Coronavirus is a deadly virus outbreak from Wuhan China. Human coronaviruses are common throughout the world. Seven different coronaviruses, that scientists know of, can infect people and make them sick.
Despite the fact that older adults are most at risk, Millennials have taken on an outsized role in the COVID-19 pandemic. During press briefings, the Trump Administration has zeroed in on young adults, calling on them, specifically, to stay home and practicesocial distancingto slow the transmission of the virus. Stories about healthy young people who contracted serious cases of COVID-19have gone viralon social media.
Now,new dataout of the U.S. Centers for Disease Control and Prevention (CDC) have thrust younger adults into an even brighter spotlight: it suggests adults ages 20 to 44 have accounted for nearly 30% of U.S. COVID-19 cases, and 20% of related hospitalizations. After adding adults ages 45 to 54, the percentages swelled to nearly 50% and 40%, respectively.
That’s a somewhat surprising finding, given the refrain that elderly adults areat by far the highest riskfor serious illness and complications. It’s also a conclusion that should be taken with a grain of salt.
“For younger adults, the bottom line is there is still a small percentage that can get severe disease,” says Dr. George Anesi, director of the Medical Critical Care Bioresponse team at Penn Medicine. “In the overwhelming majority of cases, they do okay.”
On the whole, the report affirmed data out of China showing that older adults, who are likely to have underlying conditions and poorer overall health, are at the highest risk of dying or suffering very severe disease, whilechildren are largely unaffected. Despite the relatively high number of young adults included in the new CDC report, it still backs up that conclusion. Younger adults may be getting sick, but not many of them are progressing to the ICU or death, the report shows. Meanwhile, about a third of confirmed U.S. hospitalizations were among people 65 and older—but more than half of patients admitted to the intensive care unit were in this age range, as was the vast majority of the (very small) pool of people confirmed to have died from COVID-19.
Only 5% of total U.S. cases were among people 19 or younger.
There are also caveats to all of the report’s numbers. It was based on the approximately 4,200 COVID-19 cases reported to the CDC by March 16. Givendomestic testing shortages, that’s likely a gross underestimate of the total number in the U.S.
“We are prioritizing testing for more symptomatic and sicker patients, rather than testing everyone. We’re almost certainly missing less-sick patients,” Anesi says. Once we include them, “these numbers might look a little bit better, in that a lower proportion of patients [would get severe disease].”
Even within the report, a lot was unknown. The CDC could only confirm the patient’s age in about 2,500 cases. Only about 500 people were known to have been hospitalized, while 120 had been sent to the ICU and about 40 had died. That’s not to say the report is flawed, only that it’s preliminary. In this outbreak, as is always the case,numbers are shifting constantly. It’s important to get an early read on the situation, but that early read is likely to evolve considerably as time goes on.
To be sure, people of all age groups need to take coronavirus seriously. The CDC has urged everyone—young or old, sick or healthy—tostay homeas much as they are able. The new data is a good reminder that no one is immune to COVID-19, and that everyone has a role to play in slowing its transmission.
Older adults need to be most vigilant of all, but “any adult of any age is certainly at risk,” Anesi says. “We need a full societal commitment to this. Life is going to look different for a while, and that’s important to be able to turn the tide on this.”
On March 17, Carolyn Vigil’s husband, James, became thefirst person in West Virginiato be diagnosed with COVID-19, meaning every U.S. state now has at least one confirmed case. Carolyn, who is 55 and now experiencing symptoms herself, spoke with TIME about thelong roadto getting James, 53, tested—and the even more circuitous path to getting his results.
Their story began on March 12, when James awoke with what seemed like a bad cold. By the next day, his symptoms had worsened, and seemed consistent with what the couple had read about COVID-19, despite James having no clear link to a confirmed patient or a high-risk travel history. Carolyn now believes he contracted the virus during a weekend trip the couple took to Washington, D.C. the prior weekend. Here’s what happened next, according to Carolyn (what follows has been edited and condensed for clarity):
We went to the ER, and I left James in the car. He was really sick: his fever had been as high as 104°F; he had a cough, terrible headaches, body aches. He has asthma, which can lead to more serious disease. I had no symptoms at that point, but I was trying to keep my distance from people at the hospital, because I thought I could be a carrier. A staff member met me at the door. She was very kind, but she said, ‘I don’t think we’re equipped to do this.’ A nurse came out to the car with a sticky note and the number for a hotline—which I had already tried to call, only to find that the number didn’t work—and told me I had to leave and just call that number, or drive to Morgantown, two and a half hours away. I told her, ‘I’m going to remain calm, but I’m not leaving unless he is at least screened.’ The head nurse came out and saw James, and she could tell he was sick. James and I waited in the car until they took him to a room where they could do the exam without risking others in the hospital. Once he got back there, they were very compassionate. They gave him very good care.
