Episode 184 – Stephen Goldstein Ph.D

Episode 184 of Talk Ultra is a Covid-19 special with Stephen Goldstein Ph.D. who is currently a postdoctoral researcher associated at the University of Utah Department of Human Genetics studying viral evolution, including the evolution and origins of SARS-CoV-2, the virus that causes COVID-19.
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Please read two articles that coincide with is podcast:

 Race Cancellations and Covid-19 HERE

Covid-19 : A Simple Guide HERE

 
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COVID-19 : A Simple Guide

The world is under siege from a novel Coronavirus and there is a great deal of uncertainty as our everyday lives are grinding to a halt and our freedoms are being suppressed and controlled for the greater good.

I openly admit I am not in any way an expert: however, I have compiled information and with the cooperation of Stephen Goldstein Ph.D. who is currently a postdoctoral research associated at the University of Utah Department of Human Genetics studying viral evolution, including the evolution and origins of SARS-CoV-2, the virus that causes COVID-19 – This article addresses many of the issues that we are all asking and wondering about.

Podcast HERE

You may well disagree with some of the points made, particularly when I add personal opinion. That is fine, please comment and be respectful.

And if you are a medical professional and see any errors, please point them out and they will be addressed.

A podcast with Stephen Goldstein Ph.D will be recorded and released this week on Talk Ultra. As Stephen says, “Fair warning, there’s still a lot we have to learn, so in some areas I may not be able to speak with much certainty.

It’s a good time to self-isolate, social distance and spend time alone if allowed.

What is Covid-19?

In simple terms, Covid-19 is a variation of the flu but experts know much less about this novel coronavirus. It was first identified in Wuhan, Hubei Province, China, that has only spread in people since December 2019.

What is the difference to other coronavirus?

Covid-19 is more infectious than other coronavirus and current stats show that a person who is infected with Covid-19 spreads it to more people than the common flu. The precise case fatality ratio for Covid-19 is unknown because of incomplete testing of possible cases and insufficient information about outbreaks. Infectious disease has something called R0, the current R0 of this virus is between 2 and 3, meaning that an infected person will likely infect 2 to 3 additional people. With Covid-19, most deaths are caused by acute respiratory distress syndrome (ARDS), which causes already-damaged lungs to fill with fluid and makes breathing difficult. Unlike flu, there is no vaccine for Covid-19, yet!

Difference between flu and a cold, transmission and symptoms?

A dry cough and fever is similar to common flu, however, Covid-19 more often causes shortness of breath and difficulty breathing. Influenza causes aches, fatigue, headache and chills. From what is currently understood about Covid-19, these appear to be less common. With Covid-19, symptoms may be more gradual and take several days to get worse unlike flu symptoms which tend to come on abruptly, getting worse in a day or two. Sneezing have a stuffy or runny nose; the good news is that you probably just have a cold.

COVID-19 is primarily spread through respiratory droplets, which means to become infected, people generally must be within six feet of someone who is contagious and come into contact with these droplets. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. Symptoms of COVID-19 appear within two to 14 days after exposure and include fever, cough, runny nose and difficulty breathing.

If you show any symptoms, please self-isolate and respect social distancing.

Recommended advice is self-quarantine and social distancing – how does this work?

Wash your hands frequently and thoroughly, avoid touching surfaces if at all possible. Cover your coughs and sneezes and importantly stay home if you’re feeling ill and self-quarantine for 14-days. Specifically, for Covid-19, actions of universities and workplaces are closing and allowing telecommuting and distance learning make sense. Large public gatherings need to be cancelled or radically altered as we have seen all over the world. By reducing interaction, the virus has reduced capacity to spread. Non-essential travel needs to be cancelled and we are already seeing the impact on all travel systems, particularly airlines.

