Thoughts on COVID 19

People are either calling me in a panic or rolling their eyes at what they believe to be massive overreaction.

Big actions are being taken. Ones most of us haven’t seen before.

Universities are moving to “remote learning” for the rest of the academic year. The NBA has suspended its season. St. Patrick’s Day parades have been cancelled. There is temporary restriction on people entering the U.S. People are being told to change their behaviors – to stand a few feet away from others when out in public, to avoid crowds, to cancel large gatherings.

It seems terrifying.

But the above is not cause for panic nor for eye-rolling – it is prudent, it is sensible, and it is cause to be reassured that the public and private sectors are working together to slow the spread of a highly contagious disease before it has a chance to overwhelm our medical infrastructure.

The disease itself is concerning. COVID-19 (this particular circulating corona virus, which is related to previous viral outbreaks such as SARS and MERS from past years) has a reasonably high mortality (death) rate in lab-confirmed cases. This overestimates the actual mortality rate, since many people will have only mild symptoms and not seek medical care and no one knows they have the virus because they aren’t that sick and so they aren’t counted in the denominator of people with the disease. This virus is really bad for older individuals, those with weakened immune systems, and those with underlying heart or lung issues. Everyone should be diligent with general hygiene and infection-control practices to reduce spread (frequent hand-washing, not touching your face/mouth/nose/eyes, not sharing drinks/silverware/etc., covering coughs/sneezes, frequently disinfecting high-touch surfaces (door knobs, tabletops, etc.), keeping a few feet away from people when out in public, and staying home and away from others when you feel sick). All of the aforementioned, I might add, is what we should do in general, but we tend to get sloppy about it when there aren’t publicized or imminent infectious threats.

People with underlying heart or lung issues, older individuals, people with compromised immunity, and others at higher risk (or who spend time with those who are at higher risk) will want to be more aggressive about avoiding public or crowded places. Follow WHO and CDC recommendations and the recommendations of your local health department. From current data in Korea (where they have done extensive testing for the virus), it appears that the overall mortality rate is around 0.6% (although current worldwide case mortality is looking like 2-3.5%, and we won’t know more exactly for some time), which is higher than that of influenza (which is generally about 0.1% or so in the U.S.). And even though most young, healthy people who are exposed to and contract this virus will be fine, some will die. The number of cases is likely to increase substantially – the reason for avoiding crowd exposure and cancelling conventions and big events/gatherings is so that we can avoid too many people getting the virus at once, causing us to run out of ICU beds and/or ventilators if the spread isn’t contained/slowed down (which is why we should listen to WHO and CDC recommendations, as well as the recommendations of our local health departments).

Here’s some of what we know so far about the clinical aspects of COVID 19: Virus symptoms start with achiness, feeling run-down, cough, low fevers, then development of difficulty breathing about 8 days in, and lung inflammation about 9 days in. (This is in contrast to influenza, which hits you like a Mack truck). Fever is usually, but not always, present. The most common lab finding is a low lymphocyte count (a specific type of white blood cell), but overall white blood cell count can be elevated or low. The CT scan findings show patchy inflammatory changes in the lungs. No other symptom/lab/radiologic findings are consistently found. Looking at a large group of patients in China, it appears that onset of symptoms from time of exposure is between two to nine days, with a median of 5 days, but there are reports of incubation periods up to two weeks, so quarantines are officially two weeks for those who have been exposed. The virus seems to be most contagious when a person has symptoms. A person can “shed” viral RNA for several weeks after they’re better, but it is not yet known whether those post-illness viral RNA particles are actually infectious. So for now, patients are kept isolated until there are two consecutive negative tests (i.e. no viral RNA detected) at least 24 hours apart.

Most people in the U.S. who have severe disease have been receiving Remdesivir (an anti-viral medication) from the company Gilead on a compassionate use basis, but soon patients receiving it will need to be in an official randomized controlled trial. There are other medication recommendations coming out of China and Korea that are indicating that there has been success decreasing the mortality rates (death rates) with other anti-viral medications, with chloroquine (an anti-malarial med), and also with some other types of drugs which target the immune system response, since some of the severity of illness and death is due to the immune system’s reaction to the virus.

There are some very smart brains in multiple countries working on medication and vaccine development to combat COVID 19, but it will take some time to figure out and, once figured out, to ramp up production, so slowing the spread of this virus is our best defense at this time.

Our best chance to slow the spread of COVID 19 is for all of us to work together. Wash your hands. Keep your hands away from your face. If official large gatherings have been cancelled, don’t make your own unofficial large gatherings instead. Avoid movie theaters for a few weeks and watch T.V. with a couple of friends instead. Don’t share drinks/plates/eating utensils. Keep at least 3 feet between you and other people, 6 feet if possible. Wash your hands. Keep your hands away from your face. Avoid unnecessary travel in busses/planes/trains/subways. Wash your hands. Keep your hands away from your face. Work from home if you can. Stay away from others if you feel sick. Disinfect high-touch surfaces regularly. Wash your hands. Keep your hands away from your face.

There will be inconvenience. There will be economic consequences. But hopefully there will be lives saved and grief averted if we all do our part and work together.

Oh, and wash your hands and keep them away from your face.

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