COVID-19

 

 What is COVID-19?

 

Let’s start first by explaining what viruses are and what we know about coronaviruses.

 

A virus is essentially an infectious particle of genetic material that attaches to a host or cell that in turn hijacks the host’s machinery to reproduce more (virions) which leads to damaging a specific type of cells (infection/inflammation). Viruses are unique in that they are even smaller than our regular cells so essentially, they are just genetic material capable of reproducing when the environment is just right. They need to have the proper conditions (whether hot or cold or moist), attach to a specific cell, and evade our immune system.  There are many viruses that are known and many viruses that are unknown. However, viruses carry very specific genetic information that can further classify them into a collective family of viruses. For example, rhinovirus is a very common virus that causes the common cold. Interestingly, the common cold (stuffiness, cough ,sneezing ,runny nose) can be caused by the rhinovirus, coronaviruses, and RSV. These viruses can in some people lead to bronchitis or asthma attacks or worsening lung disease. Coronaviruses are a family of viruses that typically contain a signature genetic material and are capable of causing severe pneumonia and respiratory failure.

 

Therefore, coronaviruses as a whole family can cause pneumonia (lung infection) or worse lung failure. We have had examples of coronaviruses in the past. Previously, we had a coronavirus called  SARS (2002) and MERS (2012). MERS and SARS are viruses capable of causing respiratory failure and are quite infectious. The novel(newest) virus that we are dealing with in this pandemic is called SARS-CoV-2. The actual disease is called COVID-19 The medical community decided to refer to the disease more so than the viral designation as it would confuse everyone. COVID19 is the disease caused by SARS-CoV-2.  The “19” in (COVID-19) refers to 2019 when the epidemic was first diagnosed Wuhan, China. Origin of SARS-CoV-2 virus is unclear as it was first thought to be pangolins or bats (96% genetic match in bats) but it is not clear.

 

 

 

 

FLATTEN THE CURVE!!!

 

 

 

 

What does flatten the curve really mean in English?

 

So, you’ve probably heard on the news where it is important that we flatten the curve. So, imagine this: you are in charge of a hospital with a total of 10 special beds and you find out that there’s an outbreak in your community that’s about 100 people. If you only have 10 beds and have 100 people with COVID-19 that require those special beds,  you have a huge problem.  So, how can you accommodate them? The only way to accommodate those 100 people is to average 10 people each day in your hospital.  Therefore, you will try your best (social distancing, hand washing, masks, treat infected people) to make sure that those 100 potential patients don’t come to your hospital at once (day1) and  have 90 people left without any care. So… another way to understand flattening the curve is delaying or slowing down the amount of  sick people that can come to a hospital at once….Because if you’re able to slow it down you can take care of all 100 people as long as it not all at once.. So that means all 100 have a greater chance to survive!

 

What’s the significance of the number of cases that is described in the media and deaths…?

 

 

 

 

Before I dive deeper into the cases, remember you are getting your information from the media. The media‘s goal is to keep you tuned-in to the television regardless of the inaccuracy or distress that it causes. It is very likely that the media would not hesitate to frighten you enough to keep watching. Now, that doesn’t mean that what’s happening in the world is overhyped or not truth. It just means that be careful of what headlines you read as it is usually there to keep you tuned in so their ratings skyrocket. In a pandemic, the number of cases is very important because it gives you an idea of how aggressive or virulent the virus is to the population. Generally speaking, viruses that have a low mortality rate are most easily spread/infectious. In general, these viruses tend to have a very long incubation period and due to the incubation period, they spread quite easily to millions of people. For example, the common cold and influenza (flu) are very infectious but have a very low mortality. Conversely, the Ebola virus is quite rare and has a mortality rate of 75-90%!  Respiratory viruses, like coronaviruses,  have a very low mortality rate, long incubation period, and spread to millions.  However, this virus appears to be different from the influenza(flu)  which has a mortality rate of about 1 death out of 1000 cases as it appears that COVID-19 has a mortality rate of 1-2 deaths out of 100 cases. These are preliminary numbers so things can evolve and change.