In many scenarios, individual countries are now imposing restrictions, for example, just today I received an email from the New Zealand Tourist Board:

“The New Zealand Government has announced new measures to prevent the spread of COVID-19 in New Zealand. These measures include the requirement for every person entering New Zealand to self-isolate for 14-days from the date of departure. This excludes people arriving from most Pacific Islands. The Government will also be stepping up its enforcement of the requirement to self-isolate. These measures came into effect at 01:00 am on Monday 16 March and will be reviewed in 16 days. A temporary ban on cruise ships entering New Zealand territorial waters also came into effect at 11.59pm on 14 March. This ban will be in effect until 30 June, after which time it will be reviewed. Foreign travelers who have been present in, or transited through, Iran or mainland China in the previous 14 days will still be refused entry to New Zealand.”

The contents above are not unusual for countries all over the world, and with each passing day, more restrictions are imposed.

As one friend said in conversation, “This is bigger than all of us. The virus is everybody’s problem! We need to act now, self-isolate, respect social distancing because even though we may feel ok, we are surrounded by people who are not. Our actions affect everyone.”

“At the same time, by implementing population-wide social distancing, the opportunity for onward transmission in all locations was rapidly reduced. Several studies have estimated that these interventions reduced R to below 1…. Overall, our results suggest that population-wide social distancing applied to the population as a whole would have the largest impact…” – Imperial College

What action to take?

Take everyday preventive actions:

  • Clean your hands often
  • Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
  • If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
  • To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
  • Wash your hands after touching surfaces in public places.
  • Avoid touching your face, nose, eyes, etc.
  • Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
  • Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
  • Avoid all non-essential travel including plane trips, and especially avoid embarking on cruise ships.

UK are proposing herd immunity – what is it and is it a good idea?

Herd immunity describes a scenario where so many people become resistant to a disease, either through vaccinations or exposure. Mass immunity could effectively cause the virus to burn out over the course of one or two seasons or buy time until a vaccine is developed and distributed.

“We think this virus is likely to be one that comes year on year … like a seasonal virus,” Sir Patrick said on Saturday. “Communities will become immune to it and that’s going to be an important part of controlling this longer term.”

Britain’s approach has three core elements:

  • Enact social distancing measures much more slowly than other countries;
  • Shield at-risk groups like the elderly and sick from contact with the general population;
  • Let COVID-19 slowly sweep through everybody else.

“Your house is on fire, and the people whom you have trusted with your care are not trying to put it out… “says William Hanage in The Guardian. “The UK government has inexplicably chosen to encourage the flames…”

The UK’s approach here is isolated and creating much debate, the general consensus being that we should slow the outbreak. Covid-19 is capable of shutting down countries, just look around now and you will see the world is on lockdown. South Korea has been applauded for its approach and it would appear has gained some control.

“Because Covid-19 is caused by a novel virus, it is likely that there is no natural immunity to it, unlike the flu.” Says Dr. Tom Frieden, former CDC director. “In most years, some percentage of the population will be resistant to flu infection and less likely to become severely ill from that year’s flu strains because they previously had a similar strain of the flu or were vaccinated against it.”

In the coming weeks, the UK’s approach will be tested and scrutinized, especially when most experts are talking about flattening the curve.

But guess what, before this article was finished, Boris Johnson in the UK announced on March 16th:

“Prime Minister Boris Johnson has urged Britons to avoid pubs, clubs and theatres and stop non-essential travel in an effort to reduce the impact of the coronavirus, Mr. Johnson set out the need for “drastic action” to tackle the “fast growth” of the coronavirus as cases rose to 1,543 in the UK.”

What is flattening the curve?

By flattening the epidemic curve, we reduce the chance of a sharp spike in cases that could overwhelm health care facilities. Actions that delay cases of Covid-19 allow better management of health care resources. As witnessed in Italy, surges stretch any health system to a point of breaking and the impact is terrible. Italy have had to introduce Triage at war time levels. Moderate and extensive social distancing works well and as The Washington Post shows (here) a single-person’s behavior can have a huge impact.

In Pandemic situations infection rate depends on the number of people one person can infect and then how long the newly infected people take to be infectious themselves. The virus branches out, ever multiplying and this is how we see spikes in viral activity, 3 becomes 6, 6 becomes 12, 12 becomes 24 and so on. Again, Italy being a prime example of this branching process.

“If cases double every six days, then hospitals, and intensive care units (ICUs) in particular, will be quickly overwhelmed, leaving patients without the necessary care.”

