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