000 population), 94 deaths and 2 patients in a serious/critical condition. Australia, with far less extensive testing, had 1353 confirmed cases (a rate of 53 cases per 1000 population), 7 deaths and 2 patients in a serious/critical condition. (Figures from Worldometer.)
Risk Factors for Severe/Fatal Cases
The CCDC’s analysis of all reported cases found age and pre-existing health conditions were major determinants of disease severity.
Here are the case fatality rates, by age group:
| Age group | Case fatality rate (%) |
| 0-9 | 0 |
| 10-19 | 0.2 |
| 20-29 | 0.2 |
| 30-39 | 0.2 |
| 40-49 | 0.4 |
| 50-59 | 1.3 |
| 60-69 | 3.6 |
| 70-79 | 8 |
| > 80 | 14.8 |
Males were found to have a higher case fatality rate (2.8%) than females (1.7%), a phenomenon reported in previous coronavirus epidemics.
So a 35 year old woman who contracted COVID-19 would have less than a 2 in a thousand chance of dying from the infection.
In Italy, the average age of those who deaths have been attributed to the virus in Italy is 79.5. As of March 17, 17 people under 50 had died from the disease, and all those under 40 were males with serious existing medical conditions.
Here are the case fatality rates, by comorbid condition (that is, presence of diagnosed illness prior to contracting COVID-19), calculated by the CCDC:
| Comorbid condition | Case fatality rate (%) |
| Cardiovascular disease | 10.5 |
| Diabetes | 7.3 |
| Chronic respiratory disease | 6.3 |
| Hypertension (high blood pressure) | 6 |
| Cancer (any) | 5.6 |
| Missing | 2.6 |
| None | 0.9 |
In other words, out of all people who were in good health prior to infection, including the elderly who are always at higher risk of complications of infection due to immunosenescence (age-related changes in immune function), there would be a 9 in 1000 chance of dying from COVID-19. Obviously younger people with no pre-existing health conditions have a considerably lower risk of dying.
An analysis of Italians whose deaths were attributed to COVID-19 found that 99.2% of them suffered from previous medical conditions.
“Almost half of the victims suffered from at least three prior illnesses and about a fourth had either one or two previous conditions. More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease.”
If you’ve been diagnosed with any of those conditions, there’s never been a better time than right now to adopt a nutrient-rich wholefood plant-based diet, engage in regular moderate exercise and make sure you’re getting sufficient quantity and quality of sleep. Coronary artery disease, type 2 diabetes and early-stage prostate cancer have all be shown to be reversible with a healthy enough diet and lifestyle, while strong evidence also exists for Lifestyle Medicine treatment of asthma.
Hypertension is also reversible in the vast majority of people with a low sodium wholefood plant-based diet, regular exercise, and smoking and alcohol cessation, as I discussed in the March 2020 Deep Dive webinar, available to all EmpowerEd members.
Influenza vaccination and COVID-19
A study of US military personnel found that getting an influenza vaccine during the 2017–2018 influenza season increased the risk of coronavirus infection by 36%.
As COVID-19 is a novel coronavirus, it is not known at this stage whether the flu vaccine increases the risk of infection, but this study should give one pause for thought.
Coronavirus vaccine concerns
The public is being told by health authorities that the only way to get COVID-19 under control is to achieve herd immunity through vaccination. The race is now on to develop a vaccine against the novel coronavirus.
But several scientists have warned against fast-tracking a vaccine, pointing out that experimental vaccines developed against other coronaviruses, including SARS, resulted in serious illness and increased death rates in experimental animals, due to “coronavirus-vaccine associated disease enhancement“.
When older mice and non-human primates were vaccinated with SARS-CoV vaccines, they developed pulmonary immunopathology and severe pneumonia when they were subsequently re-exposed to the SARS-CoV virus.
How should we respond to COVID-19?
Health officials freely admit that they know very little about COVID-19, and predictions about its ultimate effects on the population vary widely.
The policies adopted by governments around the world also vary widely, and there is much debate among scientists and public policy experts about which suite of policies will be the most effective in containing the spread of the virus and minimising serious illness and death.
It’s important to remember that the distribution of cases, severity of cases and mortality rates in each country are not solely the result of government policy, but are also affected by varying economic and sociodemographic factors of each affected population; for example, Italy has one of the oldest populations in the world (60% of Italians are aged 40 or older and nearly 23% are over 65), which means a higher population at risk of serious complications of respiratory tract infection, but it has the lowest number of intensive care beds per capita in Europe (230 per 100,000 inhabitants).
