As a mother of two small children and close relation to people who might be in denial that they fit into a higher risk category, I’ve been watching the news just like everyone else, wondering what’s to come. Though some may disagree with me, we are likely facing a national shutdown (perhaps state by state). While writing this, I’ve received three updates: President Trump has declared a national emergency, Governor John Edwards of Louisiana, where I live, signed a proclamation closing schools and banning gatherings of more than 250 people through April 13th, and Louisiana postponed its April 4th presidential primary. Updates are happening so rapidly that it’s hard to keep up.
Life as you know it is canceled until further notice
Since January 21st, 2020, when the Centers for Disease Control and Prevention (CDC) and the Washington State Department of Health announced the United States’ first case of novel coronavirus (COVID-19), states around the nation have been on alert, with some on the highest level of emergency response. Initially, communities simply shared with residents ways to prevent the spread of the virus but mostly continued business as usual. Here in New Orleans, it quickly shifted when presumptive cases became identified and later confirmed. On March 10th, LaToya Cantrell, New Orleans’ mayor, held a press conference, canceling the St. Patrick’s Day parade, Mardi Gras Indian Super Sunday, and Wednesday at the Square, a weekly live music event. Many New Orleanians weren’t happy; they felt the reaction was overblown, a result of news media fear-mongering. Some participants of the canceled events noted on Facebook that gatherings would take place in lieu of the events. The message was clear: their celebration would not be stopped. It’s only three days later, and already the tone has changed. The World Health Organization (WHO) announced on Wednesday that the virus is now a pandemic, making it the first coronavirus to become one, according to Tedros Adhanom Ghebreyesus, the WHO’s director-general. The number of identified global cases are rapidly rising, which are being tracked on a useful interactive map developed by the Johns Hopkins Center for Systems Science and Engineering. As of this writing, there have been 137,445 confirmed cases in 117 countries, of which 69,779 have recovered, and 5,088 have died.
People in the United States have been vacillating between thinking the dangers of the coronavirus are an exaggeration and buying all the hand sanitizer, rubbing alcohol, water bottles, and toilet paper available at stores. Friends have shared photos of empty product aisles at Safeway, Walmart, Target, Trader Joe’s, and Whole Foods. Online, Amazon prices skyrocketed with vendors charging $400 for 24 masks or a two-pack of two-ounce Purell. On Wednesday, March 11th, the Verge reported that Amazon responded to price gouging by restricting vendors who sell health and sanitation products and no longer accepting applications to sell “disposable face masks, hand sanitizers, disinfecting wipes/sprays, isopropyl alcohol or related products.”
The novel coronavirus is well, new—there is much we do not know—but infectious diseases are not. Like many parents of young children, I get to frequently witness how quickly viruses can spread. Just a few weeks ago, we were celebrating my daughter’s birthday at Disney World when my son fell ill with a stomach bug, which I suspect was the norovirus. In our Disney resort hotel room, my son vomited every 20 minutes for 6 hours. We’d been at Disney just 72 hours. The next day he seemed better. A day later, my husband fell ill, and by two a.m. the following day, I was down too, hugging the toilet and wondering when it all went wrong and what I could’ve done differently. Outside of taking the kids to the bathroom between rides to wash their hands, there wasn’t anything else we could have done except to avoid exposure by not going to the theme parks in the first place. It gave me an unwanted example of how rapidly viruses can go from person to person, and how one person’s experience with that illness is not identical to that of another.
Handwashing is best
During our trip, I used hand sanitizer on my children before eating and after rides. Hand sanitizer, it turns out, is nearly ineffective against the norovirus. Handwashing is far better to protect yourself and loved ones from infectious diseases, though hand sanitizer is a good tool to combat the coronavirus if you have no other option. Unlike the norovirus, the coronavirus has a lipid envelope, which is the weakest component of the virus, and soap can dissolve it, inactivating the virus. As I did, you may think you know how to wash your hands, but this video by the National Health Service, the publicly funded healthcare system of the United Kingdom, throws in some moves that were new to me.
Washing your hands takes 20 seconds—the CDC recommends humming the Happy Birthday song twice from beginning to end though there’s some competition out there on the best song to sing—and a bar of soap works just fine; there is no evidence that antibacterial liquid soap is better. If you don’t have access to a sink, the CDC recommends using an alcohol-based hand sanitizer with at least 60% alcohol. If your hands are visibly dirty, find some soap and water. People are getting super creative with handwashing songs. Here is my favorite one so far:
Two weeks after our trip to Disney—what are the odds?—at least four children in my son’s class, including my son, have confirmed cases of Type A flu. Schools around the country are on high-alert because of the coronavirus, and my children’s school is no different. His teacher is already adamant about handwashing, but alarm over the virus boosted it even further. She gave extra instruction on proper hand cleaning and the duration it takes. My son came home sharing how germs spread, and he showed me what he learned. Despite her best efforts, the flu is taking over her classroom. (And yes, before you ask, he had the flu vaccine.) I’m not saying this to indicate that precautions don’t matter, they do, but to highlight that even in the best of circumstances—and with the most vigilance—viruses can spread. That’s why we keep hearing the phrase ‘social distancing,’ which is vital to stop the spread of the coronavirus because it takes away the virus’ opportunity. (Now my oldest kid has the flu! Viruses, just like us, want to keep on living, and this is how they do it.)