 

 

The deaths that you see going up now reflect infections that likely took place 7-14 days ago. It appears based on current data that the death rate should plateau within 15-21 days of social distancing.  If your state has just implemented stay-at-home orders, the effect would be expected show 15 to 21 days.

 

 NUMBER  OF CASES CAN BE MISLEADING AS THEY CAN FLUCTUATE DEPENDING ON AVAILABILITY OF TESTS AND DECISIONS ON WHETHER PEOPLE SHOULD GET TESTED.

The new number of new cases (incidence) allow the healthcare community to start planning. The planning that’s involved in an outbreak is whether or not people in the community can spread it or will this infection be contained or whether or not it is containable in the first place. Thus far, we know that COVID-19 cases multiply quite quickly, and it is very difficult to contain in this country due our current way of life or culture. The deaths tell us how severe these cases can be and gives us an estimate of many of diagnosed cases can lead to mortality. One of the most important things to monitor is the case fatality rate. This is the number of number of deaths/total number cases x100%. This percentage tells us how bad it is affecting our country. As of yesterday, there were 123,000 cases and 2221 total death. This gives us a case fatality rate of 1.8%. Just to compare with other countries:

 

 

1. China 4%
2. Italy 10.8%
3. South Korea 1.5%
4. US 1.8%
5. Germany 0.7%

 

Below was as of March 23, 2020

 

 

How many more weeks of this do we have?

 

None of us has a crystal ball but based on other countries cases, case-fatality rate, and modeling we can make a few predictions that may be close enough to accurate time frame.  Cases (Total or per day) do not give us a true understanding of the trend as some states or countries may have a greater testing capacity than others and cases can be underreported. One strategy to help us decipher through the chaos is the total number of deaths (despite what media states) and the trend over several days.  Media will focus on cases until people realize they are being strung along. After that, they will focus on hospital capacity or ICU beds. One strategy I recommend  would be to look at the total doubling deaths.  It appears that when doubling deaths become greater than three days, then it is likely that the plateau (rate of deaths/days) has been reached or will be reached within a few days. When we first started, total deaths (not deaths per day) were doubling every 1 to 2 days but currently we are now doubling deaths at around 3-4 days which means that we are very close to a plateau and should expect deaths to begin to decline hopefully soon.  If we end today doubling our total deaths every 4 days, we are likely at the plateau and should expect a decline in deaths soon.  This data is evolving but we should see a trend in the next day or two.

 

This is how things look as of 3pm March 29, 2020

 

 

 

 

 

Everyday Practical Questions

 

Should I wear a mask?

 

In my opinion, yes. We do not have the evidence that wearing a mask in the community decreases community spread, however, it certainly does not hurt. The reason this has not been recommended is because of the lack of personal protective equipment in the medical community and  if the general community rushed out to get masks, healthcare workers would have a bigger shortage. Just being HONEST. If you look at nations that have dealt with SARS and MERS, they all wear masks even in the community. I suspect that we don’t wear masks in this country due to access and stigma (probably will change after this experience). However, what we do know is that the SARS-COV-2 virus is transmitted and can be infectious in the air for many hours. Wearing a mask may limit or prevent an asymptomatic COVID-19 person from generating transmissible virus in the air. Think of a toddler who is playing with bubbles and blows bubbles in the air. This is exactly what happens on the microscopic level.  Those bubbles travel in the air and can land on surfaces or even burst open on your face!  Now imagine that same toddler trying to blow bubbles with a mask on his or her face. No chance a bubble gets to you.  In addition, what we know is that sneezing, coughing, and talking(yes) likely can contribute to spread. Therefore, I highly recommend using a mask whenever you go out.

