Covid-19 Part 2: More Coronavirus

April 24th, 2020

Most of what I put in my first blog post on the 2019-2020 Coronavirus (officially SARS-CoV-2, causing COVID-19) at the beginning of March still stands, but now that we have all been sheltering in place for over a month, much has changed as well. Therefore, I decided to start a new post, rather than edit the last one.

The first thing most people ask are the symptoms, and how to distinguish them from a cold, influenza or allergy.

Covid vs Cold vs Flu Vs Allergies

The second thing I am usually asked is about the how many people are affected. Currently, the best source for information on COVID-19 cases in the USA is Johns Hopkins University. The best source for local information on what to do is your local health department (this link takes you to the Los Angeles Department of Public Health coronavirus information page, for example) and your primary care physician.

StayHome

As I wrote this, California is “social distancing” and will remain so for a while. I think social distancing should actually be called physical distancing, because the point is to stay as far away from as many people as possible. When you do need to go out you can reduce your risk of catching anything, or passing on the virus, by wearing a mask (only for kids age 2 and above!), washing your hands frequently, leaving your shoes at the door, instead of tracking in whatever is on them inside your house, and bathing and changing clothes when you get home. 

20200420_144532Why you should wear a mask (click on the sentence).

How to make a mask.

How to wear a mask correctly

How to use gloves correctly.

Food safety.

Cleaning your home.

Babies and toddlers under age 2 should NOT wear a mask and should NOT have anything covering their mouth and nose, due to the risk of suffocation.

If you or your child accidentally gets cleaning fluid, or anything else that could be dangerous, in their mouth, nose, or eyes, and they are stable, in the U.S. please call poison control – a free, 24-7 service that lets you speak to a physician specializing in toxicology. The number is 1-800-222-1222, and should be in everyone’s phones. It’s also good when your child breaks a glow stick and gets the glow-juice in their eyes or mouth, for example.

A good source of information for parents is Healthy Children from the American Academy of Pediatrics. This link is to their post on parenting in a pandemic, and this one is information for families with kids with special needs.

Another common question from parents is “How did my kid get sick now, after they’ve been home for a month?!”. My colleague Dr. Iannelli addressed this in a comprehensive post here.

Finally, please be wary of where your information comes from, and what bias it might have. The pandemic has lead to a large increase in false information being passed around. NPR has a great comic (with cats!) to help us all spot faux information

FB_IMG_1587356743760

Stay home, stay safe, and be well!

The first thing most people ask are the symptoms, and how to distinguish them from a cold, influenza or allergy.

Covid vs Cold vs Flu Vs Allergies

The second thing I am usually asked is about the how many people are affected. Currently, the best source for information on COVID-19 cases in the USA is Johns Hopkins University. The best source for local information on what to do is your local health department (this link takes you to the Los Angeles Department of Public Health coronavirus information page, for example) and your primary care physician.

StayHome

As I wrote this, California is “social distancing” and will remain so for a while. I think social distancing should actually be called physical distancing, because the point is to stay as far away from as many people as possible. When you do need to go out you can reduce your risk of catching anything, or passing on the virus, by wearing a mask (only for kids age 2 and above!), washing your hands frequently, leaving your shoes at the door, instead of tracking in whatever is on them inside your house, and bathing and changing clothes when you get home. 

20200420_144532Why you should wear a mask (click on the sentence).

How to make a mask.

How to wear a mask correctly

How to use gloves correctly.

Food safety.

Cleaning your home.

Babies and toddlers under age 2 should NOT wear a mask and should NOT have anything covering their mouth and nose, due to the risk of suffocation.

If you or your child accidentally gets cleaning fluid, or anything else that could be dangerous, in their mouth, nose, or eyes, and they are stable, in the U.S. please call poison control – a free, 24-7 service that lets you speak to a physician specializing in toxicology. The number is 1-800-222-1222, and should be in everyone’s phones. It’s also good when your child breaks a glow stick and gets the glow-juice in their eyes or mouth, for example.

A good source of information for parents is Healthy Children from the American Academy of Pediatrics. This link is to their post on parenting in a pandemic, and this one is information for families with kids with special needs.

Another common question from parents is “How did my kid get sick now, after they’ve been home for a month?!”. My colleague Dr. Iannelli addressed this in a comprehensive post here.

