Novel Coronavirus (COVID-19): Now What?

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Everybody calm down.  Fear is spreading faster than the coronavirus at this point.  Financial markets are in turmoil over fear of a global economic slowdown caused by the virus.  Worries about lost productivity in China, reduced demand for oil and consumer goods, and disruption of travel, tech, and financial sectors have investors around the world hyperventilating.  The price of gold has reached its highest level in seven years, and the yield on the 10-year treasury is near record lows (1.37%) — both signals of a flight to safety.  Caffeine-toxic media types are nearly histrionic.  As is typically the case, the only two things missing from their breathless banter are knowledge and perspective.

Here are the facts, as of Monday evening, February 24, 2020:

  • The number of global cases of COVID-19 is around 79,000.
  • Virus-related deaths are at 2,600.  The overwhelming majority of deaths is still in China, but China is only reporting in-hospital deaths.
  • The current mortality rate is still around 2–3%.  The mortality rate of SARS was 10% and the mortality rate of seasonal flu is 0.1%.
  • COVID-19 is more readily transmissible than SARS (Severe Acute Respiratory Syndrome), but less deadly.
  • The incubation period is still considered to be 14 days.
  • Viral transmission of COVID-19 appears to occur through large droplets in respiratory secretions.  Both oral and anal swabs have detected virus (viral particles can be found in the GI tract).
  • Both SARS-CoV and MERS-CoV infect intrapulmonary epithelial cells more than cells of the upper airways. As a result, transmission occurs mostly from patients with recognized illness and usually not from patients with minimal symptoms.  COVID-19 seems to work the same way.
  • The most serious symptoms involve the lower respiratory tract and lungs, as opposed to upper airways. The resulting disease is now called “novel coronavirus-infected pneumonia” or NCIP (NEJM, Feb. 20, 2020).
  • So far the clinical breakdown of cases is fairly predictable:
    • 80% are mild illness (requiring little or no care).
    • 14% are of moderate severity.
    • 5% are critical (requiring mechanical ventilation).
    • 2–3% are fatal.
  • U.S. cases – 35 (nearly all travel-related).
  • Italy confirms 152 cases around Milan with more than 200 cases throughout the country. South Korea confirms 833 cases after testing over 20,000 people.
  • The most vulnerable patients are older individuals and those with chronic underlying illness. (CAD, CHF, COPD, DM, chronic kidney disease).

So now what?  We wait for more facts.  The headlines will reflect a frustrating level of paranoia for another 2–3 months — at least.  Universal precautions in medical settings, careful personal hygiene, and common sense are always prudent. `

Don’t panic.  Don’t dump your investments.  Don’t overdo the caffeine.  And one more thing:  Everybody, please calm down.

 

Coronavirus – An Update

Posted Posted in Elder Care, Homestudy, Nutrition, Seminars, Webinars

By Mary O’Brien, M.D.

It’s progressing. We knew it would.

The novel coronavirus, just renamed CoVID 19, has surpassed SARS in the number of deaths caused.

The number of confirmed cases worldwide is 60,081 with 1363 deaths. Nearly 99% of cases are still in China and the mortality rate remains around 2‒3%. There are undoubtedly far more unconfirmed cases in China since large numbers of people are at home with mild to moderate symptoms, or even asymptomatic infection. Inadequate testing to confirm the virus or rapidly triage and admit patients to intensive care in Chinese hospitals appears to be a serious problem.

The Chinese physician who first recognized an outbreak of SARS-like illness was targeted and arrested for “rumor-mongering.” He was even forced to recant his story. Dr. Li Wenliang contracted the coronavirus and died last week. Even his death was denied by authorities for a day. Dr. Li joins a brave, dedicated, compassionate group of heroic physicians throughout history who succumbed to the very illness they were treating. His memory will be honored.

The only way to solve a serious problem is to address it in an open, straightforward manner. Secrecy rarely solves serious problems. We’ve all heard the old dictum, “Sunlight is the best disinfectant.” Fortunately, the President’s task force on the coronavirus has done an excellent job of educating the public, securing and screening ports of entry, coordinating distribution of viral test kits to U.S. labs, evacuating Americans from China, and quarantining appropriate people with possible exposure.

The CDC, NIH, and Department of Health and Human Services personnel are working nonstop to contain the virus and develop a vaccine and potential treatment. In the meantime, supply chain disruption is affecting car companies, tech firms, and even medical supply businesses. Many of our OTC and prescription medications, including antibiotics, are made in China. The FDA has evacuated our personnel who inspect these production plants. There may well be consequences in the coming weeks and months here in the U.S.

Meanwhile, we’re in peak cold and flu season. Fastidious hygiene remains key:

  • Wash your hands – frequently and with soap and hot water for at least 20 seconds.
  • Do not touch your mouth, nose, and eyes. Viral particles suspended in respiratory droplets can penetrate mucous membranes and conjunctiva very easily.
  • Maintain at least 6 feet between yourself and others (social distancing)
  • Avoid crowds and unessential travel
  • Get more sleep than you think you need
  • Stay home if you have cold or flu symptoms (and don’t lay a guilt trip on colleagues who are sick)
  • Disinfect hard surfaces frequently. This coronavirus can apparently survive on hard surfaces as long as 9 days. Phones, keyboards, bathroom fixtures, door handles, and steering wheels are just a few examples.

Seasonal epidemics triggered by a mutated virus can be devastating, but eventually they are contained. Until then, our job is to stay calm, stay informed, and practice the time-tested principles of good patient care and common sense.