Anyone remotely aware of Hollywood’s favorite topics has seen a “plague” movie or two. There have been many over the years, some big budget productions and some small. It’s understandable; a fear of mortality is a basic human trait. Anything which has the potential to shorten the life span of large numbers of humanity is of particular interest to many, be it real or fictional. Some of these films have been scientifically accurate and well-researched. Others have been of the zombie type and thus entirely fictional.

But plague stories remain big business and of widespread interest. This explains the tremendous attention directed toward the latest epidemic, the coronavirus, first reported in China. What is this disease and is it as deadly as some claim? Is it the next plague? And are there any concerns of zombie-itis setting in? Obviously, the last possibility is meant to be humorous, but we should look at the facts about the coronavirus, the flu, and viral infections in general.

Who has suffered from the flu? An easier question would be who hasn’t? The classic flu has been around for centuries. We are all familiar with the symptoms. The fever, the aching, nausea, we’ve all “been there, done that”. But there are many variabilities in a case of the flu, the specific type of flu causing it, the symptoms produced, and the complications that result. Of course, genetics play a major role in determining the course of each case of the flu.

The “flu” is short for in-FLU-enza (influenza), a viral respiratory infection, typically transmitted by droplets when someone coughs or sneezes. Transmission of the flu can also occur when a person touches a surface contaminated with the flu virus, then touches their own mouth or nose. As with most respiratory viruses, the number of cases of the flu increases dramatically during winter months. People infected with the influenza virus are most contagious in the 3-4 days after becoming ill. Symptoms tend to develop two days after the illness starts, so a person may pass on the flu before they feel sick.

Nasal congestion, fatigue, and a cough are all common symptoms with the flu, while vomiting and diarrhea are more common in the young. A fever is a frequent development. Symptoms can become severe, typically in the elderly or those with co-morbidities, ie other maladies. The fever can become dangerously elevated: it’s common knowledge a very high fever can have serious consequences, potentially leading to dizziness, loss of consciousness, even seizures.

This outbreak of the coronavirus in question, termed COVID-19, has attracted much attention. But human coronaviruses are common throughout the world and have been for a long time. This most recently identified coronavirus is associated with mild-to-severe respiratory illness with fever and cough. As with an influenza-type viral infection, severe consequences seem to occur primarily in the infirm or elderly.

How common will the corona virus become? To put that question into perspective, current estimates say there have been 34 total cases of it in the US and 75,000 worldwide, with 2,000 deaths. The flu, in contrast, has infected 26 million people, causing 14,000 deaths. There are other differences as well. The coronavirus in question is not as well studied since it was only identified relatively recently. We don’t yet know if the virus will easily mutate into more virulent or more contagious forms. Apparently, unlike the flu virus, the coronavirus has many similarities to SARS (Severe Acute Respiratory Syndrome), including its transmission from animals to humans. One way for this to occur is when an animal is eaten, or consumed as medicine (a regular practice in Asia). Virologists believe the two, SARS and corona, had a common bat ancestor, then mutated into new forms.

Both COVID-19 and the flu are contagious viruses causing respiratory illness. Flu symptoms develop suddenly, with the course of the illness rarely lasting more than two weeks. The incubation period seems to be noticeably longer in the coronavirus than the flu, which results in transmission to more people before the illness is discovered. About 1 percent of those who develop influenza will need to be hospitalized due to complications. Doctors are still learning about COVID-19 and have yet to draw a full picture of the disease, its symptoms, the severity. In one small study of 100 people, the most common symptoms were fever, cough and shortness of breath. Only about 5% of the patients reported cold-like symptoms such as sore throat and runny nose. One to two percent reported diarrhea, nausea and vomiting.

A larger and more comprehensive study analyzed thousands of cases of this new coronavirus and reported 81% of the cases were considered mild and about 14% were severe. In this study, 5% of the cases were critical, meaning they exhibited respiratory failure, septic shock, and/or organ dysfunction or failure. The flu’s fatality rate is about 0.1%, while COVID-19 appears to be about 2.3% in this study, which would make it significantly more dangerous.

Interestingly, the death rate for COVID-19 seems to be affected by location, not just an individual’s age. For example, in the region where the outbreak was first identified, the Hubei Province, the death rate reached 2.9% while in other provinces of China, it was just 0.4%. As with the influenza virus, older adults are more likely to experience severe repercussions. The death rate soars to 14.8% in those 80 and older. For those in their 70’s, the death rate for the coronavirus seems to be about 8% (in China) but drops to 3.6% for those ages 60 to 69. Nobody 9 and under has died of COVID-19 so far.

For a person who is generally healthy, the flu is not typically dangerous. However, it can severely affect certain groups of people. Influenza can cause severe illness and worsen some chronic medical conditions, such as asthma, heart disease, and diabetes. In some cases, it can lead to death. The same seems to be true for this coronavirus; in those with co-morbidities, separate and identifiable medical illnesses, a respiratory viral infection can have serious consequences. It really depends on one’s general health.

The outcomes of the flu are quite predictable, such as the number requiring hospitalization and how many will die. The issue with COVID-19, the coronavirus, is that there are so many unknowns. Still, the risk to most Americans is miniscule. But the media loves a good epidemic and this new infection is ripe for attention-grabbing headlines. Fear should not rule nor dictate national policy; wise and prudent decisions are called for. Recommendations like closing U.S. state borders is unnecessary, while vacationing in Huabei Province right now might not be especially wise. In this age of easy and accessible world travels, communicable diseases are a real concern and deserving of intelligent, planned precautions. Panic is not.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.