The Most Common and Concerning Questions I Get About Corona Virus or COVID19.
How bad is it? Incidence, mortality, infectious?
It appears to be more deadly and more infectious than the common flu (Influenza A and B).
But our data is super limited and it will change drastically as it is happening in real time. Secondly, the variation in data/results from country to country is astounding and shows how the results we get are completely dependent on who gets tested and who doesn’t!
So, let’s keep it simple. Compare and contrast to something we know – the seasonal flu in the USA!
|Incidence this season (USA) *1||20k (on 3/20/20, changing hourly). Check – Johns Hopkins Coronavirus Resource Center||40-49million
(Oct 2019-Feb 2020)
|Ro (people infected by 1 sick person) *2,3||2.2||1.1-1.3|
|Mortality estimates *4,5,6||2.3% (CDC), 3.4% (WHO)||0.1%|
|Symptoms||Fever, Cough, SOB, Sore throat||Fever, Myalgia, Runny nose, Cough,|
BUT! Notice that mortality is very different than case fatality rate?
Case fatality rate = deaths/cases. And thats about all that we have right now with super limited data. This isn’t a good way to look at mortality (Read why). 1.) The more we test the more the mortality rate will go down. 2.) Who we test will change this number. But here is what we have so far.
See how the case fatality (or death rate) changes drastically based on what country you are in? Its doubtful the same virus or care is so different in countries. It is more likely that the data reporting and testing is the disparity. So basically we are in the dark with bad data.
Lastly here is the VERY best illustration I can find that fits the data (as bad as it is) that I have seen.
Y-axis = death rate. X-axis = contagious (R-naught)
(btw I can’t find the creator of this graph, contact me for credit)
How infectious or contagious is it?
More than the seasonal flu or influenza.
Ro or R-naught = how many people 1 sick person will infect. An R-naught of 1 is the differentiating number between an epidemic or not. R-naught <1 then no rapid spread. R-naught >1 then there will be exponential spread and an epidemic or pandemic is possible.
R-naught influenza = 1.1 -1.33
R-naught COVID = 2.22 (the exponential math is vastly different)
Will summer kill the virus? Do viruses prefer warm or cold weather?
Summer might decrease it. The virus thrives better in cold. (read my full article on this)
- Cold dry air keeps the virus in the air a longer time and keeps the fatty envelope intact – increasing the odds of infection. Humid, warm air makes the virus drop to the ground faster and makes the envelope less stable – decreasing the odds of infection.
- This virus seems to prefer the cold, as predicted *8.
- Sunlight will help destroy it. UV rays can damage and kill viruses like this too *9,10.
BUT a virus depends on two things in order to spread: host and itself. The virus is completely reliant on us as hosts. Because it can’t travel or replicate without a host. So the more we are around each other the better shot it has of finding new hosts.
So bottom line – The envelope around the virus might not like the upcoming nice weather, but you and your friends will and you decide where the virus goes.
How long does it last on surfaces?
On surfaces, they found COVID-19 lasted for:
24 hours on cardboard
2 days on stainless steel
3 days on a type of hard plastic called polypropylene *11.
What is the best way to kill it?
Good ole soap and water!
Alcohol sanitizers work too. But, it must be the right concentration and time. 60-80% alcohol. And give alcohol time to desiccate or evaporate and dry. It is this action that breaks the envelope around the virus. These crazy pictures of cities spraying down parks with bleach are unnecessary measures. Alcohols and soaps or even acids (like your stomach juice) break down the virus better than a base (like bleach).
How do I know if I got it? Symptoms?
- Cough, Fever, Trouble breathing -> Call your Doctor or Health Department
Currently just symptomatic treatment and respiratory support. Like any virus it needs to run its course and leave the body. Antibiotics don’t work on viruses because they are for bacteria. Bacteria are not just a different species…they are an entirely different Kingdom of life form from viruses.
Chloroquine decreases COVID-19 reproductive rate in vitro (in a test tube) *12 and mice *13. But we do not have good human randomized control trials (the bar of evidence we require before using something on a person. We have one trial stuttering in China *14, and a nonrandom, non-blinded tiny trial in France *15. We also have some evidence that it worked on a former coronavirus (SARS 1) *16. So its looking good!
Maybe it will be a great choice! But the evidence we have is NOT up to the standards of proof we typically require for human use despite Trump’s claims that it is ready to be used. So we shall see if we decide to lower our bar or standard of evidence required and just go for it during this crisis.
Zpack (azithromycin)? (again a Trump claim).
No. Again antibiotics are for an entirely different Kingdom of life form.
