Corona Virus Advice From the Front Lines

 

In a war of any kind, it’s best to learn from those who are fighting on the front lines. This is certainly true of those healthcare providers who are treating COVID-19 infected patients every day.

Dr. David Price is a pulmonary specialist at Cornell Medical Center in New York City, the epi-center of the U.S. virus pandemic. The medical experts from the White House Corona Virus Task Force are specialists in seeing the big picture of world-wide infection, but doctors like Price are actually treating patients every day.

Recently, Price held a teleconference with his family to educate them about this virus and reassure them as they face the challenge of remaining healthy in this environment. His video conference can be viewed at https://vimeo.com/399733860?ref=em-share. For those who don’t have access to this video or the time to watch it, I’ve tried to highlight the salient facts for your review:

Virus Transmission

Dr. Price starts by making one thing very clear – this virus is transmitted by droplets. That means from droplets of virus on skin or surfaces that our hands touch and then we bring to our face. It is not transmitted from infected people to uninfected people through the air that we breathe. Most transmissions of virus from one to another occurs from sustained (15-30 minutes) contact with actual touching of the infected person.

That means the key to protection from the virus is clean hands and avoidance of touching your face. In the confines of your home where no one is infected, such precautions are unnecessary. But in public spaces, we must be constantly aware of what our hands touch – and then compulsively clean our hands with soap and water or hand sanitizer – before ever touching our faces. This will prevent the transmission of virus if you happen to be in contact with the virus.

That brings us to the importance of masks. Dr. Price says the main value of wearing masks is to prevent us from touching our faces! He estimates that plain surgical masks are worn 80% of the time in the ICU. He says that the much-heralded N-95 masks are only used in his ICU when nurses are suctioning patients or providing respiratory therapy that might cause the patient to cough. This is when healthcare providers are at greatest risk. For those who are uninfected, there is absolutely no need for these masks. Anything that inhibits your ability to touch your face is effective, including plain cloth masks or bandannas.

Lastly, social distancing is important. Maintaining distance of approximately 6 feet prevents contact between infected and uninfected individuals. This is especially important to prevent asymptomatic infected individuals from transmitting disease to others inadvertently through touching.

In summary, Dr. Price’s rules for preventing virus transmission:

  • Keep hands clean– with soap and water or hand sanitizers
  • Avoid touching your face– especially just after touching unclean surfaces
  • Masks prevent virus spread –by preventing you from touching your face
  • Social distancing matters– unless you’re certain others are uninfected (family)

 

Symptoms and Treatment

The most common symptom is fever, usually greater than 100.0 F, but up to 80% simply describe “not feeling good.” Other common symptoms are sore throat, cough, and shortness of breath. Dr. Price says the only symptom severe enough to warrant going to the hospital is shortness of breath.In their hospital, everyone else gets sent home unless there is a serious co-morbidity that makes the patient high-risk. If you have symptoms, but not shortness of breath, stay home and call your doctor.

Families should isolate the infected family member as much as possible; preferably with their own bedroom and bath. The infected one should wear a mask whenever in the presence of other family members, but others need not wear masks. Strict adherence to hand washing, surface cleaning, and avoidance of touching the face should be maintained by all. Family members should refrain from taking the sick one’s temperature because this increases the chances of virus transmission. Let the infected one take their own temperature, if possible. If a family member with high-risk co-morbidities becomes infected, they should try to find alternative living conditions, if possible.

Only about ten percent of the infected are requiring hospital treatment and only about one percent intensive care. Most patients requiring ventilators will recover. The average time for recovery is about 5 days. Those who recover develop antibodies and immunity from re-infection.

The young are being spared from this virus. Infections below the age of 14 years are practically non-existent, however, anyone from the upper teens to a hundred years old is vulnerable. Most serious cases are in the elderly with co-morbidities but even healthy young people are at risk. Former NFL lineman Tony Boselli, age 47, recently was discharged from the Mayo Clinic after five days in the ICU.

Dr. Price strongly believes there is no reason to contract this virus if we “follow the rules.” We may have to get used to this new normal for months to come, but we can limit the spread until eventual herd immunity, new viral treatments, and viral weakening reduce the risk to more manageable levels like other similar respiratory illnesses.

 

Corona Virus v. Influenza: Who is Winning?

 

As the news media inundates us with 24/7 coverage of the Corona Virus Pandemic with up to the minute data on infection cases and new deaths, it’s important to maintain a sense of perspective. I first talked about this a few weeks ago (Corona Virus is Coming – Should We be Worried?) but now seems a good time to talk about this again.

While every day we hear the number of Corona Virus cases and deaths, we hear nothing of the influenza cases and deaths that are happening concurrently. This is not meant to make light of the Corona Virus situation, but rather to realize that people are dying every day from influenza while we’re completely focused on Covid-19 cases.

Below is a graph from the CDC that shows the current influenza epidemic in the U.S. at a glance:

Below is a graph from the CDC that shows the current Covid-19 virus pandemic in the U.S. at a glance:

All data is based on currently available graphics on the CDC website as of 4/3/20.

Here are the two graphs compared side-by-side:

                                     Total Cases               Total Deaths

Influenza                     39 – 55 Million             24 – 63 Thousand

COVID – 19                   239,279                           5,443

 

Influenza numbers are estimates because testing for influenza is inconsistent. Many more people have influenza based on their doctor’s diagnosis but testing for influenza is less common. Testing for COVID-19 virus is ramped up now due to the pandemic but only those with symptoms are being tested. Many more undoubtedly are positive for the virus but asymptomatic.

