BY JAMES ROBB, MD FCAP
[Editor’s note: The following article and letter, both written in February 2020, are shared here in the spirit of providing common sense solutions to preventing disease transmission, as well as information on symptoms, testing, and treatment of COVID-19. Please see the CDC website at www.cdc.gov, or visit https://ncov2019.live for current information on the coronavirus disease outbreak.]
Dear Colleagues,
As some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.
The current projections for its expansion in the U.S. are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the U.S. by mid to late March and April.
Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves:
1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip—do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home’s entrances, AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!
What I have stocked in preparation for the pandemic spread to the U.S.:
1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average—everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs). The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.
2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth. (We touch our nose/mouth 90X/day without knowing it!) This is the only way this virus can infect you—it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth—it is only to keep you from touching your nose or mouth.
3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.
4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.
I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.
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This is what happens when you get the coronavirus:
BY ANTONIO REGALADO
(MIT Technology Review, Feb. 11, 2020)
Hospitals in China are reporting their experiences with hundreds of patients so far.
The epidemic of a novel coronavirus spreading from central China has sickened more than 43,000 people and killed more than 1,000, eclipsing the death toll from a related virus, SARS.
What happens when you get infected by the virus, and what are your chances if you do? A new report describing what happened to 138 patients treated in a hospital on the frontlines in Wuhan, China, has some answers—and some alarming news about how the virus can spread inside a hospital.
The Wuhan doctors, led by Zhiyong Peng at the critical care department at Zhognan Hospital of Wuhan University, say about 40% of the people they treated actually caught the infection at their hospital, including 40 health-care professionals and 17 patients who were already there for surgeries or other reasons.
They said 4.3% of the patients died and about 34% got better and left the hospital, while the rest were still being treated. Outside of China, the death rate appears to be much lower, but in Wuhan doctors are clearly struggling. The city has been under a lockdown quarantine since last month.
Early symptoms: The most common symptom of the coronavirus is a fever, which nearly everyone gets, followed by fatigue and dry cough. A few people also experienced diarrhea or nausea a day or two before any other symptoms.
Getting to the hospital: It took about seven days from first symptoms for people to check into the hospital, by which time many were having trouble breathing, say the Wuhan doctors. It wasn’t clear if their patients waited to seek help or were among those initially turned away in overcrowded conditions.
Confirming infection: The test for the virus is a throat swab, which is analyzed with polymerase chain reaction (PCR) to identify its telltale genetic material.
Chest scans: Some patients put through a CAT scanner showed spots of shadows in their lungs, what doctors call a “ground glass” appearance.
Getting to the ICU: The Chinese team said a quarter of their patients ended up in the intensive care unit, mostly because of acute respiratory distress syndrome, or “ARDS.” That’s when the lungs fill with fluid and lose the ability to carry oxygen. That can affect other organs, like the kidneys, and cause death. The chance of ending up in the ICU was higher for people who were already weak.
It affects older people more often: While older people tended to have more serious diseases, this hospital saw patients as young as 22 and as old as 92. The median age was 56.
The treatments: The report from China shows that doctors did not have a silver bullet to cure the infection. In Wuhan, most people got an antiviral drug called oseltamivir, which they say didn’t have a discernible effect. Several other drugs, including anti-HIV drugs, have also been tried elsewhere. Patients in the most trouble sometimes got oxygen therapy or were hooked up to a machine that pumps their blood and adds oxygen, saving their heart and lungs from doing the work.
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More information:
Minneapolis-based academic health system M Health Fairview announced it has set up drive-up testing sites at four of its clinic locations. Patients must call ahead or visit its 24/7 online care portal, OnCare, to first get screened by a provider to determined whether testing is necessary. Patients who show up to the drive-up site without a referral will be directed to OnCare.
COVID-19 and upper respiratory infection-related visits to OnCare are being provided with no out-of-pocket costs to patients, an M Health Fairview spokeswoman wrote in an email. “We are working out payments with insurers and the state,” the email said.
If you have questions about Coronavirus testing you can call M Health Fairview at 1-855-324-7843.
