Sunday, March 8, 2020

Is it really that bad? Coronavirus versus the Flu

I have seen a couple of comparisons of the newest Coronavirus to the Spanish Flu in 1918 from both the worry warts and the naysayers, along with more and more desperate attempts to even compare to diseases that we have vaccines and cures for but simply never get distributed to the poorer countries.  I think we all need to understand what's actually known versus not, so we can attempt to protect ourselves.

The overly worried point out how quickly this new virus has spread similar to the "Spanish" Flu, how there is no cure in either case, and how the government has lied or mislead about the severity making the spread worse.  All true. The naysayers point out how the Spanish Flu killed millions, how it had no cure and that this is mild in comparison.  The first 2 are true.  But the 3rd is representative of exactly why the "Spanish" Flu was so bad in 1918.  So here's an explanation of the differences.

COVID19, The newest Coronavirus

Let's start with the "Spanish" Flu. This is the H1N1 virus. If it sounds familiar, that's because H1N1 was redesignated as "Swine" Flu and we had a huge surge of it in 2009.  Same bug. Not all Influenza viruses are H1N1.  But they are, as far as I have researched, given an H and N designation. Now, I'm guessing a couple of you are scratching your heads. Why call it the Swine Flu if it was the "Spanish" Flu?  Probably two or three reasons. First, the US government mislead the American public.  H1N1 started in Kansas at what is now Fort Riley.  The US government refused to discuss the outbreak and did everything to keep the news from reporting it.  The Spanish, as in Spain, were the only country reporting it regularly in their news.  So the public incorrectly designated it as the "Spanish" Flu. Secondly, the "Spanish" Flu still strikes fear if you were to Google it.  The death toll was super high.  No one wants people panicking.  Third, well, they figured out where it started, with pigs.  Why not just call it H1N1? No idea.  We like to give scary things fluffy names I guess.  Make them less scary and more comical. 

So H1N1.  It still kills, even today.  It attacks 20 somethings faster than most.  In 2009-10, they estimated it killed up to 575,000 globally.  In 1918, they estimate it killed 50M globally, 675,000 in the USA alone.  Wow, right?  How come the number is so much less, if it was the same bug from 1918?

Medicine and our knowledge of how these diseases start and progress in 1918 versus 2009 was very different.  We have vacc;ines to help prevent the different strains of the flu.  Hell, in 1918, we didn't even know what caused it.  The H1N1 virus was not identified until 1931 in pigs.  In 1933, it was isolated as the same as the "Spanish" Flu and probably why scientists renamed it then.  By 2009, they saw no reason to call it the "Spanish" Flu. Yet, it still kills, because we don't actually have "cures" for these bugs.   The death rate was lower because we know more about how it spreads, what helps and what doesn't, and more importantly, we have become more accepting of the science behind how these things work.

H1N1 aka. Swine ("Spanish") Flu

We know how flu viruses are transmitted.  We also have developed vaccines for them.  Plus, we communicate faster, more effectively what the risks are.  In 1918, the main treatments were blood letting (yes taking people's blood out), putting them side by side in huge rooms or tents, telling people to stay outside, and trying to reduce the fever.  There were no drugs they knew would help.  Some doctors would give morphine because in later stages the eyes and ears would bleed.  Until recently, we thought the morphine may have made it worse.  Recent studies do not support that. But back then, no one knew what was causing it, so there was no way to establish what would work or not.  They were experimenting with the sick.  If the sick died, they assumed it wasn't working, or if they didn't, they assumed it did. 

By 2009, we knew what caused it.  We knew how it was transmitted host to host.  This made isolating the sick from the healthy important versus shoving them in beds side by side.  We knew how to protect medical workers.  We also discovered how to treat the symptoms better.  Keeping the fever down. Keeping the sick hydrated.  Amazingly, back in 1918 no one realized dehydration was causing the body to shut down on top of fighting the virus.  Still, as we saw in 2009, no cure.  People still can die from H1N1 and even from its less potent family members.

Now, I intentionally picked pictures that made the two above similar looking with the color but that's really from the microscope used.  What they really look like when dissected doesn't look as similar.  If you look at the pictures below, you see that the interior and the exterior of the two are different.
H1N1 dissection

COVID19 dissection

The two are similar with hemagglutinin, but notice the new spikes on the Coronavirus referred to as Spike Glycoprotein. No, I'm not about to get into a whole discussion about what this is. I have no idea and that's what some scientists way smarter than me do for a living.  I'm just providing layman's information.  Suffice to say in laymen's terms, these are different and they can't automatically be assumed to be similar in treatment, transmission, or even life spans. What we do know about the H1N1 is it has never been eradicated, and the biggest problem with the Coronavirus is, by the best information we have, neither will it. 

Which brings us to the worry warts.  Yes, they are right. COVID19 is highly contagious.  It is harder to kill than the H1N1.  There's no cure and right now treatment is only an educated guess.  The government has been very misleading which we know makes it worse not better from 1918's experience. It got the opportunity to spread when it shouldn't have.  But does that mean you should stop and worry about dying from it?  Probably not.  Kids seem to be near immune.  NEAR.  It doesn't attack them like the H1N1 attacks younger hosts. H1N1 favored younger, healthy hosts.  For COVID19, the elderly seem to be the most susceptible.  To the worry warts points though, how many of us don't have elderly family?  Smokers and people with other conditions seem to be affected also.  So some of us may need to be more careful, if not for ourselves, for our loved ones.

