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Dealing With The Coronavirus (COVID-19) Outbreak

Authors:
Amar Patel, MD, Stacy Patel, RN, Michael Cantor, DO, Atish Patel, MD

Who are we?

We are a group of physicians and health care personnel that span multiple medical specialties.  We understand the confusion, misinformation, and lack of guidance that exists with the current outbreak of COVID-19 and our goal is to provide some background information on this disease along with real-life, actionable information to the public as we face this national health crisis. 

Introduction & Purpose

COVID-19 is here and the world in panicked. 

We are in the midst of an infection that is taking the world by storm.  What the the media is referring to as “coronavirus” is known in the medical community as SARS-CoV-2, which causes a severe respiratory illness called COVID-19 (“Corona Virus Disease-2019”). 

Coronaviurses are a large family of viruses and doesn’t refer to any one specific viral disease.  In fact, there are many coronaviruses that are responsible for the common cold in humans, and others which cause only infections in animals.  In rare instances, an animal corononavirus can transmit to a human, and then begin to spread amongst people. This what we suspect happened with the current COVID-19 outbreak, with the disease originating in bats.   

The primary issue at hand is that this that SARS-CoV-2 is a NEW virus in humans.  No one has previously been exposed to it. What this means is that no one has any innate immunity to this novel virus.  There is currently no vaccine for this virus. We only have data from the exposure of this virus to people in China, South Korea, and Italy, some of the hardest hit countries thus far. 

What’s the course of this disease? 

We are hearing that COVID-19 is “just the flu.” It’s not – its 10x deadlier than the common flu.  Overall, it appears that COVID-19 has a mortality rate (the percent of those killed due to infection) of 0.6% to 1%. In addition, it appears much easier to transmit from person-to-person, infecting a greater number of people then other viruses.    

Symptoms of COVID-19 share some characteristics with the common cold and flu: fever, chills, sore throat, cough, sputum production, headache, fatigue, and muscle aches/pains. One differentiating factor between the flu and COVID-19 is the presence of shortness of breath.  

Many people with COVID-19 will have mild symptoms consistent with a common cold and flu.  However, anywhere from 10-20% of people will require hospitalization due to severe symptoms, primarily due to the development of pneumonia and the development of severe lung failure, called ARDS (Acute Respiratory Distress Syndrome).  The disease has an overall fatality rate of 0.6% to 1%. 

More importantly, COVID-19 is more likely to affect those older than 60 and those with pre-existing conditions such as diabetes and COPD.  

Am I at risk?

Yes! You are.  Everyone is, unfortunately.  

What’s the big deal?

The issue at hand is something we call “systemic healthcare failure.”  We have limited resources. Our healthcare system can only take care of a finite number of patients at anyone time, particularly those who need critical care such as ventilators and breathing tubes. 

Given what we know of this disease from China, Italy, and South Korea, this disease has the potential to overwhelm our healthcare system and cause it to collapse.  Hospitals will become inundated with COVID-19 patients, many of whom will require ICU level care. This reduces the number of resources available for traditional emergencies – such as appendicitis, strokes, heart attacks, and motor vehicle accidents.  Thus, the system experiences a complete failure and unable to manage the influx of patients from COVID-19 and from other emergencies – further increasing the mortality rate not just from COVID-19, but from other emergencies as well! 

We need to “flatten the curve.” See Figure 2.

WHAT SHOULD WE DO? FLATTEN THE CURVE

The single most important act we can do is called “social distancing.” The virus is here and is likely here to stay for some time.  What we HOPE to achieve is limit the transmission of the virus from person-to-person. We can do this by limiting our exposure to and from anyone else, with or without the disease. WE HAVE TO ISOLATE OURSELVES NOW. 

By isolating, even if you are healthy, you limit your ability to get the infection and transmit it to the less healthy.  You could be saving the lives of countless people by starting to limit your exposure now, as difficult as it may be. 

The US Healthcare has a robust network of Intensive Care Unit (ICU) beds to treat those that get severely sick from COVID-19. The exception, however, is when the system is overwhelmed, resulting in a “systemic healthcare failure.” But what if we can delay and prevent some cases of COVID-19? This is what social distancing attempts to do.  By reducing the transmission of this disease, we prevent the healthcare system from imploding from an influx of sick patients. This spreads out sick people over a greater period of time – allowing more people to be treated and, thus, survive. We “flatten the curve” as seen in Figure 2.

WHAT CAN I DO NOW? 

ACTIONABLE STEPS: 

  1. Isolate yourself now. Everyone should be attempting to isolate.  Stay at home as much as you can. Do not go to parties, restaurants, or bars. You will reduce your likelihood of getting the disease and transmitting it to other. 
  2. Wash your hands with WARM, soapy water often throughout the day. 
  3. Stop touching your face.  We are inclined to touch our face throughout the day so it’s a difficult habit to bread.  But touching your face dramatically increases the likelihood of contracting COVID-19 if there are any viral particles on your hand. 
  4. Disinfect commonly touched areas in your home – such as light switches, door handles, your toiled including the flush
Figure 1
Figure 2

References: 

  1. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html
  2. https://www.kevinmd.com/blog/2020/03/a-covid-19-coronavirus-update-from-concerned-physicians.html
  3. New data suggests that the median incubation time of COVID-19 is 5.1 days. Website: https://www.marketwatch.com/story/novel-coronavirus-has-a-longer-incubation-period-than-other-human-coronaviruses-that-cause-the-common-cold-study-finds-2020-03-09?link=sfmw_tw
    • Researched at Johns Hopkins Bloomberg School of Public Health 
    • Other Coronavirus’ that cause common colds have mean illness-includation periods of about 3 days. 
    • The incubation period directly influences how fast an outbreak spreads.  IE if people get sick sooner, they obviously won’t be working, shopping, or flying on airplanes, and thus, less likely to spread the virus. 
    • Unfortunately, what this means is that there are likely people walking around with no symptoms or very mild symptoms, without realizing that they were carriers of the disease

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