Galveston County announced its first local case of coronavirus March 13. In the seven months since, the county has closed down, opened, closed again and started more slowly to reopen. As of this week, more than 12,000 county residents have been diagnosed with the virus, and nearly 11,000 have recovered, while 148 people have died after contracting it.
Although it sometimes seems little progress is being made toward combating the virus, local experts say they’ve learned things about COVID-19 that help them understand what’s happening in the world and how we can better protect ourselves.
At the seven-month anniversary of COVID-19 in the county, The Daily News asked some local experts to recount what they’ve learned about COVID-19 and what they think about recent developments in the world’s understanding of the virus.
WHAT WE DIDN’T KNOW: Health officials have been logging and counting the numbers of confirmed COVID-19 cases since the beginning. The looming unknown has been the number of cases that have gone uncounted for reasons including that people were never tested because they never experienced any symptoms. That’s an important number because it’s necessary in determining how lethal the virus really is. Many health organizations fairly recently have been making estimates based on testing for virus antibodies.
WHAT WE KNOW A LITTE BETTER: As much as 10 percent of the world’s population of 7.8 billion already has been infected with the virus, according to the World Health Organization’s “best estimate.” That’s 780 million people. Likewise in August estimates were that about 5.8 percent of the U.S. population, about 19 million people, had been infected with COVID-19, according to Johns Hopkins University. At the same time, the U.S. Centers for Disease Control and Prevention estimated that for every one case of COVID-19 discovered, another 10 were not.
TAKEAWAY: World health leaders have been warning for months that cases of COVID-19 worldwide were being undercounted and in a meeting last week said as many as 1 in 10 people worldwide already have been infected with the virus. The estimate, about 780 million, far outstripped official counts tracking confirmed cases of the virus, which is about 35 million worldwide infections to date.
The new estimate about how many people have been infected has profound implications such as the predictable mortality rate, the number of all the infected who died, which is far lower than the case mortality rate, the number of people who died among confirmed cases.
But the WHO cautioned that the figures vary between urban and rural areas and between different groups.
For Galveston County, however, the estimate seemed about right, said Dr. Phillip Keiser, Galveston County’s local health authority. To date, about 3.5 percent of the county’s population — 12,000 of 342,149 — residents, have tested positive for COVID-19. Since March, Galveston County has had free and accessible COVID-19 testing and has been offering antibody testing to identify people who might have been infected with the virus and already recovered.
The actual number of cases is probably more like 8 percent, 27,371 people, however.
“If the WHO says 10 percent, that’s a reasonable order of magnitude,” Keiser said. “If we’re off by a few percentage points, I don’t think that’s a big deal. I think that’s probably about right.”
WHAT WE THOUGHT: Being older than 65 or being obese was a major risk factor leading to severe COVID-19 complications, including death.
WHAT WE LEARNED: Just being overweight might carry as much risk as obesity and being older than 65 is not a key risk factor, according to the CDC.
EXPLANATION: Throughout the pandemic, health officials have attempted to identify risk factors for falling seriously ill from the virus versus simply suffering mild symptoms or not feeling any symptoms at all.
The CDC has a long list of medical conditions that could cause an increased list of severe COVID-19 illness including cancer, kidney disease, COPD, heart conditions smoking and Type 2 diabetes.
The list, however, is constantly changing as health officials learn more about the virus. In June, the CDC removed the warning that people older than 65 were more susceptible to severe illness.
At the same time, the CDC warned that people considered medically obese, with a body mass index of 30 or more, were more likely to suffer more severe outcomes from COVID-19. That warning put up to 40 percent of Americans in a category of severe risk.
Like warnings about age, however, that guidance has changed. Last week, the CDC expanded its warning to include being simply overweight, with a BMI greater than 25, as a key risk factor. The new warning applies to more than 70 percent of Americans.
Such changes exemplify how much there is left to understand about the virus, Keiser said. He pointed out that infection rates are higher among Hispanic residents of Galveston County, but it’s unclear whether that’s because of social, economic or genetic reasons, or some combination of all three.
“Is there some genetic factors that we don’t understand that make some people more susceptible than others?” Keiser said. “We don’t know the answer at this point, but we’re going to start looking at that in our population of people.”
WHAT WE THOUGHT: Masks aren’t necessary.
WHAT WE LEARNED: Masks protect others from me and might protect me from others.
EXPLANATION: During a town hall meeting at the University of Texas Medical Branch in March, Dr. Susan McLellan, the director of Biosafety for Research-related Infectious Pathogens at the University of Texas Medical Branch, told a group of hundreds of people what was the common thought at the time: People should be washing their hands frequently and avoiding touching their faces, but face masks don’t seem necessary.
