CORONAVIRUS INFO FOR MY FAMILY AND FRIENDS (and now YOU!)
***This document was last updated on 18 March 2020 and is NO LONGER BEING UPDATED***
Words in green are explained in the glossary. Ping @TheOriginalBrk to suggest an update.

Thanks to Jenny Brooks for fact checking and being an incredible human. This is a US perspective.

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Hi friends,

My name’s Brooke Jarrett. I'm a doctoral candidate in infectious disease epidemiology at Johns Hopkins. I speak for myself, not them. I do HIV research and have studied public health for 4.5 years. I’m not an expert on *respiratory* diseases, but I’m trying to absorb reliable information on the coronavirus disease (COVID-19). On Feb 26, I was inspired to start collecting this info to help my grandma consolidate what she was hearing on the news.

In the next four pages, I summarize info from trustworthy sources: the WHO, the CDC, Johns Hopkins, and peer-reviewed scientific articles. The document is an overview of what is known and what you can do to prepare for its spread in the US. Remember, protect yourself AND your community. If I make an assertion based on a personal opinion, I will say so.

Before you share information about the pandemic, please FACT check it with the above mentioned sources. Yourself. Even if it looks right-ish or comes from someone you trust. If the info/article/blog is more than 3 days old, ask yourself whether it is still applicable. If it cites social media or Wikipedia for critical info, consider whether it’s real. Finally, ask yourself who wrote it — do they have expertise (e.g., a reporter who specializes in science and health)? Do they quote relevant experts (e.g., an infectious disease doctor vs. an anesthesiologist (who are still important!))?

To clear up misinformation I’ve heard:

  • At first, you cannot tell COVID-19 apart from the flu. It has many flu-like symptoms.
  • COVID-19 can spread when you’re in close contact with a sick person (3-6 ft) — and that doesn't mean noticeably coughing or sneezing on you — I mean talking to you.
  • This is not the flu. It’s a different virus. It is more deadly and spreads more easily. The flu has a vaccine, a stockpile of tests, and treatment options. COVID-19 does not.
  • Only take medications if your doctor says so. There is NOT YET an approved treatment.
  • 15-49 year olds can still contract it and get seriously ill. Of 1,099 early cases of COVID-19 hospitalized in China, 55% were 15-49 years old.

AFTER you’ve fact checked me (esp. If you don’t know me), feel free to share 😘

(yes, this is probably an inappropriately happy gif, but like... We don’t need to suck the fun out of everything, do we?!)
P.S. I use the term “COVID-19” throughout. Technically that’s the name of the disease and SARS-CoV-2 is the virus.

First, COVID-19 is a totally new (novel) disease. Knowledge on it is evolving quickly. Many basic facts are unknown. Public health professionals are doing their best to make smart decisions using their experience and incomplete info. Lean on trustworthy sources.

Example: the news inaccurately reported COVID-19’s observed “reproductive number” (R)* was 3.5 (so, for every person with the virus, they will infect 3.5 new people on average). Not what science says. More likely 2.5. And in fact, click on this link. You can see that it’s still being studied. The R0 of flu is 1.5 – 2. Measles has the highest of 12 – 18.

Second, COVID-19 is somewhat like influenza.

  • Two key differences: Early data show COVID19 being more deadly (COVID-19 vs. flu) and more easily spread (COVID-19 vs. flu).
  • Two key similarities: The diseases are spread in similar ways (COVID-19 vs. flu) and cause similar symptoms (COVID-19 vs. flu). When people with sneeze, cough, or talk, they produce droplets that land in mouths, eyes, or noses nearby (i.e., 3-6 feet). People can also leave the viruses on objects like doorknobs and other frequently touched surfaces. You can infect yourself by touching those objects and then touching your mouth, eyes, nose. Both can be spread before someone feels sick (presymptomatic transmission).

Third, the WHO says COVID-19 is a pandemic (10:10 in video). A pandemic is the worldwide spread of a new disease. Pandemic, as a word, does not say anything about severity. This may sound scary… and it is. I’m afraid too. Sadly, at the onset of any outbreak, there’s lots of politics, misinformation, and fear mongering. Panic doesn’t help. Instead, take steps to prepare yourself and your neighbors. YOU have an opportunity to act now and share useful information.

