As always, a reminder that I am not a medical doctor. I know a few, and they are all awesome! But I am not one. Nor am I a healthcare professional of any kind. These updates are my way of helping everyone sift through the riff-raff. My goal with these posts is to pass along relevant information from the medical community – direct from the source – with some translation into regular English.
A couple of stats before we begin
As of March 13th at 5pm (the CDC doesn’t update their website on the weekend):
Total cases: 1,629
— Travel-related: 138
— Close contact: 129
— Under investigation: 1,362
Total deaths: 41
States reporting cases: 46 states and District of Columbia
That is a 400+ case jump in 24 hours. and 1000+ increase from 72 hours ago.
(Numbers pulled from other reliable resources) Total cases reported by other medical sites:
Johns Hopkins:
Total cases: 2,726 (1,500 case increase in 24 hours)
Total deaths: 54
Total recovered: 12
Social Distancing is a really good idea
The CDC, HHS, WHO, and countless other official outlets are urging people to avoid large gatherings and keep some distance between you and others around you. Officially, “social distancing” means remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible. That is straight from the CDC.
It isn’t just doctors and medical professionals, too. State and local legislatures, local emergency management, federal government officials are all on board. And this has bipartisan support.
You read right. That is Ted Cruz agreeing with Alexandria Ocasio-Cortez. If politicians can get along, I think we all can. And I know some of you may feel the urge to disagree anything that someone from the “other side of the aisle” is saying, but please resist that urge when it comes to common sense stuff like this.
And don’t be this person.
A quick note
I posted this on facebook today, in case you missed it I really think it is worth passing along to others. We are all in this together, friends.
Some real good news
The South Korean CDC released data of the outbreak there and it it showing a much lower mortality rate than originally anticipated.
Sadly, yes, there have still been 67 deaths. But no age group has a mortality rate above 10-percent. And in fact, even with nearly 8,000 people infected, there are now reports of people recovering. Though, it has taken a few weeks for that to occur.
How did they do it? It wasn’t by just treating this “like the flu.”
South Korea got to – roughly – where America is now (okay, a bit further along, but close enough) and started using strict social distancing methods, had a catchy hand-washing campaign, and took action to combat the spread.
New from the CDC
While the WHO recently found that dogs cannot be infected, the CDC is still suggesting that you limit contact with pets & animals if you are sick with COVID-19. Again, this is only for if you are sick with Coronavirus. But, as an example, now that research shows that the virus can survive when airborne, if a sick person sneezes around a dog, and the droplets get stuck to the dog’s fur and it runs into the other room where non-infected people are, it may then infect the non-infected.
If possible, the CDC recommends to have another person watch your pets if you are sick. If you are sick with COVID-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with pets and wear a facemask.
More from the CDC
The CDC introduced some warnings signs to look for in folks that may have contracted the virus. The original three included, fever, cough, and shortness of breath. Now, the CDC says other things to look for include a persistent pain or pressure in the chest, general confusion or extreme fatigue, bluish lips or face. A fever of 100+ degrees has also been noted in interviews here and there, though I am uncertain if that is a “rule of thumb” or not.
If you develop symptoms, the CDC recommends the following steps:
– Stay home and call your doctor
– Call your healthcare provider and let them know about your symptoms. Tell them that you have or may have COVID-19. This will help them take care of you and keep
other people from getting infected or exposed.
– If you are not sick enough to be hospitalized, you can recover at home. Follow CDC instructions for how to take care of yourself at home.
– Know when to get emergency help
– Get medical attention immediately if you have any of the emergency warning signs listed above.
The CDC also added a few links to their site this morning.
— Keeping workplaces, homes, schools, or commercial establishments safe
— CDC’s framework for mitigation
These pamphlets might be a good read for those trying to avoid contact and limit the transmission of the virus.
Other mitigation strategies the CDC recommends:
– Clean your hands often
– Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
– If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
– To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
– Wash your hands after touching surfaces in public places.
– Avoid touching your face, nose, eyes, etc.
– Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches,
handles, desks, toilets, faucets, sinks & cell phones)
– Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
– Avoid all non-essential travel including plane trips, and especially avoid embarking on cruise ships.
From Johns Hopkins
Just in case you missed it, in a new research paper titled, “The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application” researchers from Johns Hopkins identified that the incubation period for Coronavirus is about five days.
