Here's your primer on the current coronavirus.
Here's your primer on the current coronavirus. Consider it a "Corona Light."
2020. Am I right? It's been a... well, it's been.
So, what do you need to know about the current coronavirus?
This virus and associated condition were recently deemed a pandemic by the World Health Organization (WHO). With that, I'm going to try to give you a thorough and digestible bolus of information to swallow that will hopeful ease your mind a bit and give you some practical tools and information amid this media chaos.
Author’s Note: I am not going for hype. I am not going to insert opinions. I am going to give you the facts and references as I pull them from the CDC, WHO, JAMA, NEJM, Medscape, and other scientifically accepted resources. My post will contain occasional bits of sarcasm and dry humor, but that’s how I deal with stress. We all have quirks. Don’t judge me.
Quick Background: Coronaviruses, in general.
I think this is an important point. This is a “novel” virus in a family of known viruses.
Coronaviruses were first discovered in the 1960s and are a part of a large family of viruses. These are often found in animals (camels, cattle, cats, and bats). They rarely spread to us human people, but past examples of this human spread include SARS and Middle East respiratory syndrome (MERS).
Coronaviruses, in general, account for a good amount of common colds that get spread via respiratory droplets (i.e., think coughing and sneezing).
The list below are 4 very common coronaviruses that circulate in humans and cause respiratory infections in kiddos and adults the world across:
HCoV-229E (alphacoronavirus)
HCoV-NL63 (alphacoronavirus)
HCoV-OC43 (betacoronavirus)
HCoV-HKU1 (betacoronavirus)
Some other, more serious and media-grabbing, coronaviruses include:
SARS-CoV-2 (betacoronavirus, also called 2019-nCoV)
Quick Background: The 2019-2020 Coronavirus
In December 2019, China's seventh largest city (Wuhan in Hubei Province) became the site of a pneumonia outbreak with an unknown origin. In January 2020, Chinese scientists were able to isolate the novel coronavirus. This bugger is called "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The virus, SARS-CoV-2, causes the disease known today as COVID-19.
We think this novel SARS-CoV-2 originated in bats, got transferred to a pangolin, and then transferred to humans.
This is a pangolin.
"How?" You ask. Because humans like pangolin scales. Yup. We traffic these animals heavily, making the spread to us humans easy. Hooray, humans!
The Chinese Centers for Disease Control (CCDC) estimated that it took roughly 30 days for the COVID-19 epidemic to spread from the Hubei Province to the rest of China.
What does all this mean for us in the United States?
Since January in Washington State we've seen coronavirus start to spread throughout the US. Though SARS-CoV-2 has not spread as rapidly throughout communities in the US compared to other countries and communities, this may change as the ever-evolving pandemic unfolds.
To track the virus (and foster your anxiety), you can monitor this map provided by Johns Hopkins University and linked by the Journal of the American Medical Association (JAMA).
As of right now (as I type in the early afternoon on 3/13/2020), the John’s Hopkins map of the US has confirmed 1,268 cases of COVID-19 with 33 deaths as a result, making the mortality rate around 2.6%. Other data from the CDC shows that US cases may actually be around 1,629 with 41 deaths as a result, making the mortality rate around 2.5%. I’m expecting to see these number update as more and more people get tested.
You’ll find slightly different numbers everywhere, and the headlines from the New York Times will make you think we’re all already dead. I’m going to try to put all these numbers in perspective in a second. First, I’m going to talk about my current home.
What about my local Arizona folks?
We, Arizona, confirmed our first case on January 26, 2020. A look at the data from the Arizona Department of Health Services shows that we’ve only had 9 cases (3 tested positive, 6 presumed positive). The AZDHS has deemed our level of community COVID-19 spread minimal.
Now, before you celebrate and race to shake everyone’s hands over the “minimal” news, please recognize that approximately 25% of the population in Arizona is 55 years old or older. Additionally, we’re about 54% White and about 32% Hispanic or Latino, both are populations known in the epidemiological world for their “pre-existing conditions” (i.e., chronic, preventable, lifestyle diseases). We’ll see in a second that these age and pre-existing condition statuses matter in this COVID-19 pandemic.
Before we get to risk factors/symptoms, how do these numbers stack up to past viruses?
Again, depending on where you go for your reference, you will find different numbers all hovering around a similar percentage:
SARS (a betacoronavirus) back in 2002-2003 captured around 8,098 people, killed 774 people, and had a mortality rate around 9.6%
MERS (another betacoronavirus) in 2012-Present captured around 2,494 people, killed 858 people, and had a mortality rate around 34%.
Ebola (NOT a coronavirus) back in 2014 captured around 28,639 people, killed 11,316 people, and had a mortality rate around 40%.
