• Chris Thiagarajah MD

Coronavirus (Covid-19) in Denver: A Physician in Denver goes over the numbers

As an oculoplastic surgeon in Denver most of my practice is in outpatient surgery concerning the face. Some of the surgery I perform is emergent such as when a pit bull rips a child’s face apart or someone gets shot in the eye but most of the work I do is elective surgery. As a physician (and as most physicians) I have the training in medical school and residency in infectious disease, epidemiology and disease prevention. A large part of eye surgeon practices involve public health management of diseases that are infectious and non-infectious. Most physicians think about disease spread and numbers everyday. In the last three weeks me and my colleagues have thought about it more.

The opinions I express here are based on the data that is out there (for everyone) on what we know about coronavirus in Wuhan, Italy, Iraq and the rest of the world. There is nothing "secretive" about this information. I was appalled to here that Post Malone held his concert last night at the Pepsi Center exposing thousands of people to Covid-19 infection. Tonight I see tons of people out in the Highlands. No one wants their lives to shut down. That being said, it is important that we understand what is happening here and dispel misinformation from people who basically want their lives to be unchanged despite growing evidence that the opposite is necessary. There is no need to panic and the zombie apocalypse is not coming but it is important to be smart. There are a couple myths that I think are exceedingly important to dispel and I wanted to go over them.

Covid-19 is the same as the flu

There is nothing further from the truth on this. Covid-19 does start with flu-like symptoms but spreads to the lungs and can cause fibrosis of the lungs and decreased lung function. The death rate from Covid-19 looks to be between 0.7 to 1%. In some parts of the world it is higher depending on the population there (older, sicker patients, access to health care). By comparison, the flu has a death rate of 0.1%. That is a 10 times greater death rate by the most conservative estimates. The hospitalization rate for the flu is 52 in 100,000. By comparison the rate for Covid-19 is 20%. One out of five people. More people have died from the flu because more people have gotten the flu. Most people haven't gotten Covid-19...yet. We are very early in the disease process. If the same number of people who got the flu got Covid-19 millions of people would die. The medical community and political leaders are trying their hardest to prevent this.

80% of people will have mild disease so why should I care. I’m young.

First off, the ophthalmologist, who identified Covid-19 in China as a threat was 33 years old, young and healthy. He died from it. Young people have died. If you are under 9 it is extremely unlikely you will die. The older you are, the higher chance partially because of age but also because older people tend to have more diseases that make their system less able to survive the virus.

Yes it is true 80% of people will have mild or moderate symptoms. That being said that means 20% of patients will require hospital care. That involves a lengthy hospital stay with oxygen and what is referred to as “supportive” therapy such as IV fluid, monitoring, and other medicines to help one breathe better. A quarter of those patients will be in the ICU requiring intubation. 20% of those patients in the ICU will die. The Covid-19 virus causes fibrosis of the lungs which takes months if not longer to recover. This will be something that will be apparent for the 20% of patients who are admitted but don’t die in the hospital will find out.

India blocked all travel into their country for this. Why? They have 7000 ICU beds in the whole country. Their population is 1.3 billion. By reverse math if 140 thousand people there get Covid-19 their ICUs will be overrun. That is .1% of their population. That assumes no one else requires an ICU bed for any reason other than Covid-19 .

The US has 95000 to 100000 ICU beds. That would mean 2 million people would have to get it for us to have no space for them and rationing to occur. That means picking out of two people who require intubation who gets it because of best odds of survival. Not good. Italy is doing that right now.

In summary

80% recover at home, 8 weeks off from work

15% Hospitalized, lung fibrosis, giant hospital bill, months off from work

4% Hospitalized, intubated, lung fibrosis, giant hospital bill, long recovery, unknown consequences, months off from work

1% die…

Even if you recover at home you may pass on Covid-19 to a loved one who has the risk factors for a worse outcome such as diabetes, high blood pressure, lung disease, immunocompromised, heart disease or even just advanced age. That represents about 40% of the Colorado population. It is isn’t 20 people.

I have no symptoms so I am fine

Covid-19 has no symptoms or minimal symptoms in young people especially. You can pass it on the others. 4 weeks after recovery you are still viral shedding. You don’t know unless you are tested. They aren’t going to test you unless you have some symptoms.

I don’t think we are going to have a zombie apocalypse but I do think this disease should be taken seriously. Going out to packed bars, busy museums or even congregating for parties is a bad idea. Online you can look at the rate of growth of the disease in populations. Covid-19 spreads fast. There are places that you may have to go: Doctors office, pharmacy, grocery store but everytime you go to places you don’t need to go to you expose yourself and others to Covid-19. So why would Post Malone have a concert last night at the Pepsi center if this information is out there? I have no freaking idea.

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