Coronavirus


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In case you missed the news: there’s a new virus in town…and they named it after a cruddy beer!!

All of the hype surrounding the coronavirus has created a new and difficult situation for me, my staff, and on doctors around the world. How do we answer our patients who are terribly afraid of what they are hearing? China is quarantined, the Olympics might get cancelled, Oprah has been crowned Empress of civilization…OK, that Oprah thing is no true, but the rest is pretty scary. Is it hype that we should downplay, or is it seriously scary stuff that we should warn our patients, our friends, and our families about?

In response to this, I wrote a summary of what we know now about the COVID-19 virus and sent it out. The response has been overwhelming. People say that it is “concise,” “balanced,” and “level-headed.” My mom is proud of that last one. I’ve come a long way.

They also have commented on the lack of political agenda in what I wrote, a compliment that confuses me some. Why would I use a patient education piece to push a political agenda? I haven’t done so in my handouts on otitis media or ringworm. The goal of this was not to rail against the demagogues that interfere with public health, scream at the press that incites the public in attempt to increase revenue, or theorize about the authoritarian nation where this infection began and its government’s role in creating this virus for evil intent. I\’ve heard each of those opinions, and whether or not they hold truth has nothing to do with care of my patients. The handout was written to give patients a mooring of truth and sanity in a world of hype and fake news.

So here is the handout in all its glory. Feel free to share it, to steal it, to republish it, to make wrapping paper out of it. I don’t care. Just start talking sensibly about this issue that may or may not be the scariest health crisis we’ve faced in our lifetime. Yes, it’s important to have good leadership in this crisis, but it’s more important for us to work together as a country, as a world, to minimize the likelihood of disaster. The biggest danger, in my opinion, is no from the virus, but from societal panic and the chaos that could create.

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Information regarding the Coronavirus

This communication was originally written on 3/2/2020. It will be updated as time progresses.

What is a coronavirus?

Coronaviruses are a common type of virus that infects people and animals. They usually cause mild illness in people, with typical upper respiratory symptoms. As is the case with other viruses (influenza being the most important example), a virus strain that infects animals can mutate and transmit to humans, creating a more severe illness. Usually this doesn’t cause big problems, as these animal to human transmissions are not able to have person to person transmission. On rare occasions, an animal to human transmitted virus becomes contagious to other people. This is what is thought to have happened with the COVID-19 (the current coronavirus that is causing all of the problems).

There are several factors that make COVID-19 so concerning:
– It is quite contagious from person to person.
– It has a 14 day incubation period where it can be contagious before symptoms appear.
– A significant percentage of infected people have little to no symptoms, yet they can still spread the infection to others.
– For those who do get the illness, there is a much higher percentage who have serious, even fatal complications.

The virus has spread rapidly from China, despite the quarantines and other aggressive measures to control spread of the virus. Most public health officials feel that it is very likely we will face a pandemic (serious infection that affects a high percentage of the world population) in the near future. How soon? It’s too early to tell. But we do feel it is time to prepare (see below).

The COVID-19 Infection

Infection is spread through usual means for respiratory viruses: mainly through hand contact or contact with airborne droplets from an infected person. The incubation period is up to 14 days, but symptoms typically show up from 4 to 7 days after exposure.

As stated before, a significant percentage of those infected are completely asymptomatic, and a majority (over 80%) have mild illness (mild cough, fever, upper respiratory symptoms). The more serious illness is generally in the lungs: lung damage, pneumonia, shortness of breath. This is much more common in the typical ‘vulnerable’ populations: the elderly, diabetics (especially those with poor control), and people with significant lung disease. It is not expected (at the time this is being written) that there will be a significant number of healthy individuals getting the serious life-threatening disease. Of note, infants and young children have not had an increased death or disease rate in the areas of high rates of infection.

At the present time, the COVID-19 infection has a 2% death rate associated, which is more than 20 times that of influenza. There is not a rapid test to diagnose the infection at the present time, so most diagnoses will be made by sending samples to national labs or just presuming the diagnosis where and when the infection rate is high.

What is Being Done

As of now, there is no definitive treatment for the infection, other than supportive measures to help the person while their body deals with the infection. There are some medications under investigation for this, but none of the medications we typically prescribe have been found to be effective in treating the infection. Specifically, antibiotics and antiviral medications (like Tamiflu) have not been helpful in treating this. Vaccines are being developed, but even at the rapid pace these are being done, the most optimistic time frame for a vaccine is 12 to 18 months from now.

The main effort presently is focused on slowing the spread of the virus by isolating infected individuals and quarantining communities when appropriate. The hope is that this will slow the spread while treatments, public health measures, and vaccines are developed. The more time we have, the more prepared we will be to handle the problem.

How you can Prepare

The first and most important thing is to not panic. The vast majority of our patients are not at risk of getting serious infection, even in the midst of an epidemic. There is no reason to avoid school, work, or travel to places not effected by the virus (go to https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html to find specific travel restrictions/recommendations). Since we don’t know how fast this disease will spread, there is not yet cause to cancel plans for travel or other gatherings.

But we must be realistic: people will panic still, and that may itself cause significant problems. Stocking up on non-perishable food in case of a quarantine (which would last 2 weeks) is reasonable to do in the upcoming weeks/months. Furthermore, there are some practical things you should consider:
* If you have vulnerable family members, come up with a plan to care for them, and have alternate plans should the primary caretaker get sick.
* If you are a single parent, figure out ways to cope with illness to you or to one of your children.
* Workplaces should consider how to handle employee absences.

It should be noted that it is not advantageous for healthy people to wear masks, unless they are working directly with infected or high-risk individuals. Infected people may decrease the spread of respiratory droplets by wearing a mask. Overall, good hand-washing and common sense measures to decrease viral spread are always more effective than extreme measures. Is it reasonable to cut back on shaking people’s hands? Maybe, but mainly to just build good habits in case there is a local epidemic.

What our office is Planning

We have considered what measures we will take if/when the epidemic hits our area. Until that happens, nothing (aside from publishing educational material like this) will be different. If we are in a local epidemic, we will do the following:
* Cancel non-essential visits to leave room for the influx of coronavirus related care.
* Convert essential care visits to video or phone visits whenever possible.
* Be available to reach out to infected individuals as best we can.
* Continue to educate you and coordinate with other providers in our area.

This is a serious situation, but it is not the apocalypse. Most of us have not gone through a pandemic before, so this will create a lot of uncertainty and even panic in our communities. It is vital that we all think ahead, but not panic about what could happen. Reach out to your neighbors, talk to your coworkers, and make plans with your family on what you can do to prepare in a way that is thoughtful and meaningful. Avoid spreading information that is not from very reliable sources, and don’t use this crisis to point fingers or increase political divisiveness. This is a time where unity needs to be of highest priority.

The best case is that this is an over-reaction and the pandemic will fizzle out. The worst case is that we will be caught unprepared, and that lack of preparation will cause harm to those who need help.

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