What can I do — TODAY? Be hygienic and stay away from people who are sick

  1. Find and follow the local guidelines from your city, county, and/or state. As COVID-19 continues to spread in the US, local governments are sharing the most up-to-date information about the situation in your area.
  2. If you are in need of financial or other assistance due to lost wages from event cancellations, business closures, or quarantine, find and call your local 211.
  3. Stay home and stay 6 feet from visitors.
  4. Otherwise, follow these guidelines to practice social distancing: school at home, avoid social gatherings, avoid discretionary travel, and avoid nursing homes.
  5. If you go in public:  Stay 3-6 feet away from others. Do not touch your face. Avoid the temptation to scratch your eyelid, bite your nails, or use your hand to wipe your nose. Also, avoid shaking hands with others. Instead, try a nod, wave, or bow to greet people. Press elevator buttons with your elbow.
  6. Wash your hands for the full 20 seconds with hot water, especially when you return home from being in public. You can sing the ABCs (or these or these). Handwashing alone can’t solve everything, but it is helpful, in your control, and has no downside. 
  7. If you feel sick, STAY HOME. At first, COVID-19 just feels like coming down with a flu- or cold-like “something”. 80% of folks have mild or moderate symptoms. They feel fine and go out. This is part of why it’s spreading so fast. It is critical for people with fever, fatigue, cough, shortness of breath to quarantine immediately if able. If it worsens, call your doctor (more).
  8. Consider cleaning “high-touch” surfaces twice daily (faucets, tables, phones, toilets).
  9. Only share information (even this doc) after CHECKING it against reputable sources.

What other preparations can I make? A curated list from CDC’s full list

  1. Although COVID-19 isn’t pretty and can be severe in young people, COVID-19 is most deadly for people 50 years or older or who have underlying conditions. These folks should avoid going out and non-essential travel (2:39). If you live with someone like this, remember that YOU can catch the virus without knowing and pass it on without experiencing symptoms. Personal opinion: Act like you’re at high-risk too.
  2. If you are on prescription medications, it may be wise to get a few month’s worth extra. This will help you avoid potentially long lines of sick people at the pharmacy later.
  3. Think about how you would care for someone who is sick (cold, flu, etc.) at home. If hospitals become overwhelmed (This has now happened in the USA too), the best and most comfortable care will be provided in our homes. What will you need? How might you reorganize the space to minimize the possibility others get ill too? These guidelines are for people caring for COVID-19 cases, but they’re good practice for all illnesses.
  4. Suggest cross-training to your boss at work to ensure smooth operations. Make your home office more comfortable. If you are in food service, ask your employer about paid leave policies and those to encourage sick employees to stay home (CDC full guidance).
  5. There will be transmission in your community and you may get sick. During this time, you may want to quarantine yourself if you can. Check your pantry. What do you need to buy to last two weeks? Don’t buy bulk — supply chains won’t be able to absorb the shock, and it will hurt your community. During the worst modern pandemic (1918 flu), folks had enough food. The idea here is NOT that there will be shortages (update: there will be if people create them with panic). The idea is that you will want to stay home because you are sick or to reduce your exposure because others are sick. Some ideas (consider asking vulnerable neighbors if they need help stocking up!):
  1. There is no treatment for COVID-19. These may help your symptoms: Tylenol for fever and cough drops. (On ibuprofen: WHO says, “not enough data to def say yes or no.” British pharmacological society says avoid ibuprofen, just to be safe).
  2. Sick foods (e.g., 2 soups per grocery trip), jello, throat coat tea, potatoes
  3. Oral hydration solution ingredients (6 tsp sugar, 1/2 tsp salt in 1 liter water)
  4. If you don’t have it, soap and cleaning solution (e.g., simple green, 409)
  1. Exchange numbers with your neighbors, especially those over 50. Isolation = bad for mental health. Social distancing disrupts life. It’s unpleasant. Take care of yourself and each other (WHO mental health guidelines). Exercise outdoors with someone in your house; not a 5k. Have FaceTime dinner dates; don’t go to restaurants or bars. 
  2. Personal opinion: Donate $$ to a food bank and artists/freelancers. Be nice to cashiers.

