Updated Mar. 13, 2020

Coronavirus in brief (work in progress)

Bottom Line.

  • Coronavirus is significantly worse than the flu, but not the zombie apocalypse. No need to panic, but it probably makes sense to prepare.
  • It is going to affect day-to-day-life in western countries, including the U.S.
  • You and your family will probably face personal risk of illness by the end of the year.
  • You can prepare by
  • Stocking at least 1 month of nonperishable food, pet food, and other necessities, and 3 months of prescription medications.
  • Relocating away from dense cities and/or shifting to working from home, if possible.
  • Learning how to properly wash your hands, and practicing not touching your face.
  • Avoiding travel after March of this year, and/or planning with cancellation option.
  • Making plans to care for and protect the elderly from exposure to the virus.
  • Carrying hand sanitizer, and using it frequently (every 30 min outside your home, before you eat or touch your face).
  • Buying enough hand sanitizer and hand soap for at least 1 month.
  • Wiping commonly contacted items (phone, keyboard, headphones etc) down with disinfectant (e.g. rubbing alcohol) regularly.
  • Avoiding crowded places (e.g. concerts, subways, theatres, buses, airports etc) without protection.
  • For essential travel, buying N95 respirators, if you can, and learning how to use them, including shaving facial hair. These are probably less effective than hand hygiene, so lower priority.
  • Staying home, and wearing a surgical or N95 mask if you feel sick.

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What does the virus do?

  • The virus causes dry cough, fever, pneumonia, and in severe cases kidney failure and death. The most common symptom is fever (80+%). Nasal congestion and runny nose are rare (<5%).
  • 80% of cases are relatively mild, and do not require hospitalization. The rest look like moderate to severe pneumonia.
  • Approximately 1% of people who catch the virus die.
  • After symptoms show, it takes 3 weeks - 1 month for severe cases to resolve.
  • Risk is much higher for people over 40.
  • Children appear to be relatively unaffected.
  • Men may be twice as susceptible as women, although it is too early to tell with confidence.
  • Immunity may not last long, and no-one has it to start with.

Where is the virus now (Mar 13)?

What do we know about the virus?

  • It likely arose from a crossover, or “zoonosis” from animals in China, sometime in late November early december of 2019.
  • It is most closely related to a virus called SARS which caused a small epidemic in 2002. It is also related to viruses that cause the common cold.

How does the virus spread?

  • Probably similarly to the flu. Being within 6 feet of a cough or sneeze, touching a surface that has been coughed on and then touching your face, or eating food that has been coughed on are all ways to spread the virus.
  • Relatively quickly. Approximately doubling the number of infected people every week.
  • The virus can probably survive on many types of surfaces for 2-7 days.
  • Some people who are infectious and can spread the virus do not show visible symptoms.
  • It takes ~5 days (range of 2-14) for symptoms to develop.

Can we treat it?

  • Not right now. No vaccine or approved medical countermeasure.
  • Supportive care like mechanical ventilation can significantly decrease risk of death if ICU rooms are available.
  • An antiviral, called remdesivir, is in clinical trials and shows some signs of efficacy.
  • Historical timelines for new drug / vaccine rollout suggest mass availability in 2021.

Shouldn’t I be more worried about the flu?

  • No. This is worse.
  • The seasonal flu kills <0.1% of infected people. This kills ~1%. That is ~10X worse.
  • The coronavirus may spread a little slower than the flu, or somewhat faster.
  • You have some natural immunity to flu even though each season the strain is different. You probably have no immunity against this coronavirus.
  • We have a reliable vaccine against seasonal flu. We will not have a vaccine or effective treatment for coronavirus for some time.
  • Seasonal flu is very well characterized and understood. This virus is still under intensive study, and all the numbers I give have uncertainty, which means that it may be worse than our best guess. Long-term effects of catching the virus are unknown.

How can I think about my and my family’s risk?

  • Look at these charts for risk of death by age group.
  • Consider risk factors (source) which make the disease more dangerous, such as cardiovascular disease, diabetes, lung conditions, smoking, high blood pressure, and cancer.
  • Think about the population density of places you go to regularly. Ask yourself: “How many people have been here in the last week?”. Avoid places where that number is large, and take extra precautions.
  • Think about exponential spread. In the early stages, it will be doubling every week approximately. Really think about that- it means the odds of infection are about 2X higher each week this continues. So it’s twice as safe to travel April 1 than April 7. And twice as safe on April 7 as the 14th. I find that extremely counterintuitive, and chances are you will too. Here is a great video explaining how early epidemics look exponential.

This all sounds crazy.

  • Yeah, it does. The info I’ve presented above makes this look like probably the worst pandemic since the 1918 Flu. 
  • However, what’s presented above is an aggregation of facts and high-quality estimates from the scientific literature and expert recommendations, as best as I could find them.
  • The outlook presented here is largely shared by experts at: the CDC, the World Health Organization, the Harvard School of Public Health, the Johns Hopkins Center for Health Security, MIT, a biosecurity summit I recently attended, and by most of my colleagues in the biosecurity space.
  • Unfortunately, I think this is the world we live in.
  • (Update Mar. 9) it appears that South Korea, Singapore, and Hong Kong have been able to more or less contain the virus by implementing strong “social distancing” measures, like the ones I recommend above to clean hands, avoid crowds, and self isolate if necessary. Coupled with widespread testing, it looks like it is possible to get the virus under control. We should be hopeful that we can ride this through *IF* we take it seriously.

What if I’m feeling sick?

This is not medical advice, it is what I intend to do if I feel sick over the next few months.

