Editors Note: This information provides a very detailed global view of the developing Coronavirus situation (as of mid March 2020) with many links to sources and a list of useful links toward the bottom of the article. We are sharing this information because we found it very useful and wanted Klamath Alerts readers to have access to it. We understand that not everyone will agree with everything contained here but there is a great deal of useful information here. Nothing contained in this publication is intended to replace or supplement medical advise from your own healthcare provider.  The article is published with permission from the author.


PSA Regarding COVID-19: A Warning

If you just want to learn how to reduce your risk of catching COVID-19, scroll down to the “Risk Reduction” section. However, to appreciate the full scope of the challenge ahead, you are encouraged to carefully read this entire document.


The aim of this document is simple: it’s best to walk into something knowing what you’re about to face. It also aims to reduce anxiety, panic and misinformation by arming you with sourced knowledge, all without downplaying the risks of COVID-19.

The document has gone through hundreds of iterations thanks to global community feedback, including from outbreak zones such as Seattle, Australia, and the LA area. Although all facts are meticulously sourced from experts in their fields, you are responsible for your own health and your own research.

Further, contextualization of information remains an ongoing challenge, as does keeping up with a fluid situation. Final word will always belong to the health authorities, as well as the mods of this subreddit.

Now ready yourself, because this is going to suck a little bit.

CONTEXT:

A recent in-depth study has shown just how incredibly infectious COVID-19 is. Unfortunately, its spread has not slowed, and the virus has only been halted in China through Herculean efforts.

In other words, and as the Director of the WHO himself has said, this is not a drill.

The bad news: There are currently over 100,000 global confirmed cases of COVID-19. Now it seems that it has arrived upon your doorstep. That means there is likely silent human-to-human transmission in the community.

The good news: knowledge is a weapon that defeats these things. It worked in 1918 against the Spanish Flu, when we essentially stopped the medieval practice of blood-letting (you know when they drained you of blood because they thought that would cure whatever ailed you? Or leeching?). And it worked against many other outbreaks since: Smallpox, MERS, SARS, Ebola, etc. The WHO’s tackling of Smallpox alone was nothing short of scientific heroism.

And so, a hundred years after 1918, here we are again, facing perhaps the greatest test of our generation.

The problem is that these days we are inundated with so much information that, when a real threat comes along, it’s buried under a mountain of clutter. And although this document is not all encompassing by any means, hopefully it will help you see through some of that clutter, as well as give those new to the threat an opportunity to hit the ground running.

IMPORTANT:
  • The main mode of transmission is via respiratory droplets: coughing, sneezing, and possibly breathing as well (see bullet point below). But you can also get it through shaking hands, kissing somebody who is sick, or touching a contaminated surface (droplet dispersion; think of a cough plume settling). This can include handrails, doorknobs, elevator buttons, and surfaces prone to a droplet dispersion cloud. “Cough dispersion” basically means anytime a sick person coughs, they’re dispersing a plume of droplets over a given area. The viral particles within those droplets then settle on ordinary surfaces. People touch those surfaces then touch their phones or their faces, which in turn lead to contact with their eyes, mouth, or nose, inducing infection. Therefore it is best to keep a 6 ft “coughing distance” from people, and treat everything you touch in public as if it’s been contaminated (see the “Risk Reduction” section below). Here’s an excellent short video on the topic. Read a little more on the subject here.

  • [NOT PEER REVIEWED] There now appears to be evidence the virus can spread through breathing as well. Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota: “The findings [of the study] confirm that COVID-19 is spread simply through breathing, even without coughing. Don’t forget about hand washing, but at the same time we’ve got to get people to understand that if you don’t want to get infected, you can’t be in crowds. Social distancing is the most effective tool we have right now.” Source. (Crucial to understand: the research specifies patients who are symptomatic, and makes no claims about asymptomatic transfer. Also please note that this study has not been peer-reviewed, but due to the implications is included here out of an abundance of caution.) UPDATE: Dr. Osterholm just went on the Joe Rogan show to explain the situation. Although the show itself has been known to be controversial, the Doctor’s credentials speak for themselves.

