If we’re friends on Facebook and you’re reading this, you’re probably thinking ‘here she goes again!’ Sorry! Just kidding, not sorry. 😀 I’ll continue to share evidence-based information and recommendations until I tire, if that’s what it takes for us to get a handle of the Covid-19 (novel coronavirus) situation.

Our family has very actively practiced social distancing. I get it, it can he hard. We’re privileged to have the space to spread out throughout the house, to have space where we can play outside in ‘isolation’, and have tons of things to keep ourselves busy with, including my dog who seems to think I have nothing better to do than pick up after her.

Our two boys also seem to think that if friends aren’t around, they can’t play outside. Better yet, they specifically said “We can’t play because we don’t have anyone to play with.” Um, HOW ABOUT WITH EACH OTHER?! Sigh. Being indoors for extended periods of time can make them cranky and prone to bickering, so off we went to play outdoors, together. For four hours, we played baseball, basketball (me, pictured above, making a straight foo’ out of myself), rode bikes and scooters, and basically ran amok. Then, I took Advil because I’m old and out of shape. But, I digress… 🙂

On Facebook, I’ve shared a number of articles on social distancing. Here are a couple you can read while you’re social distancing. The two articles, linked here and here, give great guidance about what ‘social distancing’ means and what activities are recommended and not recommended at this time. The Washington Post also has a fantastic article demonstrating social social distancing either speeds up or slows the spread of infection. In short, it is simulating what we see in this figure from a working paper written by Famulare and others, demonstrating model-based estimates of COVID-19 burden in King and Snohomish counties through April 7, 2020, a collaboration between the Institute for Disease Modeling, Bill & Melinda Gates Foundation, Fred Hutchinson Cancer Research Institute.

In short, the paper and this figure suggests that even a 25% reduction in contact between people can have a significant effect on the number of people being infected and ultimately getting sick.

So, why does that matter??

The biggest threat Covid-19 presents is burden on hospitals, health care workers, and our infrastructure in general. Dr. Michael Saag, world renowned infectious disease physician put this into perspective in an article he published in AL.com last week:

“Here is a scenario to illustrate what seems likely to happen in Alabama over the next 10 weeks:

· With a doubling rate of infection of 5 – 6 days, cases rise exponentially over time.

· This means that we can go from 50 cases to 25,000 cases in 10 weeks.

· If 20% (5,000) of these patients are significantly ill, at least half of them will need to be in the hospital (2,500).

· Of those, at least half will need to be cared for in the ICU (1,250). And once in the ICU, they could remain there for weeks, clogging the ability to admit new patients to the ICU.

· And this scenario is only after 10 weeks; at 20 weeks from now, there could be up to 500,000 total cases or more in Alabama (you can do the ICU math).

UAB hospital has up to 300 ICU beds; other hospitals in Alabama have fewer ICU beds. And in all hospitals in Alabama today, most of those beds are already occupied. It is easy to see that hospital beds, especially ICU beds, will be in short supply as the coronavirus epidemic unfolds.

So the question then becomes: Where do the new, coronavirus patients with severe disease go?

Italy currently gives us some tragic insight. In Lombardy, Italy, last week, up to 200 patients needed admission to the hospital. But there were no more beds available. So the physicians had to scour the hospital making difficult decisions about which patients were too sick to recover and discharge them home to die in order to make room for those who had a chance to live. And I just heard from a colleague in Switzerland. They are on the verge of having to make the same decisions. No one wants to ever be in that gut-wrenching position.”

My friend, Dr. Ellie Murray created this graphic help you remember what things you can do to help #flattenthecurve!

Have I convinced you yet that social distancing is important??

PLEASE SAY YES.

 

So now what? Well, I’m sure you have lots of questions about, for example, what happens if I get sick; what if I’m pregnant…am I at risk?; what if I find out I was exposed to someone who was sick??

I planned to share some of the responses I have seen on Facebook from colleagues who are epidemiologists, infectious disease experts, and the like, however found that most of the answers were neatly covered on the Centers for Disease Control website. Topics include:

What are the symptoms and what should you do if you think you are sick?

Are my pets at risk for infection?

What if I’m pregnant, should I be worried?

What about breastfeeding?

What about schools and daycares??

Should I cancel upcoming travel?

And a number of other great topics, including whether your pets can get sick with Covid-19 and whether we should worry about our waterways/systems (the answer is no). Visit the CDC.org website for more information.

Intermountain health also has a great page with great information and visuals like the one below.

