bpwhite:open_letter_coronavirus

Coronavirus (COVID-19) open letter regarding disease severity and transmission rate in the greater Seattle/Portland area

Author: Bryan P. White, 03/08/2020

*This is a letter sent to various news organizations on Sunday, March 8th, 2020, at 1AM about 7 hours before the state of emergency was declared by Governor Kate Brown in Oregon.

Hello,

My name is Bryan P. White. I'm a local biologist here (MS, Biology; MPH candidate) in Corvallis, Oregon acting as a concerned citizen in writing this open letter to local news organizations. You can see a full list of my credentials at the bottom of this letter. As you know, as of 3/7/2020 in the US, there have been over 428 reported cases of a novel coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus, a member of the Coronaviridae family, which includes the closely related viruses that also cause the SARS and MERS respiratory diseases. While the severity of COVID-19 hasn't really been documented clinically yet in the United States, some sources suggest its transmission potential is extremely high with an R0 of 1.4 to 3.8, which means that every infected individual with SARS-CoV-2 is expected to infect, on average, 2 additional individuals - or about double seasonal influenza, which has an estimated R0 of 1.28. Recently, additional sources have corroborated this high spreading rate. This high transmission rate, coupled with a droplet route of transmission, and an average infection doubling time of 5 days, a surface persistence time of up to 9 days, and an incubation time of 2-14 days, makes the continued spread of this virus through the communities of Washington and Oregon highly likely, and only through proactive community action will we be able to slow the spread of this virus. Finally, the purpose of this letter is not to induce panic, but rather fulfill a moral obligation as a scientist and educator to protect the local community from unforeseen threats of death and disease occurring through biological routes.

My primary concerns are as follows:

1. Testing facilities and capacity nationally in the US, including Oregon and Washington, are still woefully behind other developed countries, specifically pointing to South Korea as an example of where testing rates are clearly outpacing infection rates. Currently South Korea has an estimated case fatality rate (CFR) of 0.70% (50/7134, worldometers.info), whereas the estimated CFR for the US is 4.3% (19/442 - worldometers.info). This suggests that South Korea is outpacing the US in terms of testing rate by 6X, assuming that South Korea is reaching closer to a true case fatality rate of 0.70%, the corollary to this being that the US is currently experiencing 6X more infections than being currently reported, or upwards of 2652 individuals that are currently contributing towards disease spread in the United States.

2. The World Health Organization has specifically stated that the current, global estimate for COVID-19 CFR is 3.4% and that this is generally higher than a seasonal flu with a CFR of less than 1%.

3. Proper, accurate information dissemination and misinformation are outpaced with each other, meaning that misinformation about the disease is being generated at almost the same rate as accurate information is being generated by official public health institutes. Specifically to avoid contributing further to spread of misinformation, I haven't listed any of the clinical features of the disease, suffice to say that the disease potential is much more severe than a seasonal flu according to WHO. There is currently no known antiviral therapy for COVID-19. Furthermore, the links provided at the end of this letter will include the most up-to-date clinical information as it becomes available.

4. The federal (CDC) response to COVID-19 is continually dismissive and downplays the possibility of the extreme scenarios currently being seeing in other developed nations such as Italy and Iran. CDC reported cases of COVID-19 consistently fall behind other public health agencies reports (442 at worldometers.info, 429 at Johns Hopkins, 164 at CDC). CDC does not update data on the weekends, only periodically updates data during the week, and newly updated data still lags behind other sources. Furthermore, the CDC specifically declined to use testing kits offered by the World Health Organization to fill in for the time being while the US began to manufacture its own kits.

5. Simple epidemiological models predict widespread disease as the US enters the exponential phase of the epidemic.

6. The World Health Organization has specifically stated that containment of COVID-19 is possible through contact tracing, however, with the lacking US testing, the possibility for containment via contact tracing seems unlikely.

7. Widespread anecdotal reports that COVID-19 testing is still limited to those only presenting severe disease.

8. The densely populated areas of Seattle and Portland will act as viral reservoirs maintaining high disease transmission rates between the two. This possibility would be exacerbated as hospital staff and resources become increasingly overwhelmed and sick, panicked, or worried individuals begin seeking health care elsewhere (Corvallis, Eugene, Salem, and Vancouver) - or simply stop seeking healthcare at all. This will create a positive feedback loop of increasing strain on hospital workers and staff, further exacerbating the problem.

My recommendations for calling on state and local health authorities:

1. I would like to see a comprehensive response plan enumerated by state and local public health departments regarding their plan to respond to and attempt to contain the COVID-19 epidemic.

2. Assurance that local governments agree that an attempt at containment is the best measure for thwarting the COVID-19 disease outbreak in the greater Oregon/Washington area.

3. A shift from retroactive testing of only severe/hospitalized testing towards rapid testing of all suspected cases, meaning non-severe, or cases presenting only a subset of symptoms.

4. Current status of “surge” capacities of local hospitals in the area be published routinely. If a positive feedback loop of severe cases occurs, what are local hospitals capacity to handle those cases?