However there was a french study (not randomized or blinded) that showed combining azithromycin with chloroquine had some good outcomes but this is likely due to other superimposed bacterial infections *15.
Ibuprofen. Is it safe with COVID-19?
WHO released information last week that Ibuprofen may potentiate the symptoms of COVID19 and that you should avoid its use if you become symptomatic. This was based on a theoretical suggestion in a French article in the Lancet *17. However there is no evidence for this and this risk is simply theoretical. The WHO has since updated their recommendation that there is no data to support this. That said, there is a general caution with all NSAIDs (Motrin, ibuprofen, Advil, Naproxen) when we have severe infections. NSAIDs can worsen harm to the kidney when dehydrated in our severe states of infection. So if you are getting very sick and hospitalized your providers will likely switch and use acetaminophen (Tylenol). But unless you have underlying kidney disease or are severely dehydrated this is unlikely to be a problem for you (according to our current understanding).
Best way to care for yourself once diagnosed?
- Stay home
- Call your doctor for advice on symptom management
- Go to the ER if you have difficulty breathing/catching your breath.
- Create a “sick room” in your home that is isolated from others in the home
- Use a separate bathroom if possible
- Conservative measures – Tylenol for fever, stay hydrated. Wash your hands and commonly touched surfaces frequently.
Can pets get sick or be carriers?
Unclear if pets can be carriers. However, we do know that many corona viruses do infect animals as GI bugs (cats, pigs and cows) so it may be likely…but COVID-19 is still unknown. So if you get sick…maybe just stay away from your pet.
Can you get COVID19 more than once? Are you immune after you catch it?
You will have some immunity. How much? We don’t know.
We do know that the spread of a new virus declines after a certain amount of people get them and this is because we gain immunity to them. The trouble is some viruses mutate fast (think influenza and rhinovirus) so they quickly change the way they look and our immune system can’t recognize them the next time they come around. We have yet to see this happen so lets hope it doesn’t mutate and change quickly.
Aside from social distancing, how else can our community help doctors and nurses?
- Flatten the curve (Read this to understand)
- Defer less important health concerns and visits till after the crisis (but still come in if its an emergency or you need us!)
- Call your doctor’s office prior to arriving for visit!
- Leave PPE for the people on the front line. Stop wearing and consuming it, just stay inside.
- Send a care package of things you think they don’t have time to get while at work
What are things we can do daily to stay safe aside from washing our hands?
- Again – Wash hands! #1 at all times!
- Avoid close contacts. Unfortunately, this even means those who don’t have symptoms. New information is being released daily but currently the incubation period (time of infection from when symptoms start) is thought to have a median of about 5 days and most (97.5%) of individuals will have symptoms within about 12 days*18.
- It spreads on respiratory droplets so cover every cough/sneeze with disposable tissue or into your arm.
- It attaches to your nasopharyngeal (nose and throat) membranes so you can drink hot drinks (remember it hates heat), and use saline rinses of your nose. (This is not evidence based but clinically sound).
- Keep your hydration and nutrition in peak shape! Make sure you are getting the appropriate vitamins.
- CDC Influenza data https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm
- In StatPearls. Features, Evaluation and Treatment Coronavirus (COVID-19) STAT PEARLS. https://www.ncbi.nlm.nih.gov/books/NBK554776/
- R naught estimate of influenza. https://www.ncbi.nlm.nih.gov/pubmed/25186370
- CDC data on COVID https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w
- WHO estimate of mortality. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-march-2020
- Influenza Mortality rate. https://www.cdc.gov/flu/about/burden/2018-2019.html
- Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature
- Warm weather decreases corona retrospective studies. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767
- Sunlight Inactivation of Human Viruses and Bacteriophages in Coastal Waters Containing Natural Photosensitizers
- Far-UVC light: A new tool to control the spread of airborne-mediated microbial diseases
- Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
- Chloroquine Invitro https://pubmed.ncbi.nlm.nih.gov/32150618/
- Chloroquine Animal: https://aac.asm.org/content/53/8/3416
- Human trials of chloroquine in China https://www.ncbi.nlm.nih.gov/pubmed/32164085
- French trial of hydroxychloroquine on COVID. https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf
- Chloroquine use for coronaviruses (in the past as well with SARS) https://pubmed.ncbi.nlm.nih.gov/32171740/
- LANCET article on Kidney function and Ibuprofen https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext
- Johns Hopkins Study on incubation period. https://www.jhsph.edu/news/news-releases/2020/new-study-on-COVID-19-estimates-5-days-for-incubation-period.html