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Brooke Gladstone: Careful listeners of On the Media, Wesley Morris we're looking at you. We'll know that we released our regularly scheduled podcast Extra on Wednesday but to quote many people on Twitter, this week has been a very long month, and there's more to say. Here's the second podcast Extra to tide you over until the show is released on Friday. You're welcome.

The COVID-19 pandemic has expanded our vocabulary with terms like social distancing, and self-isolation. In an article in slate this week, Jeremy Samuel Faust, who's a physician and instructor at Harvard Medical School, gave us one more: "case fatality rate", or CFR. Initial reports have the CFR for this disease at 2% to 3%, but Faust writes that the actual number could be much lower. Using the cruise ship, the Diamond Princess, a unique petri-dish, as his case study, he explains that of the 3,711 people on board, at least 705 tested positive for the virus, and six people have died, a CFR of 0.85%.

Jeremy Samuel Faust: What makes the Diamond Princess so interesting to somebody like me is that you know that pretty much everybody boarded the ship healthy. You can look at a closed system to say how does this virus behave? It gives you a really interesting idea about things that you might normally not be able to detect, like how many people actually contracted this and didn't know it, they're symptom-free or asymptomatic, as we say, in medicine.

Brooke: Among those who tested positive, how many were asymptomatic?

Jeremy: It looks like well, over half, at the last time that we receive an update, which is far more than what we've been told, in places like China, who are obviously having the first real outbreak. China did say that they went and looked and tried to find people, and they went door to door. It just doesn't seem that they accomplish that because when you have this ship, to compare it to, and more than half of the people with this virus had no symptoms. Also, really, that's what we're hearing now coming out of South Korea, where they are doing hundreds of thousands of tests literally drive-throughs. The number of asymptomatic symptom-free patients with this virus, I predict is much higher than what we initially heard out of China.

Brooke: In the ship, half were asymptomatic roughly, there were seven people who died, and all of them were either 70 or over?

Jeremy: If you look at China, which has these staggering fatality statistics, all the deaths really are concentrated in that older age group. Only about 12% of the overall cases were in the 70 plus age group, and yet they comprise the huge number of the deaths. Interestingly enough, in the Diamond Princess, that percent of the overall cases than old people is far, far more than what you saw in China, which would have said, oh, we have more old people, there's going to be a high death rate. In fact, the death rate was much lower even among those age groups. I don't necessarily assume that the spread of the virus elsewhere would reflect what happens on a cruise ship.

What I think is really fascinating is the as you zoom out of the epicenter of where this all began, the death rate does seem to have gone lower and lower and lower and we have to wonder why that is. This whole experience made me a little bit of a detective of Chinese epidemiological patterns. Thankfully, we actually have really great peer review research. Not surprisingly, in Hubei, there is far more lung disease and related problems in those areas. You might have an at-risk population.

Then the other thing, of course, is, as you get further and further away, the number of test kits probably changed. The number of cases actually skyrockets the more you test, but the number of deaths only goes up a small amount, because all the deaths were in that initial group. This is where we get into fractions and people their head spins, but it's really simple. How many people do you think died, and how many people do you think have it?

Brooke: What can we derive from the Diamond Princess case that we can't get from the data flying in from Italy and South Korea and China?

Jeremy: What the Diamond Princess allowed us to do was to say, well, maybe the overall fatality rate is a lot lower, and maybe we can get an idea actually, even within the risk group populations that things are better than we thought because we maybe had been over attributing deaths to coronavirus, which is something that we also really didn't talk about. You don't really know in ICU there could be 20 patients in there and 10 of them might pick up coronavirus, but they were actually already on their last day from cancer or heart disease.

We don't know how many people in these other countries that you mentioned died of coronavirus versus died with coronavirus. The people at Diamond Princess, you have to say pretty much whatever medical problems they might have brought with them. It's pretty fair to say they would not have died but for coronavirus. That I think is a very important distinction.

Brooke: Were there any variables from the Diamond Princess that confounded you, that seemed to be inconsistent? Is there something I'm missing?

Jeremy: The only thing that I would have liked to have seen is actually an entire manifest of all 3,700 people on board. The fact that just more old people got it on the ship, I assume that just reflects the demographic of who was on that ship. Truly, there were four times as many senior citizens on this ship than there were in the areas around the hospital and Wuhan City, that'd be nice to know is this generalizable to another group of people?

Brooke: Do you think there are any lessons that either the media or our elected officials or top medical experts aren't communicating very well?

Jeremy: I think the biggest actionable piece of information that the experience on the Diamond Princess represents is the benefit of wide-scale testing because they're thinking, "Oh, if we test a lot, we're going to find more cases, and everyone's going to look to the left and look to the right and say, "Oh, we all have it", and more panic will ensue." In reality, if you actually test everyone some really beneficial things happen. If I'm a young, healthy person who has a cough and I'm told, by the way, that cough happens to be coronavirus, I'm not going to visit the nursing home, I'm not going to expose my sick relatives to myself. Massive testing can really help save lives because if I didn't know I had it, I actually might give it to someone who's far more vulnerable.

Brooke: Can we afford to do that?

Jeremy: We do a lot of screening for medical conditions in this country and we have a belief that some of it may work and may save lives, but if you really do the deep dive, there are very few screening tests that save lives in such a predictable and measurable way. This is that rare circumstance in which that is the case.

Brooke: What do you think news consumers should keep in mind when they read or watch about new cases in seemingly every corner of the world?

Jeremy: We spent all of our time like one of those people on the beach with the metal detectors, the thing goes off, and that's what they did. That's what TV is doing. They're spending all the time right there whereas the rest of the beach is actually habitable. There is such a thing as doing too much, and people say, "Well, how is that possible? How is it possible to do too much?" The only way I could describe it would be to say if I have a shopping list that says I need to get milk, and the shopping list is one item long, it's unlikely that I'm going to forget to do it, but if I have 50 things on the list, the likelihood that I'll forget the milk goes higher and higher and higher.

I'm worried that if we're trying to do everything, shutting everything down before it even is in a town, I'm worried that we focus on the wrong things and miss the things we actually do need to worry about which is protecting the at-risk populations and doing the guidance by hand washing and those kinds of things.

Brooke: Right. What would be at the top of your list?

Jeremy: Large-scale comprehensive national testing is the priority as far as I'm concerned outside of doctor's offices and ERS and hospitals because we need to save those resources for the people who need them. I think that's how we're going to find out where the disease is, where it isn't, and how to protect the people who are the most at risk.

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Brooke: Jeremy, thank you very much.

Jeremy: It's really nice to talk to you and wash your hands, be safe, and in the coming days I hope that there will be less panic.

Brooke: Jeremy Samuel Faust is a physician and an instructor at Harvard Medical School. His article in slate is called COVID-19 Isn't As Deadly As We Think.

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