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Covid-19 Bulletin #5

Covid-19

By now, the coronavirus pandemic is firmly embedded in our national consciousness.  The pandemic has infected well over 150,000 people globally, including–at last count–3,000 Americans and around 60 deaths.  The numbers keep climbing dramatically, and no one knows how many people are actually infected because our country lacks adequate testing.  Trump and his administration have tried to blame the lack of testing on Obama, but we all know this is not true.  Trump’s failure as a leader is entirely to blame.  Nonetheless, here we are with a dramatically changed life.  Most sporting events have been cancelled, along with concerts, museums, Broadway, cinemas, conferences, Disneyland, and other large gatherings of any kind.  Schools have been closed in many states, including NYC, the country’s largest school system.  Universities and colleges are moving from classrooms to online education.  France has closed restaurants, bars, cafes, and clubs across the entire country.  Italy is on lock down, and Spain has ordered its citizens to stay home.  Many companies in the U.S. have told their employees to work virtually.  Most cruise lines have shut down, and airlines have cancelled flights or restricted them to certain locations.  The lines at Costco and WalMart stretch around the block, and many store shelves are empty.  It’s nearly impossible to find hand sanitizer, toilet paper, paper towels, and cleaning products like Lysol and Clorox.  In one of the grocery stores in my hometown, men were seen stuffing grocery carts with nothing but bags of potato chips.  It seems the world has gone mad–and we aren’t anywhere near the peak of this pandemic yet.  

 

This is Covid 19 Bulletin #5 from Dr. Sheila Sund.  The news about Covid-19 has been so ubiquitous that the content of Dr. Sund’s bulletins has now become glaringly familiar to anyone who is paying attention.  However, it is to her credit that Dr. Sund began sounding the alarm weeks before the general public became aware of the potential severity of this outbreak.

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.

 

Chinook CERT Plus – COVID-19 Bulletin #5, March 9, 2020

 

Don’t focus on numbers

“Marion County confirms first case of COVID-19.” “Cases in Oregon double in one day.” When we see this, it triggers an acute feeling of alarm. But these numbers tell us nothing new—they reflect increased testing, not increased disease spread. That doesn’t mean the risk isn’t real. It’s just confirmation of what we should have already known—COVID-19 is “here.”

So far, we have no way of knowing where we are on the growth curve – day 5, 15 or 30. Our best clue will be increasing cases identified in Marion County hospitals. In the meantime, your best action remains hand washing, disinfecting, and minimizing time spent in large groups, particularly if you are older or have underlying medical problems.

Most importantly, if you feel sick, STAY HOME, even if you suspect it’s just a cold or the flu! If possible, isolate yourself even from family members until symptom free for 24 hours.

 

We’re all going to get it, so let’s just get it over with. FALSE!

I’m hearing this sentiment more and more, but it is incorrect. It’s true that most people will get through this pandemic with just a week or two of illness. But in the meantime, COVID-19 could decimate the population over age 70.

Age US population Fatality rate Potential deaths
70-79 23 million 8% 1.8 million
80 and above 13 million 15% 1.9 million

(Based on current COVID-19 estimates)

For comparison, annual seasonal flu deaths in the US 2010-2019 ranged from 12,000 – 61,000.

Most deaths occur after 1 or more weeks in the hospital. So even if you feel callous about this specific demographic group, their use of medical resources will affect everyone. The more we can slow the spread of coronavirus, the better off everyone will be.

 

Mitigation Instead of Containment

The goal of mitigation is to decrease the expected number of new cases infected by one current case (the reproductive number). If it drops to less than one, the pandemic fades away. In practical terms, mitigation is anything that decreases interpersonal contact in the community, including cancellation of group gatherings, work and school closures, isolation of known cases, and even limitation of travel or quarantine of entire communities.

Yet we can’t really enforce mitigation in this country. Ultimately, it comes down to individuals choosing to put the good of the community over their personal interests, despite economic or social hardship.

If someone is exposed to a confirmed case, they may be instructed to implement one of the following measures immediately. Prepare yourself and your family now!

Exposed, but no “close contact” AND no symptoms:

  • Social isolation – no group gatherings, maintain 6 feet boundary from others. Shopping allowed.
  • Self-monitoring – watch for any signs of illness, possible required temperature checks
  • Active monitoring – public health assumes responsibility for conditions of your isolation and monitoring

Exposed with close contact, but no symptoms:

  • Quarantine, usually at home, for 14 days. No contact with family members or pets. Use separate bedroom and bathroom. Wear mask whenever other people are present. If symptoms develop, 14-day clock resets.

Close contact: being within 6 feet of an identified case for “prolonged” time OR having direct exposure to their respiratory secretions (e.g. coughed or sneezed on).

Exposed and symptomatic, or become symptomatic during self-isolation or quarantine:

  • Isolation, usually at home, for 14 days minimum, under same criteria as quarantine.

 

Other Preparedness Tips

There is no need for a run on the grocery stores or Costco, but if there are things you need or chores you should be doing, it’s time to stop procrastinating. Do them now. The more “caught up” on life you are, the better prepared you will be for any sudden changes.

Manage COVID-19 anxiety!

