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Germs Public Health

COVID-19 Update #2

            In the news, you may see the terms coronavirus, Novel Coronavirus, COVID-19, and SARS-CoV-2 used somewhat interchangeably. Strictly speaking, the new virus is called SARS-CoV-2.  Before the medical community fully understood the virus they were dealing with, it was referred to as Novel Coronavirus.  The disease the virus causes in people (fever, coughing, shortness of breath, pneumonia, etc.) is called COVID-19.  The virus itself is one of several viruses that are spherical with a halo of protein spikes on their surface that is crown-like in appearance – like a corona.  For simplicity of terminology, I will use the term COVID-19 whether I’m talking about the virus or the disease it causes.

COVID-19

Mistakes and Lessons Learned

            The world has watched as COVID-19 rapidly spread from a single city in China to the entire country in just 30 days. The speed of both the geographical expansion and the sudden increase in numbers of cases quickly overwhelmed public health services in China, particularly in Wuhan City and Hubei Province.  In other provinces where the Chinese healthcare system had time to respond with measures that slowed the spread of COVID-19, the fatality rate dropped significantly. That’s great news!

            In the United States, we have an opportunity to avoid the high death rate China experienced in Wuhan by slowing the spread of COVID-19 infections with social distancing and self quarantining when infected.  By slowing the rate at which COVID-19 spreads, the urgent need for hospital rooms and intensive care resources can hopefully be reduced to meet the demand.

            While stopping the spread of COVID-19 doesn’t seem likely, we can slow the rate at which the virus jumps from person to person. This is very encouraging for the most vulnerable since we have one of the best acute care health care systems in the world when not stretched beyond its limit.

            There is still a possibility that warmer weather will slow the spread of COVID-19.  For now, the experiences of other countries suggest that we best not count on that possibility and be prepared to quarantine affected groups.  For example, schoolchildren have close contact, and schools will be closed.

            The key point is, if we work together, we can keep from overwhelming hospitals by slowing the rate of COVID-19 transmission.  You will hear more about the importance of this strategy, which is frequently referred to as ‘flattening the curve’ by social distancing.  For more about social distancing, quarantines, and answers to a wide range of related issues, you will find an abundance of information in “The Vox guide to COVID-19.”

            If unsure why self quarantining is helpful, a short lesson in exponential math may be helpful.  Each person with the COVID-19 virus is expected, on average, to infect about two to three people unless quarantined.  For purposes of keeping the math simple, assume each person only infects two others. The result is an infection rate that doubles about every six days.  That means that if 50,000 people have the virus today, then in 6 days, 100,000 people will have it. In another 12 days, it’s 400,000, and in another 6 more days, a million people will be infected.  With the goal of slowing the spread of the virus, the need for quarantining is obvious.  Every day of delay makes a difference.  This video explains the exponential math described above in a way that makes it graphically clear why social distancing and quarantining is of the essence.

A Closer Look at COVID-19 in Italy

(Another Lesson Learned)

            In a press conference held March 13th, 2020, in Italy, the Department of Civil Protection confirmed that only two deaths could be attributed solely to COVID-19.

            This curiously small number is because there is a great difference between deaths with COVID-19 and deaths solely because of COVID-19. According to the  Department of Civil Proteccion officials in Italy, the lessons learned are as follows:

            With rare exceptions, the deaths associated with COVID-19 have been associated with weakened general health conditions and advanced age (older than 70, with most between 80-89 years of age.)

            Only two individuals under the age of 70 with COVID-19 and medical issues died.  Both were 39 years of age. One was diagnosed with lymphoma, and the other was significantly overweight with diabetes and additional health conditions.

            At the time of the report, only two deaths had occurred in people with COVID-19 and no secondary health conditions.

            Italy’s early experience with COVID-19 serves as a reminder of who is at greatest risk.  Italy’s lack of concern for early quarantining also serves as a reminder of how easily a healthcare system can be stretched to the limit. As of the last report, the Italian healthcare system was stretched beyond its limit, with infections still increasing exponentially.

            For more about this story and why lifestyle is the most important preventative measure read, “Health Status and Covid-19.”

COVID-19 DOs and DON’Ts

By now, I trust you have heard about the importance of washing hands and covering coughs many times.  At the risk of boring you, I’m going to say it one more time, along with a few more suggestions that can make a difference.