 

Grocery Store stop??…I personally recommend:

 

1.  Wash hands or use hand sanitizer (hands must be glazed) and WEAR A MASK. 
2.  Use antimicrobial wipes to wipe down basket or shopping cart in high-touch areas.
3. Avoid long lines. Stand 6 feet from the next shopper in aisles and at checkout.
4. Buy what you need. Food will not run out and hoarding hurts people. There’s no reason to think food or supplies are running out. If you need a toilet roll every day or two days, please see a gastroenterologist. There is no reason to buy more than you need.
5. Take off mask at door (Do not touch front!). Wash hands (soap kills virus by wedging between outer membrane and bursts) and sanitize your hands (60% alcohol minimum) and put food away.

 

If someone in my household gets sick, will I get sick?

 

The basic prevention strategies should be:

1. Wear a mask. The person who is sick should also wear a mask. If you don’t have masks, avoid each other as much as possible in the house with a closed door for the next 14 days. Make sure you cover your mouth with an elbow or tissue for a cough or sneeze rather than just your hands. The goal is to have the viral droplets into garments or tissue rather than your hands.
2. Try as best as you can to allow this person to self isolate for 14 days at the very minimum. If possible, they should have their own bathroom for 14 days, utensils, plates, cookware
3. Wash your hands as much as possible and clean surfaces with Clorox wipes if have them or any other anti-bacterial wipes In high touch services such as counters, table tops, door knobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside table.Use hand sanitizer as much as you can.
4. After 14 days, they are very unlikely to be infectious and the masks while in the house are unnecessary.

 

 

 

Can my dog  or cat get sick ?

 

It does not appear that household pets get sick from this virus or transmit the virus but there is very limited  information on this. But it appears less likely.

 

How long does the virus live?

 

1. Air: It is not really known how long this virus can live in the air but they are still researching it. The data I’ve seen ranges of 3 hours to 72 hours. It is thought that these droplets are too heavy to hang in the air for a very long time and overtime will fall to the floor so therefore it’s range of reaching you is about a meter. This is why it is recommended that we maintain at least 3 feet but optimally 6 feet from persons during this outbreak. I personally recommend wearing a mask as this decreases the chance that you will inhale those droplets even though we know that they’re likely to hit the floor within a few hours.

 

2. Surfaces: It is not known how long the virus lives on different surfaces. However, if you think a surface is a high touch surface, then spray with recommended agents that are known to kill the virus

Additionally, receiving packages is very safe as it is unlikely that contaminated goods or packaging can survive the travel and exposure to multiple different tech temperatures and conditions and infect you.

 

 

Recommended agents:

https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf

 

 

 

 

Does a person that gets an infection from droplets worse off than those that get it after touching something?

 

It is not known whether there is a different outcome on those that get the infection directly from inhaling it versus from touching or ingesting. However, in my opinion, the goal should be optimizing prevention as much as possible and I suggest people stay at home, wash hands clean surfaces, and wear a mask in public to decrease the likelihood of themselves getting infected.

 

Why does it appear to cause heart failure in some patients?

 

It is not known why this virus causes heart failure in some. However, it is known that multiple viruses can lead to infections of different organs including the heart, liver, and of course as we know the lungs. It does appear that persons with cardiac disease are at increased risk for heart failure from COVID-19. This needs to be studied further to truly understand. It has been found that there was evidence of heart damage in hospitalized persons that have contracted COVID-19.

 

What if I get COVID-19? How severe will it be for me?

 

This is a very difficult question to answer as this is one of those crystal ball questions. However, we can tackle this question by looking at the data  thus far.

 

There are 710,000 total cases as of March 29 in the world today. Of those, 26,708 are considered serious or critical. That’s roughly 5% of all cases in the world are considered serious or critical.

 

The factors that play a role in that 5% include age, gender, and pre-existing conditions.

 

1. Age those that are 80 years of age and older have a 15% death rate
2. Males have an overall death rate of 3% and females 1.7%
3. Death rate with those with cardiovascular disease is 10.5%, diabetes is 7.3%, chronic respiratory disease is 6.3%, hypertension is 6%, and cancer is 5.6%.

 

**NO pre-existing conditions and under 50 have a 0.9% chance of death at this time. Therefore, if you have no medical conditions your death rate is extremely low.