JJ’s Note: This article was written by my Father-In-Law, Dr. Robert Freedman, who is the Chief of Infectious Diseases at multiple hospitals in Miami, Fl. You can also view his blog at mymdmiami.com/coronavirus/. I wanted to share this as it is a great informative article that gives clear perspective on the current Coronavirus situation.
Written by:
Robert A. Freedman, M.D.
Board Certified Internal Medicine and Infectious Diseases
Chief of Infectious Diseases Miami Jewish Health Systems
Chief of Infectious Diseases Kindred Hospitals of South Florida
info@mymd.us (Questions submitted will potentially be answered in future articles/updates)
—
As an Infectious Disease specialist in the community, who has been fielding phone calls over the past two weeks about the coronavirus from hospital administrators, nursing homes, schools, synagogues, businesses, and patients, it is clear there is a lot of misinformation and fear about this disease. I am therefore putting out a statement to try and answer many of the questions I have received, hopefully to provide guidance to our communities, and allay some fears.
Before discussing the history, details and implications about the virus, I want to emphasize one important key fact: at this point, we must practice social distancing. We cannot wait for an index case, because by the time the index case is known, the disease has mushroomed throughout the community.
Coronaviruses have been around for a long time. The majority of them cause a syndrome like the common cold. In the past two decades we have experienced two new novel coronaviruses, and now a third one. Two of the three have originated in China from an animal food market (i.e. animal to human transmission). The first was SARS (Severe Acute Respiratory Syndrome) in 2002 to 2003, MERS (Middle Eastern Respiratory Syndrome) in 2012 originated in Jordan, and now COVID 19, specifically from an animal and seafood food market in Wuhan, China. These three new viruses can cause a severe pneumonia and sometimes death. SARS killed 770 people out of 8,000 infected, and MERS killed 3 or 4 out of every 10 people infected, according to the CDC. Unfortunately, because COVID19 is a novel/new virus, we have little information on its epidemiology (how it’s transmitted), and have no antiviral therapy or vaccines at this time. Therefore, the majority of my statements will be based on current knowledge that has been acquired over the past few months. As we have more experience with this virus, some of the information and beliefs about contagion, transmission, incubation, and mortality that I am going to discuss, may change.
COVID19 as of Wednesday 3/11/20 has been declared a pandemic by the World Health Organization. This essentially means it has spread worldwide. Transmission is believed to be from respiratory droplets from people coughing or sneezing which are inhaled by another person or “hand to mouth”. If you shake somebody’s hand or touch a surface that has the coronavirus, and then you touch your mouth, nose, or eyes, you can contract the virus. You are essentially placing the virus onto one of your mucosal surfaces (mouth, nose, or eyes). This is why you hear all the recommendations about repeatedly washing your hands or using hand sanitizer. People would be surprised how many times they touch their mouth, nose, or eyes throughout the day. This is also why they recommend not shaking hands. The most recent data suggests that respiratory droplets carrying coronavirus can remain in the air for up to three hours, which would increase the contagion. They can also stay alive on surfaces such as plastic and stainless steel for up to 3 days, copper surfaces for 4 hours, and cardboard for up to 24 hours. There is also some data that suggests if it is like SARS and MERS, it could remain on metal, glass, or plastic for up to 9 days. In contrast, our knowledge of flu/influenza reveals that it can only remain on surfaces for 48 hours. In a study published in the Journal of Hospital Infection, it was suggested that Coronaviruses could be effectively inactivated by disinfectants that contain 60-71% ethanol, 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite within 1 minute.
The current incubation period is believed to be between 5 to 14 days. This is why people are being quarantined for up to 14 days. Additional concerns with respect to transmission are that it appears people can be contagious prior to developing any symptoms. This is very dangerous, since if someone is well, the individual and his contacts assume that he or she is not contagious. This contributes to the rapid spread we have been seeing. While we are still acquiring more information about transmission, there is some data that suggests that once the patient resolves from their infection, they’ve still been able to isolate the virus from their secretions up to 50 days!
Although the illness can infect anyone, it appears that the disease and its complications are more severe in the elderly and people with immune compromised conditions. Young people seem to fare well with the illness and recover. With respect to disease course, in approximately 80% of the patients the symptoms are slightly milder than the flu, that is: runny nose, sore throat, cough and fever. In severe cases, people can have difficulty breathing. 20% of the patients will develop complications such as Covid 19 pneumonia, and 15% of those will die. As stated above, this mortality is more in the elderly and people with pre-existing immune compromised conditions.