They first tried to rule out all other respiratory illnesses. Those tests came back negative, so they decided to go ahead and do the COVID-19 test. But we had to wait until Tuesday to get the result back. Then Tuesday came and nobody contacted us. We called the ER. The ER told us to call the state health lab. The state health lab told James to call the county health department. The county health department said, ‘We have no record of you ever being tested.’ It was bizarre.
The ER doc called James back and said, ‘Listen, they’ve lost your tests. I’m not sure what to do because we’re not supposed to take any more people into the ER for testing.’ Then a different doctor called back and said, ‘Your tests were found, but they were sitting at the lab and they have not been tested. Now they’re not viable because it’s been five days, so you have to go get tested again—but we don’t know where.’
I called the governor’s office. They tried to help, but they didn’t have much information. A friend who’s very politically connected knew Senator Joe Manchin and offered to help. One of Manchin’s staffers called and said, ‘We’re going to have someone call you back within the hour.’ Dr. Catherine Slemp, West Virginia’s state health officer, called me back, personally on my cell phone, within an hour. She said, ‘Let me cut to the chase: I have your husband’s results in my hand. I don’t know why you were told they were lost, I don’t know why you were told they’re not viable, but they’re in my hand right now.’ Then she said, ‘Are you sitting down?’ I sat down, and she told me James was positive—the first case in West Virginia. If I wasn’t so persistent, and if some angel that knows Senator Manchin did not help, I think we’d be without test results, and I don’t know that we would have ever gotten them.
Now I have symptoms. I was tested on March 18 at a drive-through testing center, and it was much easier this time around. I was in and out in about 10 minutes, and I should have results in a couple days.
We’re hunkered down. We have an adult son with autism who’s not symptomatic at all, but I think he should be tested too. He’s been super, super anxious because he has a lot of questions and I can’t answer them. It needs to be black or white answers, and everything’s gray.
We’ve been told to make a list of everyone we’ve been in contact with over the past three weeks. The health department will call them, but I wanted my close friends to hear the news from me first. Most people have been 100% supportive, but a few people were like, ‘Wow, you did this to me?’ I had no idea I was doing that. It was before everything got crazy.
Hopefully, now that there is a case and we’re giving them feedback and other people are getting more involved, maybe we can get some of this fixed so we can get the health care that West Virginians need. I just want this community to feel protected and safe.
Sen. Joe Manchin’s office encourages West Virginians who need help securing testing or test results to email Common_sense@manchin.senate.gov or call 304-342-5855.
All routine or non-emergency surgeries scheduled to take place at Safadrjung hospital and a Delhi government-run Guru Nanak Eye Centre from Thursday onwards have been cancelled in view of the Covid-19 outbreak.
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This week’s issue of TIME is centered around a special report on the current coronavirus pandemic. It features six different covers, each with a portrait of individuals directly impacted by the virus, ranging from the tragically hard-hit Life Care Center in Kirkland, Wash., to the balconies of Tehran and the streets of China. Together, they offer a sense of how COVID-19 is forcing regular people around the world to adapt to a new reality.
Cheryl Chutter, 51, Stamford, Conn., U.S.
Angela Strassheim for TIME
When photographer Angela Strassheim went recently to visit Cheryl Chutter in Stamford, Conn., she was there not on assignment, but as a friend. Chutter, 51, was diagnosed with COVID-19 on March 17.
Chutter was on her first day of quarantine, and Strassheim had come by to leave some food for Chutter and her son outside the door. As she approached the house, she saw Chutter in the window wearing a face mask, and was struck by how powerfully the mask seemed to visually convey the frustration, fear and isolation her friend was feeling. Strassheim asked if she could take a quick photo on her iPhone, and came back the next day with her camera. “For me it sums up where we are at right now. We are all imprisoned in our homes and the window is like a mirror to look back at ourselves,” she says. “You are that same person in your own home whether you have the mask on or not.”
Chutter thinks she was infected when she attended a birthday party in Westport, Conn., in early March. About a week after the gathering, she learned that one of the attendees, who had recently traveled abroad, had tested positive for COVID-19. By then, she had already been once to a hospital and once to an urgent care facility duea high fever, chills, body aches and utter exhaustion. But it was only after she discovered she’d been in contact with someone at the party who was diagnosed with COVID-19 that she was able to geta test, since kits were so scarce.
When she finally received her positive test result on March 17—after eight days in quarantine—she said one word: “Relief, I felt relief. I knew now that my dad can get tested. I just want to be safe. I want to take care of my son, be considerate to other people and I don’t want to leave my house till quarantine is over.” Since the party, 20 attendees have tested positive.