The virus growth rate can be reduced by self-quarantine and social distancing and this ‘flattens the curve’ of infection and therefore, the health system is not overwhelmed. However, this scenario does not mean less infection, it merely reduces the speed of infection and therefore could mean the Pandemic lasts longer.

The USA are also hit hard and news has come in via TMZ that San Francisco will go on a three week lockdown with around the clock curfew.

Who are most at risk?

Medically vulnerable people need to keep a safe distance from others. Nursing homes need to do everything possible to prevent Covid-19 from entering their doors from both visitors and staff. The elderly are at a high risk. People with chronic conditions. Gladly, it would appear that children do not appear to get as sick. If you are young and healthy, you are unlikely to get severely ill, but this is when social distancing is so important, because you are ok, the impact of the people you interact with can have a huge impact.

Virus and runners – any special considerations?

Firstly, if you are fit and healthy, this puts you in a great place for surviving Covid-19, especially if you are a runner who enjoys open spaces. However, meeting up with run friends, attending races and interacting with large groups provides a perfect opportunity to spread the virus. If you are a gym fanatic, you need a re-think and avoid, “I think people should be extra vigilant in any area where there may be lots of people close together and sharing equipment such as gyms as this may increase transmission of infection.”

Now is the time to train alone, seek open spaces (if allowed*) and enjoy some lonely time. Also, important to point out that now is not the time to train really hard and suppress your immune system, this could leave you vulnerable to infection.

Needless to say, races are being cancelled all over the world. Originally, the criteria specified events over a certain number. However, as time passes, any event that brings people together should be cancelled or postponed at least in the short term. Of course, there is an impact for races and I wrote an article here with my thoughts.

Surprisingly, some events, for example parkrun, in my opinion have provided the Covid-19 a great opportunity to spread. They cancelled events in 15 countries based on local government advice, however, in the UK, on Saturday March 14th, they had 678 events with a total participation number of 139,873 people because the UK government said it was ok to do so! When you keep in mind how contagious Covid-19 is, the opportunity to spread the virus just with parkrun members alone is terrifying. In a release via their website, parkrun said:

“We believe that during challenging times it is more important than ever that communities are able to come together socially and support each other if appropriate and safe.”

Unfortunately, coming together socially spreads the virus at an alarming rate. I don’t wish to parkrun bash; I just feel that the implications of this number of people are off-the-scale.

Update March 18th, finally parkrun see sense:

 All parkrun events in the UK have been suspended with immediate effect due to the ongoing COVID-19 (Coronavirus) situation. All events will be cancelled until at least the end of March 👉🏾parkrun.me/covid19

*In Spain I have been informed that police are stopping individual runners in the countryside and in France, fines of 100 to 600 euros could be put in place with the possibility of a year in jail.

How long could this last?

Although the coronavirus pandemic will certainly get worse before it gets better, it will get better. And even at the worst of the coronavirus pandemic, many people (no one knows what proportion) will not get infected, and, of those who do get infected, 99 out of 100 will recover. So, it’s responsible to be proactive now to limit the harms of Covid-19, but it’s also good to keep in mind that this, too, will pass. The timescale is yet unknown.

To conclude, some perspective:

“Hi everyone, I wanted to send a message to my friends on Facebook. I live in Lombardy (Italy) in the area with the most infections and I am in quarantine because I came into contact with a person who tested positive at Covid-19. This situation is difficult (do not leave the house) but if it is for the good of all and it must be done. Covid-19 is a very serious problem that affects the whole world, there is no one who can be considered excluded. Above all it attacks the weakest people, the elderly and people who already have illness problems. Nobody can be considered immune. You may also be a carrier, the problem is that, even if you appear well, you can infect the people who are close to you; the weakest, perhaps the ones you love most? You have to stay away and stay home otherwise we won’t solve the problem. Please think carefully, how would you feel if you infected someone you love?” – Roberto Rovelli

And finally, …

When people are quarantined and life is restricted, two things happen, pregnancy and divorce increases, so, make love, not war!

Details around Covid-19 are changing by the day and at times, by the hour, so, please keep up to date with any changes at a local and global level.

