Let me begin by stating that this post is three weeks in the making. My husband had a cerebral vascular accident (stroke) last month, landing us in the center of the Coronavirus world; a New York hospital. What I share now is the most up-to-date, researched data available. Therefore, this post will be updated daily with new metrics for the remainder of the Covid-19 pandemic. In sharing the TRUTH about Coronavirus we can tamp down fear. Above all we’ll need empowerment for the tough months ahead. And foremost, we must respect the needs of the critically impacted healthcare system.
The Truth About Coronavirus
Yes, you know this by now. Fortuitously, I took the global health track for my recently completed doctorate studies. Our Special Olympics screenings, a global effort, sends vital health information directly to the Centers for Disease Control and Prevention (CDC). Therefore, I have been following the United Nations’ World Health Organization (WHO), CDC, and National Institutes of Health (NIH) religiously for the past 3 years. Preparedness, I now say.
By now you must have seen Johns Hopkins University of Medicine U.S.-focused Covid-19 data tracker. This newer map compiles each region’s demographic, stay-at-home policies, testing results, and hospital capacity related to this virus.
So much has happened in such a short time. Globally, over one million cases were documented as of April 1 (Resnick, 2020). Today, over 10 million cases have been recorded (Johns Hopkins, n.d.). One week can now last a lifetime. Though looking back to the origins of CoVid-19 can be sobering, it is instructive as we move (creep) forward. It must be remembered to not let the truth of Coronavirus be re-written now. TODAY is the time to study the lapses. So the world can be enlightened for potential “next waves” in the months or years to come.
December 10, 2019
An unexplained outbreak of pneumonia is identified in Wuhan-m China’s tenth-largest city (Schnirring, 2020).
The Wall Street Journal later reports that ‘Patient Zero’ was a 57-year-old shrimp vendor working at Huanan Seafood Market (Page, Wenxin, and Khan, 2020).
December, 29, 2019
The Wuhan Institute of Virology follows first patients admitted to the intensive care unit of Wuhan Jin Yin-Tan Hospital. Patient ‘ICU-01’ was not connected to the seafood market, but all others were. Specimens taken will eventually lead to the genome sequencing of CoVid-19 (People’s Republic of China Key Laboratory of Systems Biology of Pathogens, n.d.).
December 31, 2019
The WHO is notified that pneumonia of “unknown etiology” has been identified in Wuhan, China (WHO, 2020).
January 7, 2020
The CDC issues travel notice for travelers to Hubei Province, China due to sickness clusters (Kaiser Family Foundation, 2020).
January 13, 2020
Thailand reports the first confirmed case of Covid-19 is reported outside of China (WHO, 2020).
January 14, 2020
The acting head of the WHO’s Emerging Diseases unit tweets that there had been “limited” human-to-human transmission of the Coronavirus, and added that “it is very clear right now that we have no sustained human-to-human transmission” (Hermesauto, 2020).
January 21, 2020
CNN reports that the United States has its first lab-confirmed case of Covid-19 in Washington State (Cohen, 2020).
January 22, 2020
China imposes strict quarantine of Wuhan.
Public #transportation such as bus, subway, ferry and long-distance bus in Wuhan will be temporarily closed since 10am Thursday. All flights and trains departed from #Wuhan will be temporarily cancelled to reduce risk of spread of the new virus, local govt says. #coronavirus pic.twitter.com/gtzIlFszaf
— China Daily (@ChinaDaily) January 22, 2020
The beginning of Chinese New Year celebrations. Global events continue through February 4th (Chinese New Year Calendar 2020, n.d.).
The Trump Administration bars travel from China and declares public health emergency (Corkery and Karni, 2020).
.@WHO doesn’t recommend limiting trade & movement.
Travel restrictions can cause more harm than good by hindering info-sharing & medical supply chains & harming economies. We urge countries & companies to make evidence-based, consistent decisions. https://t.co/ksxOV6sbDN
— Tedros Adhanom Ghebreyesus (@DrTedros) January 31, 2020
Aerosolization is confirmed as a method of Covid-19 transmission (Lanese, 2020).
The WHO names this new virus “Covid-19;” replacing the novel Coronavirus “2019nCoV” (CNA, 2020).
France announces the first Covid-19 death in Europe; an 80-year-old Chinese tourist (Taylor, 2020)
First U.S. death from Covid-19 reported in Washington State (Newburger, 2020).
