By Dr. John R. Mishock, PT, DPT, DC
I wanted to review some of the recent scientific research for the week regarding COVID-19. The objective is to educate the local community and our patients using science to guide our decisions and control or reduce panic while taking on controlled risk. When COVID-19 first started in China, the CDC, WHO, and government agencies used the best information they had to guide our communities. The scientific evidence is rapidly changing as time passes, and our communities need to adjust accordingly.
Montgomery and Berks County
In Montgomery County, there have been a total of 3,474 people testing positive with 194 deaths. (Montgomery County Heath Dept, 2020) Berks County has 2,406 people testing positive with 88 deaths. (Berks County Heath Dept, 2020). Of those fatalities, 74% (Berks County) and 65% (Montgomery County) have happened in a nursing home or long-term-care facilities. In Pennsylvania, there has been of the 1550 deaths of COVID-19 with 952 coming from nursing or personal care homes. There have been very few positive tests among children ages 18 and younger and no childhood deaths in Pennsylvania.
The combined population of Montgomery and Berks County is an estimated 1.2 million people with 3,474 deaths from COVID-19. The chance of death in our community from COVID-19 is 0.005%. This would be similar throughout the country.
Positive COVID-19 Cases with No Symptoms
There is evidence mounting that COVID-19 is spreading, and many people have no symptoms. Here are some of the studies that came out this week:
1. 50 times as many people had no symptoms and tested positive in Santa Clara County, CA
2. USC and the Los Angeles County Department of Public Health found that because of asymptomatic individuals the real number of infected people in LA County would be 28 to 55 times higher than diagnostic testing showed
3. Brigham and Women’s Hospital, subacute nursing facility. Out of 87 patients total, 50 tested positive—and none had shown any symptoms. (WebMD)
4. Aboard the aircraft carrier USS Theodore Roosevelt, 600 crewmembers have tested positive, but at least 350 of them are asymptomatic. (WebMD)
5. In an Ohio prison that did widespread testing, 73% of inmates—more than 1,800 people tested positive with no symptoms.
6. In New York City, 21% of the residence in the study tested had tested positive but had no symptoms. (WebMD)
Bottom line, when you extrapolate the above studies to the general population across the US, there are millions and millions of individuals with COVID-19 who do not know they have symptoms!
What does testing positive with no symptoms mean to you?
1. COVID-19 is not a significant disease for most people. The majority of people have mild or no symptoms at all. These people should be able to resume their lives while maintaining CDC prevention techniques.
2. The disease could be spreading unknowingly when the individual has no symptoms. Because of this, wearing a mask when around others could help reduce the exchange of water droplets expelled when breathing and speaking. Keep in mind the water droplet houses the virus and allows spread. We ingest this through our eyes, nose, and mouth. We also would want to avoid contact with those most vulnerable. In our area, this would be those living in nursing homes and elderly with pre-existing conditions.
3. The fatality rate of the disease is grossly overestimated. Right now, the death rate is estimated at 1-2%. Based on the above studies, COVID-19 would have a fatality rate comparable to seasonal flu. These asymptomatic individuals and those who have minor symptoms not tested would be added to the denominator of the fatality rate (ratio of the number of deaths per total number of individuals with the disease). The bottom line, COVID-19, is not as fatal as initially thought.
4. It would be impossible to trace and quarantine those who are in contact with a positive COVID-19 individual if they had no symptoms. Test-and-trace is thought to be the best way to control the disease.
5. The more people who have it, the closer we are moving to herd or community immunity without knowing it. It is estimated that we would need 60% of the population to have had COVID-19 to create herd immunity. In the H1N1 Swine Flu (a respiratory disease similar to COVID-19 in spread) of 2009, it was estimated that 1 billion people got this novel flu over that year with approximately 200,000-500,000 deaths worldwide. (WebMD) Why is COVID-19 so different then H1N1 Swine Flu????
6. Virus testing and antibody testing (immune testing to determine those who had COVID-19) must be done in individuals who work with or who are around those most vulnerable in our population. For example, nursing homes.
7. With the majority of our US population sheltering in place, is it really working?
More articles about COVID-19:
Dr. John Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. Mishock Physical Therapy & Associates has seven convenient locations in Gilbertsville, Skippack, Phoenixville, Barto, Limerick, Pottstown, Steiner Medical,