In the past few weeks I’ve been doing my best to keep tabs on the Coronavirus research and information that – in my opinion – I haven’t spent as much time on how you can prepare for the lifestyle changes that are being / will be implemented. So, aside from the latest news on Coronavirus, I’m also going to take some time to highlight some things you can do now, and things you don’t need to do now to be ready for some things that may come down the pipe.
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.
Latest Numbers
Total United States cases: 3,487
— Travel-related: 205
— Close contact: 214
— Under investigation: 3,068
Total deaths: 68
States reporting cases: 49 states, District of Columbia, Puerto Rico, Guam, and US Virgin Islands
(Numbers pulled from other reliable resources) Total United States cases reported by other medical sites:
Johns Hopkins:
Total cases: 5,613
Total deaths: 94
Total recovered: 17
Regional Numbers:
Mississippi: 21
Louisiana: 171
Arkansas: 22
Tennessee: 52
Alabama: 29
Incubation period
quick reminder that Johns Hopkins was involved in a research paper titled, “The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application” that found the incubation period for Coronavirus to be 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.
The new part? Researchers did not that the available data may have been skewed as severe cases may be over-represented in the data. That means, the incubation period may be different for mild cases. Perhaps longer. Perhaps shorter. That is unknown.
Plus, the transmission rate and resulting problem was discussed by another recent paper, “From Containment to Mitigation of COVID-19 in the US,” where the authors wrote:
Eighty percent of patients infected with SARS-CoV-2 have minimal or mild symptoms.2 Combining these characteristics and the emergence of community transmission, it is likely that silent spread has already occurred in multiple US locales. As a result, COVID-19 containment is no longer realistic and further emphasis on containment strategies may have the unintended consequence of hampering effective health care delivery for patients infected with COVID-19 and others who require general hospital care.
New Research
More Math, sorry guys. But this is really turning into a Math thing. In a recently published paper titled, “Early dynamics of transmission and control of COVID-19: a mathematical modelling study” the authors looked at the Coronavirus in China and tried to pull out some mathematical markers to make estimations about the potential for a similar-sized outbreak in the United States.
The wrote:
Even if the reproduction number is as high as in Wuhan in early January, it could take several introductions for an outbreak to establish, because high individual-level variation in transmission makes new chains of transmission more fragile, and hence it becomes less likely that a single infection will generate an outbreak. This factor highlights the importance of rapid case identification and subsequent isolation and other control measures to reduce the chance of onward chains of transmission.
We estimated that the median daily reproduction number (Rt) in Wuhan declined from 2·35 (95% CI 1·15-4·77) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1·05 (0·41-2·39) 1 week after. Based on our estimates of Rt, assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population.
The take-away from that is that four independent cases in a population show a 50-50 chance it will become established. That may feel scary. However, the researchers also found that once restrictions were in place – and followed – it trimmed the transmission rate down to below the regular flu.
Of note!
I’m still trying to track down any research information regarding the long-term lung damage that was shown in a few patients in China. I wrote about that yesterday. Until I see some research, or a larger portion of the medical community report it, I’m going to remain optimistic that it was a problem specific to those few patients.
From the Annals of Internal Medicine
Annals On Call – Understanding the Spread of COVID-19: Dr. Centor discusses the epidemiology of the novel coronavirus responsible for COVID-19 with Dr. David Fisman of the University of Toronto.
Is it a disease? An infection? Does it matter?
I asked this question to doctors on Twitter. I heard back from someone even better – a microbiologist.
Not a medical doc but I am an college microbiology instructor. COVID-19 is the name of the disease caused by infection with this novel coronavirus. The virus’s official name is SARS-CoV-2.
— Eric (@The_Easy_E) March 17, 2020
COVID-19 stands for COronaVIrus Disease 2019. The WHO developed that name. The International Committee for the Taxonomy of Viruses (ICTV) named the viral agent SARS-CoV-2.
— Eric (@The_Easy_E) March 17, 2020
SARS-CoV-2 stands for Sudden Acute Respiratory Syndrome coronavirus two. ICTV names viruses based on genetic analysis. Based on those criteria, this virus clustered most closely with the CoV that caused the 2003 SARS outbreak, hence the name.
— Eric (@The_Easy_E) March 17, 2020
There has been MASSIVE confusion in nomenclature used in the lay press because of the two names. Scientific outlets are making the distinction, as are things like the CDC website. Elsewhere, no so much.
— Eric (@The_Easy_E) March 17, 2020
Twitter can be a painful place to be, at time. But other times, like this, it can be great.
What should I do, right now?
I know. It can seem overwhelming with the amount of information and updates flying around. But I think it is best to follow the CDC’s guidance at this point.