The WHO formally declared Covid-19 a global pandemic (BBC, 2020).
The CDC recommends gatherings not to exceed 50 persons (Taylor, 2020)
The WHO stands by the recommendation not to wear masks unless you are sick or caring for someone who is, citing universal shortages (Howard, March 2020)
Citing increasing evidence of asymptomatic transmission, the CDC changes recommendations to suggest all Americans cover their faces in public (Dwyer & Aubrey, April 2020).
Total Covid-19 cases in the U.S. 277,205, with 6,593 deaths (CDC, 2020).
Apple and Google announce contact tracing app (Wuerthele, April 2020)
Coronavirus outbreaks in nursing homes and long-term care facilities are escalating at an alarming rate, causing at least 3,600 deaths in the U. S. (Condon, et al., April 2020).
Chile institutes the world’s first “digital immunity cards” for those who have recovered from Covid-19 (NY Times, April 2020).
The WHO warns against the use of immunity passports, reporting that there is no evidence that recovery from Covid-19 prevents possible second infection (WHO, April 24 2020).
The childhood Kawasaki disease-like inflammation of heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs is identified. Multisystem Inflammatory Syndrome in Children (MIS-C) is reported in some children who have been exposed to the Covid-19 virus (CDC, May 20).
For the first time since the outbreak, the WHO announces a face-covering policy. There is now “evolving evidence.” Hence, masks are included in their “comprehensive package” of prevention (WHO, n.d.)
Global death toll approaches 500,000 (NY Times, June 2020).
How is Coronavirus Transmitted?
The family of Coronaviruses is a large one. It includes the common cold and Severe Acute Respiratory Syndrome (SARS). Fittingly, they are named for the crown-shaped (or “corona” in Latin) protein spikes that surround it genetic material (WHO, 2020).
Of note, most infectious diseases are 70-80% “zoonotic” or transmitted from animals to humans (WHO, 2020). These diseases can be propagated by international travel, population growth, urbanization, and migration (WHO, 2020). CoVid-19 (also known as SARS-CoV-2) is thought to have had “spillover” from an undetermined animal in a seafood market in Wuhan, China (Hopkins Medicine, n.d.).
Contrary to original reports cited above, community spread allows CoVid-19 to spread person-to-person. CoVid-2 is primarily transmitted through airborne respiratory droplets (largely by coughing and sneezing). And by “fomites”- touching any surface that has been contaminated by these droplets. (These include doorknobs, elevator buttons, and any other common touch point.) Unfortunately, the “viral shedding” that appears to be taking place by those asymptomatic (but incubating the disease) is still not well-understood (Auwaerter, n.d.). Therefore, the CDC recommends avoiding all close personal contact for these reasons.
“According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes. In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported.” (WHO, March 2020)
VERY. In April, theCoVid-19 registered an “R naught” (RO) of 2.5. That is to say that for every infected person, they in turn infected 2.5 others. (This number is estimated to be higher as the US collects and validates its own data.) For comparison, the deadly Ebola virus has an RO of 2 and seasonal flu 1.3. Though this statistic will most likely change as more data is collected, this is an example of how Covid-19 can tear through a demographic (Resnick, 2020).
The suspected death rate associated with Coronavirus has fluctuated from the early report of 12% in Wuhan, China (Mizumoto & Chowell, March 2020), to an interim rate of 2%, to the present 3.4%. By contrast, each year the flu kills approximately 0.1%.
Tips to Avoid Coronavirus
- Because of the fomite transmission, ANY hand to mouth habits have to be eliminated. Bite your nails or cuticles? Time to change behaviors.
- Allergy season is upon us. Do not itch your eyes. If necessary, use a clean piece of clothing or hanky to do so.
- Wash your hands (that includes between the fingers, the thumbs, and beneath the fingernails) often. As you know by now, singing Happy Birthday twice should do it.
- Use alcohol-based hand sanitizer when soap and water are not available. (Handwashing is always preferred- post to follow!)
- Use hand lotion often, as the subsequent drying out of your skin might allow bacteria to enter cracks in the skin.
- For non-healthcare persons, the debate to mask or not to mask continues to be debated. At present, it is agreed that any form of homemade mask may mitigate the chance for YOU to give Covid-19 to OTHERS if you are asymptomatic (Feng et al.,March 2020).Though availability has vastly increased, it is still advised to save the N95s for the healthcare teams!
