I run a debate club that meets monthly. A week or so before a debate is scheduled, club members discuss and choose a debate topic via email. This month’s online discussion got rather acrimonious, as members argued whether or not we should cancel the debate due to concerns about the coronavirus. This post is a (slightly cleaned up) transcript of our communications:
P: Is COVID-19 a crisis of earthquake-level importance, which I'm told is what it needs to be for us to cancel our March 16 debate? As you've probably heard, the SF department of public health has recommended canceling large gatherings for the next 2 weeks.
D: I got an email this evening from MIL [the organization that rents out our debate space], which says "Following the lead of the City and County of San Francisco, we are postponing all large events, programs, and chess tournaments for the next week." I'm beginning to think we should just cancel the March 16 debate. What do you think?
E: I agree. Let's just cancel it.
S: You guys must be kidding. Our debate is not "a large event." And how long do you think this crisis will last? I doubt it will end this month. This is not a serious disease, unless you're elderly and have an underlying condition. If so, you can and should stay away. Otherwise, there's no reason to cower at home.
D: There are a few issues here. One is that MIL is already postponing events this week, so there is uncertainty whether we could have a debate on the 16th anyway. Another is that the purpose of avoiding crowds is twofold: one is for personal protection and the other is to slow down the spread of the disease to allow more time to improve treatment protocols (i.e., treatments will probably be more effective in just a few more weeks). I just checked the latest recommendations and found that infectious disease experts at the CDC and some cities have "advised people over 60 and those with underlying health problems to strongly consider avoiding activities that involve large crowds." While the debates don't involve contact with "large crowds", traveling on mass transit may. Given that I fit the CDC profile of who should avoid crowds, I won't be attend a debate on March 16.
R: Thanks for the info, D. Makes sense. Better to be safe to debate another day as you.
S: I could not find the "over 60" recommendation on CDC web site, just "older adults." Also, I doubt very much that "treatments will probably be more effective in just a few more weeks." But, of course, you do what you feel is best for you. I still think canceling is an absurd exaggeration, much like the media reaction, but whatever. We seem to have trouble nailing the topic anyway.
D: While I don't recommend holding a debate, I'm not against a co-organizer putting together something for 3/16 - although it's risky given the possibility of MIL canceling. Maybe a motion like "Calls to limit the movements of healthy people are unwarranted".
As for "60 and older" - I've now read several articles that say the same thing, e.g. "The Center for Disease Control advises that people over 60 years of age and those with underlying health issues 'strongly consider avoiding activities that involve large crowds'..."https://www.wptv.com/news/region-martin-county/stuart/april-and-may-honor-flights-to-washington-d-c-postponed-over-coronavirus-concerns And slowing the spread of a disease to buy time to develop better treatment is a well-known public health approach to potential epidemics, e.g., e.g.,https://www.vox.com/science-and-health/2020/3/6/21161234/coronavirus-covid-19-science-outbreak-ends-endemic-vaccine To quote from Vox:
“If we slow it so that infections happen over 10 or 12 months instead of over one month, that’s going to make a big difference as far as how many people seriously infected, how many people may end up hospitalized, and how many they end up dying,” Smith says. “We talk about it as ‘flattening the epidemic curve’ — so that it’s not a big, sudden peak in cases, but it’s a more moderate plateau over time.” And that’s the current goal: to flatten the curve. The better scenario: Public health measures slow the spread and buy scientists time to work on treatments...
S: If you can't find an explicit quote on that on the CDC web site, why would you accept an interpretation by a news agency? Here it is straight from the horse's mouth: https://youtu.be/xvW17dSuX5Q?t=497 , and that's the last I will say about it here. As for developing a better treatment, yes, that might happen over the course of several months, but not in "a few more weeks", as you originally suggested.
D: My initial reference was to "infectious disease experts" at the CDC, not the CDC website, e.g., just released today:
"People who are over 60 years old, as well as those with underlying health conditions like diabetes, heart disease, and lung disease, are most vulnerable to getting sick or even dying from the novel coronavirus and should take particular precautions to help protect themselves, Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, said in a media briefing on Monday.
