So you think you’re about to be in a pandemic?

by Ian M Mackay, PhD and Katherine E Arden PhD

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 [1]) has spread to over 30 countries and regions outside mainland China. Currently, disease spread in Singapore is being slowed by their expertise but new case numbers in South Korea, Italy and Iran, and the wide national distribution of cases in Japan are all signs that the virus is ahead of our efforts to contain it.

Let’s go shopping. But bit by bit – not in a rush.
Photo by Daria Volkova on Unsplash

We’re not in a pandemic now

For now, you are more than likely not living in an area experiencing widespread community transmission of SARS-CoV-2. If more cases of coronavirus disease 2019 (COVID-19) keep rapidly appearing, and more of them can’t be traced to existing transmission chains, the efforts in some countries to contain COVID-19 will have failed.

At some point, we’ll be in the main phase of a pandemic; epidemics of an efficiently transmitting pathogen spreading widely within the community of two or more countries, apart from the first one to report it.[1] A pandemic doesn’t necessarily mean the disease is severe. Also, this word may bring to the attention an event that some still manage to ignore when softer words are used. And let’s face it if we don’t start using this possibly scary word and talking about and planning for the possibilities now – how much more panic and fear will result because we were taken totally by surprise?

For once, let’s get ahead of what’s coming.

Assumptions and severity

This post is based on the assumption that a pandemic will occur at some point and that Wave 1 will impact us, wherever we live, in the coming weeks and months.

We don’t know for certain how severe a COVID-19 pandemic will be. We may be able to assume it’s a mild or perhaps moderate pandemic, not a severe one, according to definitions in the Australian Health Management Plan for Pandemic Influenza scenarios.[4] But we won’t know for sure until we see spread in countries that ask questions, define cases, and test for SARS-CoV-2 in the same way that we do.

From AHMPPI.[4]

We know that SARS-CoV-2 is effectively transmitted among humans but it may take longer for symptoms to show up in the next infected person than it does for seasonal influenza (“silent” or unnoticed shedding may happen). We also know there are no antivirals or vaccines at the time of writing and we are pretty sure that our entire population is likely to be vulnerable to infection because it doesn’t have any immunity to their new virus.

Planning now and doing something means we can control how well we cope with some of what may be coming.

If we see events cancelled or schools closed we can rest assured that this is to slow down spread, not something scarier. Hopefully, this will be clearly explained by authorities at the time.

While closures and cancellations are possible, they are by no means a sure thing. We don’t know how mild or severe SARS-CoV-2 will be, and each region will make their own – probably slightly differing – decisions about what is appropriate – and enforceable. Having a think now about how we might respond in these situations will help decisions come faster if we get to that point.

Thanks to the expert commentary of Dr Jody Lanard and Dr Peter Sandman, in the last post, we already have some excellent ideas about what information we should be listening for, from health authorities communicating to the wider community.

What we might see happen if many get sick

If we enter into a pandemic, large numbers of people will be sick. Even if that’s just staying home with a fever and bad cough for a week. If COVID-19 is more severe, that will have a greater impact.

And when one family member is sick, one or more others may be involved in their care, removing more people from the workplace. The same effect may result if children being excluded from school. In a worst-case scenario, widespread illness may mean too few workers to drive trucks and trains, buses and taxis, run water treatment, electricity or other government services, teach at schools or staff hospitals. This didn’t happen in Australia during the 2009 H1N1 “swine flu” pandemic. But supply chains may be impacted in a number of ways.

Authorities will try to slow the speed of COVID-19 to prevent hospitals – which are essential to care for the sickest people – from being overloaded. Public gatherings – sports events and concerts – as well as schools and childcare centres, could be postponed or closed. All of which aims will be to keep people apart, making it harder for the virus to spread quickly.  Again, these decisions will differ between places, and may not even have to be made.

Measures which slow the peak (1) and “flatten the curve” (2) will delay and spread out the pressure on essential healthcare function and supply chains. [3]

Once we have a vaccine, we can mitigate the impact of SARS-CoV-2, but we’re quite some way from having a safe vaccine.

Planning for everything

A lot of the planning that is going on in many places worldwide right now revolves around supporting essential services, using the numbers we have to predict the load on hospitals and to model a myriad of impacts on daily life; planning for the worst and hoping for the best.

