The data I’ve seen talks about “underlying illnesses” but doesn’t break out specific ones. I’d expect lung disease to add the greatest risk, but that’s a guess.

Immunosuppressive therapy can cut both ways. It probably increases the chance that a given exposure will develop into disease, but it might also decrease the excessive inflammatory response that is sometimes responsible for particularly destructive cases of infectious diseases. For example, I found a clinical trial (no results yet) testing steroids in the *treatment* of COVID-19.

I can’t speak to whether particular behaviors you’re observing constitute hysteria, but this disease seems very likely to become a true pandemic over the next weeks and months. The case fatality rate for people over 80 may be as high as 15%, and 8% for folks in their 70s, which is a big deal. What we don’t know yet is how large a portion of the population will ultimately become infected, but it’s likely to be an awful lot of people in any case. There’s a delicate balance to be found in taking appropriate measures to try to avoid infection if (when, really) the disease is active in your area, trying to avoid transmitting the disease (even before a confirmed diagnosis), and figuring out when to seek medical attention.  The disease was apparently circulating in Washington for six weeks before the first diagnosed case showed up. If you’re trying too hard to wish this away then any measures may look like hysteria.

Scott F posted:

The data I’ve seen talks about “underlying illnesses” but doesn’t break out specific ones. I’d expect lung disease to add the greatest risk, but that’s a guess.

Immunosuppressive therapy can cut both ways. It probably increases the chance that a given exposure will develop into disease, but it might also decrease the excessive inflammatory response that is sometimes responsible for particularly destructive cases of infectious diseases. For example, I found a clinical trial (no results yet) testing steroids in the *treatment* of COVID-19.

I can’t speak to whether particular behaviors you’re observing constitute hysteria, but this disease seems very likely to become a true pandemic over the next weeks and months. The case fatality rate for people over 80 may be as high as 15%, and 8% for folks in their 70s, which is a big deal. What we don’t know yet is how large a portion of the population will ultimately become infected, but it’s likely to be an awful lot of people in any case. There’s a delicate balance to be found in taking appropriate measures to try to avoid infection if (when, really) the disease is active in your area, trying to avoid transmitting the disease (even before a confirmed diagnosis), and figuring out when to seek medical attention.  The disease was apparently circulating in Washington for six weeks before the first diagnosed case showed up. If you’re trying too hard to wish this away then any measures may look like hysteria.

Hi Scott

Your profile says antibiotic dependant.  Did you ever try the oil of oregano protocol suggested by Jani Patel? 

I absolutely did not try the oil of oregano, and I have no interest in trying it. If it shows enough promise to be properly tested for safety and efficacy then I’d be more interested. The current fascination with untested remedies which happen to be classified as “supplements” is, I think, ill advised. When I take a risk by ingesting something I prefer to have some decent information about the risk I am taking.

Today I’m seeing data on the COVID-19 case fatality rate by specific “comorbidity” (underlying disease). These numbers *aren’t* age-specific, and they are a few weeks old, but they offer better information than my previous guess. 

Fatality rate by comorbidity:

• Cardiovascular Disease: 10.5%
• Diabetes: 7.3%
• Chronic Respiratory Disease: 6.3%
• Hypertension: 6%
• Cancer: 5.6%

I’ve seen frequently expressed caution about increased risk for immunocompromised patients, but I haven’t seen any more specific information.

Your risk of contracting COVID-19 *today* in the US is vanishingly small. The risk of this becoming widespread in the US as time passes is quite high.

All right thanks for the info, Scott!

You strike me as doctor. Am I correct in assuming something like that?

Also, Scott. After rereading one of your replies I must comment on the part about trying to wish this away. What I'm seeing is hysteria when considering the statistics.

Taking China, for instance, the total amount of infection cases seem staggering because big numbers are scary. If you regard it in proportion to the total amount of the Wuhan's, let alone China's, population a small minority of people were affected before the spread started to peter out. 

The Hysteria on the other hand has probably already affected everyone globally and the uninformed fear, fed by social media and hearsay, is really making a mark. That is not acceptable to me when seeing modern society's preparedness to deal with, as clearly demonstrated in China and many European countries.

There have certainly been plenty of overreactions. Nevertheless, we don’t really know how many were/are infected in Wuhan, and we *really* don’t know how many are infected in the US. That’s because we only identify cases after testing, and there’s good evidence that lots of cases aren’t getting tested, particularly in the US. So we are underestimating the number of cases, but conversely may be overestimating the case fatality rate. The most believable estimate I’ve seen suggests that this will ultimately be 4-10 times as lethal as a bad flu season, but lots of things could change that.

The media I’ve read has been pretty responsible, but I choose my media rather carefully. It’s hard to effectively distinguish for a general audience between current risk and fuzzy future risk - humans don’t naturally make that distinction very well. You can make arguments for varying amounts of attention by the media, but I think you’re missing an important point: arguably reasonable efforts to control the spread have a substantial social and economic impact over and above the medical impact of the disease itself.

Personally, I am cautious, but by no means panicked. I have multiple enhanced risk factors outside of the chronic disease of IBD (autoimmune disease in general is a risk factor). I am nearly 65, diabetic, and immune suppressed (on biologics and Imuran).

I do not wear a mask, but I have been more mindful about frequent hand washing and using hand sanitizer after touching public doors, hand rails, gas pumps, etc. I also am mindful about not touching my face before washing. I take a wide berth around people who are coughing.

Common sense stuff that is true all the time, but especially true now.

Jan