Short term inconvenience and the sun will shine again.

_______________

References:

CNN Health https://edition.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html

SMH Reference https://www.smh.com.au/world/europe/herd-immunity-why-britain-is-actually-letting-the-coronavirus-spread-20200315-p54a5h.html?fbclid=IwAR0hZvKyRhMWlZFB9j64STepP9iNR0dMnVo5Sj9zqomhLEGbvBz7pIzfkOI

Washingtonpost https://www.washingtonpost.com/gdpr-consent/?next_url=https%3a%2f%2fwww.washingtonpost.com%2fgraphics%2f2020%2fworld%2fcorona-simulator%2f

The Conversation http://theconversation.com/how-to-flatten-the-curve-of-coronavirus-a-mathematician-explains-133514

CDC https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

ECDC https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-novel-coronavirus-disease-2019-covid-19-pandemic-increased

The Verge https://www.theverge.com/2020/3/11/21173157/coronavirus-health-effects-age-covid-risk-diabetes-hypertension-disease-isolation

Sky News https://news.sky.com/story/coronavirus-gyms-high-risk-locations-for-spreading-covid-19-expert-warns-11955565

The Guardian https://www.theguardian.com/commentisfree/2020/mar/15/epidemiologist-britain-herd-immunity-coronavirus-covid-19

Cleveland Newsroom https://newsroom.clevelandclinic.org/2020/03/15/frequently-asked-questions-about-coronavirus-disease-2019-covid-19/

Telegraph – https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-news-uk-latest-update-covid-19-death-toll-cases/

The Independent https://www.independent.co.uk/sport/general/athletics/parkrun-coronavirus-numbers-stats-events-a9404911.html

parkrun https://www.parkrun.com/news/2020/03/12/covid-19/

Imperial AC https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf?fbclid=IwAR3tSv76ew4ifATER5eIFKB1XwMF4tk3_0Zzq_4AWZkKib73zETjs4Y4RsA

TMZ https://www.tmz.com/2020/03/16/san-francisco-coronavirus-lockdown-curfew-three-weeks/?fbclid=IwAR0jf5tRfHkJEJx0CLsMBa8dkm4s8dBcdZxhV_srHAhoFYKgAb3fQazOWnQ

 

________

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Race Cancellations and COVID-19

As a runner, you more than likely will take time in the off-season; to sit down and plan the coming season. You will look for the ‘A’ races that hopefully will allow you to shine and achieve those personal goals – you will dedicate hours, weeks and months to prepare.

You will enter ‘B’ and ‘C’ races that will allow you to learn and adapt.

In this scenario, imagine the Race Directors who are planning the races that you will attend. Just as you plan and prepare, so do they, typically one-year in advance so that when the time comes you have a slick, well-prepared event that will allow you to achieve your goal.

Planning and working on a race really is a labour of love and yes, it’s a business.

Race Directors usually start planning immediately after the end of one event. Budgets are worked out, a timeline is put in place and then a team of people, headed by the RD, put a plan in action. This will involve route planning, course marking, providing gpx files, booking venues, planning medical care, arranging for catering, advertising the race, booking cars, maintaining a website, booking a timing system, arranging for photography/video and the list goes on…

It is endless!

To secure services, many of these items are paid well in advance of the race and in most scenarios, a non-refundable deposit will have been paid and at worst, a full balance to ensure that no problems arise.

As an event approaches, typically 8-weeks or less before the event, all invoices are paid and the RD can sit back knowing that a job is well done.

The race fee that you the runner pays doesn’t just cover the day or multiple days of the race, it covers a year or work!

Now imagine you are the RD. You have been diligent; you have crossed the T’s and dotted the I’s. You are, you think, prepared for any eventuality and then Covid-19 comes along and rips your world apart.

Read a simple guide to Covid-19 HERE

Podcast HERE and Audio Feed below

Through no fault of your own, your race is cancelled because one needs to take responsibility for the health and safety of not only runners, but staff and their teams. In many situations, this decision is often taken away from the RD as it comes from a government level.

I am asking you all to take stock of the situation, sit back and take time to reflect on the RD, the team of people involved in the race and the implications of cancelling or postponement.

