The Coronavirus Pandemic: Frequently Asked Questions

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Editors’ Note: COVID-19, the disease caused by a new coronavirus, is rapidly spreading through the world (now in over 150 countries), and confirmed cases are mushrooming in the U.S. This pandemic is interacting with the state of the world and the gross inequalities and oppressive social relations of capitalism-imperialism (see “Thoughts from a Reader on the Coronavirus COVID-19 Epidemic”), and it has the potential to have a huge impact on human society as a whole and in individual countries, well beyond even what is happening now.

This is a Special Resource Page starting with an overall orientation and Q&A that addresses the basics—as far as we understand at this point—on what the disease is, what to expect, and what can be done. As is expected with a novel—new—virus, not seen before in humans, and this still being relatively early stages of what is a global pandemic, a lot of what we know and the statistics are very much in flux, and we will strive to update this page as consensus emerges among epidemiologists, public health professionals, and in leading organizations like the World Health Organization (WHO).

We invite readers to send correspondence and suggestions, to volunteer and help maintain and update this page at this crucial juncture.

 

What is the coronavirus that causes COVID-19 disease, and where did it come from?

The new coronavirus is one of a large family of viruses, including those that cause the common cold as well as the one that caused the deadly 2002-3 SARS epidemic. Humans are not known to have contracted this virus before November 2019, which is important because it means we have no natural immunity to it and no vaccines or treatments now or expected soon.

Most scientists currently believe that this coronavirus existed among animals in some closely related form and that some small mutation made it possible for humans to catch it. This is a common pattern for the emergence of new diseases throughout human history.

In recent decades, such diseases have become more frequent and widespread, with new ones cropping up periodically—SARS in 2002, bird (avian) flu (repeated outbreaks since 2004), swine flu (H1N1) in 2009, and others. One reason this is happening more is that human society is encroaching on animal habitats, so there is closer contact between species. Another is that the world is highly interconnected. Unlike 200 years ago, a person who contracts a new virus today may easily travel thousands of miles, spreading the virus before they even know they are infected.

An important point here is that because this coronavirus in humans was first observed only about three months ago, there is still a lot that scientists don’t know, or don’t have great certainty or accuracy about. And some aspects of what we think we know now may turn out to be incorrect later.


A model of the Coronavirus COVID-19.

 


 

What happens to people if they are infected with the coronavirus?

As we understand right now, COVID-19 starts in the upper respiratory system. For an average of five days after infection, patients have no symptoms, but scientists believe they can spread the disease at this stage. Symptoms usually start fairly mild—commonly a fever, dry cough, and fatigue. And again, in this stage many people continue to go about their lives, visiting friends and family—and spreading the disease. (Many infected people may have no symptoms, but can still spread the disease to others.)

After this, particularly if the person’s immune system is not strong, the infection moves into the lungs and potentially causes pneumonia. If the pneumonia becomes severe, people will need assistance breathing—oxygen, ventilators, and other medical interventions.1 If they don’t get this help, they may die, and a significant number of people who reach this stage die even with proper medical help.

The World Health Organization (WHO) estimates that around 80 percent of confirmed cases—those who test positive for the virus—experience “mild to moderate” symptoms, lasting a week or more, that can range from symptoms similar to influenza to a pneumonia that is not bad enough to require hospitalization. They then recover, though some may experience long-term respiratory problems. The other 20 percent will have a more severe pneumonia marked by difficulty breathing that requires hospitalization. Of those hospitalized, as many as one in four may require intensive care unit (ICU) treatment, often needing ventilators—complex machines that force air into the lungs of people who cannot breathe effectively on their own.2

So it is currently estimated that up to 20 percent of confirmed cases require life-saving care that only hospitals can provide.

In terms of fatalities or deaths from COVID-19, it varies by the age of the person who gets it. The older you are, the more dangerous it is. It is estimated that around one person out of 100 in their 50s, and about 18 out of 100 people over 80, will die from it.3

The estimated death rates for different age groups are based on the data from the first outbreak in China, but it is not clear if data from outbreaks in other countries breaks down in exactly the same way. But we can say that older people are the most at risk, but that for all adults this can be a very dangerous diseases⏤the U.S. Centers for Disease Control and Prevention (CDC) reported on March 18 that nearly 40 percent of the people hospitalized with COVID-19 were between 20 and 54 years old.

Along with age, a major factor in mortality is the health of the patient. People with conditions like diabetes, heart disease, or serious lung disease or whose immune systems are compromised (like people with HIV/AIDS or people taking drugs that suppress their immune systems as part of cancer treatments) are more likely to die than people in their age group who do not have these conditions.