- The current CDC recommended “6 feet” of social distancing rule is equal to two arms lengths. Visualizing that distance will help.
- The WHO continues to advise “3 feet” of physical distancing (WHO, April 29).
Most importantly, please watch this (lengthy but reassuring) explanation from New York-Presbyterian/
Who Is Affected?
Persons with the highest risks:
- Older adults (65 years and older. Especially those in long-term care/nursing facilities.
- Younger adults 20–44 account for 20% of hospitalizations and 12% of ICU admissions
- Persons with asthma and/or chronic lung disease
- Immunocompromised persons, such as those living with cancer, organ transplants, and HIV
- Persons with diabetes
- Severe obesity. A BMI ≥ 30 occurs in nearly half of hospitalized patients.
- African Americans are hospitalized at a greater than expected frequency than expected on a population basis.
- Persons with heart disease, including hypertension
(CDC, April 2020)
Additionally, White House coronavirus coordinator Dr. Deborah Birx has noted that Covid-19 seems to be twice as deadly in males as compared to females (Today, March 2020).
Coronavirus Symptoms to Look For
Presently, you may have heard the typical signals: fever (44-98%), cough (46-82%), shortness of breath 31% .
According to the Johns Hopkins ABX Guide, here are others that the data now point to. (Note, Covid-19 is not a homogeneous disease!)
- Fatigue (11–44%)
- Productive cough
- GI symptoms (including diarrhea)
(Auwaerter, March 2020)
Due to ongoing experience in the US, the CDC more recently added these symptoms: (CDC, March 2020)
- Muscle pains
- Chills (with or without shaking)
- Sore throat
- Loss of taste and/or smell
Studies have pointed to asymptomatic transmission. In the CDC’s Morbidity and Mortality Weekly Report, a review of 243 Covid-19 patients in Singapore identified clusters of “presymptomatic” passing of the disease (Wycliffe et al., April 2020). Likewise, recent work out of Iceland indicates that up to 50% of persons identified with Covid-19 never presented with symptoms (Government of Iceland, March 2020). It is for this reason that the CDC has recently recommended the use of cloth for the general population (CDC, April 2020). However, this is purely meant to curb YOU from infecting OTHERS. Not the other way around. (This differs from the n95 mask protection reserved for healthcare workers.)
What To Do If You Are Infected
If you are exhibiting the symptoms above (especially if you are spiking a fever) you can request an appointment for a Covid-19 test with your healthcare provider. Supplies are short, and appointment times may be long. In the meantime, these are the current recommended supportive measures:
- Assume you have Covid-19 and act accordingly
- Stay home
- Isolate yourself from family, using your own bathroom if possible
- Use a cloth/paper mask
- Use telemedicine if applicable
- Wash hands frequently
- Cough/sneeze into your elbow
- Disinfect surfaces (where droplets may fall) frequently with a chlorine-based product (Vinegar solutions, such as Windex will NOT be effective!)
- Take a hot shower to facilitate deep breathing
- Use a humidifier to ease a cough
- Drink plenty of fluids
(CDC, February, 2020)
Ibuprofen Or Not??
It has been suggested that taking acetaminophen products (such as Tylenol) for fever/body aches is the safest treatment. Early warnings from France indicated that ibuprofen (such as Advil or Motrin) might limit the body’s ability to fight infection. Since that time, the CDC, WHO, and Federal Drug Administration (FDA) have all issued statements warning that these claims are unwarranted (FDA, March 2020). Additionally, the alternate acetaminophen is nearly impossible to find in stores. So, until we have a full body of evidence, use your own judgement.
When to Go to a Hospital
Do NOT wait to call 911 if you experience:
- High fever
- Severe shortness of breath
- Sensation of pain or pressure in the chest
- Blue lips
(CDC, March 2020)
As Dr. Price states in the video above, DO NOT just show up in the Emergency Department unless you have been instructed to, OR you are experiencing one of the above symptoms. Unfortunately, resources are stretched, and ancillary staff is needlessly exposed in that scenario.
The Truth About the Future of Coronavirus
The truth about coronavirus is evolving. At its essence, it’s a novel, or brand new virus. As a result, the globe has no “herd” immunity. Without antibodies to ward off the sometimes fatal disease, extreme measures have been taken. Quarantine comes from a term developed in the 1300s. “Quaranta giorni” is Italian for 40 days- the period of time foreign ships needed to sit in Venetian ports before entering the Black Plague-ridden city (CDC, 2012). Remarkably, and again in 2020.
