Do not compare the virus causing the COVID-19 pandemic to any sort of influenza — it’s far easier to give, just as easy to receive and more deadly to get, say state and University of Virginia experts dealing with the pandemic.
The virus, officially named SARS-CoV-2, is a fast-moving illness machine that has found the right mix of lethality and communicability to lift itself to the level of the first pandemic in 100 years.
The here-to-fore unknown coronavirus is more easily spread than are influenza viruses and proves fatal in far more cases, especially among older people and those with underlying medical conditions.
Because the virus is so new, researchers and clinicians across the world are scrambling to determine everything from how it’s transmitted to why it affects different age groups differently.
The flu is estimated to kill one in every 1,000 confirmed cases. The COVID-19-causing virus appears to kill one or two of every 100 confirmed cases, according to studies of cases across the world.
“COVID-19 is nothing like the seasonal flu,” said Dr. Lilian Peake, state epidemiologist with the Virginia Department of Health. “There isn’t a vaccine against it, so we can’t vaccinate against it and decrease the number of people who can become infected. We don’t have a specific antiviral treatment like we do for influenza. Also, we’re seeing more severe illness and higher percentages of people having severe disease and even death from this.”
The virus has SARS in its name because it has similar aspects to the severe acute respiratory syndrome coronavirus that became an epidemic in 2003, afflicting areas of Asia. An estimated one in 10 people who caught that virus died, according to the Centers for Disease Control and Prevention and other health agencies.
But that virus could only be transmitted by close contact with a sick person, studies showed. That contact included kissing, embracing, sharing eating or drinking utensils, talking to someone within three feet, physical examination and other direct physical contact, according to the CDC.
The new virus is not as lethal by the numbers, but it is far easier to contract than the original SARS virus and has quickly spread throughout the world, leaving far more deaths in its wake.
“People make the flu comparison because [SARS-CoV-2] is a virus that spreads through the population, affects older people and spreads in the same method. It’s definitely not the same thing, though,” said Dr. Taison Bell, an expert in internal medicine, infectious diseases and critical care at the UVa Health System. He’s also the assistant director of the medical intensive care unit at the UVa Medical Center.
Bell said the flu and the COVID-19 virus travel in the same method. An infected person sneezes or coughs or in some other way deposits the virus on a surface, usually in a wet droplet of some sort. Then another person happens along and touches the virus-packed wet spot.
“We get the virus on the surface and then someone touches that surface and gets the virus on their hand and then touches a wet spot on their face, like their eyes or nose or mouth,” Bell said.
For the flu, one person may infect 1.3 other people, what is known as the R-number, Bell said. SARS-CoV-2 has an R-number of 2.5, meaning it spreads more than twice as fast as the flu. In comparison, the R-number of measles is between 12 and 18.
“This virus is higher than a slow-churning virus making its way through the population, but it’s nothing like measles,” Bell said. “From the perspective of a virus, you don’t want to be so serious that your host dies before you can infect someone else. You want to be able to be passed around before that happens so you want to spread as rapidly as possible through a population. There’s often a big difference between how deadly a virus is and how quickly it spreads. When you hit that sweet spot, you have a pandemic.”
For most influenza viruses, a person gets sick between one and four days after contracting the virus, according to the CDC. The illness lasts about seven days, which means for seven to 12 days, the virus can be passed on.
For the COVID-19 virus, it takes as long as 14 days from exposure to symptoms and can last as long as a month after symptoms begin, according to a study by Harvard Medical School updated Friday.
“For the flu, it takes one to three days before symptoms show, and you’re infectious about a day before you feel the symptoms,” Bell said. “With the coronavirus, the middle of the time range is about five days and it appears as though you can spread long before you get symptoms.”
The virus kicks off with a fever that can be as high as 102 degrees, according to the CDC. That is the most likely tipoff to COVID-19, Bell said.
“The thing about COVID is about 90% will have a fever at some point and it’s usually at the start,” he said. “Of course, that often shows with the flu, too.”
Although 80% of cases appear with mild symptoms, when the virus kicks into high gear, it can cause crippling fatigue and deadly pneumonia that fills both lungs with fluid and restricts breathing to the point that a patient needs a mechanical respirator to avoid respiratory failure.
Respiratory failure, according to the CDC, is when the lungs cannot pull in enough oxygen to supply the body and organs begin to fail.
The breathing issues caused by COVID-19 can lead to emergency rooms crowded with patients gasping for air and full intensive care units with patients attached to respirators that breathe for them. That is currently occurring in New York, according to the CDC and New York state health officials.
“If you have a busy ER and your ICU is full and all of the respirators you have are taken up and someone comes in with respiratory failure but you have no more equipment available to treat them, that person isn’t going to live,” Bell said.
For Virginians, that has yet to become a reality. Experts hope it won’t.
“We’re at the beginning of the outbreak occurring in Virginia and we do expect the number of cases to go up,” Peake said. “At some point, they will level off and decline, but we do expect those numbers to go up for a while. The more we can practice that social distancing, the more that [sharp increase] can be blunted.”
“The cases are still going up at an exponential rate and that means more people will need critical care,” Bell said. “We expect we’ll have more people getting sick, and we’ve made preparations for that.”
Exactly how long the virus will be affecting the country is hard to say, Peake said.
“It did last for months in other countries as it circulated through the communities, so I think we can expect that, but I don’t have a crystal ball. None of us does,” she said. “We have to continue to track it and look at the information every day.”
Gov. Ralph Northam’s ordering the closing of businesses, restaurants and parks and imploring Virginians to stay home are efforts designed to keep to a minimum the number of people getting critically sick at the same time and competing for critical care, Bell and Peake said.
“It’s important that we practice social distancing and stay home as much as we can so that, while this virus continues to circulate, we’re blunting [its spread] and decreasing the number of people who get sick at any one time,” Peake said.
“That’s important both to protect people who could have more serious illness [from the virus] and so we’re not overwhelming our health system,” she said.