Now further to the worry warts points, almost nothing we know about this Coronavirus is actually based on it.  Instead most of it is based on the two previous ones, SARS and MERS.  (See below.)

SARS virus dissection

MERS virus dissection

Now, it doesn't take a rocket scientist to see there are similarities and differences.  This is why we cannot assume what we know about one applies to the others, but also why we assume that at least some, even a majority, of what we know about one applies to the others.  It's not an ideal science at this stage.  Researching these things takes a lot of man hours and a lot of people with the dedication to study these things.  Time is never on their side.

Now, the comparison to H1N1 that I eluded to earlier that makes scientists of any caliber cringe. H1N1 was a nasty little devil. It appeared towards the end of the winter in 1918.  When it started to warm up, the transmission rates lowered. This is because the most common ways these are distributed is via droplets of saliva when the sick cough.  This is why we eventually started telling people to cover their mouths.  Back then, no one realized this was the primary route of transmission.  In fact, up until the last 10-15 years, we also thought it was okay to cough in your hand and it wasn't transmittable.  Then we realized these things have a shelf life outside the body.  H1N1 for the most part lasts up to 8 hours on almost all surfaces.  After that, it's dead, even without cleaning. But from the other two coronaviruses, we know these babies have a shelf life for days on some materials.  They haven't actually established for certain the shelf life of  COVID19 is the same, yet.  We also know how to contain H1N1 and provide better treatments.  We know that because we had over 70 years to test it.  H1N1 was "discovered" in 1931 and traced to pigs. In 1933, it was confirmed to be the same one from the 1918 epidemic.  By 2009, we knew a LOT about it.  But it still killed 575,000 people globally in 2009. We only have had a little over 16 years to study the new coronaviruses.

Believe it or not, none of that is even the scariest part.  The one thing we know about H1N1 that scares scientists when they have a new virus to deal with?  In 1918, they thought it was gone, eradicated by summer.  They had no idea why.  The reason that these viruses start to dwindle off in the summer?  Because the way the moisture in our voices, in our coughs dissipates.  In the winter months, these droplets remain larger.  Bigger carriers with more likelihood to get into a non-sick person.  By summer, the temperature makes these smaller.  They dissipate faster and they become less communicable.  That all sounds good, right?  By summer it's gone?  Not exactly.  First, I already explained these babies are never completely gone. Neither flus or the coronaviruses go dormant.  Instead, they mix with other viral strains, effectively mutating.  As I've already explained, H1N1 in 2009 is the same H1N1 in 1918.  The coronaviruses are exactly the same.  They just mutate, mesh with other viral infections.  Nice, right?  But, they hold on--going from place to place, maybe even person to person during the summer months, lying in wait.  At least that's what H1N1 did in 1918.  Most of the deaths from H1N1 were in the fall and first half of winter in 1918, not the spring of 1918 when it first appeared.  It resurged because the virus held on and no one was protected.  They didn't know how.

So in 2020, scientists don't know how long before they can figure out how to contain it.  The things they are telling us aren't based on what they know about COVID19.  They are basing it on the previous two novel coronaviruses.  Isn't that special?  Looking at the dissections of the 3, you can see how that would work, but you can also see how that might not.  They are similar but not the same.  When they talk about the first two meshing to form a third, you can see how COVID19 has a mix of the SARS and MERS inside its "shell".  They are best guessing that it has the best of both right now to treat it, but it's an educated guess, which is still just a guess.  They also know they are working against the clock.  It took over 20 years to know what caused H1N1.  It took decades after that to understand as much as they do about Influenza.  Science and its equipment, even the scientists now, are better with more accumulated knowledge from the past and present.  But that clock for them will continue to tick until next winter.

Resurgence is the bigger concern then.  SARS was found in 2003 did not resurge.  That doesn't mean COVID19 won't.  Right now, they think it's a mesh of SARS and MERs.  MERS first strarted in 2013.  It resurged last year, 2019.  COVID19 has taken more lives than both.  When someone says summer can't come fast enough.  They're right.  It gives scientists some time to try and figure out how to combat it.  It also gives a little hope that it won't resurge, but that depends highly on us keeping it contained to a minimum number of people.  If everyone is running around like this is no big deal like they did in 1918, well, that can help this virus resurge in the fall.

I've said it over and over.  No reason to panic, but no reason to be irresponsible and ignore history either.  The winners here are the worry warts.  The naysayers do not have history or science on their side.  History and science tell us keep this thing to a minimum.  Take care of yourself.  Don't intentionally take risks that aren't necessary, but don't be completely worried and home bound unless you are in the at risk categories or sick.  It's that simple.  Listening to the naysayers increases our chances of this thing getting worse.  


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I'm not even going to go into the whole virus versus bacterial and parasitical diseases some people have taken to trying to compare this to.  There's literally no comparison.  Total different root causes and total different solutions.  If I see a whole bunch of that nonsense, I will, but I would like to think most people remember a tiny bit of high school biology.    

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