This is Covid 19 Bulletin #1 from Dr. Sheila Sund. Covid 19, which is the proper name for the coronavirus that is currently spreading around the world, is a far more dangerous virus than the flu. Despite what Donald Trump said on television several days ago, Covid 19 is twenty times more lethal than the flu, and it is likely that the rate of infection is much greater than what is known and being reported by the media–because no one knows how widespread the infection actually is.
Dr. Sheila Sund is a retired hospice and palliative care physician in Oregon. She became involved with disaster medicine following the H1N1 influenza outbreak in 2009. As part of a statewide workgroup, she helped developed Oregon’s Crisis Care Guidance—guidelines to direct healthcare response during a public health crisis such as pandemic or mass trauma. She served as Director of the Marion County Medical Reserve Corps and physician representative on Oregon’s Region 2 Coalition for Healthcare Preparedness. She has given over one hundred presentations to community, healthcare, and business groups throughout the Pacific Northwest on topics ranging from earthquake preparedness to pandemic response.
On February 28, Dr. Sund published the following bulletin on Covid 19, and she has graciously allowed me to reprint it on this blog. As she publishes future bulletins on Covid 19, I will reprint them here as well. Stay tuned.
Chinook CERT Plus – COVID-19 Bulletin #1, February 28, 2020
How bad is Covid-19?
Based on evaluation of 72,000 cases in China:
“Mild” symptoms (not hospitalized): ~81%. Mild cases can still be sick for up to 14 days
Serious illness (hospitalization): ~14%
Critically ill (intensive care): ~5%
Fatality rate ~2% overall. < 1% if young and healthy, 14.8% if age 80 or above
My note: serious illness does not usually occur until the second week of the illness
Covid-19 is already a pandemic by the traditional epidemiology definition:
Uncontrolled spread of an infectious agent on at least two continents
My note: there are strong social/political/economic reasons why official organizations and governments avoid labeling something as a pandemic – even when it is!
Official case counts are misleading, both in the United States and internationally. Patients are counted only if they have a positive test, yet:
- The availability of testing is limited in many places
- Testing is limited to the sickest patients or those with known case contact
Before Feb 27, a sick patient could only be tested in the United States if they had visited China or had contact with a known case. On Feb 27, criteria were expanded to travel from six countries, but otherwise, patients without known exposure can still only be tested if they are not just hospitalized, but critically ill.
My note: Given the rapid spread of cases around the world, it seems highly likely there are already clusters of infection with community spread within the United States. However, with current testing limits, these will not be identified until someone within the cluster becomes critically ill (such a patient was identified just today in Lake Oswego). Given the typical time course of the illness, these patients will already have been infectious for at least seven days.
Personally, I am taking this illness very seriously. I implemented my family’s infection control plan this week, which affects four households (including one in Lake Oswego!). I’m working on putting it all in writing, and then will share with you. But in the meantime, here is the most important tip of all – WASH YOUR HANDS! (Read on.)
YOUR COVID-19 PREVENTION TIP OF THE DAY
WASH YOUR HANDS, WASH YOUR HANDS, WASH YOUR HANDS.
Hand washing instructions (yes, there is a correct way!)
1) Wet hands with clean, running water (warm or cold), turn off tap, and apply soap.
2) Lather hands and rub front and back to wrists, between fingers, and under nails
3) Scrub hands for at least 20 second (hum “Happy Birthday” twice)
4) Turn faucet back on and rinse your hands well under clean, running water.
5) Dry hands using a paper towel
Hand washing at home
Pump liquid soap at every sink
Does not need to be antibacterial
Use paper towels even at home during times of increased infection risk
Damp hand towels can harbor germs
Dispose of paper towels in non-touch trash can – foot pedal, magic hand wave. Not inside cabinet
Use hand cream frequently
Hand washing in public
Gather paper towels before washing hands
Use one paper towel as barrier from counter – set other towels on it
Wash hands as above, drying completely with paper towels
Avoid touching public surfaces after hand washing
Use paper towels to turn off sink, open trash cans, and open doors
Option: Ziplock bag with hand soap, paper towels, and hand sanitizer for public use. Keep plastic bag “clean” – store inside purse/bag
No touch public surfaces – set on paper towel
When to wash hands in pandemic
Every 1-2 hours when out of home in public
Before leaving public location – avoid contaminating your car
As soon as you enter house (touch as few things as possible first)
Before touching any food, including packaged snacks or restaurant food
After contact with potentially contaminated things in home (groceries and supplies, outside door knobs, shoes, backpacks/purses)
Toilet, etc – just like always
Use only if you can’t wash your hands! Why? You can’t disinfect something that is dirty!
Germs hide in oils and grime…and hands get dirty very quickly.
Sanitizers work best if hands are clean
Sanitizers must be at least 60% alcohol
Rub gel over all surfaces of hands and fingers until dry (~20 seconds)
Photo credit: Coronavirus (ID 171082256 © Dgmate | Dreamstime.com)