Entering her second week of quarantine, Chutter is trying to stay positive, but the social isolation—especially the forced estrangement from her son—is emotionally challenging. “I was told to have as little contact with my son as possible,” she says. “I can’t prepare meals for him. I wear a mask and gloves in the house. I can’t be near him.”—Paul Moakley and Alice Park
Judie Shape, 81, Kirkland, Wash., U.S.
David Ryder for TIME
For the last three weeks, Lori Spencer has only been able to see her 81-year-old mother, Judie Shape, through a glass window. Spencer checked her mother into the Life Care Center nursing home in Kirkland, Wash., on Feb. 26. Since then, the facility has become one of the epicenters of the COVID-19 outbreak in the U.S.: at least 30 deaths have been linked to the Center.
After other facility residents tested positive for COVID-19, Shape tried to get tested herself, but says she had to wait 11 days. Facility officials have said they didn’t have enough tests for residents as the outbreak spread, according to the Associated Press. Spencer describes the ordeal as “surreal and maddening.”
Eventually, Shape tested positive. Spencer continued to visit her at the Life Care Center, but they had to stay separated by a window. Independent photographer David Ryder’s image of the mother and daughter communicating through this barrier gained attention after being published by Reuters. On assignment for TIME, he returned to the facility on March 17 for a posed portrait of the duo. Given the situation at Life Care Center, Ryder was not allowed on the premises, so he set up about 100 feet away, used a powerful zoom lens and had to call Spencer on her cellphone to work with them on their position at the window. Ryder says the core intent of the photograph was to convey “loved ones trying to connect.”
“This is the strangest situation where someone’s going through something so difficult with this disease… and you can’t hug them,” Ryder says. “And even the comforting voice, you can’t even really hear that except through a phone, which isn’t quite the same.”
For Spencer, the window that separates her from her mother signifies a lack of control. “When I look at that glass, what it means to me is that there was no more control, no matter how much you love the person on the other side,” Spencer says. “All control was lost.”
Shape is doing well now, despite the difficulties, Spencer says. “At least I can see my mom.” —Andrew Katz and Sanya Mansoor
Gao Zhixiao, 32, Beijing
Wang Wei for TIME
Since the outbreak erupted in China, Gao Zhixiao, a 32-year-old delivery driver living in Beijing, has had to take a health test and spend 20 minutes disinfecting his motorcycle and clothes every day before setting off on his route. Without drivers like Gao, who works for delivery giant Meituan, to bring goods to their homes, families would go hungry and the sick wouldn’t get vital supplies. Luckily, Gao has not contracted COVID-19, but he puts his health at risk every day.
Elmira Laki, 30, and Elahe Laki, 33, Tehran
Forough Alaei—VII Mentor Program/Redux for TIME
As the virus spread in Iran—one of the hardest-hit countries to date—Elmira Laki, 30, decided to self-quarantine at the Tehran home of her sister Elahe, 33, just to be cautious. In this image from March 3, Elmira stands on her sister’s balcony; Elahe’s face can be seen reflected in the window through which the photograph was made.
Patrick Walker, 52, London
Anastasia Taylor-Lind for TIME
After learning he’d been exposed to someone with COVID-19, Patrick Walker, a 52-year-old tech entrepreneur and cofounder of the startup Uptime, began self-quarantining at his London home on March 9. Five days later, he tested positive for the virus. “I’m living proof [the coronavirus] can be picked up sitting in a meeting with somebody,” says Walker. “A lot more people have it than they think right now.”
This March 18 portrait shows him outside his home with his wife Noemie Olivero Walker, and young children Henri and Celeste—all of whom have tested negative so far.
Fulvio Avantaggiato, 60, Torre d’Isola, Italy
Luca Locatelli for TIME
COVID-19 has hit northern Italy harder than almost anywhere else in the world. In a bid to stop the spread of the virus, Italian authorities imposed travel restrictions—expected to last until at least early April—on the country’s 60 million residents. Fulvio Avantaggiato, 60, is an emergency room radiologist at the San Matteo Hospital in Pavia, in northern Italy; when he’s not working, he self-quarantines away from his wife and daughter at their home.
On Tuesday, March 17 the Brooklyn Nets reported that four of the team’s players had been diagnosed with COVID-19: Kevin Durant was one of them. (He said he’s doing fine). Most Los Angeles Lakers players were reportedly tested for COVID-19 on Wednesday. The traveling party for the Toronto Raptors was tested last week: the results came up negative. Also last week, Utah Jazz All-Star Rudy Gobert received a positive diagnosis in Oklahoma City: Oklahoma health officials then scrambled to test 58 Utah players, coaches, staff and associates at the Chesapeake Energy Arena, where the Oklahoma City Thunder play home games. A second All-Star, Utah guard Donavan Mitchell, also tested positive for COVID-19.
