COVID-19

UPDATE 3/27: Read "Grief in the Time of Corona" by BJ Miller & Mike Rabow

Too many people are finding reasons to doubt the need for isolation. If the coronavirus is akin to the common cold or flu, as is often said, then what’s the big deal? That comparison is regrettable and misleading. Here’s why:

This is a virus that humans have never experienced before (a “novel” virus), and therefore we possess no immunity to it. That also means that, unlike with the cold or flu, we – the health system – don’t know for sure what to expect from the virus and, for myriad reasons, are not prepared for the strain on the system’s capacity.

The pandemic is dynamic, with too many variables in play across many settings for us to draw conclusions with great certainty, but we know that the virus spreads very easily. It can linger in the air for hours, and up to days more on many surfaces, especially indoors. Epidemiologists who study outbreaks put the R0 (naught) value at 3, meaning that every person who is infected will give the virus to three others. This is where the math gets exponential and scary: after 15 revs, over the course of a few weeks, over 14 million people will have been infected.

Most people who become infected experience only relatively mild symptoms and are done with the infection within two weeks or so. Some infected people will show no signs of disease whatsoever. That’s great, in some ways, but it’s a big problem too. Through basic social contact of everyday life, and from a relative dearth of testing availability to date, people are casually spreading the disease either without knowing they’re doing so or are mistakenly presuming the illness isn’t a big deal. In other words, the biggest threat to most of us is that we unwittingly might harm others, a prospect that can feel worse than being sick ourselves.

So far, the mortality rate appears to be between 1% and 3%. No one is immune from being infected or from becoming dangerously ill, but the likelihood for life-threatening infection is significantly higher in older folks or for people with otherwise weakened immune systems (in other words, people living with chronic illness). Most recent updates from China – the oldest data -suggest that far more people have been infected than they had realized, which would drive the death rate lower. That sounds like good news, but that also means that the virus is more widespread than imagined.

At the moment, there is no treatment and no vaccine. This may change, but not likely for many months, at least. Meanwhile, we have three ways to push back on the virus:
- Isolate ourselves; this lowers the risk of transmission.
- Shield people who do come in contact with COVID-19. This option is limited by availability material supplies, such as specific face masks, eye-wear, gowns, and gloves. These things also lower the risk of transmission.
- Medically support people who become ill. This option is limited by the speed and adaptability of our already-stretched healthcare system. Medical support – specifically hospital beds-lowers the risk of death from COVID-19.

By the way, COVID-19 is an acronym, which stands for COronaVIrus Disease of 2019. COVID-19 is the disease caused by this new strain of coronavirus.

Social Distancing and Resource Links

We talk of “social distancing” like everyone should know what that means. Thanks to our friends at the St Louis County Dept of Public Health, by way of my parents (who say hello), here’s a succinct definition:

“Maintaining at least six-foot social distancing from other individuals, washing hands with soap and water for at least twenty seconds as frequently as possible or using hand sanitizer with more than sixty percent alcohol, covering coughs or sneezes with something other than hands, regularly cleaning high-touch surfaces, and not shaking hands.”

Note on staying tuned-in to the news: do your best to stay up on the latest – the situation is changing dramatically by the day – and also do your best to put the news down just as often. No one can stay for too long in crisis mentality without searing their nervous system. It’s a crisis alright, on a monumental scale, but we also need rest to get through this. The outbreak will take months to work its way through and out, so slow your pace and settle into a marathon. Think months, not days.

Here are some sources we’ve found useful to follow:

The CDC
Your state and local public health dept (here’s a directory)
Google has a nice one-stop-shop site that bundles a bunch of useful information
Here’s a link to my friends at the MERI Center at UCSF. While some of the info is San Francisco-specific, most of it is relevant no matter where you are. It’s a great site to keep you up to date on both medical information as well as tips for coping along the way
Here’s a tool to help model the strain on state hospital systems and the impact of varying degrees of social distancing

If You Think You Have Coronavirus

Lastly, here is the basic triage pathway if you’re concerned you or someone you know has Coronavirus:

If you have a fever (100 degrees or higher) or persistent cough or difficulty breathing, begin by going or staying home and avoiding contact with others. If you’re otherwise not feeling horrible, stay home and call your physician's office for further direction.

If you don’t have a doctor or are otherwise out of reach, (here’s a directory).
If you’re feeling really ill – high fever, labored breathing - and are unable to contact a physician, stay home and call your local emergency room. They will guide you while protecting your safety and the public’s too. (Note: as the pandemic rolls on, your local health system may establish its own pathway for testing and medical care, so be sure to stay up on local alerts through the public-health resources listed above.)
For a quick and easy, evidence-based questionnaire that will point you in the right direction, check out this site from the University of Southern California