Coronavirus March 2020—Part 2

The novel coronavirus story continues to evolve. This article will update readers about what we know about the novel coronavirus (now officially named SARS-CoV-2) as of the beginning of March 2020.

Disease PRESENTATION

Many people infected with SARS-CoV-2 have no symptoms whatsoever or very mild symptoms (we estimate currently about 80%, though due to underreporting of asymptomatic cases, this number could be even higher). This is both good and bad. Good because that means if you catch it, you’re most likely to be just fine. Bad because if a person doesn’t know he or she has it, he or she can spread it to others more easily. When people do develop symptoms, they most commonly present with fever, cough, and shortness of breath. Chest x-rays show bilateral infiltrates (pneumonia). Recovery time appears to be around two weeks for mild infections and three to six weeks for severe disease.

Risk of Transmission and death

How easy is it to catch SARS-CoV-2? Current data suggest (and this may change as more data becomes available) that the risk of transmission of SARS-CoV-2 is similar to that of influenza. Thus, each person infected with SARS-CoV-2 will on average transmit the virus from 1.4 to 4 people.

Currently, we believe the virus is transmitted via hand-to-mouth and via respiratory droplets when infected people cough or sneeze. The incubation period appears to be up to 14 days (though most become symptomatic within five), meaning people can be infected and presumably infectious a full two weeks before they begin to show signs and symptoms of infection. We don’t yet know if the virus is airborne, meaning that it hangs out in the air into which infected patients have coughed or sneezed, giving the virus the ability to infect people long after an infected person has left an area. SARS-CoV-2 is similar in structure to the coronavirus that causes SARS, however, which isn’t thought to be airborne, so that gives us reason to hope that SARS-CoV-2 isn’t either. While we don’t know exactly how long SARS-CoV-2 persists on surfaces, other coronaviruses persist on surfaces anywhere from a few hours to a few days.

What percentage of people infected with SARS-CoV-2 will die from it? This percentage is called the “case fatality rate,” or CFR. Because we don’t have accurate information on the total number of people infected with SARS-CoV-2, we are likely overestimating its CFR. This is because there are likely far more people who’ve caught SARS-CoV-2 than are being reported, so the denominator in calculating the CFR is likely higher than the one being used, which currently estimates the CFR as being between 1.4% to 2.1% as of mid-February 2020.

Importantly, though, CFRs are also being found to vary with age and co-morbid medical conditions. The following data comes from a study done in China: Patients older than 80 had a 14.9 percent chance of dying after being infected, while those in their 70s were found to have an 8 percent chance of dying. Patients in their 50s were about three times more likely to die than patients in their 40s, at a rate of 1.3 percent. Patients ages 10 to 19 were as likely to die as patients in their 30s, at just 0.2 percent. The study did not report any deaths in children younger than 10, who represented less than 1 percent of patients. Patients with pre-existing heart disease had a 10 percent mortality rate, while those with diabetes had around a 7 percent mortality rate.

Current incidence

To track in near real-time the number of cases around the world, go here.

Prevention

As of right now, this virus appears to be transmitted like most other viruses, through hand-to-mouth contact and via respiratory droplets. This means it’s most likely just like any other virus. This means the very best way to prevent infection is through strict adherence to some basic personal hygiene principles:

  1. Masks will not likely prevent you from becoming infected. Even N95 masks that filter out 95% of particles may not stop the virus. Even if the disease becomes pandemic (as it looks now like it will) wearing masks in public will do little to help prevent the spread of this disease. For one thing, if you wear a mask onto which infected people sneeze or cough, when you remove it, you will likely contaminate your hands. If you then touch your mouth, nose, or eyes, you may become infected yourself. Masks are most useful for healthcare workers who must come into close contact with potentially infected people. Everyone else should focus on avoiding people who are coughing or sneezing (8 feet at least). Masks can be put on people who are already infected as that may limit the spread of respiratory droplets into the air when an infected person coughs or sneezes.
  2. Stop shaking hands. Stop hugging people. Push aside all the social obstacles to adopting this strategy. The best way to prevent catching a respiratory virus is to avoid getting it on your hands, mouth, nose, and eyes.
  3. Wash your hands with soap and water frequently. Consciously avoid touching your face (studies suggest that we touch our face with our hands an average of 15 to 23 times an hour, often without realizing it). Realize that the virus might be transmitted from surfaces (desks, door handles, etc.). Thus, the more you wash your hands in general and the less you touch your face the better. This might be the very best way to prevent infection spread. To wash your hands effectively, spend a full two minutes with soap and water on them (it’s the length of time soap sits on the skin, not the vigor with which your rub it in, that correlates to disinfection rates). Pay particular attention to the spaces between your fingers and your fingertips (under the nails). Use moisturizers if your skin starts to dry and crack. Alcohol-based hand sanitizers are second best (as long as they have at least 60% alcohol content).

Travel Recommendations

It might be prudent to avoid travel to hotspots. However, as the pandemic progresses, this will likely soon be a moot point. Airplanes, buses, and trains that throw people into close contact may increase the risk, but if you stay more than 8 feet away from people who are coughing or sneezing (which admittedly might be challenging), avoid touching other people and your face, and wash your hands frequently and correctly, domestic travel and travel to countries in which the infection rates remain low seems reasonable.

What to Do if You Think You Have SARS-CoV-2

SARS-CoV-2 produces typical lower respiratory tract infection symptoms (that is, cough) when it produces symptoms at all, so it’s nearly impossible in mild infection to determine if you’re infected with a run-of-the-mill virus or SARS-CoV-2. The one symptom that run-of-the-mill upper respiratory tract infections don’t cause, though, is significant shortness of breath. Both SARS-CoV-2 and influenza can do this. If you become ill, the first step is to call your ImagineMD physician. Upper respiratory tract infections are mostly viral and don’t respond to antibiotics. They can usually be diagnosed over the phone. Socially isolate yourself if your physician diagnoses you with an upper respiratory tract infection. If you also have shortness of breath, your physician should instruct you to head to the ER.

Bottom line: One reasonable way to think about the coming pandemic is that there’s a fair chance that COVID-19 will end up being only slightly more transmissible than influenza and just about as deadly (meaning, an overall mortality rate of 0.1%, with higher rates in the elderly and infirm). Yet most people aren’t panicked every year about the flu. Worry over SARS-CoV-2, of course, is driven by the fact that it’s a new infection and we don’t have as much knowledge about it as we need. But that knowledge is growing every day. So keep calm, wash your hands, don’t touch your face, and carry on. To learn how ImagineMD is approaching patients who might be infected with SARS-CoV-2, click here.

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  • As of today (March 12, 2020), ICU facilities in Italy are overwhelmed, and some infected patients seeking treatment are being turned away. News reports state that younger patients are being prioritized over older ones, since younger patients have a greater probability of successful recovery.

    What can older people living in the US do to prepare for the possibility that this may happen here? If I or a family member were to become infected, but was turned away from the ICU, what preparations can I put in place now to be better prepared to successfully recover at home?

    Linda: You ask a great question. Sadly, the answer is if you or a family member actually require ICU care and can’t get it, there’s nothing you can do to recover at home. The real answer is for all of us as a society to band together to socially distance ourselves (and all that entails) to slow the spread of SARS-CoV-2 so that our healthcare system doesn’t become overwhelmed and have to make the terrible choices being made in Italy right now. If we can flatten the infectivity curve, our healthcare system can absorb the cases without buckling.