Everyone knows the precise numbers of cases and deaths are not as precise as we’d like them to be. This is where modelling gives the authorities options – from most likely to happen, to least likely. From least concerning outcomes to the most devastating ones. And we plan accordingly. In this process, a lot of guidelines and plans and documents get written, but few of them are of use to you (or us) as members of the wider community.

It seems to take a while to get to around talking to the community about what they can do. Part of that’s because of how consumed with work many are right now because this epidemic is still only 8 weeks old; an infant, yet one that moves like a teenager who just discovered caffeine. And yet, late last week and over the weekend, the signal fires of pandemic awareness and increased communication started to light.

But what can we plan for and do?

Let’s break this into two main categories.

  1. Reducing our risk of being infected
  2. Reducing the chance we will run out of, or have to go out to get essential foods and goods

Reducing our risk of being infected

We can do a few things and we’ve probably heard them all before. They won’t guarantee to protect us from infection, but they can reduce our risk of infection. These are just as useful for avoiding influenza (flu) virus infection during flu season and for dodging SARS-CoV-2, once your local community is known to have it circulating.

REMEMBER: As long as the virus circulates, and as long as you have never been infected, you are susceptible to infection resulting in COVID-19. This will be the case for the rest of your life until you have been infected which should protect you from severe disease. COVID-19 is mostly a mild illness but can cause severe pneumonia in approximately 20% of cases, leading to hospitalization for weeks and in a portion of these cases, to death.

World Health Organization.[2][5]

These are things we can do to reduce our risk of SARS-CoV-2 infection.

  • Stay at least 2m away from obviously sick people.
    We’re trying to avoid receiving a cough/sneeze in the face, shaking hands, or being in the range of droplet splatter and the “drop zone”
  • Wash your hands with room temperature water for 20 seconds or alcohol-based hand sanitiser & do this more frequently than you do now
    Soap and water and then dry, or an alcohol-based hand rub after you walk out of eth lift, drag your hand along that handrail, held onto the bus for that trip, and air dry
  • Try not to touch your face.
    There is a chance your unwashed fingers will have a virus on them and if you touch/rub your mouth, nose or eyes, you may introduce the virus and accidentally infect yourself. Practice this; get others to call you out when you forget. Make it a game.
  • Keep air circulating with a fan or open a window
    This helps spread out any floating droplets – just in case they are a risk. It reduces the chance of being exposed to enough virus to cause illness
  • Don’t share crockery and cutlery and clean your shiny surfaces
    If a time comes that we are looking after an ill loved one in our own house – or we’re ill and housebound – cleaning kitchen and bathroom surfaces, door handles, light switches with household detergent of disinfectant and not sharing items with others can reduce the risk of spread, as can having the person stay in a room away from the rest of the household.
  • Get a flu shot
    Two things you don’t want: to be in hospital during a COVID-19 epidemic or to add to what will be an overloaded healthcare sector by becoming sick when that can be avoided

Masks are not perfect, they need to be put on, taken off and disposed of carefully and they may give the wearer a false sense of security – but they do reduce the risk that you will infect others. There isn’t a lot of good evidence (still!) that shows a mask to reliably prevent infection when worn by the public at large but they have an effect when put on a sick person to reduce their spreading of the virus.

If you or a loved one becomes sick, follow the practices of the day. Call ahead before going to a Doctor, fever clinic or hospital and get advice on what to do. Hopefully, this message is already out there and we’ll see it more once transmission of the virus is widespread.

Reducing our risk of running short of food or having to go out to the shops to get more important goods – the 2-week list

What we’re looking at here is trying to minimize the impact of any shortages of goods we rely on having at the grocery store or at the end of an online ordering system but also, to reduce the risk due to us mingling with people at the shops who may be infected.

Dried fruit. It lasts and is nutritious.
Photo by VisionPic .net from Pexels

But don’t panic buy and don’t hoard!

Most of the world is not seeing any widespread ongoing transmission of SARS-CoV-2, so now is a great time to make list, label up a “Pandemic Stash” box, and begin to slowly fill it with items that won’t go off and that you won’t touch unless needed. Buy a few of the things each weekly shop. Don’t buy things you won’t eat later, don’t hoard and don’t buy more than you’ll need for a 2 week period. We’re not talking zombie apocalypse and we very probably won’t see power or water interruptions either.

Our household is trying to get food that fulfil a need for carbohydrate, protein, and fibre. We also want supplies for caring for the sick (or for when sick yourself) and cleaning supplies to try to reduce the spread.

