Managing Patient Worry – a Look at Statistics in COVID-19.

In the current climate, it’s easy to be terrified. My patients are and I’m sure others are too. This is now the most talked-about disease in history with over 2.1 billion media mentions since January 2020[i]. As physicians, it’s our responsibility to educate and de-catastrophize our patients. In these trying times, that’s harder than ever, but with a few stats in your back pocket, you can share information without spreading the disease of panic.

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Number of cases vs. our population

The total number of cases rises every day – so do deaths. At the time of writing (4/19/2020) there have been 690,714 confirmed cases and 35,443 deaths[ii], according to the CDC. Hearing those numbers on their own can be, understandably terrifying. They need context that we as physicians can provide.

As a nation of 328,000,000, the number of currently confirmed COVID-19 infections comprises just 0.21% of our population. Now, we theorize that the confirmed number is much smaller than the actual prevalence – our emergent data[iii] suggests it might be as much as 5% of the population, meaning as many as 16 million people have already had COVID-19 without being tested, diagnosed, or hospitalized. But even if the total number is more like ten or fifteen or twenty million, we’re talking about something that has impacted fewer than a third to a half of the people who have had a strain of the flu this year[iv], which the CDC estimates is between thirty-nine and fifty-six million and comprises approximately 11-17% of the US population.

You have an immune system

Another fear-inducing piece of this pandemic is that as the days have gone on and face coverings are an aspect of every-day life, public perception about natural resistance to diseases has become skewed. We’ve become societally sensitized to the point where everyone thinks getting sick is assured as soon as contact is made. This simply isn’t supported by statistics or our understanding of immunology. We are all wearing the ultimate personal protective equipment all the time – skin, with its pathogen-blocking abilities, is one of the reasons we have survived as a species for thousands of years[v]. Add to that our body’s ability to rapidly dismantle, engulf, and eradicate the vast majority of microscopic invaders before an initial encounter turns into disease, and we’re looking at a huge majority of humans who will likely never succumb to COVID-19, even if they come into direct contact with a person who has it.

Careful, not suspicious

One of the worst side effects of the COVID-19 pandemic has been the widespread suspicion and xenophobia left in its wake. Suddenly, people aren’t only worried about diseases themselves, but are actively encouraged to avoid each other – as if that other person might be the ultimate carrier and bringer-of-destruction. This attitude is counterproductive to living in a community where we care for each other, but also to physiology, since stress is a well-documented aspect of weakened immunity – especially those stressors that are chronic and ongoing, like living through a pandemic that requires separation from loved ones. In a metanalysis of more than 300 empirical articles, authors describe the relationship between stressors and measurable parameters of the immune system. They conclude that long-term stressors, like living through a natural disaster, decrease lymphocyte proliferation and cell differentiation throughout the immune system by as much as 53%[vi]. And although they acknowledge that more study must be done to differentiate which types of stressors create these severe immune-suppressing outcomes, they conclude that using our fight-or-flight system to combat long-term stressors and worry is a misappropriation of our body’s innate resources and leads to ‘immune effects that are detrimental’.

There will be an end

For the majority of people, the not-knowing is the hardest part of this period. Many of them have not been alive in a time where a new disease emerged, and none of us have experience with the way our world-wide governments have responded to it. In times like these, understanding the real scope of this disease and the way our bodies are equipped to handle it, may be potential sources of solace. Ultimately, though, this is a war of attrition, wherein we need to encourage everyone to do the best they can – physically and emotionally – until its eventual resolution.

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Dr. Chris Cherubino, the medical director of ARCpoint Labs, is a chiropractic physician and certified medical examiner. She is committed to healthcare information access and demystifying the diagnostic process in the realms of musculoskeletal, neurological, and laboratory medicine. In her work with ARCpoint, she attempts to provide information and education to other physicians in order to increase patient compliance, understanding, and wellbeing.

 

 

[i] https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/

[ii] CDC, Real Time cases in US. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

[iii] Myer, Madrigal. “A New Statistic Reveals Why America’s COVID-19 Numbers Are Flat

https://www.theatlantic.com/technology/archive/2020/04/us-coronavirus-outbreak-out-control-test-positivity-rate/610132/

[iv] CDC, Flu Season 2019. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

[v] National Academy of Science. How Infection Works. https://www.ncbi.nlm.nih.gov/books/NBK209710/

[vi] Seagerstrom, Miller. “Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/

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