Under normal circumstances, news of Americans—professional athletes or otherwise—getting tested for an infectious disease would not be cause for outrage. But during this global pandemic, the U.S. is faced with a shortage of testing kits for COVID-19. Even many health care workers, tasked with treating sick patients on the front lines and doing what they can to halt the spread of the disease, don’t have ready access to coronavirus testing.
So it’s only natural to wonder why professional sports teams seem to have easier access to testing than the general population. It’s only fair to ask, how come the Utah Jazz can get tested for COVID-19, but I can’t?
New York City mayor Bill de Blasio tapped into this dissatisfaction upon reacting to the news about the Nets players. “We wish them a speedy recovery,” de Blasio wrote on Twitter. “But, with all due respect, an entire NBA team should NOT get tested for COVID-19 while there are critically ill patients waiting to be tested. Tests should be not for the wealthy, but for the sick.” (According to sources, the Nets paid a private company for the testing).
We wish them a speedy recovery. But, with all due respect, an entire NBA team should NOT get tested for COVID-19 while there are critically ill patients waiting to be tested.
A Oklahoma State Department of Health spokesperson told TIME that the Jazz players and supporters were tested as a precaution, since they had been in close proximity to a player with a confirmed infection. Isolating positive cases could help halt the spread of disease. On Tuesday, doctors at the OU Medical Center in Oklahoma City gave a COVID-19 briefing; there are now 29 positive cases in the state. “It’s very important to get testing, that we have the ability to test large numbers of people,” said Dr. Douglas Drevets, chief of infectious diseases at the University of Oklahoma Health Sciences Center.
I reached out to Dr. Drevets with an interview request. Drevets wrote an email to an OU Medicine publicist about the request: I was copied on the correspondence, presumably unintentionally. “I am concerned that what he wants to talk about is the thunder situation,” Drevets wrote. “[Where] NBA players got tested with a shortage of tests in the community. Please work through that issue first. Otherwise I’m available.” When I asked the publicist why it would be “concerning” for the chief of infectious diseases at the University of Oklahoma Health Sciences Center, who has talked about the need for widespread testing, to discuss whether testing the Utah players was a proper use of scarce resources, she replied via email: “As University of Oklahoma employees, our faculty and staff are not allowed to give opinions on medical issues. We may discuss matter of factly what the protocols are for testing and what testing involves, if you would like to discuss that. We will not discuss if something was a wise use of resources or not.”
Through the spokesperson, Drevets declined the interview request.
To be sure, disease experts and health care economists point out the benefits of testing professional athletes, especially NBA players. “The best use of a limited number of tests is to prevent ‘super-spreaders,’ people who because of their job are likely to spread the virus widely,” says Alex Tabarrock, economics professor at George Mason University. “Since basketball players are in close physical contact with one another and the players are spread over the entire United States it was a good decision to test NBA players. Once one test came back positive it was imperative to test other players.
The NBA tests have had a welcome if unintended consequence. “By shutting down the NBA, thousands of fans were not crowded into arenas where players and almost certainly other fans were infected,” says Tabarrock.
The decision also had a stunning ripple effect throughout sports—the NCAA’s March Madness basketball tournament was soon cancelled, Major League Baseball and the National Hockey League suspended their seasons, the Masters golf tournament was postponed—and society. “There likely was some societal benefit with major organizations moving quickly to mandate physical distancing because these diagnoses were in people who who are household names,” says Dr. Kevin Volpp, director the University of Pennsylvania’s Center for Health Incentives & Behavioral Economics. “One of our big challenges as a society right now is getting people to take physical distancing seriously. Ifit were not for Rudy Gobert getting tested, a lot of the very important physical distancing initiatives in the last week may not have happened. To avoid the type of situation Italy is in, with their health system being completely overloaded, moving quickly on these initiatives has been extremely important.”
COVID-19, however, has rapidly moved into a new phase. Those 58 tests for the Jazz traveling party did carry an opportunity cost: an asymptomatic Oklahoma City Uber driver, for example, who might be unknowingly be carrying COVID-19, and in close physical proximity with many people, could have potentially benefitted from that 58th test used on someone in the Utah Jazz universe. And with social distancing now the norm, tests for asymptomatic young NBA players carry less urgency than those for at-risk patients showing COVID-19 symptoms like a fever. Even if that player unknowingly has COVID-19, he should be isolated anyhow and halting the spread on his own.
With scarce testing available, imperfect testing prioritizing is now necessary. And asymptomatic NBA players can safely move to the back of the line now that the season has been paused. Volpp offers a rough blueprint: First priority goes to hospitalized patients showing symptoms. Second goes to health care workers who may have been exposed to COVID-19. Third are symptomatic individuals, especially older adults and people at risk of getting sick quickly, such as oncology patients. The final group is very much in flux; it can be symptomatic people with known contact to COVID-19, or people with symptoms in places with the highest rates of COVID-19 diagnoses.
