Coronavirus. What to know. What to do. Should you panic?

The new coronavirus, COVID19, is going to cause significant disruption to life as we know it. It will likely infect half of the population. It will cause millions of deaths across the USA and the world. Most people either just don't know enough, or think this is just another flu, or are in denial. Please read the following and share with your loved ones so you can prepare accordingly.

What is COVID19?

20% of the common colds we get are from coronaviruses. Most are passed human to human and are very mild. Occasionally, these viruses infect an animal- like a bat or a camel or pangolin- where they mutate and then infect humans.  

Two such viral strains have emerged that are more infectious and deadly: SARS with mortality of 9.5% and MERS with mortality of 34.5%. These have been contained.  

A new 2019 strain of SARS (called SARS2) which is 80% similar to the old SARS is the new mutation that causes COVID-19.  It appears to be more infectious and much harder to contain. It is transmitted both in droplets of cough when standing less than 6ft (2 meters) away, and in the stool.  

Typically, the time from infection to the time of developing symptoms, known as the incubation period, is 5 days but there are reports of incubation period of 28 days. This means a person can carry the virus and infect others while not knowing that they themselves have been infected. Asymptomatic transmission can happen which makes this virus harder to contain. 

R0 or R naught.  R0 refers to how many people each infected person ends up infecting. Measles is thought to be highly infectious and its Ro is 12-18. Every person with active measles infects 12 to 18 others! The R0 of the seasonal flu is 1.5. The R0 for COVID19 is yet not known, but it appears to be much higher than the flu by 4 folds.Marc Lipsitch, an epidemiologist at Harvard University, predicts that between 40 to 70 percent of adults in the world will become infected with the coronavirus.  If you think of 40% of the adult US population and round it down to 100 million people, at 2% death rate- that is 2 million deaths in the US alone. Current mortality statistics based on best available prelim data:

It should be noted that these are largely based on Chinese numbers which are unreliable. Cases are probably under-reported, so mortality rate is probably actually lower. We will likely see lower mortality rates in a more developed health care system like the US. Bill Gates and others believe that the mortality rates will be closer to 1%. That still is 10 to twenty times higher than the mortality of the seasonal flu.

• the average overall mortality rate of 2.3%
• anyone with a history of diabetes, heart disease, chronic lung disease, or cancer carries a higher mortality risk of 5-10%
• no history of chronic disease <1%
• overall men have a higher risk of 2.8%
• overall women fair better at 1.7%
•  Risk increases by age after 10 and jumps significantly after 70:
• over 70 years old 15%
• 0-9 years of age ~0%

What are the symptoms of COVID19?

Usual symptoms of having the flu: Fever. Cough. Shortness of breath. The cough of COVID-19 infection is dry, non-productive! From CDC: Diseases can make anyone sick regardless of their race or ethnicity.

People of Asian descent, including Chinese Americans, are not more likely to get COVID-19 than any other American. Help stop fear by letting people know that being of Asian descent does not increase the chance of getting or spreading COVID-19.

When should you go to the hospital emergency room?

• If you experience lots of trouble breathing (breathing faster than > 30 breaths a minute)
• If you can't walk without feeling faint
• If you don't feel better even when your fever is down (e.g., ~1 hr after ibuprofen/acetaminophen)
• If you are no longer making much urine
• If you are confused and not making sense when you talk. 

Most “cold” viruses stay in the upper respiratory system- the nose, the throat, the sinuses. It is when these viruses move to the lower system- the lungs- that they cause pneumonia (viral pneumonia) and a cascade of total body infection known as sepsis and inflammation in the lungs known as ARDS. Pneumonia and ARDS and multiorgan involvement are complications of COVID19 which markedly increase the risk of death.

How is it diagnosed?

Some labs can test for the genetic material of the virus which is similar to SARS. The CDC is working to provide kits for testing the sputum, just like we do now for the flu. Unfortunately, at this time, local clinics do not have the testing kits. Suspected cases are currently being referred to the department of public health for testing. The CDC is only advising testing for patients with cold symptoms who have traveled to endemic areas like China, Iran or India or have a known exposure to a COVID-19 patient.

Myths.

Myth: Regular face masks can protect you from the virus. (Unfortunately, regular masks will not protect against this virus. There are protective masks like N95, but they require special fitting by a professional to be effective .)