Until the world body of science can play catch up, draconian mitigation has been our only recourse. Rapid testing/results, contact tracing (this began in New York’s Westchester, but the system quickly was overwhelmed), and quarantine have been the world’s only tools.
Word to the wise- flatten the curve does mean lengthen the curve. It is only in that manner that each country will not overwhelm the healthcare system while waiting for scientific interventions. Specifically, antibody testing will identify those who may re-enter the workforce safely. A “quick test” will mark those infected who will then be isolated from the rest of the community. According to the WHO, over 70 vaccines are under development globally, with 3 in clinical human trials (WHO, April 2020).
So What Do We Do NOW?
Strict personal hygiene will be the new normal. Get used to it. STOP touching your face. Certainly a new habit to break! Don’t leave home without your hand sanitizer. Practice your singing voice while you wash your hands. MANY times daily. According to most honest experts, social distancing in some manner will last for the better part of a year. Taking personal responsibility for our own health will taper anxiety. (Undeniably, this includes physical, mental, and spiritual health!) The real truth about Coronavirus will continue to reveal itself and we’ll be on it. Daily.
Advice for public. (n.d.). Retrieved June 13, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
AppleInsider. (2020, April 10). Apple, Google team on ‘contact tracing’ smartphone software to combat spread of COVID-19. Retrieved from https://appleinsider.com/articles/20/04/10/apple-google-partner-on-contact-tracing-to-combat-covid-19-spread
Auwaerter, P. G. (n.d.). Coronavirus COVID-19 (SARS-CoV-2): Johns Hopkins ABX Guide. Retrieved from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_
Cases in U.S. (2020, April 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
Center for Drug Evaluation and Research. (n.d.). FDA advises patients on use of NSAIDs for COVID-19. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19
Chile to Issue Coronavirus ‘Immunity Cards’ to Those Who Recover. (2020, April 19). Retrieved from https://www.nytimes.com/2020/04/19/world/coronavirus-news.html
Chinese New Year Calendar 2020. (n.d.). Retrieved from https://chinesenewyear.net/calendar/
Cohen, E. (2020, January 22). First US case of Wuhan coronavirus confirmed by CDC. Retrieved from https://www.cnn.com/2020/01/21/health/wuhan-coronavirus-first-us-case-cdc-bn/index.html
Common Human Coronaviruses. (2020, February 13). Retrieved from https://www.cdc.gov/coronavirus/general-information.html
Condon, Bernard; Herschaft, Randy (13 April 2020). Nursing home deaths soar past 3,600 in alarming surge. Associated Press. Retrieved 13 April 2020.
Corkery, M., & Karni, A. (2020, January 31). Trump Administration Restricts Entry Into U.S. From China. Retrieved from https://www.nytimes.com/2020/01/31/business/china-travel-coronavirus.html
Coronavirus confirmed as pandemic by World Health Organization. (2020, March 11). Retrieved from https://www.bbc.com/news/world-51839944
Coronavirus Live Updates: Global Tally of Known Cases Passes 10 Million. (2020, June 28). Retrieved June 28, 2020, from https://www.nytimes.com/2020/06/28/world/coronavirus-updates.html?campaign_id=60
Dwyer, C., & Aubrey, A. (2020, April 3). CDC Now Recommends Americans Consider Wearing Cloth Face Coverings In Public. Retrieved from https://www.npr.org/sections/coronavirus-live-updates/2020/04/03/826219824/president-trump-says-cdc-now-recommends-americans-wear-cloth-masks-in-public
Early Release – Estimating Risk for Death from 2019 Novel Coronavirus Disease, China, January–February 2020 – Volume 26, Number 6-June 2020 – Emerging Infectious Diseases journal – CDC. (n.d.). Retrieved from https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article
Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control. (2020, April 3). Retrieved from https://openwho.org/courses/introduction-to-ncov/items/3E1PsZwgM9k6NS5QfUUH99
Emma_newburger. (2020, February 29). Washington state confirms first US death from coronavirus. Retrieved from https://www.cnbc.com/2020/02/29/washington-state-confirms-first-us-death-from-coronavirus.html
Feng, S., Shen, C., Xia, N., Song, W., Fan, M., & Cowling, B. (2020, March 20). Rational use of face masks in the COVID-19 pandemic. Retrieved from https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30134-X/fulltext