  • Be proactive and isolate yourself, even if it feels mild, while you figure out what’s up. Don’t go to work or expose others if at all possible.
  • Don’t panic! In most places it is still much more likely to be either a cold or the standard seasonal flu. Even if it is the coronavirus, most cases are mild.
  • Compare your symptoms to those you would expect from the COVID-19 disease. The most common symptoms are fever (80+%) and dry cough (70%). Nasal congestion (runny nose, the sniffles etc) is rare (1 in 20) and make it more likely to be a cold. This graphic might be helpful.
  • If you just feel a little under the weather, try riding it out at home to reduce the burden on hospitals who have more severe cases to care for.
  • If you are feeling quite sick, consider calling ahead to the doctors to ask how they are handling patients who have symptoms like yours. They might, for example, ask you not to go directly into the waiting room to avoid exposing others, or refer you to a clinic or testing site which specializes in COVID-19.
  • Wear a mask and stay 6 feet away from people as much as possible if you have to go out (e.g. to a clinic).

Why these particular prep. measures?

I didn’t originally include justifications for my recommendations because of time constraint and the desire to keep this document simple. By request, I have updated to include this section as of Mar. 9.

  • Primarily, these are the measures I have seen people I respect take on, and those which I intend to follow. If taken seriously, I think they can reduce the impact of the virus on our health system, control spread, and flatten the epidemic curve.
  • Recommendations to social distance in a pandemic are fairly standard and appear to have helped in areas where the virus is better controlled: avoiding gatherings, working from home, avoiding crowded transport,
  • Likewise for standard hygiene advice: frequent correct hand washing, hand sanitizing, surface sanitization, wearing a mask when sick.
  • Most public health experts seem to agree that wearing a mask, if you are not sick, is much less important than proper hand hygiene and social distancing, so above I recommend it as a lower priority.
  • However, experts agree that it is essential to wear a mask *if you are sick* to avoid spreading droplets and contaminating others.
  • Mask wearing is also standard practice in China, which has done a good job of containing the virus.
  • Because of the long incubation period, it seems difficult to know when it makes sense to know when you are definitely sick, and therefore when it makes sense to wear a mask. Combined with the success of public health measures in places where mask wearing is standard, I think it makes sense to wear a mask, if you have one, in crowded places,  to protect others in case you are asymptomatic. *I do not condone hoarding masks*.
  • Re stocking food and supplies:
  • Most importantly: if you become sick with a mild case, it is the socially responsible thing to do to quarantine yourself. ~4 weeks is a reasonable timeline for overcoming the illness, if mild, and you will need food and supplies.
  • In places that seem to be more successful in containing the virus, and in others like Italy which are making efforts too, whole cities have been put under quarantine or restricted movement. In this eventuality, it would be nice to have some supplies stocked up.
  • Even if a quarantine is not officially mandated, self isolation is one way to reduce your own risk if the disease spreads more widely, and will also reduce transmission in your community.
  • Isn’t that panic buying though? Isn’t that bad?
  • As of today (Mar 9) we are still very early in the spread of the disease. Stores will have plenty of time to restock many times over. If the situation gets worse, and people have not stocked supplies, there may be a panic to stock up which cannot be easily resupplied (for example, because mandated quarantines have disrupted supply chains).
  • For example: imagine if you decided to take these steps 2 months ago, instead of now. You wouldn’t be a blip on the radar of grocery supply. Fast forward 2 months from today: do you imagine that will be a better time?
  • There is no reason or need to clear out a grocery shelf. You can stock up gradually, by buying a little extra supplies each time you go shopping, and going to multiple stores. Don’t buy everything all at once

Other resources

  • Dashboard for tracking the spread. Update 3/13: this dashboard has been buggy for me lately, including missing cases which were reported elsewhere. I now recommend this one.
  • California county-specific map.
  • Article on prep.
  • Resource of coronavirus-related data.

What is this doc and who are you?

(By request)

Hello! My name is Ethan. I’m a masters student and research assistant at MIT with Prof. Kevin Esvelt’s group, co-advised by Prof. George Church at Harvard Medical School. I’m also the Co-Founder and President of altLabs, a research non-profit startup that works to develop technologies which reduce risks from pandemics like this one. My research background is in deep learning, statistics, computational biology and synthetic biology, and I’ve published in journals like Nature Methods. I’m also a 2019 Emerging Leader in Biosecurity Fellow with the Johns Hopkins Center for Health Security. I spend most of my time thinking about risks from pandemics and biotechnology.

This document is an amalgamation of scientific literature I’ve read, advice I have received from people I consider to be experts, and the estimates and projections of people who I think are smart and work in biosecurity. At two recent biosecurity conferences attended by myself and my colleagues, the outlook I gave above was broadly shared. At the time of writing, it is as close as possible to my best guess about the facts of the situation, as the preparation measures are those that I actually plan on taking myself. I’ve shared with my friends and family in the hope that the info is helpful to them.

I am not a professional epidemiologist or public health professional. As I’ve tried to emphasize in the text, the scientific community, and my interpretation moreso, are highly uncertain. Please seek out other sources of information to get a fuller picture of the situation, and understand that nothing here is a sure bet.

Please also forgive any mistakes or inadequacies. I wrote this document for my family and friends and was not planning on it being shared so widely. I have been swamped by messages, most of them positive but some from people who have been mean and/or trolls. I’m keeping this document online because it seems to be helping some people, but I can’t promise to respond to messages quickly or incorporate your feedback as I work full time and am especially busy right now. The best place to reach me is on twitter DMs @EthanAlley, not by stalking down other contact info. Thanks!

Mandatory disclaimer: The opinions here are my own. They don’t represent my employers.

Stay safe!

Ethan