Staying Safe with COVID-19
In an effort to provide information to help keep everyone safe, I will from time to time add to this post as I find valuable updates.
Today's information comes from Atlanta and was too good not to share:
Doctor D's guide to staying safe in the age of coronavirus
Hey everyone, Doctor D of 2 MDs and a microphone and other popular Frolicon events (if you know what I mean). I've been working tirelessly to help hospitals and fellow physicians get ready for this pandemic and will be on the front lines of cases as they spread, but I think it's equally as important to assuage fears through education. After I saw Frolicon was postponed, I figured this would be a good time to put together a document of extremely relevant and easy to understand information and pragmatic steps you can do to get through this.
On to the guide:
Coronavirus Q+A with Doctor D
What is coronavirus/SARS-CoV-2/COVID-19?
Coronavirus is a large family of different RNA viruses primarily found in bats (but can also infect other animals like civets and camels) and some of these viruses have the potential to jump from these animals to humans.
There are 7 known coronavirus strains which infect humans, 4 cause a cold-like illness and 3 have caused more serious illness. The 3 known to cause serious illness are: SARS-CoV-1 (the virus that caused the 2003-2004 SARS outbreak) SARS-CoV-2 (the virus that causes COVID-19) MERS-CoV (The virus that causes Middle Eastern Respiratory Syndrome)
So using HIV as an analogy:
HIV is the virus/infectious particle that can cause the clinical syndrome known as AIDS
SARS-CoV-2 is the virus/infectious particle that can cause the clinical syndrome known as COVID-19
What symptoms should I be aware of to suggest COVID-19? The 3 most reported symptoms are (in order of prevalence): Fever Cough Fatigue
How is this different than seasonal influenza? This is very different and much more serious than seasonal influenza: There is no approved treatments for COVID-19 There is no protective vaccine for SARS-CoV-2 There is no herd immunity to help limit the virus from being spread broadly The probability of developing severe lung disease (called Acute Respiratory Distress Syndrome or ARDS) is much higher with SARS-CoV-2 In severe cases, there are many reports now of patients dying of heart related complications even if they survive the ARDS, especially if they have a history of congestive heart failure.
How is it spread? The majority of cases are spread 2 ways: Droplet respiratory transmission (coughing on someone) Fomite transmission (a surface gets contaminated with virus from respiratory droplets, a person touches it, then touches their mouth, nose, eyes)
If I’m infected with SARS-CoV-2, what is the expected outcome? This depends on multiple factors, namely if you are at high risk for severe disease, i.e. those with advanced age (over 60), congestive heart failure, immune compromised or requiring immune suppression medications, diabetes, or pregnant. For the cases from China, 80% of those with the virus had mild illness and recovered, 14% developed severe disease (pneumonia, breathing issues) requiring hospitalization, and 5-6% developed critical disease requiring ventilators and other critical support interventions in the ICU.
Should I wear a mask if I don’t have symptoms: NO!
Masks are intended for 2 populations right now: Those who have COVID-19 infection Those in the healthcare field or caretakers in prolonged contact with confirmed or potential COVID-19 patients. Shortages of masks for those who need them are happening right now. If you have a supply of unopened masks, see the end of this article for an important thing you can do to help your community.
Who should be tested for COVID-19? This is a difficult question that will likely change in the coming weeks.
From my research, it is possible to get infected with the virus and early on after exposure test negative. Additionally, until we have large scale testing kit availability AND a way to test people without putting uninfected people in waiting rooms and health care personal at risk, those with mild symptoms (fever, cough) and do not have risk factors for developing severe disease requiring hospitalization, i.e. those with advanced age (over 60), congestive heart failure, immune compromised or requiring immune suppression medications, diabetes, or pregnant should instead stay at home and contact the health department instead of getting tested. The health department will use this information to do something called contact tracing, which means try to identify people that may have given you the virus or those you could potentially have transmitted it to.
How is testing performed? For right now, the testing is via a swab of from the inside of the nose and the back of the throat, which then uses a technology called RT-PCR to see if they can detect the RNA of the virus in the specimen. Other tests looking at antibody responses the body develops to the virus which will be much more rapid are currently being developed but not available at the time of this writing (3/15/20)
Does the testing test for infectious virus? No, it looks for the presence of certain RNA targets of the virus, but that does not necessarily mean the virus is live/infectious. This is most relevant when someone feels better and isn’t having fever but still tests positive and makes the question of when someone can return to work and come off quarantine very challenging. On average, it seems most people once they get sick will shed virus for 7-12 days.
My church/school/event is closed/cancelled, does that mean someone there has the virus or that the situation gets worse? Do not fear public gathering closures This is not a sign that things are getting worse, it is needed to help prevent dissemination to large groups at one period of time which makes contact tracing for the health department difficult. The best thing you can do is not panic and educate yourself in preparedness measures from CDC, WHO, NIH and your local health department.
How long after exposure until I have symptoms? The average has been 5-6 days with a range of 2-14 days (hence the 14 day travel quarantine)
How long after I start to feel sick until I feel better? On average people with mild illnesses from onset take 2 weeks to fully recover. Those with more severe illness (i.e. pneumonia, breathing difficulties, ARDS) can take 3-6 weeks to fully recover if they do not progress to worsen disease.