What is the novel coronavirus?
Outside of the basics and what is obvious—wash your hands, stay home if you are sick, sneeze into your elbow—what we know about the coronavirus is there is a lot that we don’t know. Here’s what we do: the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes the coronavirus disease COVID-19. It’s part of the coronavirus family, which, when examined under an electron microscope, look like they have a ring of light like a corona. The common cold is a coronavirus, and so is Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). Coronaviruses change and mutate quickly, presenting therapeutic and diagnostic challenges. Meaning, by the time a vaccine is created, the virus may be on its way to a whole new look. They are also zoonotic, which means they can spread between non-human vertebrate animals and people. While many researchers suspect the source of exposure was the Huanan Seafood Market in Wuhan, China, some don’t, they are still searching for patient zero and trying to find what animal passed it along to us. This matters because it can lead to intervention. The South China Morning Post published that Chinese authorities identified a man who had the coronavirus in November though that doesn’t mean he was patient zero. It does indicate that the person was ill more than a month before health authorities were put on alert of a new coronavirus.
What kills it?
As I mentioned before, the novel coronavirus has a lipid envelope, which handwashing can dissolve, rendering the virus inactive. That said, it can remain viable on surfaces and in the air for quite a while. A new study—it hasn’t been peer-reviewed yet—found that the virus was still viable in the air 3 hours later, on copper for up to 4 hours, on cardboard for up to 24 hours, and on plastic and stainless steel for up to 2 to 3 days. The CDC gives instructions on cleaning, and if a person is ill, how best to avoid spreading the virus from person to person in a household. For cleaning, the institute recommends wearing disposable gloves and using diluted household bleach or a product with at least 70% alcohol for hard surfaces.
How contagious and lethal is it?
The experts don’t yet know precisely how contagious or deadly the novel coronavirus is. At the moment, the basic reproduction number (RO) is believed to be 2.2, which means an infected person, on average, will likely infect 2.2 other people. People who are identified are mostly symptomatic, which means there may be a significant number of people without symptoms who don’t know they have it. Of those identified on the map, roughly 50% have recovered, and 3.7% have died. An article in Stat looked at demographics in identified cases in Wuhan, noting that the China Center for Disease Control and Prevention reported that 87% of people identified with the novel coronavirus as of February 11th were ages 30-79. The WHO found that 78% of cases identified in China by February 20th were ages 30-69. China’s CDC reported the following fatality rates:
Young doctors on the front lines in China have also died, drawing concern because they are healthy and in their 20s and 30s. Healthcare workers are overworked, exhausted, stressed, and disproportionately affected by pandemics. At the end of January, as the battle against the novel coronavirus was in full gear in Wuhan, the Washington Post reported that hospitals were not only experiencing shortages of beds and staff but also gloves and masks. The novel coronavirus is also highly contagious and, because they are working with many people who are ill with the virus, medical workers are exposed to more “virus particles” than the general population. Additionally, there are cases of people recovering, testing negative, and then displaying symptoms again, but they are rare.
Nearly 50% of the 109 identified people with the novel coronavirus treated at Central Hospital of Wuhan—ages 22 to 94—developed acute respiratory distress syndrome (ARDS). The Mayo Clinic says that it’s “when fluid builds up in the tiny, elastic air sacs (alveoli) in the lungs,” which prevents the lungs from filling with sufficient air, resulting in less oxygen for your bloodstream. People who survive can recover entirely from ARDS or experience lasting adverse effects. Stat reported that 50% of the people who developed ARDS died compared to 9% of those who didn’t. Comorbidities (chronic diseases or conditions) such as cardiovascular disease, diabetes, chronic respiratory diseases, hypertension, and cancer also raised the risk of dying. About 60% of people in the United States have at least one underlying condition, and 40% have more than one.
Is there a cure?