  • Up to 1 in 5 infected people may require hospitalization source 1source 2. But this is an oversimplification as the metric skews toward the elderly and those with comorbidities (see the Mortality/Comorbidities section below).

  • Here’s a breakdown of the above: Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases. 13.8% have had severe disease requiring hospitalization, and 6.1% were critical, requiring the ICU (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). (These numbers are as of Feb 20, 2020, based on 55,924 laboratory confirmed cases in China, from the WHO report.) Update: European Society of Intensive Care Medicine is reporting a 10% ICU rate, and has issued a word of warning.

  • Due to the highly infectious nature of COVID-19, the danger is not just the mortality rate for the vulnerable, but the possibility of overwhelming the health infrastructure, which in turn causes unnecessary fatalities.

  • As it stands, it wouldn’t take much to overwhelm hospitals, hence why it’s important to start taking preventative measures now (outlined in the Risk Reduction section below)–especially because hospitals are already burdened with a heavy flu season (in the Northern hemisphere, that is). For example, if only 10 out of every 1000 people required a bed, we’d already be coming up short, as in the USA there are only 2.77 beds for every 1000 people, and 2.58 in Canada. Why is this important? In South Korea, 4 in 22 deaths happened while waiting to be hospitalized (source in Korean, as well as a discussion about it), and that’s from South Korea, who is #2 in the world and has 12.27 beds per 1000 people. And of course many beds will already be occupied for regular patients. Toronto Star soberly warns hospitals can’t cope if coronavirus outbreak worsens in Canada: March 6th.

  • A surgeon working in the heart of Italy’s outbreak gives a harrowing testimony and urges everyone to heed the warning that it can easily overwhelm hospitals (translation / Original).

  • This is a “novel” virus, which means the immune system has never been exposed to it and therefore everyone is susceptible. There is no vaccine, nor do authorities expect one for some time.

  • People are thought to be most contagious when they are most symptomatic (the sickest). (Source: CDC)

PSYCHOLOGY:
  • Do not panic, but give yourself permission to feel fear. Fear gets you prepared. As for panic, all one has to do is look at the crowded halls of Wuhan hospitals during the early phases of the outbreak to understand how panic worsens problems. A jolt of fear is all right, as it gets you moving in the right direction. After that point, however, you must turn to thinking clearly, level-headedly, and listen to your local health authorities. As for what you can do, follow the steps in the “Risk Reduction” section below.

  • Normalcy bias plays a factor. So does denial. You may hear things like “it’s just a flu, nothing to worry about.” Facing the threat will help you prepare for it while denial puts you and your loved ones at risk. People in denial may take foolish risks like attend crowded events during an active outbreak, or fail to take precautionary measures, thereby accidentally passing the virus on to others. Denial also slows community response.

  • Here is an excellent Harvard piece on reactions and overreactions, denial versus panic, and the five principle bulwarks against denial. It is short and absolutely worth your time.

  • For officials, crisis management teaches us that it is important not to downplay a threat, otherwise you may lose the public’s trust. Do not fear inducing a panic (see the aforementioned paper). The public needs you to be clear, informative, competent, and proactive. Studies such as this one about the 1918 pandemic have shown just how effective a proactive approach can be on the part of leadership. But look what can happen on the other end of the spectrum.

  • If you’re experiencing distress regarding this epidemic, please consider visiting COVID-19 mental health support.

RISK REDUCTION:

Think of those in your life who are vulnerable (see the Comorbidities section). If not for yourself, do it for them.

  • Practice social distancing.

  • Do not touch your face (practice this one at home, as it’s harder than you think).

  • After every outing, wash your hands and disinfect your phone (the virus can likely live up to 96 hours on phone screens). And you’re probably washing your hands wrong. Here’s a short 1.5 minute tutorial by the WHO.