Although the current mortality rate is quoted as 3.4% when compared to the flu which has a 0.1% mortality, I personally believe that the mortality rate from this disease is much less than 3.4%. This is because a majority of patients have a mild illness similar to a cold or mild flu, and they do not come to clinical recognition, that is, they never see a doctor. Mortality rates are calculated based on putting the number of deaths in the numerator and the number of people with the illness in the denominator. Since a large proportion of people are not reporting their illness, because they’re not very sick, the denominator is actually much larger than the current data suggests, which would bring the mortality rate down significantly. I believe as we get more experience with this virus, and have more testing, we will see a fall in the mortality rate.
The classic teaching in Infectious Diseases is to isolate contagious diseases. This is why, travel has been restricted, schools have gone to virtual classrooms, parks and museums have closed, and the NBA has cancelled the season, etc. Social distancing is extremely important. We need to isolate this virus and let it “burn out” within each community, not allowing anyone else in who could carry the virus back into the community. Unfortunately, these decisions are extremely costly, which has delayed the decision to practice social distancing. As leaders however, we have a higher responsibility, not just to ourselves, but to the entire community, and I believe these tough decisions need to be made. This is classical Infectious Disease principles, and if they are adhered to properly and in a timely manner, we will be able to stop the spread. Waiting for an index case to occur in the community before we start practicing social distancing is very dangerous. By the time the patient is diagnosed, they’ve had contact with multiple people, those people have had contact with multiple people, and the disease has already mushroomed and spread throughout the community. Therefore, one should not wait for an index case. There are currently no recommended/approved antivirals (medications) to treat this illness, nor is there a vaccine at present. But we are currently studying some antivirals that may have some promise, and are trying to develop a vaccine as well.
I want to ensure the community that the United States of America has the best healthcare system in the world. We have an infrastructure that is unparalleled. There is a Department of Health in every major city in the United States. We have the CDC, and the National Institute of Allergy and Infectious Diseases, headed by one of the most prominent physicians in the world, Dr. Anthony Fauci. By following the recommended principles and guidelines, we will be able to stem the tide of this pandemic.
I hope this has been informative and educational, and that I have answered some of your questions and concerns.
Leave a Reply
72 Comments On "Op-Ed: Informative Article Giving Perspective On Coronavirus"
All opinions expressed below are user generated and the opinions aren’t provided, reviewed or endorsed by any advertiser or DansDeals.
Thank Dan for posting the article.
Stay Well
Gut Shabbos
thank you so much for explaining this in such a clear manner. (and not writing like the MSM who seem to enjoy scaring the living daylights out of people)
Plenty scary.
Thilim, Thilim and more Thilim
Thank you.
Thank you DansDeals
Thank you
Finally an article well written and understandable
Read the post?
Well written
Thank you Doctor Freedman and thank you Dan and JJ!
What’s your take on the widely read Medium article?
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
people will die from everything, it’s a media hype
@Shmoogrr
Do you specialize in infectious disease?
On what authority can you dismissively say it’s a media hype?
Do you have any idea of the presumed 1000’s of cases of Frum people in the NY area since you commented who mostly haven’t even been tested but were directed by health professionals to self isolate as well as the too many who were hospitalized with severe symptoms and got back positive results after Shabbas or are still waiting for results?
I directed my comment to a professional with a real name and credentials.
End of rant.
I am not questioning this doctor or any other but wouldn’t it be a lot more effective to practice social distancing of those 50 and older and/or those with underlying health conditions (and those who live with them)? Instead of closing shuls just restrict shul to men aged 13-49 who are healthy and don’t live with anyone older than 50 or with an underlying health condition. This population should daven in small groups in line with what the Israeli Health Department has recommended.
I live in a community that has closed call the schools and shuls but yet I saw hundreds of people (including elderly frum Jews) at a local supermarket last night. I know of a senior citizen planning on attending a chasuna next week. This is all in a community that the local Jewish leaders have instituted these strict restrictions.
It still would be a big deal to socially separate the at risk population but it would effect much less people and prevent the same amount of hospitalization and death than attempting to socially separate everyone. I would understand if this social distance policy would be for a few days or even a week but most medical experts expect the spread of the virus to get worse not decrease in the coming weeks. Does it really make sense for health kids to be out of school for a month? Public health decisions should be
The healthy get it and give it to the immune compromised or elderly. Social distancing doesn’t work unless EVERYONE practices it.
No. The younger people who are not at risk of dying are at risk for speading it to those at high risk. And yes, I’m a physician.
So where do we draw the line? Shouldn’t we close grocery stores and make them delivery only? The social distancing guidelines are themselves causing people panic and the grocery stores were a lot more crowded than usual last night. Closing schools and shuls don’t fully help if people are still going out other places, does it?
If the younger population has no interaction with the older/high risk population they won’t spread it. Public health decisions are always made on a cost/benefit analysis. Do you really think after week a shul being closed people won’t start questioning how long this will go on for?
Do you mean a case where your friend’s neighbor has elderly parents who need their help or family who is immunocompromised?