Not yet. People are comparing the novel coronavirus to the flu, but there are numerous vital differences. We have vaccines and antiviral medication tailored to the flu. That doesn’t yet exist for this new virus. What’s more, is that coronaviruses are tricky to pin down; they have a habit of mutating and changing rapidly. There are doctors worldwide who are trying other antivirals on a compassion use basis to see if they will help people who have the novel coronavirus. This includes remdesivir, a broad-spectrum antiviral that was developed by Gilead for use against Ebola, though some researchers have concerns about its efficacy for the novel coronavirus and its adverse effects.
Social distancing and stop touching your face
To mitigate the spread of the novel coronavirus, the CDC has recommended social distancing. Communities and employers can choose steps that best fit the level of infection in their area. It can range from reducing the number of large gatherings to canceling school for a couple of weeks to six weeks or more, implementing online school, and working remotely. The CDC gives strategies for households, schools and childcare facilities, employers, assisted living and senior facilities as well as adult programs, healthcare settings, and community and faith-based organizations. Social distancing, avoiding crowds, limiting travel, and frequent and proper handwashing can limit the spread of the novel coronavirus, which reduces the risk of overwhelming our healthcare system. Taking these measures will save lives.
You also need to stop touching your face. Apparently, this is a problem for me. I timed myself, and the longest I could go without touching my face was 5 ½ minutes. I don’t even know who I am anymore. Another mitigating measure is to put distance between you and another person—more than six feet. (I gave this explicit instruction to my six-year-old who responded by climbing his fevered self onto my lap.)
Okay, I’m not going to lie, this category sent me down a rabbit hole looking at atypical symptoms. The WHO identified the following symptoms in 55,924 confirmed cases during their mission to China. Symptoms include:
- Fever: 87.9%
- Dry cough: 67.7%
- Fatigue: 38.1%
- Sputum production (phlegm, thick mucus, not saliva): 33.4%
- Shortness of breath: 18.6%
- Sore throat: 13.9%
- Headache: 13.6%
- Myalgia (muscle pain) or arthralgia (joint pain): 14.8%
- Chills: 11.4%
- Nausea or vomiting: 5%
- Nasal congestion: 4.8%
- Diarrhea: 3.7%
- Hemoptysis (coughing up blood or blood-stained mucus): .9%
- Conjunctival congestion (engorgement of the posterior conjunctival arteries and veins. Basically, red eyes): .8%
If, after reading this list, you’re asking yourself, ‘Huh, do I have the coronavirus?’ you aren’t alone. Some of the main symptoms of the flu and common cold are fever, cough, fatigue, phlegm, and shortness of breath. The CDC recommends that people call their healthcare provider for medical advice if they “have been exposed to COVID-19 and develop a fever and symptoms, such as cough or difficulty breathing.” The problem is that people are testing positive who were not aware they’d ever been exposed to the virus. That’s why, on March 4th, the CDC broadened its criteria to not only include people who had a fever or signs of lower respiratory illness like cough or shortness of breath and epidemiologic risk like having recently traveled to a country with an outbreak or having had close contact with a laboratory-confirmed patient. Today, theoretically, a doctor can simply order a test for a person who fits the clinical criteria, but many states and communities still rely on the more stringent, now defunct, criteria. Some cities have set up drive-through testing sites modeled after those in South Korea, a nation where tests are free and take no more than 10 minutes, and results are typically texted the following day. Among cities doing so are Denver, San Francisco, Hartford, Seattle, and New Rochelle.
The situation is changing rapidly. In less than a week, communities have gone from business as usual to shutting down schools and activities. Yours may not be there yet, but for those of us living this new reality, it comes with numerous challenges. Thankfully, people are incredibly creative and already coming up with ways to make the best of a situation most of us have never seen in our lifetime. The Metropolitan Opera is offering live HD “Nightly Met Opera Streams” on its website during the coronavirus closure, and Google has teamed with museums and galleries to allow us to experience online exhibits and virtual tours. If you’re not sure how we are going to get through this and need some inspiration, listen to people in Italy singing with one another from their balconies and windows. It’s beautiful.
If you want to know whether kids who are quarantined lose their sense of humor and mischief, check out this tweet by journalist Mike Bird. “In locked down Wuhan, teachers use an app called DingTalk to set homework. Kids realised if it got enough one-star reviews it would be removed from App Store. Thousands of reviews flooded in, and DingTalk’s rating fell from 4.9 to 1.4 overnight. Legends.”
We are a community and must protect those most vulnerable
We will get through this together. To help, we have created a tab that we will keep packed with updated information on tricks for working from home, fun activities, and updates on what’s happening with mental health crisis during this time. If you have ideas, questions, or information you’d like to share, please email me at firstname.lastname@example.org. We also aim to write a similar piece to this one related to the work of crisis staff who are navigating this challenging time. If you have an experience you’d like to share, please reach out.
-Stephanie Hepburn, editor in chief of #CrisisTalk