COVID-19 or SARS-CoV-2

I am so old, I can recall SARS 1, which placed former colleagues in my hometown of Toronto in the world’s eye.  It was not our vision to be writing on this in our first blog and I hope our observations put some things in perspective.

• SARS 1 was scarier.
• Everything is happening so fast!
  • In less than 2 weeks since the first reported case, the entire genetic sequence is in the GenBank. This has led to the rapid development of PCR based diagnostic tests in many parts of the world.
  • Unfortunately and embarrassingly there have been hitches with CDC’s diagnostic test. By the time you read this, we should be able to “broadly” test; but, by the end of February, only 500 tests were done in the US compared to thousands in most other countries.  LabCorp currently offers to run the test if you collect it after influenza has been ruled out.
  • Impact of social media: an extraordinarily efficient way to transmit and summarize data sometimes with either an overstatement of alarm or reassurance.  At least the election took the virus briefly off the front page and minds of people.
• Will there be pushback from health care workers?
  • Institutions should ask for volunteer teams.
  • We should start practicing putting on and especially taking off the protective equipment as this maneuver puts us at most risk.
  • Hoarding of masks and other protective equipment cannot be tolerated as health care workers need ample access.
  • In Wuhan, HCW’s comprised 3.6 % of total cases – much less than SARS (23%) and MERS (10%).
  • The emergency room and walk in clinic will be most vulnerable.
  • Our health care system may not have the needed surge capacity.
• There is a lot we don’t know. This is why the public will not be reassured.
  • We don’t know the full impact or the denominator for our statistics. Many people, (approximately 80%), will have mild disease so the mortality rate (currently quoted around 1-3%) will lessen.  The first SARS was deadlier.
  • Initially the death rate in the US will be on the high side due to the virus showing up in a nursing home. In China, the mortality rate among those older than 80 is 15%.
  • In South Korea, 7314 cases have been confirmed after testing over 140,000 people with a death rate of 0.6%.
  • The contagiousness rate is estimated at 2.5 people (18 for measles).   This means every person with COVID-19 will share it with 2.5 people.
  • The virus is sparing children – unlike this year’s flu virus that is hitting children especially hard.
• We are still in influenza season and accept and tolerate its risk far better. Why else don’t people get vaccinated?  This year 45% of adults and 63% of children got their vaccines and it is still not too late to vaccinate.
  • This year, the CDC estimates there have been:
    • 34-49 million flu illnesses
    • 16-23 million flu visits
    • 350,000 – 620,000 flu hospitalizations
    • 20,000 – 52,000 flu deaths and 125 pediatric deaths.
  • As of March 8, there are 110,627 cases of COVID-19 and 3841 deaths with most of the fatalities occurring in China.
• With respect to decisions to travel, don’t forget to consider what would happen if you get quarantined. Your decision depends on how much risk you want to take.  To assess risk, ask if it is possible to get COVID-19 and then how probable.  If you have other medical conditions that put you at high risk consider cancelling.  Cancel your trip if the anxiety of going would make you not enjoy it.
• It is amazing this has turned into a political issue. I hope my comments don’t have to be cleared by our Vice President.  Hopefully, our local public health departments will have not only emergency but sustained increases in funding for years to come.
• Its impact on the economy is sobering. Already in town, there have been layoffs as a result of it.  May be some business will return to the US as a result?
• There has been extraordinary global cooperation from doctors, scientists and public health officials. May be this cooperation and unity will infect our own politicians?
• Canadians were adherent to quarantine measures back in SARS 1. Will Americans act the same?  Is social distancing the politically correct term? 
• What to do?
  • Screen patients and don’t let anyone with a flu like illness come to your medical office. Still give phone or internet advice but there is very little you can offer them at this time.  Instruct them what should lead them to the emergency room and to call ahead so they can be isolated.
  • Stay home from work if you are sick. We, in health care, myself included, have a terrible time adhering to this.
  • Wear a mask if sick.
  • Cover your nose and mouth with your elbow when you sneeze. (?change clothes frequently); or, cough close to the floor and away from people.
  • Keep sick kids out of school. Perhaps we need to check students’ temperatures with ear thermometers prior to entry each day?
  • Seems simple and I know you are tired of hearing this but wash your hands: frequently and long enough (20 seconds).  If soap and water are unavailable, hygienic alcohol based products can be used.
  • Use a towel or your sleeve on door handles when leaving a restroom.
  • No sharing of food and wash your hands before you eat.
  • Avoid busy places: restaurants, sports, theaters, conferences.
  • Avoid being close to sick people – six feet or 2 rows away.
  • Don’t shake hands or hug and kiss when greeting people.
  • Consider wearing gloves – old fashioned cotton ones – to prevent you from touching your face.
  • If we get into an outbreak situation and if you are well, then it is reasonable to wear a mask in a crowded area.
  • Remove your shoes when entering homes. This was common in Canada even before SARS 1 but less so in the US.

I don’t have a crystal ball but I suspect this will get worse before it gets better.  We may have to change the way we do things and this may have a lasting positive impact.  Wouldn’t it be nice if kids don’t get sick as often?  It is a time for cool heads and common sense; and, is an opportunity for improvement in many areas.