It has been a busy week following all the information coming out about novel coronavirus or COVID-19. Some days, it feels a little like drinking from the firehose, except, in this case, sometimes it feels like you need to make sure everything that it coming out of the hose is actually water and not something toxic disguised as water.

Many of you have reached out and said that there are a lot of conflicting messages out there. To wear a mask, or not? Use hand sanitizer? Okay, but why is it $40 an ounce on Amazon now???? Some people are saying don’t worry, and others are WAY freaked out. I get it. Let me break down all the information I have gathered this week and try to give you some guidance.

First, what’s going on in the US: Well…we have cases in the US and those cases are definitely increasing in number. A few weeks ago, we had 6 total cases and as of 7:41pm Saturday March 7, 2020 Central time, there are 424 confirmed cases.

This geographic information system (GIS) developed by John Hopkins University is a great place to keep up with numbers real-time. Source: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

I want you to pay special attention to the word “confirmed” in that last sentence. At the moment, approximately 1895 people in the US have been tested. Probably more since this was reported March 6th, but not a whole lot more. Part of the problem we are facing is not enough people are getting people tested. In order to truly know how many cases of coronavirus are out there, we’d have to do a whole lotta testing, and currently, we don’t have enough test kits to do so. People are reporting that individuals who call their doctors to report possible coronavirus symptoms, aren’t tested. In some cases, the criteria needed to be tested vary by health department, in other cases, we may not have had enough test kits to test individuals who are not at high risk like older people in nursing homes and people with pre-existing conditions and/or weakened immune systems.

Okay, so if we can’t test everyone, then what are we supposed to do?? Good question. If you think you have symptoms that seem to suggest that you have COVID-19 (novel coronavirus), then the general advice is that you call your primary health provider or doctor, or call the health department. Ideally, they will talk to you about what symptoms you are having and advise you to stay home and stay away from others so you don’t also get them sick. Please know that it is unlikely you will get tested UNLESS you fit all the criteria for getting tested and/or you are super sick.

How will I know if I’m super sick? According to the CDC,

• Pay attention for potential COVID-19 symptoms including, fever, cough, and shortness of breath. If you feel like you are developing symptoms, call your doctor.
• If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs*:
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

Why are we closing schools and stopping travel? Self-isolation, self-quarantine, and social distancing; that means you have to stay away from people as best as possible, for about 14 days. It’s also why you hear rumors and news of daycare/school/workplaces closing. Also why there are recommendations to try to limit your out-of-home activities, if you have COVID-19 infections in your state or communities. While the virus itself is supposed to not be serious in about 80% of the population, it is very serious for that remaining percentage of the population, especially older people (ages 60 and above). In order to help lower the number of total people infected and decrease the number of people who can get really sick, isolation or quarantine, closures, and good hand and respiratory hygiene are SUPER IMPORTANT. Basically, what we are trying to prevent is the burden on hospitals and infrastructure so that IF people get really sick, they will be able to be cared for in as fast and accurate manner as possible. This is called “flattening the curve” as pictured in the figure below. In China, Iran, and Italy, you heard of stories where beds were being set up in hallways of hospitals and/or makeshift hospitals. If we can slow down the rate at which people are getting infected, we might be able to lessen the strain on hospitals and other infrastructure.

Summary: In the image below, you see that if you take action early, you’re able to slow down the number of people who get infected. Why does that matter? Because you create less burden for hospitals and infrastructure (all please and people needed to treat all sick people as best as possible) and in turn, see fewer deaths linked to COVID-19.

Should I panic?? I know you’re hearing in the media that the virus isn’t that dangerous, that’s it’s just like the common cold or flu, and I know you read in my last two posts that I suggested you should not panic. I am still saying don’t panic. I still believe that the virus isn’t making a majority of the population super sick, and very interestingly, kids seem to not be too affected by the virus. BUT, what I am saying, is that WE NEED this to be an ALL HANDS ON DECK situation. Older people do seem to get pretty sick, as do people with weakened immune systems, and it’s our responsibility to protect them. How do we do that?? We avoid getting sick and try to reduce the overall number of people who are sick! We need you to continue to:

• Wash your hands for 20 seconds (as long as it would take you to sing Happy Birthday or the chorus of Old Town Road). When soap is not available, use hand sanitizer with at least 60% isopropyl alcohol.
• Cough or sneeze into your sleeve or elbow (this helps all the saliva and droplets that come out of your body to land on your clothes, rather than releasing them into the air or a surface that someone else can touch)
• Try to stay home if you can. This last one is tough, especially if you don’t get paid if you don’t work. 😦

Treating COVID-19: Some people have asked me whether there is anything they can do to build up their immunity to help fight the virus (if they get infected). Honestly, there are no evidence-based supplements that can help you fight this off. Scientists are currently in the process of testing whether an anti-viral drug called ‘Remdesivir’ can be used to treat people who become infected with COVID-19, but we don’t yet know if it will really work, and it will be a while (months or a year) before we know with certainty, or enough to give it to people who are sick.

What about the vaccine: Similarly, you may have heard that a vaccine will be ready SOON or in no time. While there is work happening now to develop a vaccine for COVID-19, it’s going to be a year at best, longer maybe, before we have a vaccine that works. So the answer is: No. We will not have a vaccine immediately. It’s going to be a while.