Seven months into the pandemic, that advice seems backwards, McLellan said. Masks are now known to be a big deterrent to the spread of the virus and are the most commonly cited protective measures recommended by health officials.
That changed because of a better understanding of how COVID-19 spreads. Early on, the idea was the virus mostly spread by people contaminating surfaces and others coming into contact with those surfaces. One person would breathe the virus onto a surface and other people would touch it, pick up the virus on their hands and, typically, eventually to their faces.
Masks do less to protect in that situation, McLellan said.
“Based on information on other coronaviruses, of which there’s plenty out there, and other respiratory viruses, the likelihood that they would help much seemed low,” McLellan said, adding that at the time some health officials were urging against the general use of masks out of worry about supply shortages at hospitals.
Newer research has shown that COVID-19 is different. It’s more airborne and less likely to spread on surfaces. And more people are potentially asymptomatic carriers than previously known. Given those factors, altruistic masking — wearing a covering to protect others — makes sense, McLellan said.
Even newer research suggests that masks also protect the wearer, at least a little, reducing the viral load, which might mean less severe case of COVID-19, and perhaps even preventing infection at all, according to researchers at the University of California, San Francisco.
WHAT WE THOUGHT: We don’t know how to treat COVID-19 in hospitals.
WHAT WE LEARNED: There are some effective treatments, but no cure.
EXPLANATION: When COVID-19 appeared, there was little knowledge about the most effective ways to treat people. The early months were rife with speculation about the benefits of zinc or hydroxychloroquine, even as experts cautioned against moving too fast on unproven treatments.
Time has made courses of treatment clear, said Dr. Shawn Nishi, a pulmonologist at the University of Texas Medical Branch, and one of the doctors overseeing COVID-19 treatments there.
There is no vaccine that prevents a person from getting COVID-19, and no drug that flushes the virus from a person’s system, but some treatments have shown promise at helping people recover from the virus more quickly.
The medical branch, for instance, was the site of a trial for remdesivir, the antiviral drug that is now a commonly used treatment for the virus.
Although some physicians report good results with remdesivir, results of an interim trial the WHO conducted “suggest that Gilead’s remdesivir was no better than a placebo at limiting severely ill patients’ need for mechanical ventilation, the length of their hospital stay or their risk of death,” the news service Reuters reported Friday.
“The trial involved 11,266 hospitalized adults with COVID-19 in more than 30 countries, including 2,750 who were randomly assigned to receive remdesivir,” according to Reuters.
The medical branch, which now has a team of doctors experienced in treating COVID-19, also has been using blood thinners early in a person’s treatment to help prevent blood clotting. That’s something that had to be figured out on the fly during the pandemic, Nishi said.
The doctors at the medical branch have unfortunately had a lot of opportunity to learn. At one point this summer, there were 42 COVID-19 patients on ventilators at a single time, Nishi said.
Treatment is helped along by the public knowing more about the virus and seeking treatment at the right time, Nishi said.
“Patients are coming in earlier, which they should, we’ve done a really good job about educating patients to take this very seriously,” Nishi said. “Making sure they understand the signs and symptoms, I think that’s the biggest thing.”
WHAT WE THOUGHT: The virus was highly lethal and might kill an unprecedented number of people.
WHAT WE LEARNED: The virus might not be as deadly as first feared.
EXPLANATION: Early estimates of COVID-19’s fatality rate — the number of people it killed out of the number of people it infected — was estimated anywhere between .1 percent and 25 percent depending on where a COVID-19 outbreak occurred, according to a WHO analysis in August.
More recent estimates have put the mortality rate of the virus on between 2 percent and .65 percent, depending on whether the calculation is factoring in just confirmed cases, or assuming there are cases that were never officially diagnosed.
The WHO’s estimate that 10 percent of the world’s population has been infected implies a mortality rate even lower than .65 percent, something like .13 percent.
The consensus is forming that the rate that COVID-19 kills people is far lower than some of the earliest dire predictions.
But lower projected mortality rates are only one way to judge how dangerous COVID-19 is. The virus has been blamed for more than 203,000 deaths in the United States this year, and 148 deaths in Galveston County. A typical flu season causes about 22,000 deaths from about 35 million cases in the United States, according to the CDC.
People shouldn’t use the death rate to be cavalier about the threat of the virus, Keiser said.
“It’s not the apocalypse, but it is more people than we would see in a given flu year,” Keiser said. “More people have died from COVID-19 since February than have died in the last five years from influenza. So it’s not the flu, but not like you see with ‘Contagion’ or some of these movies where people are just dropping dead in the streets.”