While China, South Korea, Australia, the UK and most European countries have adopted draconian policies that seek to limit the spread of the virus by minimising social contact among the entire population, the Dutch have taken a different tack:
“The approach in the Netherlands aims to control the novel coronavirus as much as possible (maximum control) and to protect the vulnerable groups, such as older people and people with health conditions. The government has taken containment measures. These measures are aimed at reducing the peak in infections and spreading those infections over a more extended period. This approach ensures that our healthcare system is able to cope with the demand. An important effect is that this allows for population immunity to build up.”
It remains to be seen which approach will prove most successful in the long run, but Dr Ioannides points out that
“Evidence is lacking for the most aggressive measures. A systematic review on measures to prevent the spread of respiratory viruses found insufficient evidence for entry port screening and social distancing in reducing epidemic spreading. Plain hygienic measures have the strongest evidence. Frequent hand washing and staying at home and avoiding contacts when sick [my emphasis] are probably very useful. Their routine endorsement may save many lives. Most lives saved may actually be due to reduced transmission of influenza rather than coronavirus.”
While healthy younger people need have little fear for their personal safety – if they do come in contact with COVID-19, the overwhelming odds are that they will either remain completely asymptomatic or develop a mild and self-limiting illness – the elderly and those with pre-existing illnesses are susceptible to complications of this, and all respiratory infections.
I recommend that people in these high-risk categories adhere to current advice to avoid public places. And of course, family members, friends and health care workers should protect people at high risk of serious illness by avoiding contact with them if they develop any symptoms of respiratory tract infection themselves, or have been in contact with anyone who has.
But if you are well, please cook them a nutritious plant-based meal to support their health, and loan them a copy of Forks Over Knives to watch while they’re self-isolating – hopefully they will be inspired to go plant-based!
Anyone who develops symptoms of respiratory tract infection should stay home and rest until fully recovered and symptom-free, for their own good as well as to avoid infecting others.
Avoid going to a doctor’s office or emergency department if you have mild symptoms; there is nothing that medicine has to offer you as there is no treatment for COVID-19, and you are putting vulnerable others at risk of infection. People who are in respiratory distress need medical attention; people with a mild fever and cough do not.
Rest (including taking a break from the endless media coverage of COVID-19!) and fasting will maximise your immune system’s self-defence capability.
Do not use ibuprofen (Nurofen) to reduce fever or relieve headache or muscle pain; like ARBs, it increases expression of ACE2 which may increase the ability of COVID-19 to enter cells and cause infection.
In any case, fever is one of the body’s primary defences against infection, significantly enhancing the activity of infection-fighting white blood cells. Interfering with the fever simply prolongs illness (and potentially increases the risk of complications) by hamstringing the immune system’s response.
Well-proven strategies for boosting general immunity include:
- Eat a diet rich in fruits, vegetables, whole grains, legumes, nuts, seeds, herbs and spices. This dietary pattern boosts the activity of white blood cells that fight infection.
- Engage in regular moderate exercise, but avoid overly strenuous exercise; overtraining has been shown to depress immune function.
- Ensure you are getting at least 7-8 hours of sleep per night. Insufficient sleep reduces production of cytokines, which are proteins involved in immune response. Now would be a good time to get to bed earlier than usual!
- If you don’t already have a daily meditation practice, start now; and if you do, double down on it. Meditation may increase cell-mediated immunity, the type of immune system activity that is most important in combatting viral infection.
- If you are overweight, you should be aware that excess body fat impairs the immune system’s response to infection. For example, obesity was found to be “an independent risk factor for increased morbidity and mortality following infection with the 2009 pandemic influenza A (H1N1) virus”. Adopting a nutrient-dense wholefood plant-based diet, rich in fruits and vegetables, facilitates sustainable weight loss while supporting immune function.
And finally, I would strongly recommend taking a ‘news holiday’. The relentless barrage of frightening stories on both traditional and new media are fuelling spiralling anxiety, unwarranted panic buying and grocery hoarding (come on people, what is with the toilet paper????), and end-of-the-world thinking, which negatively impacts on immunity – not to mention driving many people to behave reprehensibly.
We would all be better off taking good care of ourselves, our families and communities than immersing ourselves in the toxic soup of media sensationalism.
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