Below we list things we’ll need to have in case of a more major interruption to supply; a stock that will last two weeks. This is a figure based on other professional sites like the New South Wales Government in Australia and in the United States. Local authorities may have some more detailed advice in the future. Stay tuned.

Some of the items in the list below will last much longer and include items that may not be a top priority for authorities to keep stocked:

  • Extra prescription medications, asthma relief inhalers
    Some of these may be a problem, so talk to your doctor soon.
  • Over-the-counter anti-fever and pain medications
    paracetamol and ibuprofen can go a long way to making us feel less sick
  • Feminine hygiene products
  • Family pack of toilet paper
  • Vitamins
    In case food shortages limit the variety in your diet
  • Alcohol-containing hand rub and soap
  • Household cleaning agents
    Bleach, floor cleaner, toilet cleaner, surface cleaning spray, laundry detergent
  • Tissues, paper towel
  • Disposable nappies, baby formula or canned food
  • Cereals, grains, beans, lentils, pasta
  • Tinned food – fish, vegetables, fruit
  • Frozen vegetables, meat
  • Oil, spices and flavours
  • Dried fruit and nuts
  • Ultra-heat treated or powdered milk
    Ian is not drinking black coffee, no matter what
  • Batteries for anything that needs batteries, powerbanks
  • Think about elderly relative’s needs
    Their medications, pets, pandemic stash, plans for care (see later)
  • Pet food and care
    Dry and tinned food, litter tray liners, medicines, anti-flea drops
  • Soft drink or candy/chocolate for treats

The last-minute fresh list

In a more severe pandemic, supply chain issues may mean fresh food becomes harder to get. So this list is an add-on to the one above, and its items should be the last things to buy if you have a hint of when supplies might slow or stop for a (hopefully short) time.

  • Bread, wraps
  • Meat for freezing
  • Milk
  • Eggs
  • Yoghurt
  • Vegetables, fruit
  • Fuel for your car
  • Cash

Don’t forget mental health

As this event has travelled along, things have become more scary and confusing for many people. The media have in some cases fed that anxiety and in others tried their best to take a calm but factual tone.

Throughout it all and whatever comes next, remember to keep in contact with your friends and family.

If we all do end up at home for some time remember to prepare for boredom and anxiety there as well.

  • Keep an eye on the kids
    Get in touch with teachers to see if they have plans for homework
  • Get some books stocked up
    Real-life or electronic
  • Make sure you have some TV and movies to binge;
    Create a routine of watching something together; maybe not Outbreak or Contagion though
  • Keep up the daily routine
    Maintaining the normal is important for us all
  • Maybe think about a new hobby or start a nightly board game routine
  • Thinking about online chat groups, streams, social media link-ups
    I’m open to participating in online chats or live streams or something if that would help or at least distract
  • Exercise – do some – go for a daily walk

Lose weight to reduce the risk of severe disease

This one isn’t going to be popular. But obesity is a problem all over the world. Malnutrition is also a problem increased risk of severe disease from respiratory virus infection.[6]

But obesity is what I’ll talk about here. Obese people comprise a large proportion of influenza hospitalisations and are at high risk for severe infection and secondary bacterial infections.[6,8] Obese mouse studies backed up these findings. They’ve also found that the immune response is more inflammatory but also is in part delayed. Obesity has also been found as a comorbidity in almost a fifth of patients with Middle East respiratory syndrome; a disease also caused by a coronavirus.[7]

If you are serious about reducing your personal risk, and weight is an issue for you, time to get serious about using up more energy than you take in. Get walking and fight viruses!

The elderly and COVID-19

To date, looking at data from China (below), most (94%) deaths from COVID-19 have occurred in those aged over 50 years of age, with more than half (51%) in those aged over 70 years. The age group most at risk for death are those aged over 80 years.

Older people with comorbidities have experienced higher proportions of death than those with no comorbidities. Most cases identified in mainland China – 80.9% of them – even with the more severe case catching that China has favoured – have been classified as mild. This is good news although 20% is still a lot of “severe” disease. Mild cases recover in about 2 weeks from the time they showed symptoms, while severe cases can take 3 to 6 weeks to recover.

