With the rapidly evolving novel Corona virus (COVID-19) situation, I have hesitated to put out any further guidance as it has been changing day to day. At this point, the fear of ongoing spread to “pandemic” proportions and effect on international markets and travel warrant an update. I was fortunate today to hear a news conference with FDA officials and Dr. Anthony Fauci from NIH. Here is what I have to report:
The international death rate is somewhere near 2%. There have been over 77,000 worldwide cases identified.
The latest news of international spread has been an evolving epidemic in Iran that is expected to spread into other the Middle Eastern countries.
There are 14 confirmed US cases, 12 of which had international travel. Person to person community transmission has not been documented in this country. The 12 people that had been brought back from the Diamond Princess cruise line however were immediately quarantined. The two other U.S. infections were close familial contacts. These patients were aggressively quarantined in containment facilities in the University of Nebraska Medical Center.
Work on a vaccine has started and antigen-antibody responses in mice has been documented (the first step towards a vaccine). The start of any human trials is likely 3 months away at least and even with emergency fast-tracking, no distribution of a vaccine on a public health level can be expected for at least a year.
There are attempts at use of a Remdesivir, a drug from Gilead pharmaceuticals, to target COVID-19 in the 14 US hospitalized cased. No early data on the effectiveness of this drug is available to my knowledge. The drug had previously shown some mild benefit with the MERS (Middle Eastern Respiratory Syndrome) outbreaks of 2012 and 2015.
There are currently no shortages in containment equipment and medical supplies to support viral outbreaks (masks, suits, IVs, etc).
Speculations is that the virus will begin to spread in the United States. The effect of the spread is unpredictable. As the degree of illness from any infectious disease is related to several factors, we must look at what we can modify. These factors are:
- Host immune status – health and immune state of the target person. As such, elderly, babies, and people with poor health or on medications that compromise their immune state (chemotherapy, immunotherapy) will be at higher risk. Those healthy need to also think of their immune state. Get your sleep, stay hydrated, limit excessive alcohol, quit smoking, and eat good food.
- Virulence of the disease – This is the strength of the infectious agent not modifiable. This is unique to the COVID-19 virus.
- Viral load or exposure – Very simply this is the amount of viral particles at exposure time. This is modifiable. A full frontal cough in the face is a different exposure than grabbing a door knob that an infected person has touched. Simple infection control measures discussed in the first email are useful. Hand washing, hand sanitizers, wiping of door handles and shopping carts with cleanser, covering coughs, isolation of sick contacts, and even simple masks can decrease maximum exposure. In the office, we have ordered N-100 masks to protect staff and in office patients in the event of pandemics. (The WHO has a good reference for general infection control measures at this link – https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks ) During the upcoming weeks, minimizing exposure to large crowds, rescheduling travel, especially to endemic areas, and avoidance of sick contacts may be a prudent option until we understand this outbreak better. Keep your eyes on the news in case keeping children out of school or daycare is recommended. If local hospitals start to see cases, avoidance of elective procedures and unnecessary trips to the hospital might be advisable.
We have instituted office-based testing with viral panels for many people presenting with upper respiratory illness. Although Coronavirus is tested, I am not aware that this test can isolate the COVID-19 strain. I will find out if secondary testing will be done by this reference lab. In the meantime, if you have a viral presenting either as an upper respiratory infection or gastrointestinal (nausea, vomiting or diarrhea) and you are severely ill (weak, high fevers, short of breath), please call. We may direct you to a hospital-based ER which is a bit better equipped at this time to identify COVID-19. We continue to see a lot of run of the mill viral upper respiratory infections that have been caused by both Influenza A and B and some RSV. We will put out masks and sanitizer at the front door of the office for sick patients coming in with upper respiratory illness if the viral outbreaks are seen in the area.
This public health dilemma is changing rapidly. As such, there is some variability of recommendations even between reputable sites. We will promulgate more information as it becomes available.
In good health,
Dr. Long and Staff