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What You Need to Know About COVID-19

***UPDATED 3/11/2020***
I have been getting a lot of questions lately about the novel Coronavirus (COVID-19) outbreak. Most people want to know how concerned they should be and how they can keep their families protected. Here is some information based on my research and expertise. I have linked several of the resources I have used at the end and will update with new information and better citations when I am able.

Fast Facts:

  • COVID-19 is the name of the novel Coronavirus first detected in Wuhan, China in December of 2019.
  • As of 3/11/2020, COVID-19 has been officially called a Pandemic by the World Health Organization. https://time.com/5791661/who-coronavirus-pandemic-declaration/
  • The first reported death in the US due to COVID-19 happened at EvergreenHealth in Kirkland, WA (King County) and the patient was a medically “high-risk” man in his 50s as reported during the King County Health Department press conference on 2/29/20. This is extremely sad for the family members of the deceased, but is still not a reason for the general public to panic. This information is consistent with the deaths that have been observed so far in other countries with widespread outbreaks (see statistics reported below). To date, there have been over 2 dozen deaths reported in the United States, a vast majority of those in “high-risk” demographic groups.
  • Recommendations regarding quarantining and limiting gatherings of 10 or more people are currently being made in some areas–prepare for more widespread quarantine measures as this disease spreads; on 3/11/2020, the governor of WA state issued a ban of all public gatherings of over 250 people in King, Snohomish, and Pierce counties; states of emergency have been declared by several government entities primarily to make funding available should there be a need for widespread quarantining or infection control as has been done in other countries with widespread outbreaks; schools are preparing for the possibility of quarantines by providing tools for online learning and instruction. Also the OSPI has notified schools that they will not be required to make up school closures/cancellations due to COVID-19 beyond June 19, 2020.
  • Preliminary research done by Fred Hutch, UW Medicine and Seattle Children’s as part of the Seattle Flu Study demonstrates that COVID-19 has likely been circulating in the greater Seattle area since mid-January; projecting based on the numbers of infections in China before quarantining and social distancing efforts took place, the greater Seattle area could see thousands of cases in a few short weeks if social distancing efforts are not taken seriously.
  • Sustained person-to-person transmission of COVID-19 in large numbers has been established in nations near to and far from China, including South Korea, Italy, Iran, and Japan (and now the United States). For a world map of aggregated case counts updated daily, visit: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 (From the Snohomish Health District Clinician Update on 2/28/2020).
  • In response to the growing global COVID-19 outbreak, the Centers for Disease Control and Prevention (CDC) has issued travel alerts for these countries with community transmission. See Travel Health Notices at http://www.cdc.gov/coronavirus/2019-ncov/travelers for details and monitor frequently for updates to the list. (From the Snohomish Health District Clinician Update on 2/28/2020).
  • There is currently no publicly available vaccine for COVID-19, and even if one is developed and brought to market, it will not provide immediate protection as antibody responses from immunizations can take at least 2 weeks to be considered protective.
  • The incubation period is estimated to be up to 14 days, which means infected people can spread the virus for 2 weeks before developing symptoms
  • The disease is spread via droplets that enter the respiratory tract either from close contact with an infected individual (defined as over 10 minutes in a proximity of 6 feet or less) or by touching the eyes, nose, or mouth after touching a surface contaminated by droplets. Hygiene and social distancing are the best measures for stopping the spread of infection!!
  • Based on the available data, the average number of people a single person may infect is between 2 and 3, which means that there is potential for significant spread.
  • The mortality rate of those who have tested positive for COVID-19 is around 2%, while the mortality rate for those hospitalized with critical illness is 49%.
  • The demographic with the highest mortality rate (3.6% and higher) are seniors over age 60; in contrast, there have been no COVID-19-related fatalities reported in children under 10 years old.
  • Most deaths attributed to COVID-19 are a result of fulminant pneumonia or respiratory distress; unlike bacterial pneumonia, antibiotics are not an effective treatment and antiviral protocols to treat this infection are still being developed.
  • The mortality rate is significantly higher in diabetics (7.3%) and people with underlying cardiovascular disease (10.5%) or lung disease (6.3%).
  • The vast majority of those infected will have mild cold-like symptoms; keep in mind that much of the morbidity and mortality data being reported is among lab confirmed cases and there could be many asymptomatic individuals who have not been tested but are technically still infected with the virus (this is why community transmission is a concern).
  • While tests are available, these are not necessarily available at every health point-of-care; the CDC and Public Health departments will be coordinating with Hospitals and Healthcare Providers to most efficiently test individuals suspected to have the virus or for surveillance purposes (asymptomatic people who may have been exposed); anyone with symptoms who thinks they may be infected should call their healthcare provider, urgent care or hospital ER prior to going in to make sure protocols are in place to keep the infection from spreading. Public Health recommendations for testing patients require that the healthcare providers have the appropriate personal protective equipment (supply chain shortages mean some clinics are out of these important supplies) as well as sufficient space to isolate symptomatic patients. Most outpatient facilities don’t have the proper ventilation system in exam rooms, severely limiting the volume of patients with respiratory symptoms that they can safely see and/or test. Here’s more info: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDcasepositive.pdf
  • Other serious coronaviruses (such as SARS and MERS) have been shown to survive on surfaces outside of the body for up to 9 days. This is much longer than the average influenza virus, which only survives outside of the body for about 48 hours. We still don’t know for sure how long COVID-19 survives on contaminated surfaces outside of the body but some scientist estimate it could be 2-3 days at ambient temperature, which is why disinfection and proper hygiene are so important to prevent this infection from spreading.