FAQ on the basics

  • Where are you getting your information? The CDC, the WHO, the Coronavirus Expert Reality Check, the Hopkins Center for Health Security, Dr. Fauci at the NIH, science. I pulled from this article and links throughout. I even stole word-for-word. My main concern was providing accurate info to people whom I love. I think plagiarism is justified.
  • How many cases are there and where are they? You can check this semi-real time map, which is run by the Center for Systems Science and Engineering at JHU.
  • What are the symptoms? 3 most common in China: fever, cough, fatigue. Others: headache, body aches, sputum production, shortness of breath, sore throat. There’s no clinical way to differentiate between COVID-19 and most other respiratory illnesses. In fact, at first, it just feels like coming down with “something” cold- or flu-like.
  • What should I do if I have those symptoms? Call your doctor and local health department — they may tell you to stay home and then will use guidelines to determine if they should test you. Do NOT go directly to a healthcare facility. You might infect others. Unfortunately, COVID-19 has no treatment. Care is supportive. I’m not a doctor either. If you want what the doctors have, here are interim clinical guidelines from the WHO.
  • What does mild/moderate disease mean? 40% of cases in China were mild (flu-like). 40% = moderate (flu-like+pneumonia). Recovery for mild/moderate is 2 weeks; 3-6 for severe/critical. 10-15% of mild/moderate worsen to severe/critical (lecture, 8:40, slide 11).
  • How deadly is COVID-19? We don’t have enough info for an average number yet. Remember, “deadliness” VARIES by person (elderly more vulnerable) and context (good/bad care, whether the country has lots of people over 50 years). On 2/26/20, dividing deaths in China by # of cases in China = 3.5% of COVID-19 cases died. This is an initial estimate. But the death rate, on average across age and location, could be a bit lower. Why? China may have missed mild cases and/or offered insufficient care, leading to excess death. The chances of dying from COVID-19 in the US depends on the capacity of our medical system, and the final mortality rate reported in the US will depend on how many infected people we find via testing.
  • Do I need a mask? Early on, I said no to this question. Now that there is community spread in the USA, the answer is yes. Wearing a mask mainly protects the people around you. It keeps your germs to yourself. It is important to wear a mask even if you feel well. People are MOST contagious with the virus for the 2 days leading up to their first symptom. Masks can’t prevent COVID19 from infecting you via your eyes or from touching infected objects. You may also touch your face MORE with a mask accidentally.
  • Hand sanitizer or soap/water? Both work. Hand washing is best. In a pinch, hand sanitizer that’s ≥ 60% will be OK, until you have access to a sink (CDC).

FAQ on the media, travel, going out, etc.

  • Is this as big of a deal as the media is making it? Absolutely. When I wrote this in March, there were more US flu cases and deaths than COVID-19 globally. Now, COVID-19 has blown the flu out of the water. Worse yet, while the flu has a vaccine, stockpile of tests, and treatment options, COVID-19 doesn’t. It is also more deadly & easily spread than the flu. Quick spread means overwhelmed hospitals. Ergo, “big deal.”
  • Should I travel? First, no cruises – for anybody! Early on, the CDC recommended all of us cancel non-essential travel to much of Asia/Europe (Level 3). Vulnerable people should cancel ALL non-essential travel. Domestically, CDC recommends considering these things. And consider these things: what kind of healthcare system does your destination have? Can you realistically quarantine and afford it there for 2 weeks? ( Dr. Nuzzo, JHU, 2:51). Per Dr. Lessler, “it’s likely ... most of us will get infected. [Importantly,] how long will it take for that to happen? If it happens in a few months, every hospital will be overwhelmed. People will not be treated... However, if we do our best...to practice social distancing [and] reduce travel [then] we could slow the spread.” #FlattenTheCurve (p18)
  • Should I drink elderberry syrup? Not qualified to answer this question ¯\_(ツ)_/¯
  • Should I cancel going out? People at high-risk should stay home (self-protective quarantine). For everyone else, gatherings of more than 10 people should be cancelled. Personal opinion: Only having small gatherings reduces risk. To reduce it more, have a group of 10 people who agree to only be in close contact with each other over the next several weeks. If someone in the group develops symptoms, the spread of disease will only impact those in your group and no one else. This is the goal of social distancing: break the chain of infection onward and save high-risk groups. It also slows spread to help your healthcare system (p 18). Doing this now may feel extreme, but since it takes up to 15 days for 97% of cases’ symptoms to appear, there’s a big disconnect between “how bad it is NOW” and “how bad it will BECOME.” For each reported case, there are more infected people (p7, orange were reported cases that day. Blue=true number who began feeling sick that day. Blue folks become orange bars later)
  • Are you worried? Personal opinion: Definitely. I worry about my grandparents, about people panicking, and people downplaying the seriousness of this. But I also want people to be prepared and informed and not to lose sight of kindness. Social distancing is a pain in the ass. It's going to be bad for the economy. It feels stupid and unnecessary. But actions that seem extreme now will prevent this pandemic from becoming a disaster.