The results of the research found that 5.1 days was the average time of incubation and around 97-percent of those who develop symptoms will do so within about 11 days. On top of that, researchers noted that only 101 out of every 10,000 cases will develop symptoms after 14 days.
That is why the quarantine protocol for so many places is 14 days. There is only a one-percent chance you have the virus if you don’t have symptoms after 14 days. The researchers noted that understanding the incubation period will help medical professionals prepare and react to the spread of the virus within the United States.
New Research
A new research paper, “Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study” released a few days ago looked at the timeline for infections (and deaths) in people with Coronavirus.
I did not get a chance to read the full study, but it is summarized well by the WHO:
The study involved 191 hospitalized COVID-19 patients (54 deaths, 137 discharged) in Wuhan, China. Notably, the study describes the timing of various aspects of disease progression in hospitalized patients, including the time from first symptom onset to the onset of various symptoms/conditions, including dyspnoea, sepsis, and ARDS as well as their duration. The article also reports the time to and duration of ICU admission. The study found an increase in the odds of death with increased age, and the mean duration of viral shedding was 20 days from symptom onset in survivors and continuously until death in non-survivors (maximum duration: 37 days). The study found no evidence that antiviral treatment reduces the duration of viral shedding.
This study, as it says, found no evidence that any treatment helped people infected deal with or fight the virus.
Another new study that is not-yet-peer-reviewed, “Virtual Screening Based Prediction of Potential Drugs for COVID-19” looks as the genomic sequence of the Coronavirus responsible for COVID-19, as well as the experimentally-determined three dimensional structure of the Main protease. In the abstract, the authoss write, “The reported structure of the target Mpro was utilized in this study to identify potential drugs for COVID-19 using molecular docking based virtual screening. The results of this study confirm earlier preliminary reports based on studies of homologs that some of the drugs approved for treatment of other viral infections also have the potential for treatment of COVID-19.”
In the paper, the authors note that, “Saquinavir and Beclabuvir were identified as the best candidates for COVID-19 therapy based on virtual high throughput screening of clinically approved drugs and the structure of SARS-CoV-2 Mpro determined from X-ray diffraction data. The results of this study also rationalize the limited data regarding effectiveness of drugs for COVID-19 therapy, and provide information that can be utilized for choice of candidate drugs for in vitro studies and in vivo studies. ”
A different research papers, titled, “COVID-19: combining antiviral and anti-inflammatory treatments” looks to Artificial Intelligence to find a combination of drugs that may be effective against he virus. Sadly,
Three different papers, three different outcomes. What does this all mean? Is there a vaccine or drug to protect us?
No. Not yet. But this is a start.
It means that other researchers can now look at this information and run their own experiments and test to se if they can confirm or dispute the findings. But this is how science works and how treatments are developed. Piece by piece, step by step. It is usually a long process. That is why, despite what some politicians have said, there isn’t likely going to be a vaccine or treatment “by April.”
For more on some other new research, check this out! New numbers suggest the “at risk” community is actually larger than originally thought.
The flu kills more people, Nick, relax
As I posted earlier today, sadly this is not just the flu.
If you’re wondering about how fast this can spread and you want to see a ballpark way to estimate how many people could be infected right now, click that link.
From the Mayo Clinic
From the Mayo Clinic website: “Dr. Gregory Poland, head of Mayo Clinic’s Vaccine Research Group, discusses who is at risk, how to stay protected from the virus, and, if there will be a coronavirus vaccine in the future.”
The Mayo Clinic also noted that women who are pregnant need to treat the Coronavirus like they are in the special group.
“We are still trying to figure out how this virus behaves in pregnant women,” Dr. Nipunie Rajapakse a pediatric infectious diseases specialist said. “But we do know pregnancy is a time of immune suppression.”
Rajapakse says that women who are pregnant should treat themselves as if they are apart of the “compromised immune system” population until the researchers learn more about the virus. Those same researchers are also trying to figure out if the virus can spread to the fetus.
What is the coronavirus & who is at risk
The coronavirus can infect anyone. but it seems to be more potent for those who are older or those who have compromised immune systems.
The virus is like every other flu virus that can infect humans in many ways, but not every way. The main difference is it is in the same realm as the SARS and MERS viruses that affected Asia and the Middle east. Research done on the virus pulled from the first few patients to contract the disease showed a more than 80-percent match with SARS in some areas and an almost 95-percent match in others.
Researchers wrote in a recent scientific paper that SARS and Coronavirus are thus related. The authors even noted that the comparability would “[imply] the two belong to same species.”