  • Wash your hands like your life depends on it – because it might. Not only for the COVID-19, but also for the many other germs you can acquire from elevator buttons, doorknobs, money, or dozens of other surfaces that are difficult to avoid.  When possible, use an elbow to hold a door back or your car key to push an elevator button.  For now, touching others, handshakes, high-five’s, etc. are out.
  • Stay home if you’re sick. The same goes for other family members.
  • Frequently disinfect touched surfaces in areas with shared items. This includes shared pens, door handles, water taps, and toilet fixtures.
  • Avoid crowded spaces, especially situations like public transportation, schools, business meetings, sports events, conferences, and churches.
  • If you must meet with friends, meet outside where there is fresh air and fewer germs.
  • Cough and sneeze in your elbow, or shoulder, or in a tissue – not in your hand.
  • Stay away from people that sneeze, cough, or look sick.
  • Get vaccinated. While there is no FDA approved antiviral medication or vaccine for COVID-19, there is still much we can do. Be aware that far more have died from flu than from COVID-19.  So far, this flu season, the Centers for Disease Control and Prevention estimates we have had 36-51 million cases of flu, 370,000 – 670,000 hospitalizations due to flu, and 22,000 – 55,000 flu-related deaths.  Reducing the number of people that have the flu makes more hospital resources available for people with COVID-19.  Get vaccinated!
  • If you have a fever and body aches, call your doctor for advice.  Unless advised to seek emergency treatment, stay at home.
  • Don’t touch your face or pick your nose. If you must, at least wash your hands first. And then again after.
  • Keep well hydrated.  Water, green tea, and hibiscus tea are good choices. Whole fruits and vegetables also provide hydration plus good nutrition.
  • Know that unless you’re old and suffer other illnesses, you’ll likely recover from COVID-19.
  • Rest, relax, and live healthily. Stress, lack of sleep, lack of movement, and poor nutrition can all weaken your immune system.
  • Don’t shake hands. You don’t know where other hands have been, and you don’t want to get whatever they acquired. Smile instead. Maybe tap shoes together (also called the Wuhan shuffle.)
  • Don’t eat, drink or touch your face if you haven’t just washed your hands really well with soap and water.
  • Don’t visit restaurants where you are likely to contact others.  Consider order delivery where you pay online and have food left at your door.  Currently, COVID-19 is not believed to be transmitted by food.
  • Don’t visit grandma in the nursing home if you have any symptoms of illness (fever, cough, etc.). Call her instead.
  • Don’t go to the ER unless you’re deathly ill, or looking for trouble. You’ll spend a long time there and probably get a hefty bill along with everybody else’s germs. The one thing you’re unlikely to get is a straight answer since test kits may still be in short supply, and the reliability is at best between 60% -70%.  Statistically, to have high confidence that you have COVID-19, you would need to be tested four times. Tests will become more available and get more reliable in time, just not this time.
  • Don’t expect a COVID-19 vaccine any time soon. Vaccines take a long time to develop. Before millions can be given a vaccine, it takes a lot of safety and efficacy testing.  The time to create a vaccine was 1-2 years ago – long before the virus was known.
  • Don’t call the ER to ask if they’re busy. They will be busy. Even if they weren’t, they wouldn’t give medical advice by phone. Call your doctor first.
  • Don’t share food containers or cutlery. Don’t let people taste your food, and don’t try theirs.  While the virus doesn’t seem to last long on food, sharing food is another matter.
  • Don’t believe all you read on social media. Misinformation is rampant. If there were a secret cure, it would have been in the previous list of Dos.
  • Don’t share wild ideas that are likely to confuse more people.  COVID-19 is not a hoax, a democratic ploy, or a biological weapon released by the Chinese. It was not invented by vaccine companies to make money. If unsure, of what you read, the article, “Myth vs. Fantasy,” can answer many questions.

As you digest the abundance of information from popular news sources, you may want to compare what they have to say with what the community of trusted doctors at KevinMD has to offer. Below are links to eight informative articles from the KevinMD community of trusted physicians.

While we have much to learn about COVID-19, we have the benefit of lessons learned from other countries.  Fortunately, these lessons are being reviewed and translated into public policy.  Our opportunity is to take these hard-learned lessons and turn them into meaningful action.  One person that has had the opportunity to review these lessons and present the findings in an understandable way is Peter Attia, MD.  In the four short videos below, Dr. Attia sorts through a wide range of questions that may be on your mind.

            Hopefully, by being well informed and working together, we can each make a meaningful contribution toward helping our community manage the COVID-19 pandemic.

            While unknowns about the new virus may have you worried, if quarantined, don’t forget to keep smiling and looking for creative ways to use the time at home.  It’s an opportunity to get plenty of rest, cook nutritious food, and get some exercise. Even better, it’s an opportunity to reconnect with old friends by phone, email, or video chat.  For those at risk, you may find a way to help with food deliveries or other essentials.

            When possible, spend time outside in the fresh air appreciating nature. Spending time in nature and breathing fresh air feels good and is good.  It’s the gift of nature. In the evening, look up at the stars and know that everyone is looking at those same stars.  We will get through this together.

            Nancy Neighbors, MD

By Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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