“Let’s just hope that soon enough there’s testing for everyone,” says Volpp, “so we don’t need to do this kind of rationing.”
Battling a pandemic as serious as COVID-19 requires drastic responses, and political leaders and public-health officials have turned to some of the most radical strategies available. What began with a lockdown of one city in China quickly expanded to the quarantine of an entire province, and now entire countries including Italy. While social isolation and curfews are among the most effective ways to break the chain of viral transmission, some health experts say it’s possible these draconian measures didn’t have to become a global phenomenon. “If health officials could have taken action earlier and contained the outbreak in Wuhan, where the first cases were reported, the global clampdown could have been at a much more local level,” says Richard Kuhn, a virologist and professor of science at -Purdue University.
The key to early response lies in looking beyond centuries-old strategies and incorporating methods that are familiar to nearly every industry from banking to retail to manufacturing, but that are still slow to be adopted in public health. Smartphone apps, data analytics and artificial intelligence all make finding and treating people with an infectious disease far more efficient than ever before.
“The connectivity we have today gives us ammunition to fight this pandemic in ways we never previously thought possible,” says Alain Labrique, director of the Johns Hopkins University Global -mHealth Initiative. And yet, to date, the global public–health response to COVID-19 has only scratched the surface of what these new containment tools offer. Building on them will be critical for ensuring that the next outbreak never gets the chance to explode from epidemic to global pandemic.
Consider how doctors currently detect new cases of COVID-19. Many people who develop the hallmark symptoms of the -disease—fever, cough and shortness of breath—-physically visit a primary-care doctor, a health care provider at an urgent-care center or an emergency room. But that’s the last thing people potentially infected with a highly contagious disease should do. Instead, health officials are urging them to connect remotely via an app to a doctor who can triage their symptoms while they’re still at home.
“The reality is that clinical brick-and-mortar medicine is rife with the possibility of virus exposure,” says Dr. Jonathan Wiesen, founder and chief medical officer of MediOrbis, a telehealth company. “The system we have in place is one in which everyone who is at risk is potentially transmitting infection. That is petrifying.” Instead, people could call a telemedicine center and describe their symptoms to a doctor who can then determine whether they need COVID-19 -testing—without exposing anyone else.
In Singapore, more than a million people have used a popular telehealth app called -MaNaDr, founded by family physician Dr. Siaw Tung Yeng, for virtual visits; 20% of the physicians in the island country offer some level of service via the app. In an effort to control escalating cases of coronavirus there, people with symptoms are getting prescreened by physicians on MaNaDr and advised to stay home if they don’t need intensive care. Patients then check in with their telehealth doctor every evening and report if their fever persists, if they have shortness of breath or if they are feeling worse. If they are getting sicker, the doctor orders an ambulance to take those people to the hospital. Siaw says the virtual monitoring makes people more comfortable about staying at home, where many cases can be treated, instead of flooding hospitals and doctors’ offices, straining limited resources and potentially making others sick. “This allows us to care across distance, monitor patients across distance and assess their progression across distance,” says Siaw. “There is no better time for remote care monitoring of our patients than now.”
Other at-home devices and services currently being used in the U.S. allow patients to measure dozens of health metrics like temperature, blood pressure and blood sugar several times a day, and the results are automatically stored on the cloud, from which doctors get alerts if the readings are abnormal.
Telemedicine also serves as a powerful communication tool for keeping hundreds of thousands of people in a specific region up to date with the latest advice about the risk in their communities and how best to protect themselves. That can go a long way toward reassuring people and preventing panic and runs on health centers and hospitals.
Beyond individual-level care, the data gathered by telemedicine services can be mined to predict the broader ebb and flow of an epidemic’s trajectory in a population. In the U.S., Kaiser Permanente’s tele-medicine call centers are now also serving as a bellwether for an anticipated surge in demand for health services. Dr. Stephen Parodi, national infectious–disease leader at Kaiser Permanente, was inspired by a Google project from a few years ago in which the company created an algorithm of users’ flu–related search terms to determine where clusters of cases were mounting. Parodi started tracking coronavirus–related calls from the health system’s 4.5 -million members in Northern California in February. “We went from 200 calls a day to 3,500 calls a day about symptoms of COVID-19, which was an early indicator of community–based transmission,” he says. “Our call volume was telling us several weeks before the country would have all of its testing online that we have got to plan for a surge in cases.”
On the basis of the swell in calls nationwide, the hospital system is considering suspending elective surgeries based on local circumstances, in part to ensure that ventilators and other critical equipment would be available for an anticipated influx of COVID-19 patients with severe symptoms. Kaiser doctors also postponed appointments for routine mammograms and other cancer–screening tests and cut back on in-person appointments by turning most noncritical visits into virtual visits.