Should I cancel the trips I have planned? The general advice currently is to suspend international travel, especially to level 2 and 3 countries like China, Iran, and Italy. Domestic travel is being stopped or limited for some universities and workplaces. Why? This is largely based on the idea that social distancing is important for preventing overall spread of infection with novel coronavirus. Less travel means the virus is contained to some extent. Staying home as much as possible, helps prevent spread of the virus to other people in your community. Try fist-bumps or hand-waves instead of handshakes and hugs. Work from home if possible. Avoid crowded places. This includes churches as well. Some churches have put in place suggestions for reducing infection, including no handshakes for some services.

I should add that if you have a cruise planned, you may seriously consider canceling. Two cruise ships have resulted in a number of infections already. They are, as Dr. Jeanne Marrazo of the University of Alabama at Birmingham put it: cruise ships are incubators for disease. They present the perfect environment for this virus to spread.

So what do we do now? We sorta wait it out and do all the things recommended above. As I mentioned, we already have over 400 confirmed cases in the US. If you see a super large number of cases reported in the coming weeks, know that it’s likely due to more people being tested, and not necessarily that many more people are being infected. It is entirely possible that there are cases in places were we don’t have confirmed cases already. This is because the virus is no longer being transferred only by people who traveled to other countries who had COVID-19, but because those travelers infected others in the US who had not traveled and are now infecting others in the community. Alabama for example, is reporting zero cases at this time. It is entirely possible that we have cases in the state that simply did not get sick enough to be seen by a doctor or be admitted to the hospital. We would have no way to count them in the tally for cases in the stat.

Do we need to buy out Target, Walmart, Costco and Sams to make it through these quarantines or closures?? I mean…no. Not necessarily. Or at least not anything that is unreasonable. Please don’t hoard supplies. You should plan to have things at home that are necessary for day-to-day living, or if you had to stay home for two weeks and could not leave your house.

Bottomline: Older people and people with pre-existing conditions are at higher risk for getting REALLY sick if infected with COVID-19. CDC has recommended that individuals who are older (data suggests 60 years of age and older) or have pre-existing conditions try to:

• Stock up on supplies
• Take everyday precautions to keep space between yourself and others
• When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
• Avoid crowds as much as possible

For those of us who are at lower risk, it is our moral and social responsibility to protect them by not getting sick and not being around them as much as possible. During a COVID-19 outbreak an outbreak in your community, stay home as much as possible. For people of all ages, please remember to continue to wash your hands often, don’t touch your eyes/nose/mouth, and try to not go out unnecessarily. That includes travel.

Twitter user Marion Koopmans @MarionKoopmans this perfectly:

“Tip: don’t think about what this virus does to yourself, but think about what it could do to your grandmother, grandfather, family member with cancer therapy, brother who is a heart patient. You adhere to advice for this.”

As always, please feel free to reach out if you have any questions via DM or comments on Instagram, Facebook, or Twitter. For more information, also visit https://www.cdc.gov/coronavirus/2019-ncov/index.html, and https://www.who.int/.

Ahora, en Español!

Mensaje importante: El riesgo de infección con el nuevo coronavirus (también nombrado “COVID-19”) es mas alto en personas mayores (mas de 60 años) y personas con condiciones pre-existentes (por ejemplo, el asma, la diabetes o el cáncer).

Los Centros de Control de Enfermedades (CDC) recomiendan que personas mayores de 60 años de edad o con condiciones pre-existentes hagan lo siguiente:

• Tengan provisiones (como comida, medicamento, agua, etcétera) en caso de que tengan que estar en casa por un tiempo extendido
• Tomen precauciones cada día para no estar muy cerca a otras personas si tienen que salir a la tienda o visitar al doctor
• Cuando salgan fuera de la casa, traten de no estar con personas que están enfermas (tos y estornudos) y lávense las manos frecuentemente. Traten de no tentarse a nariz, boca, y los ojos, porque por allí es mas fácil que entre el virus.
• Traten de evadir lugares con muchas personas, como la iglesia, el cine, por ejemplo.

Para las personas menores de 60 años de edad con menor riesgo de infección: Es nuestra responsabilidad – social y moral – proteger a las personas mas vulnerables (como las personas mayores y personas con enfermedades pre-existentes). En general, para personas de todas edades, por favor lávense las manos frecuentemente, traten de no tentarse la boca/nariz/ojos, y lo mas posible, traten de no salir mucho de sus cases si no es esencial.

En Twitter, Marion Koopmans (@MarionKoopmans) dijo lo próximo:

“Nota: No solo piensen en lo que puede pasar si uno es infectado con el virus, pero piensen también que puede pasar si el virus infecta a su abuelita, abuelito, miembro de la familia con cáncer, hermano con problemas del corazón. Se siguen las recomendaciones con todas estas personas en mente.”

Como siempre, si tienen mas preguntas, por favor hablen con su doctor primario, si no, por favor háganme preguntas por Instagram, Facebook, o Twitter. Para mayor información, por favor visiten https://www.cdc.gov/coronavirus/2019-ncov/index.html, and https://www.who.int/.

Sources for this post include:

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

https://www.theatlantic.com/health/archive/2020/03/how-many-americans-have-been-tested-coronavirus/607597/

https://www.atlantamagazine.com/news-culture-articles/the-cdc-says-to-wash-your-hands-for-20-seconds-9-atlanta-songs-to-help-you-keep-time/

https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000/

https://www.nejm.org/doi/full/10.1056/NEJMoa2001316

https://www.washingtonpost.com/health/2020/02/26/how-to-prepare-for-coronavirus/?arc404=true