The social distancing is to minimize spread by anyone, which ultimately help the over 50
Thanks clarifying with a simple, understandable read!
Wow. Great article. Very clear and informative. With all the rumors and panic out there it’s nice to see someone explaining things in detail and in plain English. Thank you JJ!
Wow this is awesome! Thank you for sharing!!!
Based on current US response (testing etc, how long does he think the us might go on quarantine?
Thank you for this
JJ, Thanks for providing us with this information from a qualified source. Too much false information is being broadcast by persons with no medical knowledge.
a terrific article, addressing many of our concerns and perfetc for our communities.
While the 3.4% is likely less because as the Drpoints out the denoiminator is less but for the over 50 age the denominator is higher, meaning that the 3.4% is based on the entire population including younger people who may even account for a bigger portion of the denominator.
Only pointing this out because the Dr pointed out a reason that denominator is likely higher for the entire population, but if focused on the elderly the denominator is lower.
If the article would include a number for the elderly than the elderly may appreciate and practice social distancing.
Having said IMHO the article is perfect,
thanks for the education! for a long while i thought this was media sensationalism; trying to sell the news.. but it got real for me when my beloved NBA got suspened. Now im paying attention.. Its always real when it affects the $
Thank you for posting this. I’ve been writing my VAAD all week to close the shuls in my community, as well as the schools, until this calms down. They said that they are relying on the guidance from our local county health officials who recommend that only the ill and infirm should avoid shul. Mind you, our local county health officials have never managed a global pandemic. I applaud those communities whose Rabbis have demonstrated the courage to make the difficult decisions resulting in shul and school closures and promotion of social distancing even before the index case presents. Since we know that this virus can spread from people who do not demonstrate symptoms, by the time the index case presents, it will have been transmitted to others. There are at least 4 adult males with this virus in their 60s in intensive care, one of them on a respirator, from the New Rochelle community. Hospitals are not permitting visitors, so their family members are not able to best advocate for them. This is serious, even for people who are not elderly, and should not be taken lightly. Let’s focus on prevention in the communities where that option is still available.
May Hashem provide refuos and yeshuos to all of his children.
Great article, thanks for posting.
@JJ maybe your FIL can write up a much shorter article and “dumb it down” a bit so it can be shared easily on social media and the younger generation will start to take COVID-19 seriously
The CDC is an embarrassment
Minor amendment: can you suggest to your FIL that he should clarify the 15% statistic? Overall 15% of the 20% of “the known patients who get seriously ill” have died. It is not 15% of “all known Covid19 patients”.
He said 15% of the 20%…20% of the patients will develop complications such as Covid 19 pneumonia, and 15% of those will die.”
Which comes out to 3 out of 100 of all who become sick if my math holds true. But again, this only the clinically recognized.
If # is 3 out of 100 why does he say 3.4 isn’t the right # ??
Thank you for the clear and thorough article! Can you explain what this means please?
“While we are still acquiring more information about transmission, there is some data that suggests that once the patient resolves from their infection, they’ve still been able to isolate the virus from their secretions up to 50 days!”
Should the rabbanim come out with a psak that you shouldn’t touch your face while saying shema?
Suggestion-Use your talis and distance your hand a half an inch.
Mezuzah, Torah too
Thank you so much Dr. Freedman for sharing this valuable information to provide clear direction as to where we are now and how we all can help stem the tide.
It will spread widely, there is little doubt. The major focus now is to slow progression so that the health system is not overwhelmed. The sickest patients will need care that is available from only a limited supply of medical devices that can be used to address respiratory distress.
“The US Has The Best Health Care In The World” Really?! Thats why even though we have had over a month to prepare for this we have no testing kits available! and even when they do finally become available, 28 million Americans without any health insurance will be scared to call a doctor due to the cost. Our healthcare system is a joke compared to many countries alot poorer than us including South Korea and Canada. A doctor should know better than to make a comment that like. You yourself admit that the mortality rate is likely to be alot lower but we dont know how many people actually have the virus. Why is that? Where is the mass testing program? The only reason Tom Hanks got diagnosed is because he was in Australia and was able to get tested! Thats the brutal reality about the shambles the US health system is in. If your going to be honest about the true facts and figures here than also be honest about how ill prepared our country is to deal with this.
I live in Canada. Everyone here knows if you need good healthcare, you go south. If you are deathly ill and can not get the treatment here in Canada quick enough, you go south to the USA. The top doctors all leave Canada and practice in the USA because they get paid nothing here.
