The United States reached a tipping point on Feb. 28, 2020, in the fight to contain COVID-19, the disease caused by the novel 2019 coronavirus. With the diagnosis of two patients in California with no direct link to areas of high viral prevalence (e.g., China or the Diamond Princess cruise ship), the Centers for Disease Control and Prevention (CDC) has now confirmed this virus exhibits community spread in the U.S. This concerning and dangerous milestone means the virus has likely been circulating within the community. While the cases here in the U.S. are relatively low, we now know the virus has been circulating for some time. With further testing, we will likely see that number grow significantly.
Our leadership team at Envision Healthcare has developed a coronavirus task force to provide continuous support to hospitals and clinicians. This task force provides ongoing communications, education and training, operational resources and evaluation and treatment guidelines. As the largest emergency medicine group in the country, we understand our central role in providing solutions to our hospital partners and caregivers as we work together to treat COVID-19 patients and prevent the spread of the disease.
COVID-19 in China
COVID-19 was first identified in China in December 2019 and caused significant concern and even panic in China and around the world. Using unprecedented containment measures, the Chinese government quarantined more the 60 million citizens, grinding transportation, travel and their economy to a halt. While the efforts likely slowed the progression of the virus, the virus still escaped the Chinese border and spread to other continents, emerging as a pandemic threat. Initial infection rates and death rates seemed low, discordant with reality, when news reports of chaos, mega-hospitals construction and supply shortages flooded social media and the nightly news. Some scientists believe hundreds of thousands were likely infected, with thousands dying from the disease despite the official reported numbers. As the virus spread to other countries, more clarity developed around methods of transmission, severity of illness, mortality rate, duration of infection and incubation period.
COVID-19 and the Flu
Since many of us are familiar with influenza, or the seasonal flu, the flu provides a great comparison point with this coronavirus. Influenza is a seasonal respiratory illness spread by persons with the flu who cough or sneeze. Unknowing persons either inhale the virus directly or touch an object where viral particles remain from another infected person (e.g., a doorknob, subway pole or cell phone). Even with a vaccine, more than 26 million people will likely contract influenza this season. For those of us who get the flu, symptoms include a week to 10 days of body aches, cough, fevers and chills. Most people will recover without major health complications, but the flu can also be fatal. The influenza mortality rate is 0.1 percent, meaning 19,000-26,000 people will die this year from influenza. Those numbers are staggering, and unfortunately, they are often underreported.
How is COVID-19 Different?
Based upon research out of Asia, Australia and Europe, the picture is becoming clearer on COVID-19. First, while the virus spreads in a similar fashion to the flu, the virus tends to spread more easily than the flu. For example, for every three people who become infected with this coronavirus, seven to nine more people will become infected. This phenomenon is due in part to the virus’ long incubation period of approximately five days and long average infection time of nearly two weeks. It appears people with COVID-19 are contagious for the entire duration of the infection and even during times when they do not know they are ill. In contrast with the flu, for every three people who get the flu, four more will become infected until the virus eventually wanes as the winter ends. The duration and incubation period of the flu is much shorter. There is also a vaccine to help prevent the flu.
COVID-19 also appears to be more aggressive than the flu, resulting in higher rates of hospital admission and death. Some studies suggest the mortality rate of COVID-19 is 10-20 times higher than that of the flu. Perhaps the mortality rate is the number that is most concerning. Currently, there are no vaccines or antiviral medications for treatment for COVID-19; however, over-the-counter fever-reducing medications can be used for aches, pains and fevers associated with the flu or this virus.
Recommendations and Considerations for the General Public
- Wash your hands frequently with warm water and copious soap for 20 seconds
- Avoid touching your face if you haven’t washed your hands
- Avoid sick individuals
- Only seek medical attention for life-threatening conditions in the emergency department
- Contact your primary care physician first if you have questions about viral exposure or desire to be tested
- Researchers are working to identify antiviral medications or vaccines
- Follow the guidance on www.CDC.gov for the latest updates.
As one of the nation’s leading medical groups, Envision Physician Services is committed to assisting our clinicians, healthcare partners and patients as they navigate the complexities and evolution of COVID-19. You can learn more about our organization’s response and ongoing work to address COVID-19 at www.envisionhealth.com/coronavirus.
Adam Brown, MD, MBA, FACEP
Dr. Adam Brown is the President of Emergency Medicine for Envision Physician Services and leads the National Coronavirus Task Force for Envision Healthcare. He is a board-certified, practicing emergency physician living in Washington, D.C.