By Mary O’Brien, M.D.
A pattern is emerging. Clinical and laboratory experience in several countries reveals that there are two strains of coronavirus (COVID-19). The virus is comprised of an unstable single strand of RNA that is mutating. This is known as antigenic drift and it is expected. Researchers have identified an “L” strain and an “S” strain. At present, the “L” strain appears to be associated with more severe symptoms and a higher mortality rate. More widespread and accessible testing (which is now underway) will help us discern which strain is prevalent in various regions.
The vast majority of deaths have occurred in elderly people with significant underlying illness. The cluster of patients in a nursing home in Kirkland, Washington, underscores the fragility of sick, elderly patients in enclosed settings. Outbreaks on cruise ships reflect a similar pattern of transmission. A large percentage of cruise passengers are over 50. People don’t like to think of 50 as older, but physiologically, it is.
Clinically, patients with more serious illness have a high fever (over 101°F), a deeper-sounding cough (not a tickle in the throat), and shortness of breath. The mortality rate in countries with good health care is around one percent. China and Iran are impossible to assess, but mortality rates there appear to be around 3.4 percent. Older men in China have very high rates of smoking, which is a crucial factor in both morbidity and mortality.
For now, several additional practices make sense:
- Minimize or restrict visitors to patients in hospitals and nursing homes. Sick, elderly people need to be protected.
- Frequent, thorough hand-washing with soap and hot water for 20‒30 seconds is best; hand sanitizers are second best. Keep your hands moisturized to avoid cracked skin.
- Don’t eat with your fingers; don’t lick your fingers.
- Keep your hands away from your face, eyes, nose, and mouth.
- Sanitize your phone everyday. It’s the filthiest thing you touch.
- Facial hair on men is a veritable Petri dish for microorganisms — especially among the nose, mouth, and chin. Now would be a good time to shave.
- Change your pillow cases everyday.
- Don’t waste your face masks. Surgical masks protect other people from your coughs and sneezes. They don’t protect you from others. Besides, many viruses penetrate our immune defenses through our eyes.
- Toss your toothbrush at least every month, and whenever you are feeling ill.
- Increase oral care with antiseptic mouthwash several times a day.
- Stay well-hydrated to optimize the integrity of mucous membranes.
- Let yourself and your patients get more sleep. Sleep is immensely important for multiple aspects of immune function.
The virus will evolve, and we will adapt. At some point, it will resolve. Right now, many people, especially those in the media, are overreacting. That is always a mistake. There has never been a substitute for reason, prudence, and common sense. Steady as she goes. How often can you say it?