  • Carry disinfectant with you.

  • Do not shake hands.

  • While in public, try to keep a coughing distance from people, which is at least 6 feet.

  • Treat everything you touch in public as a contaminated surface.

  • If you use a travel mug, be sure to disinfect it after every outing.

  • Disinfect doorknobs and often-touched places, especially keyboards and phones.

  • Take initiative and disinfect doorknobs and elevator buttons in your building. Do not wait for management to do it for you.

  • Keep disinfectant by every entrance to your house.

  • Avoid anyone who is coughing, and stay away from poorly ventilated places.

  • Stay away from crowds.

  • Cough into your elbow, or preferably into a tissue that is disposed of into the trash.

  • While in public, only touch things with your knuckle, a glove, or your sleeve. Touch elevator buttons with the tip of your key.

  • Ask your boss to work from home as many transmissions happen at work.

  • There is a global shortage of face masks. If you have extra, be prepared to donate some should the hospitals/care homes send a call out to the community.

  • If you have extra bottles of hand-sanitizer, please consider sharing them with those who do not have any. This is about working together, and minimizing community spread helps everyone within the community, including you and your loved ones.

  • Have 14 days of food in your home in case you are ordered under quarantine. There’s nothing wrong with preparatory shopping in case of quarantine, but be careful not to do this once an outbreak has been declared in your city, as you may be lining up alongside sick people. At that point, it is better to shop at night/off hours, and after taking careful precautions. Or consider ordering your groceries online.

  • Don’t share a cup. Don’t share eating utensils. Don’t share a toothbrush. In fact, don’t share anything that comes in direct contact with your mouth or nose.

  • Keep air circulating. Dispersing droplets can keep you from getting a hefty, infectious dose. Open a window; turn on a fan. (source)

  • Use a humidifier. Keeping the humidity up will keep the protective membranes in your nose from drying out, which makes them less effective as they try to keep pathogens out. Mid-range humidity also appears to cause some viruses to decay faster.

  • Always remember the top three: Disinfect your phone, don’t touch that ugly face of yours, and wash your filthy hands. After every outing. Seriously, if there’s one thing you take away from this, do these three things. They may just save your life, or the life of a loved one.

  • Be proactive. How can you help?

INCUBATION PERIOD:
  • People generally develop signs and symptoms, including mild respiratory symptoms and fever, on an average of 5.1 days after initial infection.

  • 97.5% develop symptoms within 11.5 days.

  • Current 14 day quarantine recommendation is ‘reasonable’ as only 1% will develop symptoms after release from 14 day quarantine.

(Source / Discussion)

TYPICAL SYMPTOMS:

(All direct from WHO report based on 55,924 laboratory confirmed cases in China.)

  • Fever (87.9%)

  • Dry cough (67.7%)

  • Fatigue (38.1%)

  • Sputum production (33.4%) (a mixture of saliva and mucus coughed up from the respiratory tract)

  • Shortness of breath (18.6%)

  • Sore throat (13.9%)

  • Headache (13.6%)

  • Joint pain (14.8%)

  • Chills (11.4%)

  • Nausea or vomiting (5.0%)

  • Nasal congestion (4.8%)

  • Diarrhea (3.7%)

  • Hemoptysis (0.9%) (coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs)

  • Conjunctival congestion (0.8%)

Here is what those symptoms look like on a visual timeline, in Fahrenheit.

Here it is in Celsius.

Health Canada: What to do if you’re ill.

CDC: What to do in your home if someone is sick

Want to know the difference between a flu, a cold, and Covid-19? Here’s a nifty visual.

What does it feel like to be sick? The New York Times spoke to six people with the virus.

