Deacon Rob Lanciotti is a permanent deacon at St. Elizabeth Ann Seton in Fort Collins and holds a doctoral degree in Microbiology. He was employed as a virologist for the Centers for Disease Control & Prevention (CDC) for 29 years.
If you’re like me, you’re probably tired of hearing about the coronavirus pandemic. What’s even worse, however, is to have to listen to all the conspiracy theories – from both sides. For whatever reason, I seem to have friends on both sides that believe in some of these conspiracy theories. From the right, there are those who believe the U.S. government and pharmaceutical companies are driving the coronavirus epidemic and using it to their advantage to make money or to outlaw religion. From the left, I hear that the president is forcing agencies like the CDC to issue inaccurate scientific statements that minimize the severity of the epidemic. As with many conspiracy theories, they are ultimately unsupported nonsense and lead us nowhere except to further divide us.
It’s time to take a collective “deep breath” and think about where we have been and what we currently know. The objective and unbiased facts are this: A coronavirus, previously unknown to us, has gotten into the human population and spread throughout the world. And this is the worst-case scenario; a new virus for which everyone is susceptible, for which there is no vaccine and that spreads through casual contact. In this case, the only available public-health response was to try and limit its spread through human behavior modification. As a result, in March of 2020, based upon epidemiological models and the best advice from public health officials, most of the country adopted a series of risk-reducing measures that led all the way to the shutdowns. In their decision making, public health officials erred on the side of safety. This is a reasonable course of action, given the priority that we should rightly place upon preserving human life.
Now let’s fast-forward approximately two months. We certainly know significantly more than we did at the beginning, and this should guide future policy decisions. Specifically, we know more about who is most likely to die after being infected.
First, however, let’s review how people are getting infected with this virus; something that we already knew from other respiratory viruses before all this started, yet has not been emphasized. We know that the primary means of transmission is by close contact between people in which infected droplets from one person move to another, generally by coughing or sneezing. In general, the role of the asymptomatic carrier in transmission has been overstated. From previous studies of other respiratory viruses, we know that in many cases, people without symptoms are expelling fewer infectious particles than those who are sick; this is consistent with what we know about viral replication. The reason people show symptoms is because the epithelial cells lining the respiratory tract are infected and then die; literally exploding and releasing virus particles. Those without symptoms have more healthy epithelial cells and are releasing fewer virus particles. So yes, asymptomatic carriers can theoretically transmit the virus, however, this is not thought to be the primary means of transmission and should not overly concern us. Another secondary way that this virus can be transmitted that has also been over emphasized is by contamination of surfaces. There were many news reports describing how long the virus can survive on a surface. Please keep in mind one very important thing. These are all artificial and simulated studies. The only conclusion that can be drawn from these studies is that if a scientist puts the coronavirus on an inanimate surface, it can be detected at some future time point by a very good and sensitive test. It does not prove that the virus can actually be transmitted that way, and to what extent this mechanism plays in epidemics. The only way one could actually prove virus transmission in this fashion would be experiments involving humans, which are clearly unethical. The CDC coronavirus webpage now states the following:
“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about how this virus spreads.”
The take-home message is that surfaces play some role in virus transmission, but it is thought to be a minor and secondary role. And by the way, President Trump did not force CDC to make this statement; they were just reminding us of something that has long been established in the scientific community.
Secondly, we have learned quite a bit about who is dying from this virus. Let’s face it, the “million-dollar question” is: What is the risk of dying from this virus if one is infected? To determine this, scientists calculate something known as the case fatality rate (CFR), which is a very simple fraction. It is the total number of deaths due to coronavirus divided by the total number of infections; all within a particular geographic region. The total number of deaths is something that can be fairly accurately determined. I know there have been reports of over and under estimations of deaths, but in my experience working with epidemics, these are a “wash.” The problem in determining the CFR is getting an accurate denominator – the total number of infections within a particular area – since many people will not have any symptoms. In the early phase of the epidemic, this was completely unknown. That is why we heard various CFR estimates that were as high as three to five percent.
The only way to determine the denominator in the CFR fraction (total number of infections) is by conducting what is called a serosurvey. These are quite straightforward in theory, however difficult in practice to carry out. In the most common scenario, a team goes door-to-door randomly asking for volunteers to donate a blood sample. While at CDC, we conducted one of these in Queens, NY, to determine the number of West Nile infections that had occurred; you can imagine some of the responses the team received! Once enough samples are obtained (enough to make the study statistically meaningful), they are then tested for the presence of antibody to the virus, which indicates that the individual was infected, regardless of whether or not they had any symptoms.
The results of a number of these serosurveys for COVID-19 have now become available, and the resulting CFR calculations are significantly lower than originally predicted. In fact, CDC just recently released results where they have determined that the overall CFR in the USA is approximately 0.26%. This is approximately twice the CFR of our annual flu epidemics. Another very informative way to look at this data is to determine the CFR among different age and health status categories. New York provides a large data set to perform this analysis, and when the CFR is determined for various age & health categories, these data show us fairly accurately the fatality risk among these categories if infected with COVID-19. The summary message is clear: there is virtually no risk of death for those who are healthy between the ages of 0 and 17 (CFR=.0007%), a risk similar to annual flu for those healthy and between 17 and 65 (CFR=.16%), and approximately a 12 times greater risk than annual flu for those healthy over 65 (CFR=1.5%). If one includes fatalities from those individuals with one or more pre-existing medical conditions, the CFR increases significantly, up to seven percent. Estimates from New York indicate that in approximately 70-90 percent of fatalities, patients had pre-existing medical conditions.
What does all this mean in terms of what our level of concern should be, and what precautions should be in place? How should we safely reopen our churches?
With respect to the question of how to safely resume Masses, the Archdiocese of Denver has issued sound guidelines, that in general follow the Thomistic Institute document, Guidelines on Sacraments and Pastoral Care. This document was formulated by experts in both infectious disease and in liturgy, and as a result, both respects the liturgy and provides a safe way for Mass participation. Attending Mass and following the archdiocesan guidelines provide adequate risk reduction.
Finally, how concerned should we be living during this pandemic? First of all, based upon our faith in Christ, none of us should be afraid. However, we should all be concerned about this pandemic. As I stated at the beginning, it is in fact the worst-case scenario; a new virus in a population with no immunity and with no vaccine on the immediate horizon. Many people have died and more will die from this virus. However, we do not all face the same level of risk. We should look at the facts and determine for ourselves the risk that we face and adopt the corresponding risk management measures. We also need to consider not only our own age and personal health, but also the risk we posed to others if we infect them. Some of us need to be more concerned and take greater protection measures than others. For example, a healthy individual below the age of 65 should not be doing significantly more than what would be done in a typical flu season. On the other hand, those over 65 with one or more underlying medical conditions should take great precautions in public, and perhaps not even attend Mass. The bottom line is if we’re smart about this, use common sense and the data that we have to take reasonable precautions, many of us can go about our lives and attend Mass with minimal and even negligible risk.