Infographic of the largest study of cases from China.[1]

Because of this, we may see a big impact on our elderly population, both in terms of hospitalisation and death. Residential aged care is likely to suffer and visits to loved ones may be restricted to keep them safe. If you have loved ones in an aged care facility, ask the facility about its plans for keeping their residents safe from flu (a similar situation) and whether they have thought about what they will do if SARS-CoV-2 is spreading widely.

It will be important to check that your parents and grandparents have prepared a Will and have considered an Enduring Power of Attorney in case they are unable to make care-based decisions for themselves. These aren’t fun to organise or think about, but they’re important whether we see a COVID-19 pandemic or not, so just use this as a reminder to get it done.

Distance and the elderly

Keeping those at most risk of serve COVID-19 illness away from gatherings and the general public through social distancing is going to be important. At least while we wait for the arrival of a vaccine. For our older adults, this will mean planning to go out into the community less often, once the virus is more widespread in the community.

Pandemic is a word, how we react to it is down to us

We all want to have some control over our lives but when a virus comes knocking as this one is, we feel the loss of that control. The lists above are something we can actually do.

We’re working on this in our household now, bit by bit. The lists have helped us all focus on how that “thing going on in that faraway country” will impact us when it comes to our neighborhood. This process has already made things a little more familiar and a little less unknown and scary. We’ve done some things that will help. We know there are still risks but we’ve talked about them, calmly, as a family.

Of course, this doesn’t remove the many unknowns, but we’re sure we’ll gradually reduce those as science gets us more answers. Hopefully, these answers will bring good news; lower death rates, effective antiviral drugs, and new vaccines.

We do have some experience of a pandemic and it wasn’t panic-worthy. The pandemic of H1N1 “swine flu” in 2009 had some unhappy consequences, but it was by no means a zombie apocalypse.

China has bought us time to prepare. Let’s not waste any more of it. Instead, let’s get our planning hats on and all work the problem together. This is one of those rare times when we’re unarguably all in this together.

SARS-CoV-2 doesn’t care about our beliefs, our sex or gender, our colour or our clothes – it just wants to make a home in our human cells.

It’s perfectly okay to be anxious about this.

But work the problem.


  3. Interim pre-pandemic planning guidance: community strategy for pandemic influenza mitigation in the United States: early, targeted, layered use of nonpharmaceutical interventions. Published Date: February 2007
  4. Australian Health Management Plan for Pandemic Influenza (AHMPPI)
    August 2019
  5. Clean hands protect against infection
  6. Influenza in High-Risk Hosts—Lessons Learned from Animal Models
  7. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis
  8. Underweight, overweight, and obesity as independent risk factors for hospitalization in adults and children from influenza and other respiratory viruses

Views: 86300

217 thoughts on “So you think you’re about to be in a pandemic?”

  1. Just regarding the list…… My past experience has been UHT or tinned milk keep longer and better than powdered milk in QLD, because there are too many weather fluctuations to keep the fats in the powder stable past the best-before date…… In QLD I would also include storm season supplies like plastic tarps, flash-lights, tape and cable-ties, because SES workers may not be around to assist much..… I would also include recreational supplies to support mental health in isolation i.e. Darts, jig-saw puzzles, cards, bowls, board-games, art-supplies, table-tennis, bird watching, mini-golf, back-gammon, knitting etc.

    1. Similar to our cyclone preparation kits in Far North Qld, I would also have a battery operated radio. I know it’s not expected for power to go out, but depending on the time of year, there can be lots of power outages and response times may be delayed with limited staff.

  2. An excellent resource, and thank you for it. I am not sure I am prepared to follow the party line on respiratory PPE, though. As you are aware, “there is no evidence …” is not the same as “this is a bad idea and won’t help”. Firstly, how do you trial PPE in a community setting over a protracted period ? The cost would be staggering. Secondly, n-95s and PAPRs need to go to HC and essential workers first. Telling people they can keep themselves a little safer using one will create intolerable political pressure for a general distribution. If (as is inevitable in 98% of cases) it is mis-used you have just wasted a critical resource for no benefit whatever. Thirdly, public health can be a little patronizing, assuming the Great Unwashed are slightly dumber than a cat.

    Add those things together and you get the current guidelines.

    However, if you have the gear AND are prepared to follow all the usual CDC guidelines, AND are realistic about how long you can wear the horrible stuff, it has its place for people that cannot avoid social contact. Raina Macintyre (UNSW) did some research on it in the context of parents caring for sick children and concluded that masks were of benefit. She might have some insights, although of course it is a kind of touchy area.