What medicines are available for COVID-19? Right now several medications are being investigated and some are available for “Compassionate use” in the sickest patients or those most likely to progress to severe/fatal disease. These medications have shown promise in lab settings, but their utility in humans is still being investigated, so there are no “official” recommendations right now, but several existing medications have shown promise.
I tested positive for SARS-CoV-2, when can I return to work? There is varying guidance on this right now and this can absolutely change in the coming weeks, the best two answers I have seen so far. If coronavirus testing is readily available 2 negative coronavirus tests separated by at least 24 hours
Can I spread the disease before I have symptoms? Current evidence points to yes as virus shedding has been detected 24-48 hours before symptom onset and infectiousness being highest early in the disease. There are currently at least 2 clusters of events that point strongly to asymptomatic transmission occurring but for what we know right now, the majority of spread occurs when someone has symptoms (usually fever and cough)
Is there a reservoir for infection for SARS-CoV-2 like there is in HIV. There is no evidence at this time to suggest that SARS-CoV-2 has a latent phase or reservoir for infection at this time.
I heard children don’t get sick with this, is that true? For reasons that are still being worked out, children do not appear to be progressing to severe disease and dying at this time. However, children are just as likely as adults to get infected and transmit it to others, including those with weakened immune systems. Additionally, the data on children’s outcomes may be slightly skewed because the symptoms were so mild many children were not being brought in for testing. The outcome in children may change over time as more cases become recognized.
Is there evidence that SARS-CoV-2 can be passed in utero and infect my developing baby? Right now there is no evidence for something we in the infectious disease field call “vertical transmission” from mothers who were infected and later delivered babies. However, if a mother is sick with the disease, she can transmit it after birth. One very important caveat, because this disease has only been recognized since December 2019, data only exists for mothers in the 3rd trimester with more data to come in the weeks and months to come.
Is this transmitted via feces/stool? While virus has been detected in the stool in those with severe disease, it has not been shown to be a method of transmission. This may be due to the virus in the stool being inactivated or the numbers shed being too low to cause infection. For right now, the majority of spread was via respiratory droplets or infected surfaces.
Little discussed pragmatic things you can do that can save lives:
Blood shortages: Due to the coronavirus outbreak, many hospitals are facing severe blood shortages as their usual donors are no longer showing up. Many of these facilities have taken precautions to keep you safe. Despite the virus being found in the blood in a small percentage of severely ill patients, there have been NO cases of blood transfusion infection as this is thought to be primarily a respiratory illness for acquisition and transmission. Please consider donating blood so others do not need to die from transfusion-preventable illnesses.
Make your voice heard: Encourage locations that cause people to congregate close for prolonged periods of time (churches, concert venues, etc) to suspend activities or use webcasts. We as individuals need to be responsible for reducing the spread of it. Do more than just not show up, make sure we stop the spread in the community through direct activism.
Get your information from trusted sources: I recommend the CDC, NIH, and WHO. Tony Fauci, in charge of the NIH and the US response to coronavirus is an excellent resource.
Be a calm, rational, leader with your social media posts: I can’t state this enough: Do not spread photos of empty store shelves on social media! It started as someone showing an empty toilet paper shelf, then this prompted everyone to simultaneously go out and wipe store shelves clean. Posting the photos creates a self-fulfilling prophecy. The grocery supply chain has not been disrupted and shortages are simply due to unnecessary overbuying exceeding expected demand. Don’t repost COVID-19 baby yoda memes or information not from trusted sources, post and share pragmatic information to reduce SARS-CoV-2 spread that comes from reliable sources like NIH, CDC, and WHO and cite your sources.
Pay attention to kill times for disinfectants: Everyone now is aware of washing your hands (remember to get between your fingers!) for 20 seconds, but when you are cleaning surfaces which may be contaminated pay attention to the chemical kill time, the amount of time that chemical must be on the surface before the virus would be considered ineffective. A good example is bleach’s kill time is 3 minutes. That means if you are wiping down a grocery cart with a bleach wipe, you should wait 3 minutes before contacting the surface. When in doubt if you contacted a contaminated surface wash your hands as soon as possible and don’t touch your mouth, nose, or eyes.
Don’t focus on number of cases and death rate:
The number of cases WILL increase in this country as testing becomes more readily available and we identify those with milder disease. Since we focus our resources on testing the sickest when testing supplies are limited the death rate will appear to be higher than it is. As we test more people, the true denominator and natural history of progression of COVID-19 will become clearer.
Don’t panic about the lack of hand sanitizer, Use soap! Don’t worry about stores not having hand sanitizer or making your own. Soap works as well or better because this virus has a lipid (fatty) envelope to protect its easily destroyed RNA. Soap works by breaking apart that envelope, making the virus ineffective at spreading, then you wash away the remaining particles from your hands
Did you horde N95 masks? If the boxes haven’t been opened, see if your local hospital will accept them, we are experiencing severe shortages.
Hope that helps everyone. Doctor D