It’s been a very emotional time for everyone. It is hard to post anything on COVID-19 due to the sadness and anxiety we are all currently living, every single day. I am, nonetheless, providing a perspective that is evidence-based and intended to help us become better consumers of information- so that we do improve the conversation on how to accomplish the common goal we all share of protecting our family and loved ones.
We’ve been told that social distancing is imperative to “flatten the curve”. We’ve all seen the diagrams and many of us have vowed to come together to make it work. But does it really work?
A 2011 systematic review on physical measures to stop or reduce the spread of respiratory viruses concluded that “there was limited evidence that social distancing was effective, especially if related to the risk of exposure.1” A high quality systematic review is known as the most reliable source of evidence to guide clinical practice. In short, it is a meticulous summary of all the primary research in response to a question.
A 2012 research paper concluded that trying to control an epidemic spread by social distancing “may give a worse outcome than doing nothing”.2 Governor Cuomo of New York acknowledged this possibility today. He expressed doubt on whether quarantining everyone was the right thing to do, and implied that it may have even spread the disease.3
Meanwhile, South Korea and Singapore have shown that it is possible to contain the spread of the virus without shutting everything down. They used a more surgical approach in order to isolate and protect certain high risk areas and individuals, while allowing life in general and the economy to go on.4 As an example, Singapoore has kept its schools open, freeing up many frontline health care workers while placing children in a safe and productive setting- away from their grandparents who may be vulnerable to the virus.
The preponderance of the scientific evidence does indicate that the most effective solution to stopping the spread of a respiratory virus is good personal hygiene, such as frequent and proper hand-washing, especially by children.1,5 It is human nature to doubt that something so simple as hand-washing could potentially save lives, but it’s true.
When facing a health crisis, one of the most important jobs the media and health officials are entrusted with is that of communicating facts to the public, without sensationalism. Using apocalyptic language at the expense of accuracy is very dangerous. Exaggerated death rates, as an example, can lead the public and politicians to believe that draconian measures are justified. Fortunately, as better data begins to pour in from several countries, we are learning that the large majority of people that contract the virus will have mild to no symptoms. For example, Iceland has been conducting random testing and discovering that 50% of the people infected with the virus are asymptomatic, while the other half, according to their chief epidemiologist, are displaying “very mild cold-like symptoms”.6
The media has reported case fatality rates as high as 10% in Italy. However, according to a study conducted by its national health authority, over 99% of Italy’s COVID-19 fatalities were people who suffered from multiple pre-existing medical conditions, and their average age was 80.7 The reason the case fatality rate is initially appearing higher in Italy is because only individuals with severe symptoms are being tested. It is obvious that this rate will decrease if random testing is implemented, such as in Iceland. In a time where facts matter more than ever, I have no way to view the initially reported exaggerated death rates other than as an act of careless negligence by the media and “health experts”, who should understand and clearly communicate the limitations and bias of the available data.
While it is heart breaking to see isolated cases of younger people dying or having serious complications from COVID-19, we must keep things in perspective and remember that healthy adults, and especially children, are far more at risk from the regular flu.8 In fact, 149 pediatric deaths from the common flu viruses were reported this season by the CDC. Imagine how easily our attention and concern would switch to the common flu if the media were to show 149 small caskets, and interview the 149 families as they spoke about the loss of their precious children. The good news about Covid-19 is that, unlike the regular flu, the risk for children and healthy adults is very minimal.
As parents, the loss of a child is unimaginable and unbearable. But for community leaders, the response to a virus outbreak must be proportionate to the level of risk, especially when we are on the brink of collapsing our economy, social systems and life as we know it. There is also a danger that, as contagious as any virus, we could be instilling fear in our children that may mark them forever. As someone who has worked and taught in both elementary and high schools, I would be using this moment to teach how our immune system works, and why we choose to exercise and maintain healthy eating habits every day.
Since we now have concrete evidence from multiple countries that most cases of this virus will be mild and spontaneously resolve, especially for children, another downside of social distancing healthy individuals is that we may miss the opportunity of developing herd immunity in a population that will not suffer. Implementing social distancing measures only for vulnerable individuals, while allowing the rest of society to function, may offer the best long term outcome for the entire population.
Amid all the emotion, it is my hope that we start to focus on protecting our more vulnerable members of society by using solutions that are strongly supported by the scientific evidence. Let’s put all of our attention on isolating and better serving the people who need it, as opposed to implementing strategies that are, in large part, lacking in evidence while potentially causing more harm to everyone.
Markito Fitness & Nutrition
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March 31st Update:
Sweden’s response to Covid-19 is so different from that of North America. Its position, supported by health authorities, seems to imply that a more lax approach is safer than an overreaction. Should we just follow what the Swedes are doing, or perhaps the South Koreans? No! Every area in the world faces unique circumstances that dictate how the disease spreads and what strategies can be successfully implemented and executed.
That is why accurate data is so essential, and it must include testing a representative random sample of the population to understand where we are, if what we are doing is working, and how to pivot to the next phase. Testing mainly people with severe symptoms does not provide the information we need, and continuing our existing strategy without adequate data is like a surgeon cutting blindly into a patient. Simply put, social distancing/isolation measures work best in a context where widespread and rapid testing is available. Control strategies based on inaccurate information may lead to a worst outcome, including new waves of infections.
This position is the same one supported by some of the most cited and respected data scientists and health researchers, as well as multiple governments throughout the world.
I invite you to watch this important interview, where Professor Ioannidis from Stanford presents an unbiased and evidence-based assessment of where we currently stand with COVID-19. I strongly believe that the general public’s level of comprehension is vital for the future of our planet.
Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2011;(7):CD006207.
Maharaj, S., Kleczkowski, A. Controlling epidemic spread by social distancing: Do it well or not at all. BMC Public Health 12, 679 (2012). https://doi.org/10.1186/1471-2458-12-679
Hogan, B. and Feis, A., 2020. Cuomo Admits That Coronavirus Quarantine May Have Backfired In Some Cases. [online] Nypost.com.Available at: https://nypost.com/2020/03/26/cuomo-admits-that-quarantine-may-have-backfired-in-some-cases/ [Accessed 26 March 2020].
Beaubien, Jason. “How South Korea Reined In The Outbreak Without Shutting Everything Down.” NPR, NPR, 26 Mar. 2020, www.npr.org/sections/goatsandsoda/2020/03/26/821688981/how-south-korea-reigned-in-the-outbreak-without-shutting-everything-down.
Saunders-Hastings P, Crispo JAG, Sikora L, Krewski D. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis. Epidemics. 2017;20:1-20.
Narayanan, N. (2020, March 28). Covid-19 shock: Iceland research claims half of the infected people will show no symptoms. Retrieved from https://www.ibtimes.sg/covid-19-shock-iceland-research-claims-half-infected-people-will-show-no-symptoms-41879
Ebhardt, Tommaso. “99% Of Those Who Died From Virus Had Other Illness, Italy Says.” Bloomberg.com, Bloomberg, 18 Mar. 2020, www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says.
- Jaoudé, M. (2020, March 24). The Regular Flu: Don’t You Forget About Me. Retrieved from https://markitonutrition.com/the-regular-flu-dont-you-forget-about-me/