  3. thanks so much. we support people with developmental disabilities and your advice has encouraged us to start working on this now. We are in SoCal so we may have a bigger window of reprieve with spring coming on instead of autumn. Thanks too for recognizing China for giving us some lead time. I’ve shared your articles with our regional centers and state agencies as well as a FB forum for executive directors.

    1. As the parent of an adult child living in a developmentally disabled group home in Southern California, I am SO GLAD to know that preparations are already being undertaken to deal with any outbreaks. Thank you for everything you do.

  4. Excellent, practical & sensible advice. Thank you for keeping us up to date, good to see mainstream news are picking this up. Have shared widely on social media. Regards, Anne

  5. Is it possible that your bar graph is mislabeled?

    Consider the >80 age group. The red bar is 15%, the striped blue bar is 3%…

    … yet both are claimed to be fraction of the age group.

    It seems unlikely a priori that 5 times more individuals in this cohort die than are diagnosed with COVID-19. On the other hand, it’s plausible that mortality increases with age.

    Perhaps the blue bars and red bars have different scales, and the scale for one was inadvertently omitted?

    Or perhaps I’m misunderstanding the labels.

    Otherwise, very useful article…

    1. Not for Aus alone and really not a warning but instead a gentle prod to start thinking about this.

    1. We don’t know that for certain because we get reinfected by the same viruses throughout life, we just don’t usually get as sick the second, third, fourth time around.

  6. I think Prep should include a chat about what you might do should schools and child care centres close. Who will look after the kids if you are working? Are family elders at risk and therefore might not wish to look after your kids full time, or might not be fit enough. Having had the discussion, families can make considered decisions.

  7. Excellent article. Thank you so much for laying it out so rationally. All the best as we weather the storm.

  8. Thank you. Very sensible and measured comments – practical and helpful. Have forwarded to my town’s public health department here in Massachusetts. They’re being pinged for helpful suggestions that don’t come straight from the fetid swamp of alarm so prevalent on the internet..

  9. I am in the US, a city of 1/2 million people. I have multiple autoimmune diseases and am well over 50. I always try to be careful because I’m my experience, a shared common cold becomes bronchitis, sinus infection and even pleurisy, once I am exposed. My husband and I have enacted new practices and he is fully on board. Do not use ink pens in public use, do not touch gas pumps or ATM machines, no more hand shaking or hugging friends (we don’t have family anywhere near us so this will be easy for us). We started buying bleach, bath tissue, laundry soap, wipes and gel, and gloves, just enough that we think we will need for about 3 months. As the spread hit the Middle East and now Europe we mad trips to buy canned veggies, stocked up in oatmeal, rice, pasta, sugar, salt, flour and yeast, as well as comfort foods like chocolate. We’ve cleared our fridge and freezers of things like ice cream and my husbands frozen pizzas (food that takes up too much space in packaging and is wasted calories) we are prepared to make pizza dough and bread, as needed, so he will still have the carbs he enjoys. We’ve had enough food and medication for our dogs delivered. We’ve filled our freezer with meat, cheese, fresh eggs, and packed everything in small portions to minimize any food waste.

    We have created a process for opening any packages, should we order anything on line and have enough medications as insurance permits, to last us about 3 months. Should we decide we need to lock the front door and stay only in our home and back yard, we should be relatively content for 3 months. That still may not be enough time, but it’s a start. I am not an alarmist, experience has forced me to be careful with general practices, because of existing health issues. If I die, I’m fine with that, what we don’t want is long term severe illness to affect either of us.

  10. IF this evolves to be overkill on our part, fine, we will have a hefty donation to our local food bank later this year.

  11. Goes without saying that newborns ABSOLUTELY MUST be breastfed. Nursing mothers should give their milk to other children if they get sick. A teaspoon contains millions of antibodies.

    1. None of us have anti-bodies to this virus. I get your passion, but it is best to feed babies. Some people just can’t and wet-nurses just aren’t a thing anymore.

    2. Not all people are lucky enough to be able to breastfeed. This comment is worded in a way that makes them feel inferior and it is extremely rude. Instead, please make statements such as: “if at all possible, newborns should be breastfed. If not, use extra precaution bringing them in public spaces or around possibly infected people”.

