Care Triad

COVID-19 in a nutshell

As a former hospital-based infectious diseases physician, I have been reading everything I can about the coronavirus pandemic. Because this is a new coronavirus not previously seen in humans, the World Health Organization gave the disease the name COVID-19, which stands for Coronavirus Disease 2019. While there is a flurry of high quality up-to-the-minute, information available, especially on Twitter, it is challenging to get the most important information in one place. Based on questions I am getting, here is my attempt to provide a quick overview and answer the key questions.

Are things really that bad?

YES! Experts agree that we are currently seeing the COVID-19 tip-of-the iceberg in the US. It is going to get much worse. And because we don’t have adequate testing in the US there are likely thousands of uncounted infections. While the official number of cases in the US is close to 3,000, some experts estimate that we may have as many as 40,000 infected individuals in the US already. The number infected is likely doubling every 6 days and as many as 40-70% of the US population is expected to become infected. A great source of this type of information on Twitter is Dr. Trevor Bedford @trvrb, a scientist who studies viruses at Fred Hutchinson Cancer Research Center in Seattle.

What do we know about the virus so far?

1. The pandemic started as in infection in bats and jumped to a human in Wuhan, China in late 2019. It was subsequently passes on to Taiwan, South Korea, Singapore, Italy and other countries before coming to the US
2. It has been brewing in the US (starting in Seattle, Washington) since the beginning of 2020 but we have not taken the appropriate steps to keep it contained
3. COVID-19 is caused by a respiratory virus, like influenza. This means it is mostly passed from person to person through the air by coughing and sneezing but can also be transmitted by breathing near an infected person. There is also evidence that it can be transmitted by swallowing the virus.
4. Based on studying the infection in other countries (since we have so little testing here!) the most common symptoms are fever, cough and shortness of breath but symptoms can vary and recent reports suggest that gastrointestinal symptoms are also common.
5. People exposed to the virus tend to develop symptoms after about 7 days but they can still transmit the virus to others before the symptoms start.
6. The COVID-19 coronavirus appears to be more lethal than the seasonal flu virus – in fact it may be 10 times more lethal. A death rate for COVID-19 of ~1% may sound small but there are 327 million people in the US!
7. The virus can live on hard surfaces like doorknobs and kitchen counters for a week or more!
8. Most people will recover fully from the infection but high-risk individuals could develop a very severe pneumonia requiring a ventilator (breathing machine). Those at greatest risk are older individuals (especially those over 60) and those with underlying health conditions (like lung disease, heart disease, diabetes, etc.) or who are immunosuppressed (because of an underlying condition or because they are on a drug, such as prednisone, that suppresses the immune system).
9. Generally, children do not appear to be getting very sick but they may be passing the virus along to others. Serious infections and deaths have been reported among young health people too.

What is the big deal since we see cases of influenza every year?

1. Seasonal flu cases occur over the course months and many of us have some immunity against it from getting the flu shot and from being exposed to other flu viruses in prior years. COVID-19 is caused by a new virus so there is no vaccine and no one has any natural immunity.
2. We are now on a path to having so many COVID-19 infections at the same time in the US that we will not be able to treat everyone. Not only will there be inadequate emergency room services, hospital beds and ventilators but we will not be able to treat people who come in with heart attacks, strokes and other emergencies.
3. Even if you get a mild or asymptomatic infection, you may be getting other people sick – those people at risk in the community as well as your own friends and family

What is the US doing to decrease the spread of this infection?

The US government was slow to contain the spread and very slow to develop adequate testing for the virus (which we still don’t have) and now we need to take extreme actions in order to avoid the situation that is currently occurring in Italy where the healthcare system is completely overwhelmed and people are dying because there are inadequate resources to treat them.

Local governments, businesses and national organizations are taking drastic but necessary action. The decisions to close schools, Broadway shows and sports events are aimed at “flattening the curve” which means spreading the infections out over time. This is because our healthcare system does not have enough doctors, nurses, intensive care unit beds and ventilators to care for the number of people we are likely to see in the next week or so. Even if you think this has nothing to do with you because you are otherwise young and healthy, the truth is that if the healthcare system is overwhelmed, we will not be able to take care of the usual medical problems seen in doctors’ offices and hospitals. Hospitals are trying to expand their services, medical professionals are being asked to come out of retirement and elective surgical cases are being postponed. They efforts are also drastic but necessary!

What other things should I be doing?

There are many things that we, as individuals, can do both to protect ourselves and our friends and family. These actions will also save the lives of other members of our community.

1. Wash you hands frequently using soap for 20 seconds
2. If you do not have access to a sink, use a hand sanitizer with at least 60% alcohol
3. Clean all surfaces in your home or office frequently
4. Avoid touching your face
5. Work from home if you can
6. Practice “social distancing”

There is more great information on the CDC website.

What exactly does social distancing mean for me?

1. Avoid taking public transportation, if you can
2. Avoid contact with other people wherever possible – this includes minimizing (if not fully avoiding) contact with friends and family
3. Avoid going to restaurants, bars, houses of worship and other group gatherings
4. Find ways to maintain your mental health in the face of these restrictions – go outdoors, exercise, etc.

Two good articles about social distancing are available here and here.

What do I do if I feel ill?

1. If you have fever or cough or think you may have COVID-19, stay home
2. Do not go to the emergency room or urgent care center unless you are having trouble breathing
3. Call your doctor for advice on what to do next
4. Do not worry about getting tested for COVID-19 – assume you have the infection and stay home and isolated for 14 days. As testing becomes more widely available, especially drive through testing, the situation will change.

This is a time to take action but not panic. Our health, and that of our friends, families and communities depends on our immediate actions.