  • Limit time spent reading about and planning for COVID -19
  • Use reliable sources and avoid social media discussions
  • Continue to follow normal routines as much as possible
  • Take time for reality checks:  What is happening in your life now, not what may happen in the future
  • Do deep breathing or meditation

Perform meaningful actions:

  • Prepare guest bedrooms
  • Organize emergency supplies
  • Think of enjoyable things to do even if social isolation imposed
    • Catch up on book reading
    • Time for home projects, crafts, or gardening
    • Family time
    • Time in nature
  • Address COVID-19 anxiety in kids and teens -what are they reading or hearing in school?
  • Share NPR’s “Just For Kids: A Comic Exploring The New Coronavirus

 

Photo credit:  ID 175225651 © Photovs | Dreamstime.com

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Covid-19 Bulletin #4

This is Covid-19 Bulletin #4 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 (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.  As of today (March 3, 2020), more than 130 Americans have been diagnosed with Covid-19, and ten have died.  The numbers are growing daily.

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.

 

Chinook CERT Plus – COVID-19 Bulletin #4, March 6, 2020

COVID-19 vs Seasonal Flu

Without a doubt, seasonal flu is a huge health problem. United States experts estimate 32 million cases and 18 thousand deaths from flu – just this year!

But as a virus, flu is “nicer” than COVID-19. A flu patient on average infects only 1.3 other people vs COVID-19’s 2.3 people. Functional time lost from flu averages about 3.5 days, whereas patients with COVID-19 may be sick for 7-14 days. The hospitalization rate for flu in the United States sits around 1% and the death rate rarely exceeds 0.1 %, whereas worldwide estimates for COVID-19 currently stand at 15% hospitalized and 3.4% dying.

Although these numbers are definitely overestimated because of testing patterns, they are still much higher than flu. And while both illnesses are disproportionately bad for older, sicker people, COVID-19 also seems to sicken and kill younger people at higher rates than seasonal flu.

Most importantly, as a society, we’re “used” to flu. Healthcare systems are prepared for it and there’s a reasonably effective vaccine. >55% of the population is fully immune in any given year. Ultimately, most healthy people consider flu an annoyance, not a problem. But we are not used to COVID-19, it is spreading rapidly, and we are definitely not prepared.

Medical Surge from COVID-19

Many parts of the United States healthcare system are overburdened at baseline. They are not capable of handling a rapid increase in very sick patients from COVID-19.

Using Marion County, Oregon, as an example:

  • Licensed hospital beds:  ~550  (~500 at Salem Hospital, one of the four largest hospitals in Oregon).
  • Average occupancy Salem Hospital (2018):   80%  (During flu season, this number can reach 100%).
  • Average “available extra beds” for COVID-19:  ~110.

If we assume 10% of patients require hospitalization, our “extra” beds could be filled by the time we have 1000 local cases (the current estimated number in Seattle).  Although that’s about 45 days from the first local infection, it’s potentially only 10-15 days from the time a local outbreak is first recognized. Care may also be limited by limited critical care beds, ventilators, sick hospital staff, and shortages of supplies and medications.

Meanwhile, at the clinic level, staffing drops from illness, quarantine—and parents staying home with kids when schools closed. At some point, healthcare for all patients could deteriorate, even if they don’t have COVID-19. And that’s one big reason why I personally am far more concerned about COVID-19 than seasonal flu!

Community Spread of COVID-19 – What should you do?

We will not know when COVID-19 arrives here. In fact, it might be here already, given the major outbreak a few hours north. Once in the community, it will spread. Most of the time, you will not know who is sick. It just becomes a game of odds—and your personal approach to risk!

Example: Marion County, Oregon – population ~ 350,000

 

Days into cluster

~Number of cases

~% of county infected

Day 0 (1st patient)

1

Day 30

100

0.03%

Day 45

1000

0.3%

Day 60

8000

2.3%

Day 75 65000

19%

 

No hospitalized patients have been identified in Marion County yet, so we are probably earlier than day 30 which means your odds of picking it up in the community are extremely low. Once it is identified, there may be another 30 days before community risk starts to climb significantly.

Risk will always be higher from what you’ve touched than who you are with—an object carries the risk of everyone who touched it since the last time it was disinfected.

 

COVID-19 Caution Spectrum – it’s your choice where you fall on it

  • Gambler:  Go about your business normally. The odds are in your favor.
  • A Little Cautious:  Follow recommended hand washing and avoid hand contact with others.
  • More Cautious:  Add cleaning and disinfecting routines.  (Particularly objects and settings where things are touched by many people.)
  • Getting Anxious:  Add avoidance of settings with multiple people within 6 feet for >15 minutes.  The greater the number of people together, the greater the risk
  • Quite Anxious:  Add gloves in stores, no group gatherings, work from home
  • Paranoid:  Minimize contact with people

For significant underlying medical conditions or over age 80, move up the caution spectrum!

AT ANY CAUTION LEVEL:  IF YOU FEEL SICK, STAY AWAY FROM PEOPLE UNTIL ASYMPTOMATIC FOR 24 HOURS!!!!

            Do not work. Do not go to school. Minimize contact with family members.

            Wear a mask around others if available (keeps you from spewing germs).

Many cases of COVID-19 will be mild and symptomatically similar to flu and other viral illnesses, yet much more contagious. You can’t tell if you have COVID-19 or a different infection, but you could be spreading it if you go out in public.

If everyone with mild symptoms stays home until better, community spread will slow.

 

Photo credit:  ID 174295771 © Buddhilakshan4 | Dreamstime.com