The Drive with Peter Attia — Amesh Adalja

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On: Comparing COVID-19 to past pandemics, preparing for the future, and reasons for optimism

Episode: 106

Date: 13 April 2020

Senior Scholar at the Johns Hopkins University Center for Health Security. focused on emerging infectious disease, pandemic preparedness, and biosecurity.

Key Subjects:

  • Spread.
    • COVID-19 may have spread outside of China prior to December 2019, but if so, sporadically.
  • Fatality.
    • Novel flu (1958): about 100,000 people.
    • Worst regular flu season (2017/18): about 80,000 people.
    • H1N1 (2009): spread to 61 million, but very low mortality.
    • Avian influenza: 65% mortality.
    • COVID-19:
      • Previously over-estimated (denominator too low).
        • Severity bias: only people with severe symptoms are tested.
        • Also, previous models over-estimated hospitalization rate.
          • Not 15-20%, probably closer to 5%.
      • CFR likely below 1%.
        • Perhaps in the 0.3-0.7% range.
      • On average.
        • Subject to age and underlying conditions.
      • For US, final number probably close to current 60,000 people estimate.
  • Versions.
    • Common versions:
      • Ubiquitous: spread easily, commonly infect humans globally.
      • Mild in symptoms (cause about 25% of our colds).
      • Recur seasonally.
      • Four versions: 229E (alpha), NL63 (alpha), OC43 (beta) and HKU1 (beta).
    • Other versions: evolves in animals, transmitted to humans.
      • Mostly animal to human transmission.
      • Outbreaks mostly occur in hospitals, difficult to sustain in human population.
      • MERS-CoV (beta), SARS-CoV (beta).
    • SARS-CoV-2 may become fifth common version.
      • Spreads very easily.
      • Until there is a vaccine.
  • Slow response.
    • Testing criteria too strict.
    • Scarcity of testing materials.
    • Bureaucratic snafus (see als The Grumpy Economist on April 13, 2020).
    • Lack of “diagnostic curiosity”.
  • Back to normal.
    • Lessening restrictions on schools, social distancing, businesses, hospitals.
    • Still avoid mass gatherings.
  • Sweden.
    • Herd immunity approach: comes with increase in cases.
    • Success depends on ability to sequester high risk groups.
    • Who is getting sick will determine ability to keep peak within health care capacity.
  • Masks
    • Not very helpful to the public.
    • Those with symptoms: wear mask to prevent spreading.
    • Those without symptoms: open question how much it helps to prevent spreading.
  • Selected signs of plateauing.
    • Downsizing surge capacity / field hospitals.
    • Returning ventilators to national stockpile.

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