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COVID-19 — It’s not ‘just the flu’

April 11, 2020

You woke up this morning with a headache and sore throat. By noon you ached all over and started coughing. You’re also a little bit winded and really tired. Is this the flu? Or is it COVID-19?

COVID-19 can cause anything from mild cold symptoms to most common flu-like symptoms, such as headache, cough, fever, trouble breathing, sore throat, and diarrhea. In some people it becomes life-threatening very quickly. You are 10 times more likely to end up in the hospital because of COVID-19 than the flu. COVID-19 seems to most seriously affect those who have heart disease, high blood pressure, diabetes, lung disease, cancer, and immunodeficiency – and patients who survive a serious infection may be left with lifelong problems. The most seriously affected are those older than 65, but even those age 20-40 make up 40% of hospitalized COVID-19 patients. Younger children are less likely to become seriously ill, but they can spread the disease while having mild to no symptoms. Because this virus is completely new to humans there is a lot we’re still learning and much more we do not yet know.

It’s tempting to think COVID-19 is “just a flu.” In 1918, America was experiencing the same sort of anxiety because of the Spanish flu. That was roughly 100 years ago, and no one then was saying, “It’s just the flu.” The CDC estimates that 50 million people world wide died during the Spanish Flu pandemic. Since then, the study of the flu virus has led to development of vaccines and effective treatment. Despite the flu virus mutating and changing yearly, our immune systems are better at fighting it. This is because it has seen some version of the virus before, whether through illness or from vaccination. Once fighting off an enemy virus, it’s as if the immune system maintains a “most wanted criminal” poster and a small, dedicated army just in case the virus shows up again. Our systems then have a head start fighting off a viral infection before becoming seriously ill. When many people in a population already have these immune system defenses, they become like shields protecting others who are not immune. We call this “heard immunity.” When there is no herd immunity—meaning no one is immune yet—the virus quickly spreads from person to person, infecting many people within a short amount of time.

Until recently, the coronavirus (known as COVID-19) only infected animals. One day in 2019, enough of the genetic material randomly mutated, making it able to infect a human. We do not know exactly how it happened but imagine this: The first infected human coughed on something, let’s say a door handle. Along came another human who touched the door handle then touched their lips. Just that quickly, the virus has jumped from one human to another, infecting person after person. From there it spread through the human population like wildfire, each person easily infecting two or three others before anyone even knows they are sick.

Unlike the seasonal flu, our immune systems have never seen this enemy, and we are all defenseless. We have no others around us with immunity to act as a shield and slow the spread. COVID-19 is at least twice as contagious as the flu. It’s estimated that if no action is taken to stop the spread, at least 50-80% of the world’s population will become infected. Information suggests that 80% of infected people will have mild or no symptoms, and 20% of those infected will need care at the hospital to recover. Five out of every 100 people (5%) infected will need additional care in the ICU with a ventilator to help them breathe during a long recovery. Comparatively, the flu hospitalization rate is only one out of every 100 people (1%), and that number is spread out over months, not weeks. The death rate for COVID-19 is four to 20 times higher than influenza. COVID-19 is unlike any flu we have seen in modern times. 

Sampson County’s population is approximately 63,000 people. Assuming these statistics, if we go about our business as usual and allow the virus to spread rapidly as it has in some cities, we can expect possibly as many as 50,400 people to become infected. Of those people infected, 10,800 (20%) are expected to become sick enough to need hospitalization, and 2,520 (25%) of those hospitalized are expected to need care in the intensive care unit, including breathing support. To put this in perspective, Sampson Regional typically staffs about 60 patient beds and has surge plans to expand up to about 116 beds, with at most 20 of those being ICU beds. In preparation for this pandemic, the hospital has made significant preparations to increase general supplies and the number of ventilators, but even so, you can see that there still won’t be enough room if thousands of people become seriously ill from COVID-19 in a short amount of time.

The number of people we lose in our community depends a lot on whether we can work together to “flatten the curve” and slow the spread. No doubt you have heard a lot about social distancing to “flatten the curve.” What this means is that we want to reduce the physical distance between people to slow the spread. When this is done well, we prevent a big wave of people who all need hospital care at once and instead spread out those needs over time. If the hospital is overflowing with COVID-19 patients, resources become stretched so thin that it becomes difficult to care for many other healthcare needs, such as surgeries, car accidents, traumas, heart attacks, and strokes. In the large Chinese Province of Hubei where they did not “flatten the curve” with social distancing, the death rate was approximately 2.5 people for every 100 people infected. In a smaller nearby city were people did stay home, the infection spread more slowly, and they were able to provide better hospital care. Seventy-five percent fewer infected people died from COVID-19 in that smaller city. If we are very careful and staying home, Sampson County will be like the smaller city. The difference between the two scenarios could mean hundreds of lives saved in Sampson County.

It takes about 14 days to recover from and begin developing some immunity to COVID-19. With a at least a few weeks of strict social distancing (no parties, school, cookouts, neighbor visits, or play dates), the virus will stop spreading so fast. We then will likely have developed some herd immunity to slow the spread for the time we all go back out again. It gives hospitals and medical offices time to restock supplies and laboratories time to boost testing capabilities so that we can quickly isolate new cases. It gives scientists time to develop a vaccine or discover treatments and medications to fight COVID-19. It will give us time to save many more lives.

We can do this! We have worked together to help each other through hard times after hurricanes Florence and Matthew. We can work together now to beat COVID-19. We will work together to help our community and businesses recover when this is over. Please help your neighbor. Please help your granny. Please help your doctors, nurses, respiratory therapists, other healthcare workers, and emergency services stay healthy so that we can all continue helping you.

Prepared as a special to The Sampson Independent By Dr. Amy Howerton of Howerton Family Medicine
Dr. Amy Straiko-Howerton is American Board Certified in Family Medicine and has 15 years of experience in rural healthcare. She practices at Howerton Family Medicine, serving patients in Roseboro and surrounding communities. The practice provides both preventive care and medical treatment for patients in all stages of life.