Myth: You're way less likely to get this than the flu. (COVID19 is more infectious.)

Myth: The virus was probably made in a lab. (It mutated in a bat.)

Myth: Getting COVID-19 is a death sentence. (Actually, most have little or no symptoms and 98% of the population will survive it.)

Myth: If you have coronavirus, "you'll know". (You won't. You may feel like you just have a little cold.)

Myth: The coronavirus is less deadly than the flu. (Mortality rate is much higher, perhaps 20 times higher.)

Myth: Lockdowns or school closures won't happen in the US. (Prolonged school closures are very likely!)

Any good news?

98% of those infected will survive. 

At this time it appears that children are not at a great risk of dying from COVID19.

The virus has been already fully sequenced already. This is an amazing progress in science. 

The CDC has techniques of testing that will be available to the public soon.

Given sequencing of the genetic material is available, vaccines can be made in record time, within a few weeks.

There is some evidence that anti-viral drugs used in HIV such as Ritonavir, anti-viral drugs used against Ebola such as Remdesivir and anti-malarial drugs such as Chloroquine can protect from the progression of the virus and its infection of the lungs into full-blown sepsis or ARDS.

Is there a treatment?

For most of us, COVID19 will look just like a common cold. Currently, there are no known specific treatments for COVID-19 other than supportive care, such as self-isolation, hydration, treatment of fever with Ibuprofen and or Tylenol.

If the virus ends up infecting the lungs, hospital admission will be recommended with a CT scan to check for acute respiratory distress syndrome- or ARDS. Inhalers, antibiotics, antivirals, intubation, etc. may be needed to support those very sick.

How bad could it get?

 Up to 70 to 80% of the world’s population could end up being infected with this virus over time.

Once there is a large number of people infected, it is possible that panic will lead people to overwhelm the medical system.

Hospitals could be overloaded and hospital staff could get sick, taking out 20%+ of medical professionals, further stressing out the system, creating shortage in care.

Schools could be shut down for extended periods of weeks to months.

People may be asked to stay home and to work from home for weeks to months.

Businesses will be affected if people stop eating out, going to gatherings, using taxis or Uber.How should I protect my family?

• There are simple things you can do to help keep yourself and others healthy.
• Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
• WHO video on washing hands: https://www.youtube.com/watch?v=3PmVJQUCm4E&feature=emb_logo
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Do not run to the doctor for a mild cold! Wait and assess symptoms.
• Make sure you have had your flu shot and other vaccinations such as pneumonia vaccine if indicated.  A double infection, such as flu and COVID19 could happen in the flu seasons like November which would increase your risk.
• Remind your kids to keep their hands off their faces! Pathogens enter the body through the eyes, nose, and mouth. Give them hand-sanitizers (alcohol-based) to carry with them to school. Keep sanitizers in the car, in their backbags. 
• Don't send your kids to school or to public places when they are sick and may be contagious. 
• Consider canceling any travel plans until further information. Buy travel insurance. 
• Avoid closed public areas. 
• Avoid hand-shaking. Bowing from a distance like the Japanese is most prudent. 
• Keep very good control of your diabetes or asthma. Take your medications and check with your doctor that all your chronic conditions are optimized and under control.
• Avoid smoking. Avoid vaping. 
• Avoid drinking alcohol which reduces your immune system. 
• Get a full night of sleep. Viral infections are less traumatic to those who get more than 8 hours of sleep, but cause more damage if you get less than 6 hours of sleep. 
• Some practitioners recommend the use of supplements to boost your immune system: Vitamin C 2000 mg, chewable zinc 50 mg, vitamin D3 5000 mg, elderberry supplements.  

What should I do to prepare for the worst?

Before a Pandemic

• Store a two week supply of water and food.
• Periodically check your regular prescription drugs to ensure a continuous supply in your home.
• Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
• Get copies and maintain electronic versions of health records from doctors, hospitals, pharmacies and other sources and store them, for personal reference. Get help accessing electronic health records.
• Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.

During a Pandemic

• Limit the Spread of Germs and Prevent Infection
• Avoid close contact with people who are sick.
• When you are sick, keep your distance from others to protect them from getting sick too.
• Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
• Washing your hands often will help protect you from germs.
• Avoid touching your eyes, nose or mouth.
• Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

I encourage you to share this with friends and family. 

Best Regards,

Afshine Ash Emrani, M.D., F.A.C.C.