Another big factor influencing death rates is not the health of the individual, but the functioning of the society as a whole. If everybody who is seriously ill with COVID-19 receives the needed medical interventions, death rates drop dramatically. For instance, in the early stages of the epidemic in China, the city of Wuhan was hit hard and suddenly, hospitals were overwhelmed, physicians did not know how to treat it, and the death rate was 5.8 per hundred people. But its spread in other parts of China was much slower, health care systems were not overwhelmed, and the death rate plummeted to about nine per thousand infected people.4

Because of all these variables, combined with the fact that—because of insufficient testing—we don’t know how many people have the disease to begin with, it is hard to state with any certainty what the death rate has been, or what it will be. Estimates run as high as 3.4 percent and as low as 0.2 percent. But as a rough guide, most experts are currently using a figure of 1 percent—one death per a hundred people infected.


Indian doctor walks past patients waiting to get examined for coronavirus symptoms at a free screening camp at a government run hospital in New Delhi, India. Photo: AP


The threat of the coronavirus has contributed to the great chaos that travel, especially international travel, has become. Here passengers at O’Hare Airport waited for up to 6 hours to get their luggage, and another 2 to 4 hours to get through customs. Photo: Twitter

Since most people don’t get seriously ill, why is COVID-19 so dangerous? Why take such drastic measures like shutting down sporting events, businesses and meetings, even whole countries?

First, COVID-19 spreads very rapidly. Scientists estimate that every infected person will infect between two and three other people. If one person infects three people, then those three people infect nine people, and then those nine people infect 27, and so on. This is one reason we saw the number of confirmed U.S. cases go from about 500 on March 8 to over 3,000 cases just one week later—an increase of 600 percent! The other reason for this is an increase in testing, meaning that more of the existing cases are actually being counted.

And because there are no natural immunities and currently no vaccine, everybody on the planet is potentially susceptible to this disease. If no significant measures were taken, epidemiologists estimate up to 70 percent of the world’s population would be at risk (or 5 billion people!)—and at currently estimated death rates, this could mean roughly 25-50 million deaths worldwide in a short period of time.

As a warning of the danger and to get a sense of the potential scope of the disease, in 1918 an influenza epidemic (the so-called “Spanish flu”) killed an estimated 50 million people around the world—and the world’s population was much smaller at that time.

This brings us to the second problem, which is the speed at which COVID-19 is spreading, coupled with the high percentage of patients who require hospitalization and advanced care and equipment.

Health care systems around the world—especially in poor countries, but even in wealthy countries like the U.S.—have nowhere near the capacity to deal with a sudden potential influx of hundreds of thousands of patients. For instance, the U.S. has less than a million hospital beds and 45,000 ICU beds total, and these were almost all in use before this pandemic.

In some possible scenarios, even with basic measures of containment and mitigation, COVID-19 may send millions to the hospitals, with significant proportions requiring ICU (intensive care unit) treatment, ventilators, etc. If this happened rapidly—over the next few months—it would totally overwhelm the hospital system. In fact, severe shortages are already cropping up in disease “hot spots” like New York—shortages not only of beds, but of doctors, nurses, ventilators, respiratory therapists, and protective gear for staff (masks, gloves, gowns). The lack of protective gear means many healthcare providers may be infected with COVID-19. Such a loss of personnel would further intensify the crisis. Not only would death rates for COVID-19 increase dramatically, but hospitals would be unable to treat other patients properly—accident victims, people with heart attacks—and their death rates would go up too. Infected people would be less willing to go to these chaotic and understaffed hospitals, which would increase the spread of coronavirus in the community. The capacity to quarantine infected people could also be overwhelmed. All this is just beginning to unfold now and is certain to get much worse.

This is what happened in Italy over the past few weeks, starting when they had “only” about 15,000 confirmed cases. (As of March 29 Italy reports nearly 98,000 cases.) It got to the point where one doctor reported that “doctors have to choose who to treat ‘according to age and state of health, as in war situations.... If a person between 80 and 95 years old has severe respiratory failure, it’s likely we will not go ahead [with life-saving interventions.]’” Some 10,800 people have died in Italy as of March 29.


What can be done to prevent these kinds of “worst case” scenario?

These kinds of major health disasters are not inevitable. Public health professionals long ago developed a basic approach to combating epidemics that is effective, or at least very helpful, if implemented early. Covering this approach and best practices is beyond the scope of this article, but it includes at least two basic aspects:

The first step is “containment”—aimed at preventing the virus from becoming widespread in the population. Public health organizations use testing to identify who has the disease. When they find an infected person, they interview them to find out how they contracted it and who they have come in contact with since. Then they go to all those people, test them, and if infected go through the same process. All the infected people are placed in treatment, but under quarantine (isolation) until they recover, or die.

If this is carried out right away, it is possible to cut off spread of the virus pretty quickly. And some countries have apparently done this successfully with coronavirus, so far.