And, yes, a few weeks can make a difference. Doctors experiments with existing drugs and learn which ones might reduce the severity of symptoms, e.g., Favilavir, an existing anti-viral drug that China recently approved to treat coronavirus. And a few weeks gives clinics and hospitals a lot of time to stock up on supplies and equipment (e.g., diagnostic test kits, respirators).
J: ER doctor says the cruise ship is a data sample that indicates that the virulence of the virus is not as bad as has been said. 0.6%!! https://www.cnn.com/videos/tv/2020/03/07/how-vulnerable-is-the-average-person-to-the-coronavirus.cnn
A: Perhaps as a topic— “this house believes we should have cancelled this debate for coronavirus concerns” :)
S: CNN's Smerconish this Sunday... the voice of reason, as usual . One of the better news analyses out there. https://www.youtube.com/watch?v=njXncDUJmOA
E: It would be hilarious if Smerconish got coronavirus after saying all that.
S: His point was "so what if I get it" not, "I won't get it."
D: Yes, a large majority of people under 60 who have been infected with the coronavirus have only mild symptoms. And I guess if someone is only concerned about their own health, that's enough to be cavalier about the possibility of getting sick. But higher risk individuals can get seriously ill and, given how contagious the coronavirus appears to be, the more people who get sick with mild symptoms, the more people who will get seriously sick in the general population. CDC reports about 19% out of 44,000 cases in China were classified as " severely or critically ill", with fatality rates at 3.6% for ages 60-69, 8% for 70-79, and 14.8% for 80 and over... https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html .
So how many Americans are at higher risk? 51.1 million age 65+, 29 million diabetics under 65, 15.3 million under 65 with heart disease, around 3% of Americans that are immunosuppressed (biggest group is women, 50-59, on cancer medication; also the HIV+), 19.1 million US adults with asthma. Granted, there's some overlap among these groups - but it still adds up to a lot of people.
Some refs: https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_A-1.pdf National Diabetes Statistics Report 2020. Estimates of diabetes and its burden in the United States. https://media.jamanetwork.com/news-item/prevalence-of-immunosuppression-among-u-s-adults/ National Diabetes Statistics Report 2020. Estimates of diabetes and its burden in the United States. https://www.cdc.gov/nchs/fastats/asthma.htm
Somehow I don't consider it particularly admirable to be cavalier about putting other people in harm's way. Besides, the CDC is only advising at-risk populations to avoid crowds, etc. so Smerconish's smirky display of personal bravery (with its implicit shaming of the cowardly) didn't strike me as a service to humanity.
S: He wasn't trying to be brave; he simply refused to alter his routine. I didn't detect any "shaming of the cowardly." He said it at the beginning - you can do as you please. You, on the other hand, seem to want to impose your view on him. I don't consider THAT particularly admirable.
J: The part I liked about the ER doctor was that he was using a credible data source, people trapped on a cruise ship, to determine virulence. I don't feel we can trust the data from China. Another good data source is South Korea since that have been testing people heavily: https://www.worldometers.info/coronavirus/country/south-korea/
S: If you yourself follow all the precautions suggested, "cavalier" and "careless" attitudes of people like Smerconish (and myself) will not put you at any more risk than what you take every day by, say, taking a shower, driving a car or riding in one. So spare me the lecture, and the shaming.
D: My point was that anyone who thinks precautions are only about one's own health are missing the bigger picture. As for Smerconish, you, Steve, indicated his point was that he didn't care if he got sick (were you imposing your view on him?). Smerconish gave lip service to people making their own decisions, but his reducing the matter to personal choice with minimal discussion of what might be valid reasons for caution in some circumstances, and given the large higher risk population, struck me as irresponsible.
I do notice from the Korean data that 19% of the closed cases died, although of their current active cases just 1% are serious (no age breakdown given). This is what the World Health Organization says:
"Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing." https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
Postscript: the March debate was canceled.