The COVID-19 pandemic may be the trial by fire that telemedicine finally needs to prove its worth, especially in the U.S. Despite the fact that apps and technology for virtual health visits have existed for several decades, uptake in the country has been slow. Medicare only recently began reimbursing for telemedicine visits at rates comparable to in-person visits, and states have just begun to relax licensing regulations that prevent doctors in one state from -remotely treating patients in another state. “This -pandemic is almost like us crossing the Rubicon,” says Wiesen of MediOrbis. “It’s a clarion call for America and for the world on how important telemedicine is.” Parodi agrees. “I think this pandemic will bring in a fundamental change in the way we practice medicine and in the way the health care system functions in the U.S.,” he says. “We’re going to come out of this and -realize a lot of health care visits don’t have to be in person.”
Other tech innovations that haven’t fully made their way to the public-health sector could also play a critical role in controlling this -pandemic—and future outbreaks. Taking a closer look at health-related data, such as electronic health records or sales of over-the-counter medications, can provide valuable clues about how an infectious disease like COVID-19 is moving through a population. Retail drugstores track inventory and sales of nonprescription fever reducers, for example, and any trends in those data might serve as an early, albeit crude, harbinger of growing spread of disease in a community. And given the proliferation of health–tracking apps on smartphones, analyzing data trends like a rise in average body temperature in a given geographical area could provide clues to emerging clusters of cases.
Geotracking on phones, while controversial because of privacy issues, can also streamline the tedious task of contact tracing, in which scientists try to manually trace infected patients’ whereabouts to find as many people with whom they had direct contact and who could have been infected. In South Korea, this strategy helped identify many of the contacts of members of a Seoul church that formed the first major cluster of infections in the country. In countries with a less robust health care infrastructure, smartphones can be critical for gathering information about emerging infections on the ground. In Bangladesh, says Labrique, programs created to canvass for noncommunicable diseases like hyper-tension and diabetes are now being modified to include questions about COVID-19 symptoms. These types of real-time data can rapidly provide a snapshot of where and how fast the disease might be spreading, to distribute health care workers and -equipment where they’re needed most.
It’s all about catching these cases as early as possible, to minimize the peak of a pandemic so the health system doesn’t get overwhelmed. But it’s not just about seeing the trends. Flattening the surge of an infectious disease also requires action, and that’s where the advice gets -muddier—but also where Big Data and artificial intelligence (AI) can provide clarity.
By deeply analyzing the care that every COVID-19 patient receives, for example, AI can tease out the best treatment strategies. Jvion, a health care analytics company, is using AI to study 30 million patients in its data universe to identify people and communities at highest risk of COVID-19 on the basis of more than 5,000 variables that include not just medical history but also lifestyle and socioeconomic factors such as access to stable housing and transportation. Working with clients that include large hospital systems as well as small remote health centers, Jvion’s platform creates lists of people who should be contacted pro-actively to warn them about their vulnerability so health providers can create a care plan for them.
In the case of COVID-19, that might include social distancing and avoiding large public gatherings. To help public-health departments better prepare communities for this and future outbreaks, the company has communicated with the U.S. Centers for Disease Control and Prevention to share what it has learned.
Privacy issues, however, nest in every single byte of data about a person’s health. So the power of AI methods in controlling outbreaks depends on how effectively data can be anonymized. Only when people are assured of privacy can algorithms help to navigate the next big hurdle: predicting surges in cases that strain health care personnel and availability of supplies like ventilators, masks and gowns.
If COVID-19 teaches public-health officials one thing, it’s that there are now tools available to help contain an infectious disease before radical measures like quarantines and curfews are needed. “What we were doing 10 years ago and what we are doing now is vastly different,” says Wiesen. “There is a tremendous opportunity here, and hopefully by [the next pandemic], the use of technology and data analytics is going to be light-years ahead of where it is today.”
By now, it has become clear that COVID-19 is not “just the flu.” Without a vaccine or treatment available, the novel coronavirus has spread through communities around the world virtually unchecked, prompting entire cities and countries to go into lockdown—their best defense against the fast-moving illness.
COVID-19 and the flu do share some symptoms: cough, fever, weakness, body aches. But, as of March 17, COVID-19 has killed about 4% of the approximately 200,000 people who have been diagnosed with the illness around the world. The flu, by contrast, infects millions of people each year, but usually kills less than 0.1% of them.
COVID-19 demands to be taken seriously—but the death rate associated with it is not set in stone, and may well come out to be far lower than 4%.
Since the COVID-19 outbreak began to pick up steam in Wuhan, China in January, experts have been scrambling to get a handle on the disease and the way it behaves. But they have also warned that estimates are not exact, and that numbers are likely to shift over time. One key reason: people with milder versions of the illness are underrepresented in official case counts, since they may not be sick enough to seek medical attention or realize they have anything more than a cold. Some people, research now suggests, may get infected and become contagious without showing any symptoms at all.