    3. No, they don’t.
      Antibodies from breastmilk do not pass into the bloodstream and therefore will only offer local protection in the intestines.
      And the nursing mother will only produce antibodies when she gets infected, and only with a delay of several days from infection until antibody prodction kicks off.
      Virus particles instead are produced much earlier in infection.
      Therefore, breastfeeding offers no protection at all to the nursing baby in this setting.

  12. Scary..and we all should be ! I haven’t been out in months avoiding people..places..starting tomorrow stocking up good a phone call from schools …don’t send your child if they have a tiny fever…or temp..sick..cold..flu simtims….NOW THAT HAS NEVER HAPPENED EVER THAT KINDA PHONE CALL

  13. I’m in Australia & you have the year of swine flu wrong it wasn’t 2009. My disalbled child died from the swine flu in 2007.

  14. Thank you for sharing – I am four months pregnant and am finding it really difficult to find information for pregnant women, do you have any specific information to share or give reference to on how to manage pregnancy through this? Thank you in advance!

    1. Sorry but I’ve not yet seen much that is useful. But please keep referring to your local public health experts for the latest. Also, the WHO may have advice on their dedicated coronavirus

    1. It’s to help minimize the chance of your child contracting other illnesses. Their best chance of minimizing the effects of the virus should they contract it is to not be sick with another illness at the same time.

    2. I dont mean to jump in (hopefully have not misunderstood you), but no one has antibodies unless they have caught and recovered from this specific virus. It will circulate & affect everyone it comes in contact with. Hence, we must all do what we can to slow the circulation so our health care systems (economy & infrastructure) can weather this storm & treat all that need help. Too many very sick people in a short time means they may not get the help they need & essential services will be at risk. Take care of your health.

  15. Dr. Mackay – I’ve been tracking the reporting by country and recently noticed an interesting trend. In Korea, the mortality rate (deaths / total cases) is far lower than in China, Italy or anywhere else, really (currently ~0.5%). The same is true for severe & critical patients / total cases (also ~0.5%). I have zero background in medicine, let alone epidemiology, but I am a bit of a data geek, and as I understand it, Korea has been testing much more aggressively than any other country. Could it be that their figures are in fact closer to actual mortality rates than the figures we see from China and elsewhere? And if so, this seems closer to a bad seasonal flu than the spanish flu. Then again, maybe the aggressive testing in Korea is yielding a lot more false positives… Any thoughts on this?

    1. Almost all experts think there are far more cases circulating then reported. Each day we are making great strides in detection & understanding this virus, so it is expected we should have a more accurate data as days go by including a more accurate mortality rate. And yes, health authorities in Korea & Hong Kong are some of the world’s best at this…Thanks to the authors for some of the best level-headed and truthful info @this site. I am proud to be part of a brotherhood of dedicated & reasoned physicians & researchers.

    2. By testing many in the early stages of the disease you find a very low proportion of people already very sick of that have died. That’s the reason why the case fatality defined by deaths/cases has been steadily increasing in China now that the epidemic is slowing down.

  16. “dont hoard and dont buy more than youll need for a 2 week period.”

    Ya, too late. See you in six months… maybe.

    Not having at least two months supply of food is absolutely irresponsible. I value your point of view but I’d rather have the ability to slam the door shut and shoot anything that tries to get in for a month.

  17. since one of the greatest risks is that covid can lead to severe pneumonia, would people who’ve had pneumonia shots be protected from that complication? If so, might pneumonia shots be a good recommendation for certain vulnerable groups?

    1. No. The main issue here is a *viral* pneumonia, not a bacterial one which that vaccine will protect against.
      However, yes, the vulnerable groups should have that vaccination or a booster as recommended. They should see their local doctor about this.

  18. In re “COVID-19 Cases and Deaths by Age”, the feature of these data that strikes me is that deaths fall disproportionately in those of greater age. An analysis of these data that I would find interesting is the age distribution of the ratio of fatalities over diagnoses. For instance, the >80 age group contains about 3% of the cases and about 15% of the fatalities, the 50–59 age group represents about 22% of the cases and ~1.5% of the deaths.
    Stipulated that correlation does not indicate causation, of course. A care facility with many older residents might be advised to take measures much more vigorous than those taken for the general population.