But China—where COVID-19 first appeared—initially tried to cover up and downplay the outbreak, waiting weeks to report the new disease to the WHO. Soon after that, things got out of control, with tens of thousands of infections and thousands of deaths in the province of Hubei and its capital, Wuhan. As that started to happen, Chinese officials did move decisively to halt the spread. They combined massive “containment” strategies (testing, tracing, isolating infected individuals) with the second step of epidemic control, which is known as the “mitigation” stage. They did this in a highly repressive manner, consistent with the nature of this regime, which has not been genuinely socialist since the mid-1970s.5

“Mitigation” means trying to slow the spread of the virus by “social distancing” (drastically limiting contact between people) and by promoting good hygiene, such as frequent handwashing. (See box “What can people do to avoid contracting or spreading the virus?”) If done successfully, this increases the ability of the healthcare system to handle the lower numbers of sick people, saving more lives and further reducing new infections. “Mitigation” doesn’t stop the disease, but it makes it more manageable and less damaging. And it buys time so that scientists can develop better treatments and vaccines.

This also means potentially locking down entire areas, closing factories, stores, businesses, and ordering people to stay in their homes for many weeks. This was done in China, and similar measures are now being taken in Italy, France, and other European countries, and in increasing numbers of states and cities in the U.S., including California, New York, and Illinois. But in each case authorities delayed taking these steps until the virus was widespread. And in the U.S. even now, many cities, states, and areas that have hundreds of confirmed cases (which means thousands of actual cases) are taking little or no action to combat the disease, making it very likely that the disease will spiral out of control there as well.

Measures like these are often necessary for public health. They are also subject to abuse by oppressive and repressive governments, including that of the U.S. This contradictory situation requires people to ask critical questions, make an overall analysis, and act on the basis of the answers. Those questions could include among others: Is there a sound scientific basis for the measure? Is the measure medically required? Is it being carried out in a repressive manner? Are already existing social inequities and oppressive social relations being further reinforced and heightened?

Even though the COVID-19 crisis erupted in China in December, the U.S. took almost no steps to prepare for the coming epidemic. For the first six weeks of the virus’ spread there was virtually no testing done. As of March 14, fewer than 20,000 people had been tested in the U.S., while 248,000 had been tested in South Korea, a country with 16 percent of the U.S. population. The lack of testing made it impossible to carry out the “containment” stage in the U.S.—if you don’t have any idea who has the virus you can’t trace and isolate the people they infected. So, effectively, the virus was allowed to spread, uninhibited by any serious intervention. At this point we have no clear idea of how many people have the disease in the U.S. This means that the “mitigation” stage is even more urgent to avoid scenarios of massive infection, collapse of the healthcare system, and deaths.


A parent with her child, a grade school student in New Orleans, after the Louisiana governor closed all schools because of the coronavirus, March 13. Photo: AP


What can people do to avoid contracting or spreading the virus?

Different health organizations and websites are putting out basic guidance for proper hygiene, “social distancing,” and recommendations on when to seek professional medical care. The points below from the World Health Organization website6 provide very good guidance. But since the WHO issued them, understanding of the disease has developed, and most public health experts now say that social distancing should be about six feet (not three feet as WHO said); that this distance should be maintained regardless of whether you or others are coughing or sneezing; that handshaking is a significant way in which the virus is transmitted; and that thorough handwashing is more effective than hand sanitizer (WHO treats them as equally effective).

Finally, we want to emphasize that if people notice any relevant symptoms, they should contact medical professionals quickly.

Wash your hands frequently

Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water.

Why? Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.

Maintain social distancing

Maintain at least 2 metre (6 feet) distance between yourself and anyone who is coughing or sneezing.

Why? When someone coughs or sneezes, they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.

Avoid touching eyes, nose and mouth

Why? Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose, or mouth. From there, the virus can enter your body and can make you sick.

Practice respiratory hygiene

Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

Why? Droplets spread virus. By following good respiratory hygiene, you protect the people around you from viruses such as cold, flu and COVID-19.

If you have fever, cough and difficulty breathing, seek medical care early

Stay home if you feel unwell. If you have a fever, cough, and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.

 


Footnotes

1. See “What does the coronavirus do to your body? Everything to know about the infection process,” USA Today, March 14, 2020.  [back]

2. See segment of the CNN Town Hall on Coronavirus, Dr. Sanjay Gupta’s interview with Dr. Maria Van Kerkhove, an epidemiologist who is the WHO Technical Lead for Coronavirus Response.  [back]

3. See “Does the Corona Virus Think I’m Old,” New York magazine, March 12, 2020.  [back]

4. See “Coronavirus: Why You Must Act Now,” at Medium.com.  [back]

5. For more on the defeat of socialism in China after the death of revolutionary leader Mao Zedong in 1976 and the rise of capitalism in that country, see the special Revolution/revcom.us issue: You Don't Know What You Think You "Know" About: The Communist Revolution and the REAL Path to Emancipation: Its History and Our Future  [back].

6. More detailed guidelines can be found at the CDC website.  [back]

 

 

 

 

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