The biggest difference between Covid-19 and other viruses like the flu virus, for example, is that

you can infect other people BEFORE you even know you’re sick.

Refer to the period between the dotted lines, before people start showing symptoms in the figure below.

 

Are you mentally exhausted from reading all of this yet?? I know I’m exhausted just writing it! Friends. We are facing something completely unprecedented. We have never been faced with anything like this before. More so, this is something that is affecting all countries, even if it’s happening in waves. Dr. Tony Fauci, Director of the National Institute of Allergy and Infectious Diseases was on Meet The Press this morning and said, social distancing measures are currently not being practiced as they should. We need to do more.

 

 

I urge you, friends: Please practice social distancing as much as you can. If it works, we will help slow the spread. The field of public health will accept your criticism if you think we went overboard, if what we accomplished was a complete mitigation of the spread of disease. We would rather be responsible for doing too much and handling the situation TOO well, than handling the situation poorly. We are already at risk for increased spread because we have no idea how many people are out there currently infected, spreading virus.

“I think Americans should be prepared that they are going to have to hunker down significantly more than we as a country are doing,” Dr. Anthony Fauci, the nation’s top infectious diseases expert, said on NBC’s “Meet the Press.” Elderly people and those with underlying conditions need to be especially cautious.

Finally, please don’t forget: We are not just social distancing for ourselves. We are social distancing to protect all who are vulnerable, including ourselves should we happen to BECOME vulnerable. If there was ever a time in history for people to come together, the time is definitely now. As I stated in last week’s post, it is our moral and social responsibility to slow the spread and protect the vulnerable, including overburdening our hospitals and health providers. We can do this, friends. We can do it.

For additional questions, please refer to cdc.org, who.int, nih.gov, local health department COVID-19 info pages, or university websites who have information on COVID-19. If you’re on Twitter, feel free to follow me @berthahidalgo. I share and retweet a lot of information related to #COVID19. Many of us also have lists of people you can follow to stay up-to-date, including Dr. Carlos Del Rio, Dr. Natalie Dean, Helen Braswell, Dr. Ellie Murray, Dr. Jeanne Marrazo, Dr. Rachel Lee, Dr. Marc Lipsitch, Dr. Tedros Ghebreyesus of the WHO, Dr. Anand Iyer, and many others. Dr. Ellen Eaton has also crafted great posts on Facebook. There are many others, but these are the ones that come to mind immediately.

With that, I leave you and say, social distance like CHAMPS, friends!

 

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

I know this post is coming late tonight, but hopefully you will read it first thing Monday morning, and hopefully it will help answer some of the questions you might have about COVID-19, formerly known as “2019-N Cov Virus”. A few weeks ago, I wrote a post all what we knew then (if you haven’t read it, brush up here), but we have learned a lot about it since I wrote that post. Buckle up, there are a number of things to keep in mind below.

1) The Media and Scientists

First, let me be clear. There are two wars we are fighting in this moment: 1) the fight to stop the spread of COVID-19 and 2) the fight to combat misinformation. Many scientists are actively working to gather as much evidence-based information as possible and subsequently share it with the public as quickly and accurately as possible. This is happening in the form of press conferences, social media posts, newspaper articles, etc. If you happen to read or hear something about COVID-19, be assured that it is coming from a reliable source. Information from the Centers for Disease Control, the World Health Organization, the National Institutes of Health (yes, especially Dr. Anthony Fauci), heads of local health departments – all reliable sources that you can count on to have reliable, not overly exaggerated or inaccurate information. My colleague Dr. Ellie Murray curated a list of trusted scientists who are sharing information on Twitter. She shared it with me here if you’re interested. Lots of other trusted sources you can follow on that thread. Yes, this – like many other situations – has become highly politicized and there are media outlets and businesses that will benefit from headlines and tag-lines that cause fear. Let me ask you this: When is panicking ever a good idea? NEVER. Probably not unless a lion is chasing you through the savanna and honestly, how many times is that going to happen in your life, really? So, take a pause, think critically, and double check the information you hear or read about by going to one of the sources I named previously. If you ever have additional questions that can’t be answered there, please feel free to email me or send me a DM on Instagram.

