Expect U.S. Outbreaks, But Don’t Panic

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The COVID-19 pandemic is spreading to scores of countries in all continents except for Antarctica. I say “pandemic” not to instill panic, but vigilance and action. Unlike some World Health Organization health officials, I believe that people are more likely to prepare for a storm when they are shown the black clouds of the horizon.

In the U.S., the number of cases and locations affected are increasing. With local human-to-human transmission the most likely cause for some, it is only a matter of time before a country as large as ours will see hundreds or even thousands of cases. Well-meaning government efforts to ban travel are likely to slow down the timeline of the disease in the U.S. but won’t prevent eventual outbreaks in multiple areas.


There are, certainly, many reasons to be concerned. COVID-19 has a severe form that causes pneumonia and worse in about one in five or sick patients. Seasonal influenza is rarely deadly, but COVID-19 kills about three percent of the time. This probably is similar to the death rate seen during the Spanish Flu pandemic of 1918-1919.

COVID-19 is very contagious and our current tests have not proven to be 100% accurate in identifying it. The U.S. has improved its isolation protocols for contagious disease in the last few years but the general public isn’t always aware of ways you can prevent becoming infected.

Underdeveloped nations may not have the medical infrastructure to handle large numbers of people who might need respiratory support.

That’s some of the bad news, but there is good as well.


The three percent death rate may be too high. With many countries either unable or unwilling to obtain accurate statistics, I believe there are hundreds of thousands more out there that are:

  • Only mildly affected, didn’t seek medical care, and recovered
  • Asymptomatic and unaware they have the virus
  • Unreported by the nation’s government
  • Sick but the nation lacks testing capability or mechanisms to report cases

One example of the last item above is North Korea, which shares a border with China. You haven’t heard of one case there. I’ll bet, however, that COVID-19 is probably running rampant throughout the country but not counted. The numbers from certain other countries, like Iran, are likely under-reported. Add them to the numbers and the death rate drops, perhaps significantly.

Another bit of good news is that China’s hot zone seems to be reporting lower numbers of new cases. This could mean that the disease is taking its course in the country and is now on the far end of the bell curve. If China’s outbreak could wax and then wan in just two months, perhaps other countries will do so in turn.

It’s also important to remember that influenza’s millions of cases this year are still far greater than the numbers for COVID-19.


Once community-wide spread occurs, we will have to have a plan of action; one that involves changes in our lifestyle.  If you haven’t put together a strategy yet, it is time to do so. As no specific medicines cure or even treat COVID-19, we must turn to giving symptomatic relief such as acetaminophen for fever and other drugs as needed. The simple act of hydrating patients dropped the Ebola death rate in the 2014 epidemic from 60% to 40%.

Other than that, we will have to turn to non-pharmaceutical interventions (NPIs) NPIs are strategies that help to decrease your chances of catching the infection.

They include frequent hand washing with soap and water, use of alcohol-based hand sanitizers, and strict attention to respiratory hygiene. With regards to hand sanitizer, don’t use one drop and think your hands are now clean. Use more and get you hands good and wet. If your hands are visibly dirty, however, use soap and water.

One of the most common ways to get sick is to touch a contaminated person or surface and then touch your face with your hands. You do this much more often than you’d think. Just ask a friend or family member to watch you for 15 minutes and count the number of times you absentmindedly brush your hand against your nose, mouth, and eyes. You’d be surprised how often it happens.

Respiratory hygiene is meant to keep your family safe by decreasing airborne infectious particles and droplets. Besides frequent hand washing, it entails:

  • Covering all coughs and sneezes with a tissue or, at least, your upper arm. Dispose of tissues safely in a covered waste receptacle.
  • Cover your nose and mouth with a mask or cloth if you are sick and in the company of others.
  • Clean all surfaces that have been touched or coughed on by sick people with a disinfectant.

The other NPI strategy is more social than personal. It is called “social distancing” and is most helpful if your city or town is in the middle of an local outbreak. It includes:

Staying away from large crowds.

Not going to work if you’re sick or a lot of people there are sick

Keeping children home from school

Avoiding public transportation

Avoiding physical contact with others (even shaking hands)

Keeping a distance of about six feet from other people

Avoiding community candy jars or other items many people have touched

Isolating sick persons in your family from healthy ones.

The above seems to be almost paranoid to the average citizen, but these are recommendations that are endorsed by U.S. government agencies in the event of a deadly infectious disease outbreak.

The pandemic will reach the U.S., but that doesn’t mean it will damage the country long-term. Have a plan of action that decreases your chances of COVID-19, and you will find that this, too, shall pass.

Joe Alton MD

Joe Alton MD

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