Finally, please be wary of where your information comes from, and what bias it might have. The pandemic has lead to a large increase in false information being passed around. NPR has a great comic (with cats!) to help us all spot faux information

FB_IMG_1587356743760

Stay home, stay safe, and be well!

Coronavirus COVID-19 Information

COVID-19 information for families

This post is to summarize all of the current information and links I have been sharing regarding the 2019-2020 pandemic #coronavirus illness, as of March 11, 2020.

To clarify, COVID-19 is the name of the illness, and the type of coronavirus that causes this illness is the SARS-CoV-2 strain. Coronaviruses in general are quite common, and usually only cause mild colds, but this new strain attaches to receptors in our lungs, instead of just our noses/ upper airways. It is more closely related to other outbreak strains that caused MERS and SARS, the main difference being that COVID-19 is far less deadly than those, while being more easy to spread. This means that more people will get sick with the mild form of the virus, and spread it. Unfortunately, the latest numbers show it is still at least 5 times as deadly as the regular seasonal flu (influenza case fatality rate, or CFR, 0.1% in the U.S.A., best epidemiology guess on total CFR for COVID-19 is 0.5% from several sources, including the American Hospital Association, but it could be as high as 10% if spread is not controlled and there are not enough hospital beds and ventilators, so anywhere from 5 times to 100 times more deadly than influenza). For more on the CFR and risks, please look at the end of this blog.

For a great video that you can watch WITH YOUR KIDS, please see Brain Pop (the links will open in a new window). You can also click here to see a comic about this new virus, made for kids, but nice for the whole family.

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Check out the World Health Organization COVID-19 Outbreak page for the latest statistics, videos, and science.

WHO Symptom Comparison

Symptoms of COVID-19 are similar to influenza, but there is still a lot of influenza going around right now, so don’t forget to get your flu shot to reduce your chances of being hospitalized or worse with the flu! Symptoms of COVID-19 to watch out for include are fever with shortness of breath.

Case Fatality Rates for COVID19 by age

The good news for parents is that young children are much, much less likely to become sick enough to need the hospital or die of COVID-19, worldwide. Children usually have mild cold symptoms, or may be silent carriers (have the virus passed to them, but get no symptoms, but be able to pass it on to others). This does not mean to ignore serious symptoms in your kids, but at least there is some hope. The elderly, especially those with lung and heart problems, are the most at risk for getting very ill and dying from COVID-19, but everyone has some risk, and everyone can spread it to the others. Therefore, we ALL need to do our part to flatten the curve! Currently, you can help by staying home, physically distancing, wearing a mask (only age 2 years and above) if you go out, and washing your hands a lot.

handwashing1

To prevent yourself from getting sick, or even passing on germs, the most important thing you can do is WASH YOUR HANDS!!!

Coronaviruses have a fatty outer layer which makes them very easy to kill with soap. Use warm water, any regular soap (it does not have to be labeled anti-bacterial), and SCRUB for more than 20 seconds. Get all of the nooks and crannies, and create friction while washing. Then rinse and dry. This method is much better than using hand sanitizer gels. Use those if there is no access to soap and water, but use soap and water when possible.

Coronaviruses can live on some surfaces for days, if not cleaned, so wipe down surfaces and clean your home and work areas with sanitizing wipes or diluted bleach (click on the underlined words for links on how to make it at home).

Try and keep your hands off your face, and remind your kids to do the same. Face masks can prevent you from exhaling your germs onto other people (regardless of which germs you have), so if everyone wears them, even silent carriers will reduce spreading the illness. However, please do NOT hoard face masks!!! Currently, there is a worldwide shortage so bad that hospitals and clinics are unable to buy them for the people that are actually at risk.

20200420_144532

If you think you might have this virus, please CALL your doctor first, do not go straight into the office.

Most clinics in the USA still do not have tests for COVID-19, as of March 10, 2020. Some clinics, especially on the West Coast, in states whose governments have agreed to pay for testing, like California and Washington, are now able to send the test to commercial labs, like LabCorp. However, that doesn’t mean your insurance or the state will pay for your specific test with your criteria, and they could be quite expensive, so please triple check.  The department of public health is running free tests for people at high risk (such as known contact of someone with COVID-19, or hospitalized in the ICU with risk factors, or very ill and recent travel history), so your physician can help direct you to where you need to go, if you qualify for testing. If you are being tested or think you might have the virus, you also need to keep yourself totally isolated until you get a negative test result, or continue to be isolated if positive. That means no school, no supermarket, no playdates, no park, etc.