2) Don’t Panic

While we’re on the topic of panicking though, it would be insensitive of me to tell you not to panic when you have clearly heard that there have been deaths associated with COVID-19, including one to date in the US. Especially if you have loved ones who fall in these age categories or may simply more likely to get pretty sick with any viral infection. The data suggests that deaths have occurred as a result of infection with COVID-19, affecting some age groups more than other. According to reports:

• 14.8% of deaths among people known to have COVID-19 aged >80 years of age
• 8% of deaths among people known to have COVID-19 aged 70-79 years
• 3.6% of deaths among people known to have COVID-19 aged 60-69 years of age
• 2.3% of deaths among people known to have COVID-19 aged 10-59 years of age

As you can see, the biggest risk seems to be for people in the older age groups. As mentioned in my original post and my flu post, people with weakened immune systems, COPD, and other conditions that may them get pneumonia more easily, are likely to get pretty sick if infected with COVID-19 too. It’s important to note that these are percentages based on known cases. We don’t really know how many people are infected overall, so these percentages are just estimates. The number of total cases and deaths do still remain lower than the total number of cases and deaths due to flu. That said, still important to treat this epidemic with seriousness and try to…

3) Prevent the spread

Okay, so if I’m telling you not to panic, then why shouldn’t we panic and what should we do instead? Well, for starters, you should do what you should be doing even in the absence of COVID-19:

• WASH YO HANDS!
• COVER YO MOUTH WHEN YOU COUGH
• STAY HOME WHEN YOU’RE SICK – I recognize this is hard for those who do not have flexible jobs, so as best as you can, please try not to be around other people when you are feverish and sickly.

Sorry, was that too shouty?? Yikes. #sorrynotsorry Seriously, friends. These tried and true measures will do a lot to help prevent the spread of COVID-19, BUT ALSO, the flu, the common cold, strep throat, pink eye, I mean…the list is kinda endless!

Practicing good respiratory hygiene is so important. Also important to keep in mind is to try and avoid touching your eyes, nose, or mouth as much as possible. That’s so that if you happened to not wash your hands well enough (more on that below), you will lower the chances of transferring any virus on your hand into the parts of your face where the virus can enter your body. It’s obvi more complicated than that, but you get the message – I hope!

4) Prepare

Okay, fine. So, what if I do all those things but I hear that the numbers of cases are still increasing?? Well, chances are that you will likely see the number of cases increase FO SHO. Why? Because it’s part of the natural process of identifying new people with the infection, especially when we don’t yet have a good way to screen for COVID-19 like we do with the flu or strep throat for example. So, if there happen to be more cases – and there will – and if there happen to be school or workplace closures (and there might), keep a few things in mind, just as you would for your regular preparedness plan – because you have one, RIGHT??!

1. Do NOT buy a mask. If you are healthy, you do not need a mask. Most masks require fit-testing in order to be truly effective. No need to spend your money on that. Buy some mascara or extra deodorant. I promise.
2. If you simply MUST buy something, buy what you would for the flu or cold: decongestants, anti-inflammatory drugs and acetaminophen for fevers.
3. Have non-perishables on hand like canned goods, water, toilet paper, etc in case there are any closures and/or if you happen to be sick and cannot get to the store. This is always good to keep on hand though, so a good plan regardless.
4. In general, it’s good to have a preparedness plan that can apply to any situtation. You can find a good one provided by the CDC here: https://www.cdc.gov/ncbddd/hemophilia/documents/familyemergencykitchecklist.pdf

5) Be a good citizen

This is a lot of information, and honestly, there are a lot of details about COVID-19 that I didn’t include here. But honestly, based on what we know currently, this is as much as I thought was worth sharing. The situation is changing very rapidly and we still don’t fully understand what things will look like here in the US. We still don’t have a gold standard for screening for COVID-19 nor do we have a tried and tested treatment, though there are treatment recommendations should you test positive and need to be treated.

What I do want to emphasize is that in order to prevent further spread in the US and to come out of all of this in the best way possible, it’s so very important that we all be good citizens. What does that mean? Do all the things I mentioned above to the best of your ability, and don’t let fear get the best of you. There are so many reports out there of prejudice and discrimination against certain groups and populations since news of COVID-19 began to circulate. If you want to blame someone, blame the virus. Don’t blame your neighbors. Deal?

Information for this post came from:

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

https://www.popsci.com/story/health/how-diseases-spread/

https://jamanetwork.com/journals/jama/fullarticle/2760782#.Xlqw4Q2V-iY.twitter (especially good read for clinicians)

https://www.sketchplanations.com/post/611288424379449344/how-to-wash-your-hands-in-these-times-and-to-be (with wonderful infographics like the one below)

The Centers for Disease Control

World Health Organization

National Institutes of Health