COMORBIDITIES:

Individuals at highest risk for severe disease and death include those who meet any of the following conditions:

  • People 60 years of age and older

  • Diabetes

  • Hypertension

  • Cardiovascular disease

  • Chronic respiratory disease

  • Heart, lung or kidney disease

  • Cancer

  • Those with weakened immune systems

  • Obesity (source / credentials of source)

  • People with weakened respiratory system due to smoking/vaping

If you fall into any of the above categories, the CDC says “it is especially important for you to take actions to reduce your risk of exposure.” Additional: “CDC: Americans over 60 should ‘stock up’ on supplies, avoid crowds” (source.)

Sources for comorbidities: WHO report / CDC. A CDC guide titled People at Higher Risk for COVID-19 Complications expounds on the point.

MORTALITY RATE:

(As of 20 February 2020 and based on 55,924 laboratory confirmed cases as per the WHO report)

Age % of population % of infected Fatality
0-9 12.0% 0.9% 0
10-19 11.6% 1.2% 0.1%
20-29 13.5% 8.1% 0.2%
30-39 15.6% 17.0% 0.2%
40-49 15.6% 19.2% 0.4%
50-59 15.0% 22.4% 1.3%
60-69 10.4% 19.2% 3.6%
70-79 4.7% 8.8% 8.0%
80+ 1.8% 3.2% 14.8%

Disease in children appears to be relatively rare and mild with approximately 2.4% of the total reported cases reported amongst individuals aged under 19 years. A very small proportion of those aged under 19 years have developed severe (2.5%) or critical disease (0.2%), via WHO report.

ADDITIONALS:
  • It’s still far too early to know for sure, but the Case Fatality Rate (CFR) is estimated to be 0.94% (0.37%–2.9% with a 95% CI) (source paper). Though here is a recent Slate piece that mentions a CFR between 0.2 to 0.4. South Korea, after doing 140,000 tests, reports a CFR of 0.6% (source)

  • The Average time from first symptoms to death is estimated to be 18 days (source paper). Again, the metrics skew toward comorbidities.

  • Due to the high mortality rate for people over 60, the authorities in Seattle are encouraging anyone in that demographic to stay home as much as possible. (Source).

  • But even as a young person you want to avoid COVID-19, and not only because you could pass it on to others with comorbidities, as SARS-like virus can have long-term consequences: “Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: says a 15-year follow-up from a prospective cohort study“. And then there’s the potential of suffering. The following is an example of a healthy 25-year-old nonsmoker who felt like he was going to suffocate from the virus.

  • The virus is of zoonotic origin, sharing 99% DNA with the coronavirus that infects pangolins (source).

  • During a black swan event, knowledge is power, and taking proper precautions now will minimize risk exposure for you and your loved ones.

A CURATED SET OF LINKS WORTHY OF YOUR TIME:

Why I created this post:

I’ve done the best job I could giving the sources context. I’ve asked the public and some medical professionals to weigh in, and have adjusted the document based on what they have said. I don’t have an agenda or anything of that sort, and to reiterate, you are responsible for your own health and your own research. I’m just a volunteer who’s put countless hours into this as I have a very particular communicative and collative skillset that I suspected could be of benefit in this ordeal–that and I’ve been following Covid-19 closely since mid-January. I hummed and hawed whether to even to start this document, yet after seeing how much it benefited people even in its crude early form, I decided to give it all of my focus.

And now the beast is upon my doorstep, and I too have susceptible loved ones around me.

The aim of this document is to inform, without minimizing risk. Accurate information reduces panic and anxiety, and helps people make the right decisions in a difficult time. I hope it succeeded in that regard, and that you found it useful.

Yet there’s always room for improvement, so feel free to constructively suggest changes (but if you’re going to be a jerk about it, you will simply be blocked and ignored, and that’s that). If you have a trustworthy more up-to-date source on an old metric of mine, please leave it in the comments. Also you are welcome to suggest alternative word/sentence choice changes.

As I mentioned in the intro, this document went through many versions. Thank you to those from all around the world who had constructively weighed in to make it a more robust and useful PSA.

My very best wishes from Victoria, BC, Canada, and good luck to us all.

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