That means the total number of reported cases is very likely an underestimate—and by not counting many mild or asymptomatic cases, we’re likely overestimating the disease’s overall case fatality rate. The same problem likely applies to other diseases—such as the flu, which can vary in terms of severity from year to year—but it’s especially pronounced in an unprecedented outbreak with limited testing capacity.
Looking at data from countries with robust testing systems does support the idea that the disease’s case fatality rate may be lower than 4%. Countries that have tested many people are generally reporting lower case fatality rates than those that have tested fewer, and focused on severe cases. This suggests that when testing networks are broadened to catch people with less serious illnesses, and case counts then reflect this range of severity, death rates go down.
The case fatality rate in South Korea, where 5,597 tests had been administered per million residents by March 17, comes out to 0.97%, for example. In Japan, where only 130 tests had been administered per million residents, the case fatality rate is 3.3%.
Emily Barone/Lon Tweeten/Elijah Wolfson for TIME
What’s happened in the U.S. over the last few weeks shows this trend clearly: On March 5, when the country was testing at a rate of only 58 per million, the case fatality rate was around 5.4%; by March 17, testing rates nearly tripled, and the fatality rate fell to 1.7%.
The same logic suggests that strikingly low infection rates reported in some of the most crowded parts of the globe—a scant 174 cases among sub-Saharan Africa’s 1.1 billion people, for example—reflect poor surveillance more than hope.
Emily Barone/Lon Tweeten for TIME
Few countries that are testing at relatively high levels are reporting death rates above 2%, but Italy has proven an outlier. Even with over 2,400 tests given per million people, the country is still reporting a case fatality rate nearly 8%. While the exact reason for the discrepancy is unclear, it could point to differences in the country’s testing strategy, the specific test it is using or something unique about the actual outbreak there. One prominent theory is that Italy has suffered more than most countries due to its relatively elderly population. According to the United Nations, Italy has the world’s second highest median age—and COVID-19 seems especially dangerous for the elderly.
Even when taking the current estimated global case fatality rate of 4% at face value, COVID-19 looks more like influenza than other once-novel coronaviruses, though it does seem to be more contagious than other strains in the coronavirus family. Severe Acute Respiratory Syndrome (SARS) killed about 10% of the people who got it, while Middle East Respiratory Syndrome (MERS) was even deadlier, killing 34% of patients. Of course, there was uncertainty during the height of MERS and SARS, too—these numbers are based on epidemiologists’ post-outbreak calculations.
Emily Barone/Lon Tweeten/Elijah Wolfson for TIME
At least so far, COVID-19 does seem more lethal than the seasonal flu but it’s closer to that end of the spectrum than to previous coronavirus outbreaks. And, based on the fact that we’ve had limited global testing to date, and that, to this point, we’ve mostly only tested those with the most severe symptoms or the highest risk of infection, it’s reasonable to imagine that when we have a complete picture of how many people have been infected with COVID-19, its case fatality rate may, indeed, keep falling.
The research is starting to reflect that possibility: A new but not-yet-peer-reviewed paper submitted to the journal Nature Research estimated, based on available data out of Wuhan, that the overall case fatality rate there is about 1.4%. The researchers noted that it could be even lower, since their analysis accounted only for symptomatic reported cases.
All that said, there’s at least one critical difference between the seasonal flu and COVID-19: we have a vaccine for the former but not the latter. While an experimental COVID-19 vaccine is in development, even if it proves safe and effective, it won’t be publicly available for at least a year. In the meantime, the only way to slow and eventually stop the spread of a pathogen as apparently virulent as COVID-19 is aggressive social distancing—and testing at a scale that can provide individuals with clear guidance on their own personal risks to their communities, and public health officials with population-level information they need to make the right policy decisions. Experts call this “flattening the curve.”
Emily Barone/Lon Tweeten for TIME
If a community doesn’t take the right protective measures early on, its local outbreak could rapidly spin out of control and turn into a crisis, as the health care system becomes inundated with a caseload it cannot handle. The goal is to avoid a sharp, concentrated uptick in cases that exceeds the capacity of the health care system, in favor of a lengthier outbreak that stays within the bounds of what the system can handle—resulting in fewer people getting sick and dying overall.
Emily Barone/Lon Tweeten for TIME
Some countries are succeeding. South Korea, for example, quickly passed a government reform that allowed local manufacturers to make tests based on the WHO’s specifications, scaling up testing resources within weeks of the outbreak intensifying in Wuhan. As a result of that decisive action, it was able to swiftly implement measures like drive-through testing centers, which allowed for wide-scale diagnoses with minimal risk of exposing others.
