The Scary in the Hidden

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by jgleaso1  4/15/2020 11:12:03 AM -- 

As we anxiously await medicine to help us fight COVID-19, we’re left with the evasion tactic. We can’t see this horrible monster that is making millions of people sick and killing more than 120,000 people worldwide (so far). And we certainly can’t see it in our neighborhood where there might not be any confirmed cases (so far). One way to know that this is still serious in our personal lives is to look at when the confirmed cases started getting sick.

One of the problems we have right now (and we have so, so many) is that we can’t tell who has been infected with COVID-19. We’re told that it’s dangerous “out there.” We’re told to be careful of being near people in stores, but also of the items that we get from the stores.

The New England Journal of Medicine published research on March 171 that revealed the novel coronavirus can stay in the air for at least 3 hours, remain viable on cardboard for a day and on plastic and stainless steel for 3 days. We can’t see it, we can’t smell it, we can’t hear it, we can’t feel it – but we sure can suffer from it. It’s a monster - and not only do we not have the weapons to fight it, we don’t even know where it is. This hidden monster is scary to so many of us, but by keeping an eye out and paying attention, we can see a glimpse of it now and then.

So much of the last three months has been about estimating future possibilities. Since we didn’t know very much about this monster, we used indicators, past experiences, and circumstances in foreign countries to get some idea of what we’re up against. There has been a need to give the monster a form so that, until we have the medicines to fight it, we can, at least, evade it.

There is one fact-based outline that we can assess at this point. One of the many pieces of information that comes from case investigations is the date in which someone diagnosed with COVID-19 began experiencing symptoms. This date is not always accurate since it relies on someone’s memory and in some cases, the person is already too sick to provide a date at all. This little bit of hazy information proves that the monster is always larger than it appears.

To understand this, let’s start by looking at national trends. The Centers for Disease Control and Prevention (CDC) publishes the reporting date for each case in the U.S. as well as the date of symptom onset2. By simply combining these two bits of information into a single graph, a picture can emerge. Figure 1 below maps daily new cases based on their confirmation date (red bars) while those same cases are mapped to the date when their symptoms began (grey bar). What we see is that on March 7 there were 65 reported cases in the U.S. while 682 people started having symptoms but were confirmed with having the virus on a later date.

Simulation Chart

In addition, on March 15, the number of new cases drastically increased by 915 from the day before, going from 338 to 1,253 cases. The total cumulative count of confirmed cases by the end of that day was almost 3,500 (see Figure 2). What we didn’t realize at the time, was that there were actually 5,572 new symptomatic cases that day and a cumulative 28,000 people who had experienced COVID-19 symptoms.

Simulation Chart

Here in northeast Nebraska,3 we currently have 47 confirmed cases. After obtaining data on symptom onset from our local public health departments, we can see that our trends are similar, though, of course, the scale is much smaller (see Figure 3). Last week, when there were only 24 cases confirmed in northeast Nebraska, twice as many had already started displaying symptoms. A week before that, we believed that we had 15 cases. However, we now know that there were 9 more people who were on their way to be confirmed.

Simulation Chart

There are two more things that are important to remember before we move on. First, there is an average of 3 to 5 days before symptoms kick in and an infected person is able to spread the virus (called the incubation period)4,5. The CDC states that this period will normally range between 2 to 14 days6. This could mean that individuals who become confirmed cases of COVID-19 could be inadvertently spreading the disease to others for days or weeks before they have any indication that they might be sick.

The second thing we must remember is that this data only includes confirmed cases. We know for a fact that many mild cases never get tested and, therefore, never become confirmed. We also know that there are many people who never show symptoms and are able to spread the virus. Though there have been reports that say that there might be around 20% to 25% who are asymptomatic, the Centre for Evidence-Based Medicine performed a meta-analysis (analysis of available research) and concluded that current studies on this topic are not reliable7. The National Institutes of Health announced on April 10 that it will be conducting a massive new study that will specifically target the non-confirmed spread of the novel coronavirus throughout the states8.

How does this help us with our monster? It tells us that, no matter how big (or small) you think of the monster’s presence where you live, it is, in fact, much bigger. You know how many people have been confirmed with COVID-19, but you don’t know how many people are spreading the disease around you. It tells us that our isolation efforts are warranted, and we must continue to do what we can now so that the monster doesn’t get too big. We must aim higher in our efforts. So far, we have been doing a decent job with our social distancing and, even though our numbers are low, many of us are taking it seriously. Most of us have been lucky enough to evade the monster’s reach.

So, as we sit at home and protect ourselves, our family and friends, and our neighbors, please also remember to take care of yourself. Take a break from the doom and gloom. Call up your loved ones and laugh. Watch Some Good News by John Krasinski9(especially if you are a fan of The Office and/or Hamilton). Don’t forget to get some exercise and drink plenty of water. And, don’t forget that all this hardship we’re experiencing right now will be over some day. This monster will be pummeled and hopefully vanquished.

3 Northeast Nebraska is expanded past the normal 20-county service area for Northeast Community College in order to incorporate all counties under the district public health departments. The Northeast Community College service area includes: Antelope, Boone, Boyd, Brown, Burt, Cedar, Cuming, Dakota, Dixon, Garfield, Holt, Keya Paha, Knox, Madison, Pierce, Rock, Stanton, Thurston, Wayne, and Wheeler. The additional counties for this article are: Blaine, Cherry, Colfax, Custer, Greeley, Howard, Loup, Nance, Platte, Sherman, and Valley.

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