How to Keep Your Family Protected

  • Pay attention to public health recommendations regarding travel and quarantines–even though not all travel outside of the US is currently restricted, it is a good idea to check the State Department website and CDC for recommendations regarding travel to any parts of the world where COVID-19 is currently active and spreading.
  • Air travel of any kind (even domestic) or even being in an airport can increase your risk of being exposed to travelers from other parts of the world who may be infected, so good hygiene and immune support are a MUST if you will be spending anytime in an airport.
  • Proper hygiene (hand washing, avoiding touching face, sanitizing surfaces before eating) can prevent transmission. Good old soap and water with proper handwashing technique is more effective than most hand sanitizers, so reserve the use of sanitizer for the times when you have no access to soap and water.
  • Hypochlorous acid as a sanitizer/disinfectant has been shown to kill 99.99% of coronavirus; this is the active ingredient in many of the alcohol-free hand sanitizers. Disinfectant sprays are also available for retail purchase and can be used to clean and sanitize surfaces in kitchens and bathrooms. Alcohol based sanitizer must contain at least 60% alcohol to be effective. Bleach solution must be properly diluted and made fresh daily to be effective (https://www.doh.wa.gov/Portals/1/Documents/8340/970-216-Disinfect-en-L.pdf). For proper disinfection of surfaces, you have to leave the disinfectant on the surface for up to 10 minutes (air dry) to be effective.
  • 50mg of Zinc daily for adults has been shown to inhibit viruses, including coronaviruses, by slowing replication. (This is not a cure for COVID-19, as Zinc has not been specifically studied on COVID-19).
  • Daily Vitamin D supplementation has been shown to prevent acute respiratory tract infections (again, no specific data on COVID-19, but can potentially prevent or limit severity of a number of viruses, including ordinary coronaviruses); the recommended daily doses are 400IU of Vitamin D3 daily in children ages 1-5, 800IU daily in children ages 6-11 and 2000IUs daily for ages 12 and up; higher doses of Vitamin D3 do not provide additional benefit when it comes to preventing respiratory infections.
  • Vitamin A supplementation has been shown to reduce symptom severity of viral pneumonia in children and in vitro studies have also shown that Vitamin A helps regulate the cytokine response in cells that line the respiratory tract; for these reasons, Vitamin A supplementation may be beneficial to protect individuals from severe symptoms if they do become infected with COVID-19. The recommended daily allowance of Vitamin A by age can be found here: https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
  • Vitamin C used at symptom onset has been shown to decrease symptom severity and is one of the few successful treatments (in IV form) being used on the front lines for patients with Acute Respiratory Distress Syndrome caused by COVID-19 (AKA viral pneumonia); this treatment may be effective if taken orally, but more research is needed to determine how helpful it may be.
  • Staying well-rested is important for healthy immune function; lack of quality sleep can increase stress hormone levels, which can leave you more susceptible to infections.
  • Humidity can decrease the spread of many airborne and droplet-borne viruses, so if someone in your household is sick, consider investing in a humidifier to keep the rest of the family protected.
  • Facemasks with an N95 respirator are recommended for healthcare workers to prevent transmission of COVID-19, but due to the significantly increased demand and disruption to supply chain, the general public may not have access to this level of protection, nor is it recommended. Wearing a mask or bandana over the nose and mouth may prevent you from spreading your germs to others, though, so this is recommended if you have symptoms and must venture out in public (please avoid this if at all possible). Masks are not necessarily helpful at protecting you from getting infected, so not advised as a general precaution. Plus, healthcare workers and first responders NEED masks to protect themselves and their patients from a number of communicable disease (not just COVID-19).
  • There is no known “cure” for COVID-19, so any claims made, especially for the purpose of selling products, services or equipment intended to treat, prevent or cure COVID-19 should be viewed with skepticism. Yes, there is good information out there on general measures for immune function and virus prevention, but no peer-reviewed published research on treatments for COVID-19. Research proposals for some treatments have been submitted and some preliminary papers and case studies have been published, but this information is not enough to warrant broad recommendations or claims.
    •  