I personally arrived in Hong Kong in January only to find that as my plane landed in HK, the race I was arriving for was cancelled due to the ever-changing Covid-19 virus.

So, as a runner what can you do?

First of all, there is immense disappointment for each of us on a personal level as an event that we have prepared and dreamed of is removed.

Then attention turns to several scenarios:

  • Can I change my travel plans and what will the cost be?
  • Can I get a refund on the race?
  • Will the race postpone and plan for later in the year?’
  • Will the race defer my place and give me entry next year?
  • What about my hotel booking?

The list goes on.

Let’s be clear here, the Covid-19 scenario is impacting on the world at an unprecedented level. Just yesterday, Omar Hassan writing in The Independent stated that:

‘Coronavirus will bankrupt more people than it kills – and that is a real global emergency.’

Millions of dollars have been wiped from the financial markets but this impact filters down and down to a grass roots level and the impact will be huge for all of us.

 ‘If the virus does directly affect your life, it is most likely to be through stopping you going to work, forcing your employer to make you redundant, or bankrupting your business.’

So, when asking the RD and race for a refund on race entry, please just take time to step back and think, in these special circumstances, can you afford to let that fee go so that you can at least provide an opportunity for that race to return the following year.

Most races will have insurance, but having spoken with multiple insurance experts, the general consensus is, ‘Successful claims under business interruption coverage for infection are not common… Indeed, for example, there are no reported cases in the United States regarding business interruption coverage in connection with human infectious disease epidemics or pandemics.’ – via stroock.com

Even sport specific insurance companies who look after runners/ sports people doing ‘extreme’ sports are confirming that there is no cover for disease, virus or pandemic.

In the last week, Ultra-Trail Mount Fuji, Madeira Island Ultra Trail, Ultra Skymarathon Madeira and so many more have had to pull the plug on a 2020 event. Even the iconic Marathon des Sables has had to postpone and the financial impact of this is still yet to be seen.

In the words of one Race Director, ‘When the Government cancel all Sport Events or public gatherings we are in big trouble, insurance does not cover us in case of pandemics.’

Masako Suzuki, of Ultra-Trail Mount Fuji recently sent out a press release and in it he says:

‘…we apologize for causing great trouble to racers who have been training and preparing for this race, volunteers who have participated in the course maintenance thus far, volunteers who were planning to work during the race, and UTMF supporters including sponsors, companies participating in the UTMF Expo, public and private organisations, and local people.’

The impact is far reaching, cancellations are happening everywhere, and racing is just one aspect. Schools are closing, employees are being asked to work from home, airlines are reducing flights daily and asking staff to go on unpaid leave, hotels are empty, and restaurants are closing. Covid-19 is without doubt a health crisis but it is also an economic crisis.

“It may one day be said that the coronavirus delivered the deathblow to the New World Order, to a half-century of globalization and to the era of interdependence of the world’s great nations.” – WND here

One of the key jobs of a race team is risk management, many races, UTMF, MIUT, USM and so on all started to look at logistics and emergency planning long before the decision to cancel was made. The money is spent!

So please, when you ask for a refund or deferment, just ask the question,

‘Can I let my fee go for 2020?’

And in the process, hopefully, the race you entered will be around in 2021.

It is highly likely that some races will not recover from this but we as runner’s and a community, in a small way, can help keep the sport we love alive to fight for another time.

‘I have been organising #USM for some years now with a fantastic team. We always aimed high because we were convinced, he had a SUPER event. We still do,’ João Canning Clode announced via Facebook, ‘This was the most difficult decision we had to take in all these years. But the health and safety of our athletes, teams, local community, fans and volunteers is of vital importance. We move on…’

As a closing note, we all need perspective. Covid-19 is killing people daily and my heart aches for the distress and loss from this pandemic. Italy, as an example, have been hit so very hard and they have now entered Wartime Triage. This is truly catastrophic for all. But the government have stepped up to the plate and suspended payments on mortgages. When asked about the possibility of halting mortgage payments on Radio Anch’io, Laura Castelli, the deputy economy minister, said: ‘Yes, that will be the case, for individuals and households.’ I applaud that leadership and foresight. We can all learn a lesson from this action. (Article here)

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CORONAVIRUS disease COVID-19 basic advice

COVID-19 aka CORONAVIRUS is creating chaos and panic over the world and rightly so. For sure, the media has taken hold of it and created a scenario of fear, however, after SARS respecting any potential pandemic is no bad thing.