— Know where to get your local / state-level information
For Mississippi: https://msdh.ms.gov/msdhsite/_static/14,0,420.html
For Louisiana: http://ldh.la.gov/Coronavirus/
For Alabama: http://www.alabamapublichealth.gov/infectiousdiseases/2019-coronavirus.html
If you live in a state outside of the region, head to google and type in, “dept of health” followed by whatever state you live. Google should take you to that state’s department of health and on the main page, most states have a link to an update on the Coronavirus.
— Know the Symptoms
Look for things like a fever, dry cough, and shortness of breath. But also know when it may become an emergency. It becomes an emergency when you have difficulty breathing, a persistent pain or pressure in the chest, you develop general confusion, and if you develop bluish lips or face.
Also recognize that body aches, weak stomach, nasal congestion, a sore throat, and other symptoms of the regular flu are not the same as the symptoms with Coronavirus.
— Stay home when you are sick
Any kind of sick. If you feel like you may have Coronavirus, call your health care provider’s office in advance of a visit. If you have any sickness, the CDC recommends to limit movement in the community, limit visitors, and practice good social distancing.
— Know if you are at a higher risk
Know what additional measures those at higher risk and who are vulnerable should take. Those at higher risk include older adults (over 60), people who have serious chronic medical conditions (like heart disease, diabetes, lung disease). Some research has indicated that people with asthma may also be included in the higher risk category.
— Take steps to mitigate your infection
The CDC recommends to “Implement steps to prevent illness” by washing high-traffic areas more often, washing hands with soap and water and if someone is sick, to isolate the sick person into a low-traffic area of the home.
— Create a Household Plan
Create a household plan of action in case of illness in the household or disruption of daily activities due to COVID-19 in the community.
From the CDC:
Talk with the people who need to be included in your plan. Meet with household members, other relatives, and friends to discuss what to do if a COVID-19 outbreak occurs in your community and what the needs of each person will be.
Plan ways to care for those who might be at greater risk for serious complications. There is limited information about who may be at risk for severe complications from COVID-19 illness. From the data that are available for COVID-19 patients, and from data for related coronaviruses such as SARS-CoV and MERS-CoV, it is possible that older adults and persons who have underlying chronic medical conditions may be at risk for more serious complications. Early data suggest older people are more likely to have serious COVID-19 illness. If you or your household members are at increased risk for COVID-19 complications, please consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19. CDC will recommend actions to help keep people at high risk for complications healthy if a COVID-19 outbreak occurs in your community.
Get to know your neighbors. Talk with your neighbors about emergency planning. If your neighborhood has a website or social media page, consider joining it to maintain access to neighbors, information, and resources.
Identify aid organizations in your community. Create a list of local organizations that you and your household can contact in the event you need access to information, health care services, support, and resources. Consider including organizations that provide mental health or counseling services, food, and other supplies.
Create an emergency contact list. Ensure your household has a current list of emergency contacts for family, friends, neighbors, carpool drivers, health care providers, teachers, employers, the local public health department, and other community resources.
Consider 2-week supply of prescription and over the counter medications, food and other essentials. Know how to get food delivered if possible.
Establish ways to communicate with others (e.g., family, friends, co-workers).
Establish plans to telework, what to do about childcare needs, how to adapt to cancellation of events.
— Know the “Emergency Plan” for work & school
If you job or your kids school moves to a different schedule or other emergency plan, know that plan and be prepared to take appropriate action.
From the World Health Organization
Yesterday, for the first time, the total number of cases and deaths outside China has overtaken the total number of cases in China. The WHO notes that “If you are not in an area where COVID-19 is spreading (if you live in the US, you are) or have not travelled from an area where COVID-19 is spreading or have not been in contact with an infected patient, your risk of infection is low.”
Unfortunately, here in the United States, your risk is not low. So the WHO recommends take the risk of infection seriously. Follow the the guidance offered by health authorities. For most people, this virus will cause mild symptoms. Though, as we have seen, it can make some people very ill and, in some people, it can be fatal. Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for more severe symptoms.
What’s next?
Thats a great question that I don’t think anyone has the answer to. Because this virus is a bit like a tornado (you can follow that link to an analogy I discussed last night) we can make predictions about total cases and potential deaths, but we can’t tell you specifically what it will be like for you and your family.
But until people start to self-quarantine, isolate, practice good social-distancing, etc. it looks like this will continue to spread.
It is good to know that there is some research out there – based on math and numbers – that shows once isolation and quarantine are established this is only transmitted as rampantly as the flu. Still bad. But much more manageable.
The problem? Wuhan has been under a lockdown since January 23rd. And it is March 17th. That is almost eight weeks or quarantine.
So, if you are wondering, “How long will this last?” it may be awhile before this is all over in the United States. And around the world.