Hong Kong, Singapore and Taiwan have also seen good results from early travel controls and aggressive case surveillance, while Hong Kong, Singapore and Japan have benefited from governmental funding that covers the costs of individuals’ testing and treatment, according to a recent paper in the Lancet.
There’s still time to flatten the curve in the U.S., but the clock is ticking. Models from the CDC reportedly show that, without adequate efforts to slow the virus, more than a million Americans could die and more than 20 million could end up in the hospital. The country has already taken some steps to combat that worse-case scenario, but there’s more to be done. The U.S. government was quick to limit international travel, and has encouraged Americans to stay home and avoid large social gatherings, though some critics say that guidance should have come sooner. The demand for COVID-19 tests also still far outpaces supply, and hospitals preparing for the wave of patients surely incoming fear crucial supplies will run out. These problems require systemic solutions, but people are not powerless. Individuals, healthy or not, can do their part simply by washing their hands frequently and keeping their distance from others. Temporary isolation may be what’s required to help the whole country rebound from COVID-19, together.
The number of people infected worldwide crested the 200,000 mark and deaths topped 8,000, with the number of people now recovered at more than 82,000, according to a tally kept by Johns Hopkins University.
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Police say the 23-year-old was admitted to the hospital around 9 pm and was shifted to the quarantine ward at the hospital’s Super-Specialty Block (SSB) building. The incident happened around 9.15 pm when guards heard a thud and rushed to the courtyard where they found him lying in a pool of blood.
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Everlywell, a home testing company that offers dozens of lab tests to consumers, is adding a COVID-19 test beginning on March 23.
Given the slow roll out of testing for COVID-19 in the U.S., and concerns about spreading the disease, at-home testing could help to diagnose more cases. After initially limiting testing to one provided by the Centers for Disease Control and conducted at state and local public health labs, the Food and Drug Administration allowed certified labs, including commercial lab testing companies, to develop and distribute COVID-19 tests on Feb. 29. Though other private companies have been involved with creating tests for COVID-19, this is the first company to offer its test directly to consumers.
The Austin-based Everlywell offers a range of validated tests for everything from cholesterol levels to fertility and infectious diseases like STDs.
People can order the Everlywell COVID-19 test on the company’s website, after first answering questions about their basic health, symptoms and risk factors for the coronavirus disease. A doctor still needs to prescribe the test, so telemedicine doctors from PWNHealth, a national network of physicians who prescribe diagnostic tests, then reviews these answers to determine if a person qualifies for testing, based on criteria established by the Centers for Disease Control and Prevention. Currently, because COVID-19 tests are not plentiful in the U.S., doctors are trying to rule out other respiratory diseases like flu first, and only ordering tests for people with symptoms who also have other risk factors for infection, such as being in close contact with others who have been diagnosed.
If the telemedicine doctor decides to prescribe an Everlywell COVID-19 test, the company says it will send the $135 test kit in two days (customers can pay $30 more to receive the kit overnight). The kit comes with a special swab that is long enough to take samples from the back of the nose and throat area, along with instructions for how to seal the swab sample to send it back to the company. People can also provide both spit and sputum samples as backups. (For now, the Food and Drug Administration only validates samples from nasoparyngeal swabs, but companies have applied to test spit and sputum.).
The sample is sent in a pre-paid overnight package, and processed at one of several labs approved by the FDA to perform the test around the country within 72 hours. As with many of the commercially available tests, this one extracts SARS-CoV-2, the virus behind COVID-19, from the sample and then probes for specific genetic signatures of the virus.
The company says it will then send results by text and email, and doctors may advise people to self-isolate until they receive them. If the test is positive, the company also provides a full telemedicine consultation with one of around 200 physicians that is included in the cost of the test. That physician also reports the result as a positive case to the appropriate state health departments, as is required by health authorities.
Everlywell says it is ready to ship 30,000 COVID-19 tests, and plans to expand the number of labs processing the samples. But CEO and founder Julia Cheek says that scaling up the number of testing kits will depend on the availability of swabs for collecting samples. Three major manufacturers make the swabs, but the main producer, it turns out, is a company based in Italy. Because the country is under lockdown, limited supplies from there, as well as the surge in demand as more COVID-19 testing is conducted around the world, are leading to a global shortage of swabs for any lab performing the test. That’s why Everlywell’s first kits will contain only one swab, and Everlywell will limit kits to one per household until the supply of swabs becomes more plentiful.
“We’re working hard to ramp up weekly capacity to test 250,000 Americans,” says Cheek. “Our goal is to continue to refresh capacity but with the global swab shortage we don’t have a confirmed timeline for that yet. Ultimately, she says, the testing kits could be designed for a household so everyone in a family could be tested if needed to know what protective measure they might need to take.