I am not a medical expert but I travel and I travel a great deal. With much of my work taking places at races, public gatherings and in locations throughout Europe and beyond, I wanted to understand what I was dealing with and pass on my thoughts.

I was in Hong Kong in January for a race. As I landed and transferred to meet the RD for dinner, the race was cancelled… Yes, the virus and reaction to it was changing by the hour.

I decided to cut my trip short, escape Hong Kong and return to the UK so that it would not impact on future work.

As February comes to a close, the situation is now greater than one month ago with the virus appearing in New Zealand, Italy and many more locations.

The Virus

CDC have listed several points on the virus:

  • The virus is spread mainly person-to-person.
  • Between people in close contact, less than 6-feet.
  • Via respiratory droplets when coughing or sneezing by an infected person.
  • Touching surfaces or an object that has the virus on it – this is then passed on when the person then touches eyes, nose or mouth.
  • It appears that people who are infected are most contagious when at their sickest.
  • Some virus spreading may be possible before people show symptoms.

You will have seen many images coming from China and Hong Kong showing everyone wearing masks. Do not be fooled into thinking this is a completely safe thing to do – masks have issues and problems:

You only need to wear a mask if you are taking care of a person WITH the virus.

Wear a mask if YOU are coughing and sneezing, this stops potential spreading.

Masks are only effective when combined with frequent hand cleansing.

Masks MUST be worn correctly and changed regularly.

Tips for mask use:

  • Clean hands with alcohol based cleanser.
  • Cover mouth and nose with mask and make sure there are no gaps.
  • Do not touch the mask whilst wearing, if you do, cleanse hands.
  • If mask becomes damp, replace.When removing mask, do not touch the front, remove from behind and discard immediately.

As a runner or endurance athlete, the last thing we want is a virus that impacts on breathing. Covid-19 needs to be respected, despite what you may think about the media and its scaremonger tactics.

Cases are now reaching close to 100,000 and the situation is changing daily.

Incubation period is up to two weeks and this is why the virus is spreading worldwide, it is so difficult to track and contain. Once a positive case is found, it is too late as more will be infected and then the reverse pyramid scenario starts.

What can you do?

Look after personal hygiene.

Avoid public places and gatherings.

When traveling, avoid travel through highly infected areas. Particularly important for long-haul travel. Much better to pass through the Middle East (for now) than pass through China, Hong Kong or Bangkok.

Face masks have a place but understand the restrictions that they have.

Public toilets, bars, restaurants etc etc are a potential perfect storm for passing on the virus, so, avoid in areas of potential or real risk.

As I write, the W.H.O says we are at a ‘Decisive Point’ in the outbreak.

Cases in the UK have risen (19) and New Zealand, Italy, Iran, South Korea and Nigeria have announced first cases. The stock markets across the globe have plunged under the fear of recession. Cases have been confirmed above 84,000 and currently 2867 deaths (sources The Independent and Worldometers)

The Swiss government has banned events with more than 1000 people and already we have seen mass participation events cancelled globally.

NBC has confirmed the virus has spread to at least 40 countries worldwide. It says cases in the USA have been limited but warns, “Americans should prepare for the spread of the virus in communities.”

Ultimately, COVID-19 currently is spreading, we personally need to be aware of risks and mitigate as appropriate. With each passing day, more news comes in and it can be terrifying but let’s keep perspective too, the common Flu can kill up to 646,000 people per year (medicinenet.com) – the figure coming from the US Centers for Disease Control.

So, be careful out there and keep a perspective of the risk, start to do the following now:

Wash hands frequently.

Maintain social distancing.

Avoid touching eyes, nose and mouth.

Feel unwell, seek medical advice immediately.

Do not cough or sneeze in public.

Be safe!

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