  19. Dear Ian and Katherine,

    Thank you for all of the valuable information you have been providing on COVID-19. I am a doctoral level psychiatric epidemiologist, but I’ve had a lifelong interest in ID epidemiology. I am hoping you might be able to provide me with some insight into two issues:

    1) Why is it that everyone seems to be calculating the CFR without using survival analysis? Given the length of time from onset of symptoms to diagnosis and from diagnosis to death, don’t we need to take duration of illness into account – particularly when we are comparing the CFR inside China to that among cases outside China when the vast majority of cases outside China were diagnosed less than 2 weeks ago?

    2) In your post, you refer to the 2009-2010 H1N1 pandemic. I have been doing so myself by comparing the stats from COVID-19 to H1N1 at a similar point in the progression of the pandemic. How appropriate/inappropriate is this comparison? If you look at the H1N1 numbers based on the WHO Situation Summary from June 24, 2 months after the first Situation Summary on April 24, there were 55867 confirmed H1N1 cases in over 100 countries, with 238 deaths (0.43% of confirmed cases). Per the February 29 WHO COVID-19 situation report, approximately 2 months into COVID-19, there were 85403 cases in 54 countries with 2924 deaths (3.42% of confirmed cases). In the WHO press release declaring H1N1 a pandemic, they say that 2% of cases are serious; as we have frequently been told by the WHO, approximately 18% of COVID-19 cases have been serious or critical.

    Based on this – even if we only look at cases outside China of which 1.4% have died thus far – would it be correct to think that there is a high likelihood that a COVID-19 pandemic would/will be much more severe than H1N1? I suppose it all hangs on whether we can prevent community transmission; however, it seems very likely that community transmission is already occurring on several continents…

    I look forward to hearing your thoughts.

    1. 1. Absolutely. And some do that by building the lag in. A proportion of fatal cases as a snapshot is not much use.
      2. It’s a comparison of two different viruses. There are all sorts of issues in there. But it’s appropriate inasmuchas you’re comparing speed. Of course there was less sensitive PCR testing in 2009 which impacts on numbers.

  20. I may have missed something in my science obsession, but I’m yet to see any information about the longer term health implications for severe and critical case survivors. Is there a possibility of retrospective mortality rate assessment to take into account deaths that occur in the coming years due to cardio vascular damage? Or perhaps that falls outside of strict definition of disease mortality rate?

    And thank you Dr Mackay. Your information & advice is very appreciated.

    1. I think we’ll need to wait for that longer-term period to pass. But such studies should be done, as they should on severe influenza pneumonia cases etc. I doubt any future rates could capture that level of damage/detail.

  21. Why has no one questioned your use of the term SARS-CoV-2
    Which you use interchangeably with COVID-19
    I notice that you have not specifically stated that they are the same virus, nor unequivocally stated that they are not the same virus. Perhaps you should if you want your advice to be taken seriously.
    Plus anyone can write PhD after their name. Which university are you actually from?

    1. Because that’s the virus’s name.
      Could you show me where I use the names “interchangeably”?
      The University of Queensland.
      Google has a wealth of information that could also answer all these questions

    2. CORVID-19 is the condition SARS-CoV2 is the virus . Much Like AIDS is caused by HIV.

        1. aaaaand that’s why you are the one with the PHD, and I’m the line cook haha. I think I transposed the R from SARS into to. Oops.

  22. Thank you! This is about the best information/advice I’ve found. Certainly everything that comes from the government here in USA has to be looked at critically. A few notes: Re last minute fresh list, some fruits can be found green for a longer shelf life, e.g., bananas, mangoes, papaya. Among vegetables, beets and carrots are long-lasting. Cabbage, broccoli, carrots, and many other veg can be kept long-term (even without refrigeration) by fermenting them like sauerkraut. For mental health, if you can make some of those books large print, you’ll find them easier to read by candlelight in the event of a power outage. (In my rural area, loss of electric and phone for up to several days is common after storms.) Speaking from experience, losing weight can be hard, but it’s possible, and even going down 10 or 20 lbs. can make you feel a lot better. Research it.

  23. This is a great source of information and I appreciate how carefully you have mentioned things/ precautions that we need to take care about aggressively. The world is suffering now, hope will fight it back.

  24. I loved your blog and thanks for publishing this about so you think you’ve about to be in a pandemic!! I am really happy to come across this exceptionally well written content. Thanks for sharing and look for more in future!! Keep doing this inspirational work and share with us.

  25. Thank you Dr Mackay & Arden. Stumbled upon this article when seeing Sydney going back into lockdown. Sincere commiserations to our friends across the pond. Our hearts go out to you once again.

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