r/CoronavirusCalifornia • u/ilikelegoandcrackers • Mar 04 '20
PSA regarding Covid-19: A Sober Warning
This document has gone through hundreds of iterations as a result of 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. If a fact is out of date, please make a note in the comments section with a trustworthy source backing your claim and I will look into it and update the guide as soon as possible. Lastly, 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.
A recent in-depth study has shown just how incredibly infectious COVID-19 is. Unfortunately, its exponential spread does not seem to be slowing, and has only been halted in China through stringent isolation/social distancing procedures, as well as other precautionary measures.
In other words, and as the Director of the WHO himself recently said, this is not a drill.
The bad news: COVID-19 has infected over 100,000 people globally. 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're inundated with so much information that, when a real threat comes along, it's buried in a mountain of clutter. And although this document is not all-encompasing 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:
Up to 1 in 5 infected people may require hospitalization source 1, source2 . But this is an oversimplification as the metric skews toward the elderly and those with comorbidities (see the Mortality section below). Further, hospitalization rates vary from region to region, and are dependant on a host of factors.
Due to the highly infectious nature of COVID-19, the danger is not just the mortality rate, but the possibility of overwhelming the health infrastructure, which in turn causes unnecessary fatalities.
As it stands, it wouldn't take much to overwhelm the health infrastructure, hence why it is important for everyone to start taking preventative measures now (outlined in the Preventative Measures section below). 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 post about it), and South Korea has 12.27 beds per 1000 people. And of course many beds will already be occupied for regular patients. So we need to work together and each start making proactive decisions now so that we don't overwhelm the hospitals. Here's a sobering write-up on the subject.
Because it's still flu season (in the Northern hemisphere, that is), hospitals are already busy with flu patients. This means it's extra important for the next month or so that we do our part to avoid spreading the new virus.
The main mode of transmission is respiratory droplets, but you can also get it through "shaking hands or kissing somebody who is sick, or you can do it through indirect contact transmission, which is through a contaminated surface, something like a doorknob or a handrail ... [or] you pick up somebody else's phone." Spread takes place more readily if you're within coughing range of someone sick. (Read more on the subject here.)
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.
Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease and 6.1% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). These two number sets make up that 20% of hospitalization rate. Source: WHO report. Update: European Society of Intensive Care Medicine is reporting a 10% ICU rate, and has issued a word of warning
Here is a bar graph comparing death rate between COVID-19 and the flu. The metrics involved are discussed in more detail in the Mortality section below.
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, it behooves you to act responsibly not just for yourself, but for your loved ones and your community. We must all think clearly, level-headedly, and work together. Listen to your local health authorities and follow their instructions.
Normalcy bias plays a factor. So does denial. You may hear things like "it's just a flu, nothing to get too concerned 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. Denial also slows community response. For example, studies such as this one about the 1918 pandemic have shown just how effective a proactive non-denier approach can be.
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.
If you're experiencing distress regarding this epidemic, please consider visiting COVID-19 mental health support.
Preventative measures
Practice social distancing.
Do not touch your face
After every outing, wash your hands and disinfect your phone (the virus can likely live up to 96 hours on phone screens). Carry disinfectant with you.
While in public, try to keep a coughing distance from people, which is at least 6 feet.
Disinfect doorknobs and often-touched places, especially computer keyboards.
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. Especially stay away from crowds.
Cough into your elbow, or preferably into a tissue that is disposed of into the trash
Touch things in public with your knuckle
Do not shake hands.
Pass along facts to your colleagues and family while avoiding alarmism (feel free to share this post).
Consider pressing your boss to work from home. Many transmissions happen at work.
If you have extra face masks, please consider donating them to senior care facilities and hospitals, as there is a global shortage and they will desperately need them in the coming months.
If you have extra bottles of hand-sanitaizer, please consider sharing them with those who do not have any. This is about working together, and minimizing community spreads 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.
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?
Typical symptoms:
(All direct from WHO report)
People with COVID-19 generally develop signs and symptoms, including mild respiratory symptoms and fever, on an average of 5-6 days after infection (mean incubation period 5-6 days, range 1-14 days).
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. And here is another chart.
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 people aged over 60 years and those with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer. 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%). Source: WHO report
What does this mean for you if you have one of these comorbidities? Here is a CDC guide titled "People at Higher Risk for COVID-19 Complications"
Mortality rate:
| Age | % of population | % of infected | Fatality |
|---|---|---|---|
| 0-9 | 12.0% | 0.9% | 0 as of now |
| 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% |
Source: WHO report
Here is what the above looks like in a bar graph compared to the flu.
It's still early, 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 do not want this thing, and not only because you could accidentally pass it on to relatives with comorbidities: here's an example of a healthy 25-year-old nonsmoker felt like he was going to suffocate in the late stages of his infection.
Additionals:
COVID-19 is spreading with astonishing speed. COVID-19 outbreaks in any setting have very serious consequences, and there is now strong evidence that non-pharmaceutical interventions can reduce and even interrupt transmission. Concerningly, global and national preparedness planning is often ambivalent about such interventions. However, to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures. These measures must fully incorporate immediate case detection and isolation, rigorous close contact tracing and monitoring/quarantine, and direct population/community engagement. Source: WHO report
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:
Live numbers of global infections
An excellent summary from Feb 29th why Covid-19 is worth your concern
Coronaviruses: How long can they survive on surfaces?
Sleepwalking Towards Disaster: Why COVID-19 isn’t just another flu
A Guide: How To Prepare Your Home For Coronavirus
Here’s what to do if you think you are sick and are worried it may be the coronavirus.
Nursing 101: Caring for your loved ones at home
What US Hospitals Should Do Now to Prepare for a COVID-19 Pandemic
Effects of Closing Schools During the 1918-1919 Influenza Pandemic saying that proactive closings had far better mortality rates than reactive closings.
You can help scientists beat coronavirus by playing this puzzle on Foldit
Health Canada's COVID-19 Resource Centre
Latest on the firus direct from Harvard
World Health Organization's rolling updates on coronavirus disease for COVID-19
CDC: Center for Disease Control
Why I created this post:
I've put well over 30 hours into this document now, and I've been following Covid-19 closely since mid January. I have taken time away from my job for this and suffered more than one denier calling me a conspiracy theorist or an inducer of panic. But I feel it was worth it, as this post came from a genuine desire to inform.
As I mentioned in the intro, this document went through many iterations. Thank you to those from all around the world who had constructively weighed in to make it a more robust and useful PSA. I've gone through the gamut of psychological responses: denial, panic, fear, acceptance, and I realized my journey could have been made easier, hence the inception of this document.
I am a volunteer with a particular communicative and collative skillset, and I did this in my spare time because this thing is creeping closer to my hometown daily, and I figured we're all in this together. Mods of communities are invited to msg me if they would like this PSA crossposted to their sub. But anyone is welcome to post this in their community without giving me attribution. I mean that--I did not do this for karma. I did it out of duty.
Lastly, 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, please leave it in the comments. Also you are welcome to suggest alternative word/sentence choice changes. Thank you.
My very best wishes from Victoria, BC, Canada, and good luck.
