Hanover
In the spring of 2006, Dartmouth-Hitchcock Medical Center was the site of a serious, rare epidemic of pertussis, a bacterial respiratory infection that can be serious, especially in children.
DHMC administrators took drastic steps to curb the epidemic, including vaccinating thousands and treating hundreds of infected employees with antibiotics, sending many employees home to recover, posting guards at the doors of pediatric wards, excluding anyone who admitted to coughing that day or had any other symptoms, and issuing daily updates describing an inexorable troubling spread of the disease.
DHMC made national headlines. Eventually everything died down as epidemics tend to do and the victims all survived. The Centers for Disease Control and Prevention conducted an investigation. It concluded that the test used to diagnose pertussis during the DHMC epidemic was meaningless and no one was ever actually infected. The entire incident was rather embarrassing for the medical center.
The current COVID-19 epidemic reminds me in many ways of the 2006 pertussis “epidemic,” although COVID-19 is a real infection with real victims. Despite that, I think we should reflect upon these considerations before we panic:
■ No medical test is 100% accurate. Every medical test has false negatives and false positives (quantitatively measured as “sensitivity” and “specificity”) and it usually takes a long time to determine what these numbers are, since human studies are complicated and difficult. COVID-19 tests are very new, so these numbers are likely unknown. The DHMC experience shows the importance of knowing what they are.
■ So far, in early March, about 20 people in the U.S. diagnosed with COVID-19 have died, according to news reports. About 40,000 people are estimated by the CDC to die in the U.S. each year from ordinary influenza, although the number varies widely each year. The “flu season” is six months long, so you can calculate that since the beginning of February about 8,000 people have died from influenza in the U.S. COVID-19 thus accounts for about 0.25% of these deaths in 2020 if the figures are correct, which they probably are not.
■ On a worldwide basis, the mortality rate is calculated as the number of deaths divided by the number of people infected. No one has any idea of the total number of people who have contracted COVID-19. Many patients are asymptomatic, so they are never tested. China and many other countries have adapted policies such as forced quarantine that have actively discouraged patients from reporting any illness. Because of these and other factors, the denominator in the mortality equation is completely unknown. When you consider that the sensitivity and specificity of the COVID-19 tests are also unknown, the numerator of the mortality equation is questionable. Because of this, no one has any idea of the actual mortality rate, regardless of what you hear on the news. It could be higher, lower or the same as ordinary influenza.
■ The news media has always loved doomsday scenarios, so it will always exaggerate the negative. Public officials are unwilling to take any risk because a wrong decision, however reasonable, could be used against them in the next election or get them fired or demoted. As a result, officials and news outlets never consider the economic and overall consequences of political decisions and hysterical reporting. The U.S. government last week allocated $8 billion to fighting COVID-19. It is unclear exactly what this will accomplish or what will be done with the money. There is no treatment.
In my opinion, this is not the time to panic and there is little reason to be “tested” if you have no known exposure. I predict that COVID-19 stories will be gone by the summer and the news media will have moved on to the next end-of-the-world-as-we-know-it disaster.
I sincerely hope I’m right.
Timothy Quill, of Hanover, is a Geisel School of Medicine professor emeritus.