The most common estimates around SARS-CoV-2 (COVID-19) estimate the mortality rates around 2.0-2.5%. However, an editorial from the New England Journal of Medicine suggests that this number might actually be less than 1%…
“On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
Another note from Medscape:
“Although the fatality rate of influenza is low (0.001%-0.05%), more people have been infected by and died from the flu (26,000,000-36,000,000 and 14,000-36,000, respectively) in the current 2019-2020 flu season (data from October 1, 2019, through February 8, 2020) that from MERS-CoV, SARS-CoV, and SARS-CoV-2 (2019-CoV) combined.”
With (evolving) numbers in perspective, what are the symptoms?
First off, COVID-19 is believed to be transmitted via respiratory droplets (e.g., coughing or sneezing). We think that each infected person has the capacity to infect 2.2 other people, and you don’t have to be symptomatic to be infected.
It’s believed that asymptomatic people can still “shed” this virus and infect others. Hence, the recommendations to avoid large crowds and the cancellations of sporting events and concerts. So, while I’m upset about the NHL and NBA. I’m also happy we’re doing what we can to “flatten the curve.”
As for symptoms, initial reports of patients in Wuhan, China (predominantly men) showed:
98% of patients had a fever
76% of patients had a cough
44% of patients had fatigue/myalgias (“body aches”)
Less commonly reported were headaches, sputum production (e.g., “productive cough”), or diarrhea.
Eventually, 55% of these patients went on to have trouble breathing (from pneumonia), abnormal blood tests, and 100% of them had abnormal lung imaging.
Below, we have the CDC guidelines given to doctors for evaluating patients believed to have COVID-19.
These are the criteria put forward by the CDC. (Table from CDC)
The CDC criteria above clearly show that if you develop a fever (100.4F [38C]) and symptoms of respiratory illness related to being in China or near someone who was in China, you are at a high risk. With current person-to-person transmission and the ability to spread this asymptomatically, I am assuming this focus around the Hubei province will be decreasing and focuses on European, Los Angeles, New York, and Seattle travel will be more interesting to doctors.
if you are concerned you have covid-19, call your healthcare facility/doctor before going in for evaluation.
This is an important note. The second you enter a busy clinic, you have a chance of catching or spreading COVID-19. Simply calling ahead can allow your clinic to be sure they are staffed, have adequate equipment, and can evaluate you safely and properly.
Who’s at the greatest risk from this COVID-19 disease?
A recent study published in The Lancet, revealed that risk factors for more severe COVID-19 cases include:
Older age (typically denoted as >60yo)
Hypertension (high blood pressure)
Diabetes
Coronary Heart Disease (CHD)
Elevated D-dimer (>1ug/L) on admission
The CDC adds “lung disease” to that list
Bringing it back to my Arizona remarks earlier. One-in-four of our population is 55 years old or older, and statistically has a premorbid condition (e.g., hypertension, diabetes, heart disease, lung disease). While Arizona’s risk is currently deemed “minimal,” don’t go potentially spreading stuff around our “snow bird” and retirement populations.
Enough doom and gloom, what do we do about it?
I’m going to be honest, these precautions are intuitive and not very sexy. The benefit comes from actually doing them. Sort of like diet and exercise, when you do it consistently - you get the results.
These measures are directly quote from Medscape, which I believe pulled pulled their recommendations from the CDC:
Handwashing with soap and water for at least 20 seconds. An alcohol-based hand sanitizer may be used if soap and water are unavailable.
Individuals should avoid touching their eyes, nose, and mouth with unwashed hands.
Individuals should avoid close contact with sick people.
Sick people should stay at home (eg, from work, school).
Coughs and sneezes should be covered with a tissue, followed by disposal of the tissue in the trash.
Frequently touched objects and surfaces should be cleaned and disinfected regularly.
For more information about prevention and staying well, visit this link from the CDC.
And that’s kind of it, for now. Let’s recap that jumble of information…
The coronavirus is a novel virus sweeping the world with a highly contagious, maybe not so deadly pneumonia.
We say novel, but it’s part of a family of some pretty familiar viruses.
It is more deadly and more of a risk in older populations with pre-existing metabolic conditions.
The best thing that we can do now is try to minimize the spread, support healthcare workers, and keep the mass hysteria and hype to a calm, cool, and collected level.
Wash your hands.
Don’t cough/sneeze at people, and don’t let them cough/sneeze at you.
Recognize that toilet paper has never killed a virus, so save some for the rest of us.
Visit the Centers for Disease Control, World Health Organization, or Journal of the American Medical Association to stay up to date with the science on this disease. Feel free to visit the NY Times if you’d like to lose sleep at night.
If anything massive changes or needs to be updated, I will be sure to update my blog. I may provide a post in the near future looking at evidence-based, integrative options for immune support and COVID-19 protection. Though, with a novel virus, everything at this point would be an educated speculation.
For now, be healthy, be cool, and “spare a square” for your neighbor.