5. What is the capacity for the region as a whole? Is there a central authority coordinating response between the Seattle and Portland/Vancouver metropolitan regions?

6. Proactive measures to engage in the containment of COVID-19 be routinely published and coordinated between state, local, and private health institutions.

7. Specific plans to avert panic as local cases of community transmission are detected. Free dissemination of the relevant information provided below, to the public.

General COVID-19 information sources: Tracking/Maps:

  • Johns Hopkins University CSSE
  • Healthmap
  • Nextstrain
  • Worldometers
  • University of Virginia
  • coronainfo.xyz
  • BNO News

Journals

  • NEJM
  • Lancet
  • JAMA

Resources from Organizational Bodies

  • WHO Daily Sitreps
  • European CDC Latest
  • USA CDC Latest
  • Promed
  • Imperial London College MRC
  • CDC Info for health professionals
  • London School of Hygiene & Tropical Medicine
  • WHO Technical Guidance
  • AMA resource center for health professionals
  • ACP Information for Internists
  • CDC Pandemic Preparedness Resources
  • UpToDate COVID-19
  • Internet Book of Critical Care (IBCC) chapter on COVID-19

Relevant News Sites

  • CIDRAP
  • Stat News

Thank you for taking the time to read this letter. I would be happy to answer any and all questions to the best of my expertise, and provide additional supporting data analysis as needed. If for some reason any of the information provided in this email turns out to be incorrect, please notify me and I will make the required corrections for my records.

Thank You,

Bryan
—————————————————————
Bryan P. White, MS Biology/MPH (candidate)
ORCID: https://orcid.org/0000-0003-4191-3511
Publication History: http://www.bpwhite.iiress.com

Addendum 03/12/2020:

Hello,

This letter is a response to the recent editorial published in the Oregonian: https://www.oregonlive.com/opinion/2020/03/editorial-oregons-mixed-messages-on-its-coronavirus-emergency.html

Here are some of my thoughts from the perspective of a biologist living in Corvallis. My background is computational biology, genetics, genomics, and data analytics. I currently have a Masters degree in Biology from Cal. State Fullerton, and am pursuing a Masters of Public Health from National University, in La Jolla, California (online program). Overall, the response I have been observing in Oregon is still very reactive (rather than proactive), and is very concerning to me as I calculate my own metrics and perform data analysis. Here are a list of my current comments/concerns as to the status of the response.

1. US national confirmed cases of COVID-19 is currently experiencing exponential growth at a doubling rate of 2-3 days, with no sign of disembarking from an exponential curve (See attached).

2. State response has been delayed, but adequate. As of the righting of this email, OHA has not released any new case information for the day (last update was 03/11/2020 10AM), yet it is extremely likely that additional cases have been detected in the area. At a positive rate of 7%, I would expect around 4 of the pending cases to turn into positives.

3. OHA website still states that “not everyone needs a test”, yet in countries where we see low case fatality rates (e.g., South Korea), testing is given freely as requested to citizens. As of the time of writing this email, the US CDC and Public Health Labs have tested approximately 7,200 individuals, whereas Korean CDC has tested over 200,000.

4. The US estimated case fatality (CFR) has dropped from a peak of 7.4% down to 2.9% as of today, which suggests that testing capacity is picking up, but still lacking (See attached). South Korea is currently reporting a CFR of 0.84%, or about 1/3rd of deaths the US will be expected to experience.

5. State mandates regarding public health warnings are being ignored or treated like a joke. Anecdotally, I still see people discounting the disease as “just a flu”. While I agree the Oregonian's response has been excellent, clearly there are still national and local news sources that are propagating misinformation about the disease. Sadly, many of the people propagating this misinformation are the most at risk (50+ with comorbidities).

6. Many young people (21-35) simply don't care about the disease severity because they are low risk for fatality. However, this is dangerous thinking because A.) young, healthy people will still be carriers of the disease while experiencing minor, cold-like symptoms exposing more at-risk individuals and B). there is no known clinical report of conferred immunity from surviving an infection of COVID-19. Young people are quite likely putting themselves at an increased risk to their own health, unbeknownst to them.

7. A lack of local communication. I have not personally heard from any local health authorities here in Corvallis about any measures intended to combat the spread of the virus or aid in its containment. As a city that depends on its food service industry, I am concerned that unexpected community transmission in the city will cause a far greater impact than transmission of a prepared, informed populace.

8. I am already hearing anecdotal reports of individuals being within 1 degree of an exposed person that is currently on quarantine, suggesting that community transmission within Benton county is extremely likely, and already occurring. As I mentioned, every day of unchecked transmission of COVID-19 can lead to potentially dozens of new cases. If it is the case that community transmission of COVID-19 is already occurring in Benton county, its spread might be unstoppable within the city of Corvallis.

Thank you for taking the time to read the letter and please let me know if you have any questions.

Thanks,
Bryan

bpwhite/open_letter_coronavirus.txt · Last modified: 2020/03/31 19:33 by bpwhite