We wait to get regular health tests. You can wait a month to 3 months at times to get a serious health test. Yet all the stupid people just talk garbage , based on no facts about a country they know nothing about. Be happy that you have the best healthcare in the world. If you make $0. and your on medicare or any other government free healthcare in the USA you have MUCH BETTER healthcare then any Canadian on OHIP.
you forgot to mention that if you need an MRI you get to book a appointment about 6 months later for 2 AM. absolutely nuts
Many experts are saying there is no reason for widespread testing. If you have symptoms or were exposed you should self quarantine at home. If you are older have an underlying medical condition that requires medical care then you should go to the hospital and will be tested to confirm (and to rule out other possible causes). We live in an instant generation. If we want something we order it online and get it the next day. People need to relax. Stop the run on toilet paper and water. There’s enough for everyone!
Mass testing is to subject people for mandatory isolation. for people who are carrying around the disease without feeling any symptoms. Which is really common.but yes we stop the run for toilet paper!!
Testing in the us so far is a disaster per dr. Fauci’s admission. But healthcare system overall is much better then Canada by far. And p.s. South Korea isn’t poorer then us they are actually richer per capita of course!
Yasher Koach for posting!
Excellent article — I will note, however, that many news reports indicate that unlike the flu, this disease DOES NOT present with a runny nose or other nasal symptoms!
Other observations, including a cough, spiking fever in some and difficulty breathing are correct.
“We have the CDC, and the National Institute of Allergy and Infectious Diseases, headed by one of the most prominent physicians in the world, Dr. Anthony Fauci.”
Above him, we have a total imbecile & Narcissistic President..
#Trump2020
you mean #TRUMP2020INPRISON
THANK YOU!! How can any human not see what an ignorant, self-serving monster this person is. Apart from EVERYTHING ELSE, he literally dismantled the system that would have predicted and mitigated this situation. I a, so ashamed that so many in our community can’t see through this “president”.
Please blame this on him. This is God’s doing.
Stop blaming your problems on trump. He’s done so much good and people like you just make your party look worse
This may seem crazy, but a genuine question relative to the decision to close Universities and send the students home. Would it not be better to keep a University isolated as a community; have COVID19 progress a full and complete transmission through that community (assuming the severity is low in this demographic); such that when Summer comes and they redistribute around the country, they have already had the virus and can no longer be carriers for it? Similar idea that vaccinations do not just protect the vaccinated, but also the people they come into contact with.
TL/DL: Speed up the virus progress in isolated communities of young healthy demographic to reduce future carriers.
Genuine question for genuine doctors
It is not clear that immunity is acquired from exposure/infection of COVID19. There are cases that seem to prove otherwise, with some Doctor’s positing that maybe the facts are mispresented.
Well written and very informative.
sounds like an excellent clinician and a wonderful human being
You should see his son in law!
Thanks, JJ!
(Don’t worry, you’re still more famous than your FIL in my book 🙂
A good article, but one complaint. He uses the term “index case” several times but doesn’t define it.
Good question! “The index case, however, is the patient in an outbreak who is first noticed by the health authorities, and who makes them aware that an outbreak might be emerging.” from this article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62331-X/fulltext
SHAME on you for minimizing this situation and for defending the indefensible. But keep watching FOX “News” and spreading deadly ignorance. There is more at stake here than your blind political allegiance.
When will you stop making everything political?
Political? Like saying this was all a “Democratic hoax” and telling people to continue to go to work? This isn’t political at all. But it is about leadership and facts and policy to protect people. None of which are in evidence now.
When will you realize that nothing any president does or says isn’t all straight from God? If you are so “ashamed” of this president as you said earlier, then you think you know better than God. Stop making everything political.
You think Hitler (an elected leader) was “straight from G-d”?? That no one should have fought against that evil, but rather just let it play out? Was speaking out then being “political”? What I said/meant was, I am ashamed of our community. For not calling out gross incompetence and greed that is going to cost thousands – if not more – lives in this crisis.
Everything (including Hitler Yemach Shemo) is from Hashem. And you “calling out” anything political, is coming from a place of arrogance, like you know better, and you can control things. The only thing you can do is your own protection and pray.
Thank G-d others in the world didn’t take your attitude during the Shoah and countless other horrors. I guess you think Tikun Olam is political (and unnecessary), too. I’m genuinely baffled by your words.
Like you can do something about about our president. Sorry for upsetting you.
thanks dan
amazing how some people feel the need to discuss trump and politics even in serious situations such as this one.
either way thanks for a great article
one thing i dont understand is how do we know that corona is any more underdiagnosed than the flu,also there not everyone who has the flu goes to the doctor
shame on you for trying to play down an issue that will bring to Chas veshalom the death of many who could have been saved. shame on you for considering yourself a relialable and prominent doctor when you obviously don’t have the basic understanding of statistics. yes there are many infected that we don’t even know about but to use a number that is outright false and a underestimate of the real number. take the survival rate as a starting point its at about 50% so use that number instead of the death rate, obviously both numbers are incorrect but a educated doctor should know better.
shame on you for posting such false and bad advice