FAQ on the US government’s response and recommendations

  • The president says the risk of coronavirus is low. Where do I get up-to-date information about this? A daily risk assessment about COVID-19 is available at this link. You can find a general list of CDC FAQs here.
  • Was banning incoming travel from Europe a good idea? It will reduce imported cases. It won’t reduce pre-existing community spread.
  • What’s “community spread” and why are we concerned about it? Originally, all cases in the USA had a known origin. For instance, at first, most people with COVID-19 were either in China or exposed to someone who was in China. “Community spread” means that the new case of COVID-19 resulted from an unknown chain of people. In other words, the new case was caused by an existing case in the USA.
  • Why didn’t the USA test people earlier? Since this is a new virus, the CDC has had to make their tests from scratch. To check the tests were accurate, the CDC used them on samples they knew did NOT have COVID-19. Unfortunately, those tests erroneously came back positive (the tests weren’t working correctly). So, the CDC limited the criteria for testing. There may have also been other delays. States can make their own now.
  • What will happen now that non-CDC entities can make tests for COVID-19? The hope is to test more especially since the CDC relaxed the criteria needed for a test: clinicians can use their judgment. You don’t need to have “travel to an at-risk area” or a “known exposure.” but per Dr. Fauci (NIH), the US is not providing adequate testing (0:28). More testing=more cases. Partly because you only find what you look for. But mainly because the disease is spreading and there ARE more cases (graph at bottom).
  • “Flatten the curve”? Slowing the spread of disease to avoid everyone getting sick simultaneously. “You know how everyone rushed for groceries at the same time instead of staggering visits? Imagine the same thing in hospitals, but instead of toilet paper, it’s ICU beds & ventilators” (cite). Excess death will occur if hospitals are overwhelmed and can’t handle day-to-day business. More in this article. See “social distancing” in glossary.

GLOSSARY

Presymptomatic: While a person is not yet showing symptoms (e.g., feeling well). Scientists have a hunch (update: we know!) that people may be able to transmit even if they aren’t yet showing symptoms. An early article even erroneously reported so in a peer-reviewed article. Later, it was found that the person transmitted while feeling “a bit warm” and then had “minor aches and felt tired”, which they attributed to the time change. This article reports on potential presymptomatic transmission within a family unit. This article suggests transmission the day before they began to have symptoms.

Centers for Disease Control and Prevention, CDC (link): Federal agency in the United States of American that is responsible for preventing and controlling disease in the United States.

Dyspnea: Shortness of breath

Interim guidance: Because coronavirus is so new, the WHO and CDC didn’t have pre-written, ready-to-go guidelines on how to prevent, respond, and treat the disease. We are learning more each day, so they’ve put together “interim guidance” instead. This guidance is likely based on previous outbreaks and will continue to change as we learn more.

Public Health: Doctors help patients at an individual level. Public health professionals help people stay healthy with actions at the community level (e.g., recommending guidelines that instruct doctors when/who to screen for prostate cancer; measuring the impact of community gardens on nutrition).

Epidemiologist (link): A person who studies the distribution (e.g., how common or where) and causes of health-states and events (e.g., measles, happiness, autism, vaccination status) in populations. Some people like to simplify and just say that we are disease detectives. As an infectious disease epidemiologist, we learn the biology of various bodily systems and organs, how immune systems work, microbiology, how to interpret outbreak data, the most common infectious diseases, foundational terms (e.g., reproductive number, case fatality ratio, incubation period), etc.

Peer-reviewed articles: In the scientific community, we communicate our results by writing an article (i.e., a paper in a specific format). To more broadly disseminate our work, we submit our article to journals. If the journal thinks our article is interesting, they send it to three other scientists who also study our topic. These three other scientists (our peers) are responsible for reviewing the article to make sure it is truthful and well-written. Generally, peer-reviewed articles from trustworthy journals are reliable. Articles that are in “preprint” mean that they are available online without any peer-review (e.g., bioRxiv).

Reproductive number (R): The basic reproductive number (R0) is a theoretical concept that describes the number of secondary cases generated by someone who is sick, if everyone is susceptible to the disease and are mixing at random without interventions. That last point is key! Most people do not walk around randomly bumping into other people. When people talk about the R now, they’re talking about the OBSERVED reproductive number, which can be changed by how densely packed people are, how much they are moving around, and what precautions they are taking to avoid disease. Even though the calculations from data in China for R was 2.5 and sounds frightening, it also assumes that we aren’t doing anything to stop the spread of disease! You can help do this :)

Respiratory: Related to the act or process of breathing

Self-Protective Quarantine is when a person is entirely isolated from other people to avoid getting a disease.

Social distancing: Actions taken to reduce or eliminate people’s physical contact with others. There are various levels and include quarantining people (i.e., isolating them), standing six feet away from other people, shutting down schools, cancelling events where lots of people show up, not going to coffee shops or restaurants, etc. Social distancing slows the spread of disease and lowers the number of people who are sick at the same time. This is also known as “flattening the curve.” Flattening the curve is important because it buys time for vaccines/drugs to be developed and reduces strain on our healthcare systems. You can see a great “flattening the curve” animation here.

Symptomatic: While a person has clear symptoms (e.g., sneezing, coughing). Much of the current guidance from the CDC and WHO (e.g., stay home if you are sick) is based on data that show while people are symptomatic, they produce snot and mucous that contain high levels of the virus.

Virus: A genetic element that cannot replicate independently of a living cell. They can only make more copies of themselves by infecting and hijacking a live host (e.g., a human).

World Health Organization, WHO (link): A global organization of the United Nations that makes public health recommendations and provides technical support to countries.