For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. (2020, May 20). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html
Global research on coronavirus disease (COVID-19). (n.d.). Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov
Hermesauto. (2020, January 14). Wuhan virus has limited human-to-human transmission but could spread wider: WHO. Retrieved from https://www.straitstimes.com/asia/east-asia/wuhan-virus-has-limited-human-to-human-transmission-but-could-spread-wider-who
History of Quarantine. (2012, January 10). Retrieved from https://www.cdc.gov/quarantine/historyquarantine.html
Howard, J. (2020, March 31). WHO stands by recommendation to not wear masks if you are not sick or not caring for someone who is sick. Retrieved from https://www.cnn.com/2020/03/30/world/coronavirus-who-masks-recommendation-trnd/index.html
“Immunity passports” in the context of COVID-19. (n.d.). Retrieved from https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19
Johns Hopkins COVID-19 Map. (n.d.). Retrieved from https://coronavirus.jhu.edu/map.html
Kaiser Family Foundation. (2020, January 7). Chinese Health Authorities Work To Discover Cause Of Viral Pneumonia Outbreak; CDC Issues Travel Notice For Wuhan. Retrieved from https://www.kff.org/news-summary/chinese-health-authorities-work-to-discover-cause-of-viral-pneumonia-outbreak-cdc-issues-travel-notice-for-wuhan/
Laboratory, C. M., & People’s Republic of China Key Laboratory of Systems Biology of Pathogens. (n.d.). Identification of a novel coronavirus causing severe… : Chinese Medical Journal. Retrieved from https://journals.lww.com/cmj/Abstract/publishahead/Identification_of_a_novel_coronavirus_causing.99423.aspx
Lanese, N. (2020, April 1). New coronavirus may spread as an airborne aerosol, like SARS. Retrieved from https://www.livescience.com/coronavirus-can-spread-as-an-aerosol.html
Large scale testing of general population in Iceland underway. (2020, March 15). Retrieved from https://www.government.is/news/article/2020/03/15/Large-scale-testing-of-general-population-in-Iceland-underway/
Lisa Schnirring | News Editor | CIDRAP News | Jan 07, 2020. (2020, January 7). Nations step up screening and await word on China’s pneumonia outbreak. Retrieved from http://www.cidrap.umn.edu/news-perspective/2020/01/nations-step-screening-and-await-word-chinas-pneumonia-outbreak
Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. (n.d.). Retrieved from https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
Page, J., Fan, W., & Khan, N. (2020, March 6). How It All Started: China’s Early Coronavirus Missteps. Retrieved from https://www.wsj.com/articles/how-it-all-started-chinas-early-coronavirus-missteps-11583508932
People Who Are at Higher Risk for Severe Illness. (2020, April 2). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html
Presymptomatic Transmission of SARS-CoV-2 – Singapore, January 23–March 16, 2020. (2020, April 9). Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm?s_cid=mm6914e1_w
Recommendation Regarding the Use of Cloth Face Coverings. (2020, April 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html
Resnick, B. (2020, April 2). 12 things everyone needs to know about the coronavirus pandemic. Retrieved from https://www.vox.com/science-and-health/2020/4/2/21197617/coronavirus-pandemic-covid-19-death-rate-transmission-risk-factors-lockdowns-social-distancing
Symptoms of Coronavirus. (2020, March 20). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Taylor, D. B. (2020, February 13). A Timeline of the Coronavirus Pandemic. Retrieved from https://www.nytimes.com/article/coronavirus-timeline.html
Today Show. (2020, March 26). Is COVID-19 deadlier for men than women? Retrieved from https://www.today.com/health/covid-19-men-vs-women-coronavirus-more-deadly-men-t176950
Symptoms of Coronavirus. CDC (2020, March 20). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
What Is Coronavirus? (n.d.). Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus
When and how to use masks. (n.d.). Retrieved June 13, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
WHO. (2020, January 16). Novel Coronavirus – Thailand (ex-China). Retrieved from https://www.who.int/csr/don/14-january-2020-novel-coronavirus-thailand-ex-china/en/
WHO. (2020, January 30). Pneumonia of unknown cause – China. . Retrieved from https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/
WHO names novel coronavirus as ‘COVID-19’. (2020, February 12). Retrieved from https://www.channelnewsasia.com/news/world/wuhan-virus-coronavirus-who-new-name-12424116