If and when COVID-19 becomes a public health threat in the US, it is important not to panic and to get your news from reliable sources, such as the CDC. Most of the fear surrounding this novel virus is coming from the fact that we don’t know everything about it yet. As time passes and more data is collected, there will soon be answers and a better picture of what to expect. Being prepared at home with an adequate supply of food, water and medicines and having a plan in place if schools, workplaces or public venues are closed are things you can do now to minimize the impact this could have on your household.

CDC website for up-to-date information about COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/index.html
US State department website for information about international travel advisories: https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html

References:

https://www.cdc.gov/media/releases/2020/t0225-cdc-telebriefing-covid-19.html

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200310-sitrep-50-covid-19.pdf?sfvrsn=55e904fb_2

http://www.cidrap.umn.edu/news-perspective/2020/02/study-72000-covid-19-patients-finds-23-death-rate

https://www.theatlantic.com/science/archive/2020/01/how-fast-and-far-will-new-coronavirus-spread/605632/

https://www.the-scientist.com/news-opinion/why-some-covid-19-cases-are-worse-than-others-67160

https://www.the-scientist.com/news-opinion/why-some-covid-19-cases-are-worse-than-others-67160

https://www.sciencedaily.com/releases/2019/05/190513155635.htm

https://www.ncbi.nlm.nih.gov/pubmed/29985866

https://alertsenseadmin.blob.core.windows.net/snohomish-county-wa/COVID_clinician_update_02282020[1].pdf

https://kingcounty.gov/depts/health/communicable-diseases/disease-control/novel-coronavirus.aspx

https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

https://nextstrain.org/ncov

https://bedford.io/blog/ncov-cryptic-transmission/

https://clinicaltrials.gov/ct2/show/NCT04264533

https://www.evergreenhealth.com/coronavirus

https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1?fbclid=IwAR0uaXgGAAB0a06Sotc6Wu6fHu-C1-RegaR8Q6Tv1mN2LuY6DgDhoO038LA

China Treating Coronavirus COVID-19 with Intravenous Vitamin C

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