And according to medical researchers, it was believed that those diseases and this new Coronavirus, came from bats.
But those same researchers noted there were a few things they didn’t know yet:
We don’t know the transmission routine of this virus among hosts yet. It seems the virus is becoming more transmissible between human-to-human. We should closely monitor if the virus continue evolving to become more virulent. Owing to shortage of specific treatment and considering the relatedness between SARS-CoV and 2019-nCoV, some drugs and pre-clinical vaccine against SARS-CoV probably can be applied to this virus.
The difference in death-rate between Coronavirus and SARS/MERS
A recent paper, published last week, by Zunyou Wu and Jennifer M. McGoogan, highlight the difference.
A total of 8096 SARS cases and 774 deaths across 29 countries were reported for an overall CFR of 9.6%. MERS is still not contained and is thus far responsible for 2494 confirmed cases and 858 deaths across 27 countries for a CFR of 34.4%. Despite much higher CFRs for SARS and MERS, COVID-19 has led to more total deaths due to the large number of cases. As of the end of February 18, 2020, China has reported 72,528 confirmed cases (98.9% of the global total) and 1870 deaths (99.8% of the global total). This translates to a current crude CFR of 2.6%.
You can read the whole article here: https://jamanetwork.com/journals/jama/fullarticle/2762130
So, Coronavirus is 1/3rd as deadly as SARS. And Coronavirus is 1/13th as deadly as MERS. And, as one medical researcher put it on CNN the other day, as it evolves in the future, it is statistically more likely to become less deadly. Because the viruses that mutated to become more deadly will stay within the hosts that are dead, rather than continue to be passed along.
What does Coronavirus do to people
The coronavirus is very contagious. And only causes symptoms of a fever and cough for most people. That may be the biggest concern for people. It seems innocuous until it is deadly. And it spreads quickly within an infected community.
Here is a snippet from a research paper from Ying Liu, Albert A Gayle, Annelies Wilder-Smith, and Joacim Rocklöv in the Journal of Travel Medicine:
[transmission] estimates for SARS have been reported to range between 2 and 5, which is within the range of the mean [transmission] for COVID-19 found in this review. Due to similarities of both pathogen and region of exposure, this is expected. On the other hand, despite the heightened public awareness and impressively strong interventional response, the COVID-19 is already more widespread than SARS, indicating it may be more transmissible
For the medical community, they are also focused on identifying the symptoms and how to resolve them.
Currently, the medical community says symptoms are fever and cough, “which frequently lead to lower respiratory tract disease with poor clinical outcomes” for people who are older or have pre-existing health conditions. And diagnosis can only be made based on the symptoms, the history of exposure, as well as chest imaging.
That means if you have a runny nose and headache, it is less likely to be coronavirus. If you have a stuffy nose and clogged up sinuses, it is less likely to be coronavirus.
And if you have not been to China or been exposed to someone who has been to China is it unlikely you have Coronavirus.
Are facemasks a good idea
This is straight from the CDC:
CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19. You should only wear a mask if a healthcare professional recommends it. A facemask should be used by people who have COVID-19 and are showing symptoms. This is to protect others from the risk of getting infected. The use of facemasks also is crucial for health workers and other people who are taking care of someone infected with COVID-19 in close settings (at home or in a health care facility).
Things to do right now
Right now, simply keep tabs on the news with Coronavirus. Continue to wash your hands – like you would do to combat the spread of the common cold or flu – and avoid touching your face. If you know someone who has traveled to out of this country or to a place with widespread infections, monitor them for symptoms. And try to no be within six feet of people who are infected.
And again, since the death-rate of Coronavirus is around two-percent, this virus isn’t as deadly as SARS or MERS to the general population. But, since there are about 1600 cases and 41 deaths, it means gt the mortality rate in the United States is barely higher than the average. Since the average two-percent would leave only 32 deaths.
But the biggest concern is for those with compromised immune systems and people over 60.
The other thing to do is to keep this potential outbreak in perspective. While, yes it is dangerous to those infected, and yes there is the potential that it could spread to the United States, at this time the best thing to do is remain calm and do what you would normally do to fight against the regular flu. Plus limiting contact with others to suppress the spread of the virus.
And, as a reminder, the regular flu is still out there, too. This isn’t comparative suffering. Both are bad. The flu has sent 21,000,000 people to the doctor and – according to the CDC – is responsible for up to 46,000 deaths. So protect yourself from the regular flu, too.