America has taken the influenza epidemic much too casually for years. Even though there is an influenza vaccine available, only about 40% of the whole population and 60% of the vulnerable population bothers to get vaccinated. No one has ever called for social distancing for influenza nor stressed the value of hand washing, avoiding contact with the face, compulsive washing of surfaces with disinfectant and other measures we now hear about every day since the COVID-19 pandemic.

More importantly, the government has never before called for a voluntary shut-down of the economy, yet thousands continue to die every year from influenza. Why are things so different now?

The politically correct answer is that COVID-19 is a new virus whose behavior is unknown. Yet that statement could have been made for the H1N1 influenza pandemic of 2009 but no such strict governmental intervention happened then. That year the CDC reports 60.9 million cases (range 43.3 – 89.3 million), 274,304 hospitalizations (range 195,86 -402,719) and 12,469 deaths (range 8,868 – 18,306). Remarkably, these data show the 2020 influenza season is actually worse, though no one sounded the alarm until COVID-19 appeared.

The biggest thing that has changed in the last ten years is the loss of a reliable, unbiased media without a political agenda. This has increased distrust of the information we receive in the news. It can be difficult to discern the difference between legitimate concern and needless fear-mongering. It will be even more difficult to determine when the crisis is over and we can return to some semblance of normalcy.

Keep calm, America. We have weathered storms worse than this before and we will again. We have the greatest healthcare system in the world and the greatest private sector with the ingenuity to respond to this crisis. We can do this.

“Who of you by worrying can add a single hour to his life?” – Jesus (Matthew 6:27)

Corona Virus Update: Time to Go Back to Work, America

 

The Corona Virus Pandemic has brought America, and the world, to a halt. In a world-wide reaction unseen for any previous pandemic, the lives of nearly every human being on the planet have been impacted. All of this has been done in the interest of slowing the spread of the virus, containing the pandemic, and saving lives. But is the cure worse than the disease?

The answer to that question depends entirely on the virulence of the virus – best measured by the mortality rate. The mortality rate can be calculated in many ways but the simplest is the number of deaths divided by the number of infected patients. For EBOLA virus the rate is generally believed to be 50 – 90% depending on the outbreak. For MERS the rate is about 35% and for SARS the rate is around 10 percent. These high mortality rates surely warrant measures as stringent and pervasive as what we are experiencing with COVID-19 (Corona).

But recent statistics show that COVID-19 has a mortality rate of less than two percent. As I write this post Sunday, the 29th, the U.S. mortality rate is 1.7%.The Corona Virus Task Force recently announced testing in the U.S. has exceeded testing in South Korea for the first time.  As testing increases, the likelihood is the mortality rate will decline as the denominator in the equation gets larger. Even so, there are many more people probably infected with mild or no symptoms who are not being tested, yet should be included in the accurate calculation of a mortality rate. The true mortality rate is therefore more likely much less than 1.0%.

The United States now has more cases of infection than anywhere in the world. This reflects our large, diverse population and mobile society, but more importantly, our widespread testing. We are now testing over 100,000 Americans per day and even though only those with symptoms and a fever are being tested, only about 9% test positive.

The South Korea mortality rate is 1.5%. The rate in Germany is 0.8%. Rates are higher in other countries such as China, Italy, and Iran where medical treatment systems are not up to the standards of countries like the U.S. and South Korea. Once again, accurate mortality rates are difficult to calculate unless all citizens are actually tested and all positives are included in the calculations. Results from totalitarian states like China and Iran are especially unreliable.

South Korea is perhaps the best model of Corona Virus response in a highly developed medical system. Corona virus statistics from there are considered highly reliable and have given us much needed information. For example, we know that 99% of actives case in the general population are “mild” and do not require specific medical treatment. These people are staying home and recovering in approximately 14 days.

We also have learned that the small number of cases requiring active treatment are highly concentrated in the older population. The risk of mortality is 3 times higher for people over 70 than for those ages 60 to 69. The risk of mortality is 2 times higher for those over 80 than for those ages 70 to 79.

Dr. David L. Katz, a specialist in preventive medicine and public health, writing in The New York Times, says the time has come to focus our resources on testing and protecting all those people the data indicate are especially vulnerable to severe infection: the elderly, people with chronic disease and the immunologically compromised.  Those that test positive could be the first to receive the first approved antiviral therapies.

However, he says the rest of society should return to life as usual while maintaining good hygiene, washing hands regularly, and self-isolating when sick. Healthy children could return to school; healthy adults go back to their jobs. Travel should return to normal. Theaters and restaurants could re-open, though very large social gatherings like sports stadiums and concerts might still be wise to avoid.

Dr. Katz says, “So long as we were protecting the truly vulnerable, a sense of calm could be restored to society. Just as important, society as a whole could develop natural herd immunity to the virus. The vast majority of people would develop mild corona virus infections, while medical resources could focus on those who fell critically ill. Once the wider population had been exposed and, if infected, had recovered and gained natural immunity, the risk to the most vulnerable would fall dramatically.”

There is a point in this Pandemic when the extreme measures being taken now to prevent spread of the virus even to healthy individuals will come at tremendous expense to the economy and the lives of millions of Americans. When economic depression sets in, the number of deaths related to suicide, drug addiction, alcoholism, and domestic violence will escalate and may greatly exceed those caused by the Corona Virus. We are rapidly approaching that situation and all Americans should be prepared to accept a higher risk of a mild viral infection in return for resumption of a more normal life style existence and restoration of our economy.