If you are very ill (such as short of breath, chest pain, dehydration), call 911 or go to the emergency room. If you have fever, cough, sore throat, or other symptoms that are getting worse, or not going away with usual care, make an appointment to see your doctor – we are still seeing plenty of influenza and strep throat. However, you must let the scheduler know if you have been traveling in the last 14 days or have had direct contact with someone who is positive for the virus.

Treatment of COVID-19 is mostly supportive – alleviating the symptoms, while waiting for the body to heal itself.

Around 80% of cases just have mild symptoms, similar to the common cold, so treat it that way: nasal saline mist in the nose, a clean humidifier with distilled water, etc. For specific tips, see this post. For a small subset of people, mainly the elderly with comorbidities, especially smokers, COVID-19 can progress to pneumonia and/or ARDS, which may be deadly. Early treatment plans included steroids and antibiotics, but we now know that steroids are not recommended for outpatient treatment in most cases because they prolong the illness, and do not prevent its progression, and antibiotics are not indicated because the pneumonias that the virus cases are viral pneumonias, and there is very little secondary bacterial pneumonia. (Antibiotics only kill bacteria. Compare this to influenza, where secondary bacterial pneumonias are much more common, and antibiotics are indicated if that happens).

Here are more links with easy to read information about COVID-19:

Summary information from Dr. LaSalle.

5 Things To Do If You’re Worried About Coronavirus In The U.S. 

Mixed Messaging – What You Need To Know

A letter from a PhD in Public Health about COVID-19. 

In conclusion, prepare yourselves and your families, but there is no need to panic. This is not the zombie apocalypse, but it will be a lot worse than a bad flu season. Do your part by physically distancing, washing your hands, staying home, and encouraging social distancing. One thing that makes things out of control is people’s over reactions, so please stay calm and help your neighbors. When in doubt, ask your doctor.

P.S. A bit about CFR / Mortality Rates – as of 3/8/2020

As we get some great news on very low death rates from places like South Korea, and predictions from some US organizations, the World Health Organization conversely has higher CFR (case fatality rates) rates published. Why the discrepancy?
To get the CFR, you take the number of people who have died from the illness and you compare that to the number of people who have been infected with the virus. The humongous difference in reported rates is because of this bottom number – the number of people infected. To get this number we use the number of positive tests. But that does not account for silent carriers and people with mild diseases, except in places where they actually test everybody. 
In South Korea, they have drive-by testing for SARS-Cov-2 (the virus that causes COVID-19 illness, aka the novel Coronavirus) for everyone- if you feel sick or you just want to, you drive up, someone comes and swabs your nose, and you get results later. They currently run 15,000 tests EVERY DAY. This way they know actual background rates of how many people are infected. They publish these numbers online at their center for disease control daily. Their mortality rate is currently only around 0.6% (that’s less than 1%, which is great, but still 6 times higher than seasonal influenza’s CFR).
The WHO is also being transparent in their math, but they use numbers from many countries where they only test the people who are sick enough to be hospitalized. This is similar to what the USA does, but here we are currently only testing a small subset of those cases, so we do not have accurate numbers of how many people are actually infected in the USA. Therefore, the WHO gets a 3-4% case fatality rate based on people who are already very sick with COVID-19, not all of the people infected or exposed.
The BMJ is publishing a report that gets a CFR somewhere in between these two reports, at 1.6% for China alone, based on statistical modeling that takes into account that people with very mild disease may not be tested at all, but still uses the numbers officially given by China, which some people say is much lower than their reality.
The CFR age stratification risk chart is based on the WHO criteria, so the risks is actually likely lower than this chart. Still, it doesn’t comfort the families of the 2 men in their 20s who are currently hospitalized with ARDS in the USA as of this posting.
Case Fatality Rates for COVID19 by age

The take away from that is that we should be testing more people, and starting to quarantine ourselves more in the USA. The more we do this, the lower our own CFR will be. So please, cancel those big parties and conferences, and play some board games or do some art with your kids. It will be healthier for the whole country. 

For more on why social distancing and canceling plans is very important, click here.