COVID-19 Update: Eliminating the Fear around the Coronavirus

With the declaration of a national state of emergency, what is the reality around Corona?


The Literature Low-Down

This segment is meant to give you the skinny; the short and simple; the low-down on a noteworthy scholarly article from a number of different scientific journals to give you the knowledge and power to take your health into your own hands (within reason).


The Literature

In this special edition of the literature low-down, we are going to go over “Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China - Summary of a Report of 72,314 Cases From the Chinese Center of Disease Control and Prevention” written by Zunyou Wu, MD, Ph.D. and Jennifer M McGoogan, Ph.D. at the Chinese Center of Disease Control and Prevention (CDC).


It was published in the Journal of the American Medical Association (JAMA) on 02/24/2020. JAMA has an average impact factor of around 51. The impact factor basically gives you an estimation of how popularly cited the articles in the journal are and by proxy its reputation in the academic community. The most popular journal in the world, The New England Journal of Medicine, has an impact factor of around 70. It is important to note, the impact factor does not tell you anything about the content or validity of each of the articles written in the journal, just its popularity. Just like social media, the more popular journals have more reach and publicity than less popular journals.


This means that this information in this article should be known by healthcare providers due to the reach of the journal and the relevance to the current COVID-19 pandemonium. With those caveats out of the way, let’s dive into it.


The Low-Down

With the craze of public school and event shutdowns, it is easy to start believing that the COVID-19 (aka. Coronavirus) pandemic is the beginning of the end of the world. In these times it is important to really look at the data and not get caught up in the speculation and hype of the media


Study Design

Again this report was developed by researches at the Chinese CDC based on all the case reports from not only the Hubei province, where the virus was first reported in the city of Wuhan, but all of China.


Results

There have been a total of 72,314 case records with only 63% of those being official diagnoses. The remaining 37% of cases are suspected or clinically diagnosed cases. 87% of those cases were those ages 30-79 years old; 2% less than 19 years of age; and 3% were age 80 years or older.


The large majority (81%) of cases were classified as mild with having as great as mild pneumonia complications. 14% were severe with respiratory distress which is consists of trouble breathing, >30 breaths per minute, lower oxygen blood saturation, and lung infiltrates that can lead to pneumonia. The last 5% were classified as critical. These individuals had respiratory failure, septic shock, and/or multiple organ dysfunction or failure. Importantly, there were no deaths reported among mild and severe cases.


The overall Case-Fatality Rate (CFR) was 2.3% which is the statistic that is touted but when we look at the individual characteristics then we can tease out more information. Those aged 70-79 had 8.0% CFR and it increased to 14.8% once the patient was 80 years or older. No deaths occurred in those aged 9 years and younger. As stated previously there were no fatalities in those in the mild and severe case group, but those categorized as critical patients had a CFR of 49%.


Some of the most valuable information was about the fatality rate and those with pre-existing comorbidities. These are other disease processes that the patients already had before developing the virus. Below is the CFR’s for individuals with different comorbidities for all ages.


  • Cardiovascular Disease: 10.5%

  • Diabetes: 7.3%

  • Chronic Respiratory Disease: 6.3%

  • Hypertension: 6.0%

  • Cancer: 5.6%


Take-Aways

At the end of February 18th, 2020, China had 98.9% of the global confirmed case as well as 99.8% of the global total death toll of the COVID-19 outbreak. The reported CFR at that time was 2.3% but we know that, outside of Hubei province, its 0.4%. To add to that the fact that there are inherent difficulties in identifying and counting asymptomatic cases these numbers might be slight elevations to the true CFR. Although the CFR is low in those areas outside of China, due to the increased transmission rate, the total fatality count is bound to be higher than that of COVID-19’s predecessors in the coronavirus family SARS and MERS.


Unfortunately, we have yet to figure out how to stop and reverse aging so we cannot influence the risk that age plays in the COVID-19 infectious process. We do know that increased age leads to a lowering of the body’s innate immune system and we can use things like Ginger, Green Tea, Echinacea, Vitamin D, Omega-3 Fatty Acids, NAC, and Mushrooms (Reshi, Maitake, & Shiitake). You can find that information in our first blog post about corona Here


With the information from this report, we can try to reduce our risk of complications from COVID-19. Reducing the severity of individuals comorbidities could be our next best bet besides directly influencing the immune system. There are a number of strategies that one can take to influence the five comorbidities listed above like exercise, fasting, intermittent cold exposure, and other lifestyle interventions. Although these interventions would have been best implemented before corona gets into your community it is never too late start.

Having a plan on how to best support these factors should be something you discuss with your healthcare provider. If you or someone you know is scared about the coronavirus, please share this blog and spread the knowledge. For access to the article Click Here. If you have any other questions or comments, please leave a comment so a discussion can take place and those answers can help other people.


Chase Davidson, DC is a Board Eligible Chiropractic Neurologist and specializes in concussion and sports rehab, as well as functional medicine and immunology. He is the founder of Action Potential - Sports and Neurological Rehab. He also is a member of the International Association of Functional Neurology and Rehabilitation (IAFNR). Stay connected with Dr. Davidson on Linkedin @dr-davidson or on Instagram @washparkchiro or @thatneurologyguy.


Bibliography

This article

- https://jamanetwork.com/journals/jama/fullarticle/2762130

Other supporting articles

- Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly. Accessed February 20, 2020. http://weekly. chinacdc.cn/en/article/id/e53946e2-c6c4-41e9- 9a9b-fea8db1a8f51

- Battegay M, Kuehl R, Tschudin-Sutter S, Hirsch HH, Widmer AF, Neher RA. 2019-Novel coronavirus (2019-nCoV): estimating the case fatality rate: a word of caution. Swiss Med Wkly. 2020;150: w20203. doi:10.4414/smw.2020.20203

- Xu, J., Xu, Z., & Zheng, W. (2017). A Review of the Antiviral Role of Green Tea Catechins. Molecules (Basel, Switzerland), 22(8), 1337. doi:10.3390/molecules22081337

- Chang, J. S., Wang, K. C., Yeh, C. F., Shieh, D. E., & Chiang, L. C. (2013). Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines. Journal of Ethnopharmacology, 145(1), 146–151. doi:10.1016/j.jep.2012.10.043

- Hudson, J., & Vimalanathan, S. (2011). Echinacea—A Source of Potent Antivirals for Respiratory Virus Infections. Pharmaceuticals, 4(7), 1019–1031. doi:10.3390/ph4071019

- Wu, D., Lewis, E. D., Pae, M., & Meydani, S. N. (2019). Nutritional Modulation of Immune Function: Analysis of Evidence, Mechanisms, and Clinical Relevance. Frontiers in Immunology, 9. doi:10.3389/fimmu.2018.03160

- Geiler, J., Michaelis, M., Naczk, P., Leutz, A., Langer, K., Doerr, H.-W., & Cinatl, J. (2010). N-acetyl-l-cysteine (NAC) inhibits virus replication and expression of pro-inflammatory molecules in A549 cells infected with highly pathogenic H5N1 influenza A virus. Biochemical Pharmacology, 79(3), 413–420. doi:10.1016/j.bcp.2009.08.025

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