Five Easy Steps to Take during the COVID-19 Pandemic

As a Physician, Immunologist and Virologist who studied basic mechanisms associated with Coronavirus infection during my PhD years, I've been frequently asked for my perspective on COVID-19. The article below represent my own attempt to summarize some steps to take for the COVID-19 pandemic originally written for my immediate friends and family. These thoughts are my own, and are provided for further consideration and discussion. (March 2nd, 2020)

by Daniel S. Chen MD PhD

1.     Isolation if you have symptoms. For those with fever, cough, flu-like symptoms, sneezing: minimize contact with others and wear a mask when in contact with others. Wipe down all exposed surfaces with virus-disinfecting wipes, detergents, etc. Hygiene becomes very important for both the infected and those around them. Wash hands, face with soap and water (for 20 seconds) and/or use an alcohol-based hand sanitizer (eg Purell). Use lotion as well, as your skin may dry/crack with repeated washing. The infection may run days to a couple of weeks. Once infected, it may take a month or more to become immune to repeat infection. If you develop shortness of breath and/or pneumonia, please contact a health worker immediately, as some of the infected may develop severe symptoms. Avoid going directly into a hospital, as you’d like to allow them to prepare for your arrival, so as to not infect others at the hospital.

2.     Practice enhanced hygiene practices. Wash hands with soap and water (for 20 seconds) and/or an alcohol-based hand sanitizer (eg Purell) frequently. Use lotion as well, as your skin may dry/crack with repeated washing. Wipe down surfaces with virus-disinfecting wipes, detergents, etc. when it makes sense. Avoid touching your nose, mouth, face. avoid shaking hands, etc 

3.     Protect your lungs. The most serious sequalae of COVID-19 is infection of your lungs, so protect yourself from getting a lot of virus in your lungs. The best way to get a lot of virus in your lungs is from breathing in respiratory droplets from an infected and symptomatic individual, followed by breathing in respiratory droplets from an infected and asymptomatic individual. Imagine respiratory droplets as a cloud of mist around an infected person who is sneezing/coughing/breathing (if you’ve ever seen a sneeze or a mister in sunlight, you might imagine what this looks like). Those respiratory droplets hang in the air and contain the virus particles. Avoiding being around those respiratory droplets is the best thing you can do. However, you don’t always know ahead of time if someone is symptomatic and/or infected, so avoiding these situations may be an important step for limiting the rate and severity of infections. That could mean minimizing contact with groups of people, particularly in more enclosed spaces. It could also mean wearing a mask or covering over your nose and mouth. Consider the potential exposure at large conferences or gatherings, the gym, cruise ships and airplanes and elevators, to name a few. N95 medical masks or better are what are used in the medical setting, but there is a shortage of masks, and they need to be fitted properly to work best, and few are perfect. However, anything that captures some/all of the respiratory droplets may cut down on the amount of viral exposure you receive in your lungs, which may be important. Interestingly, the size of the viral particles is actually much smaller than the pore size of the N95 mask. However, the respiratory droplets that carry the virus are larger than the pores, so the droplet hits the mask and sticks to it. Masks also prevent you from touching your mouth and nose, limiting inoculation with your hands. If you are going to fiddle with the adjustment on a mask, using an appropriate hand sanitizer or soap and water on your hands first is probably a good idea.

4.     Don’t Panic. Do be Prepared and Do Take Action. We can get through this if we are smart and thoughtful as a society. We are fortunate to have a pandemic outbreak that isn’t associated with an even higher severe infection or death rate. Imagine if this virus was highly infectious, but looked more like MERS or the 1918 Spanish Flu. This is a wakeup call to the world that will make us all more prepared. 

·      Simple life modifications should slow or prevent spread, and this should be our objective. Slowing the COVID-19 virus infection rate has multiple positive effects. It will stretch out infections over time, extending utility of our ICU beds and healthcare resources. It should also reduce the number of people susceptible to infection over time- because an increasing number of people will be immune- further slowing spread. And it potentially buys time for seasonal declines in infection, and perhaps most importantly, buys time for implementation of a vaccine, of which some are already in clinical testing. 

So don’t panic- it’s not the end of the world today- but do take the active steps to limit the impact of the pandemic. Lack of action is not acceptable. This is a responsibility to not only ourselves and our families, but our society. The experience in some countries or regions where logarithmic spread of COVID-19 has overwhelmed the ability to care for the severely ill may reflect the consequences of not taking more intensive early steps to limit the speed of infection.

5.     Isolation if you have contact. For those with exposure to the symptomatic infected, and to a lesser extent, asymptomatic infected, and did not have appropriate protection per the above, isolation per the above may be warranted. One of the most problematic features of COVID-19 virus is that it can lead to a prolonged asymptomatic incubation period (generally believed to be up to around 14 days). It appears that one can be actively shedding virus during this period of time.

Some Additional Resources:

CDC recommendations

WHO recommendations

New England Journal of Medicine

Nature

Lancet

Cell