Question: I am not one to panic, but I would like to know what I can do about this novel coronavirus COVID-19 (C19).
Answer: To put things in perspective, we can look at what happened with the H1N1 flu pandemic in 1918. About a third of the world’s 1.5 billion people (over 500 million) were infected and developed clinically apparent disease, and 50 million died (some estimates are even higher). A vaccine would have made a huge difference. Consider the difference between the 1918 and 2009 H1N1 flu outbreaks — although this is not a true apples to apples comparison, at least some of the reduced negative impact in 2009 was due to vaccine availability.
Some diseases are airborne spread (for example the measles and chickenpox viruses, and the bacteria tuberculosis), meaning they become airborne and float around for hours, spreading widely. Some diseases are droplet spread, meaning they are carried on droplets and typically travel 6 feet or so. Therefore, droplet-spread diseases (which includes C19) do not spread as easily as airborne diseases. Other factors to consider is how infectious the agent is (for example a larger “dose” exposure of TB is required to transmit disease than for measles, so measles is spread much more easily) and whether the disease can be spread by someone with minimal/no symptoms — as is the case with C19.
The characteristics of C19 point to its potential to spread widely, and it has a significant fatality rate. This is why the World Health Organization, WHO, and the Centers for Disease Control, CDC, are concerned that the world is in the early stages of a worrisome pandemic.
So, what is the point in the travel restrictions, school closings (for example in Italy and Iran), and other measures being instituted if the virus is very likely to spread anyway? The answer is delay: an efficacious vaccine would strongly change the game here! As it will likely take a year or longer to develop an efficacious vaccine, slowing/limiting the spread may yield huge benefits.
So why are we so far behind the eight ball in all of this? Unfortunately, many policy decisions of the last several years have compromised our ability to respond to this kind of potential hazard. For example, elimination of the National Security Council position that coordinates responses to pandemics, “gagging” government medical experts from being able to speak freely, the initial denial of C19 as an issue that would affect the U.S., the rejection of science in general and the short-sighted budget cuts — present proposals include decreasing the CDC budget by almost 16%, the Department of Health and Human Services budget by almost 10%, and a $3 billion cut to global health programs including a 53% cut to the U.S. support of the WHO and a 75% cut to the U.S. support of the Pan American Health Organization — are examples of the recent mismanagement which has/will compromise our preparedness and planning to address an impending pandemic. These issues must be addressed, in addition to a very aggressive short-term focus on delaying/limiting the likely inevitable spread of this pandemic to allow development an effective vaccine.
What can individuals do to support these efforts?
If you are sick you need to stay home; self-isolation can limit the spread of disease.
Cough/sneeze into the inside of your elbow. If you are sick and must go into public, only then is when a mask may be of value so stop buying masks! Masks are useful for sick people to use to keep their contaminated droplets from spreading. This is different than respiratory-type “masks” that are needed to protect health care workers or others that need to come into contact with sick patients.
Wash your hands frequently, especially before you cook/eat and before/after you use the bathroom — use soap and water, and sing the happy birthday song while you wash to ensure you scrub for a reasonable amount of time.
Avoid touching your eyes, mouth and nose; these are ways you may self-inoculate with an infectious agent.
Clean/disinfect surfaces whenever there is any chance that they may have been contaminated (most household cleansers/disinfectants will suffice).
As the number of cases spread, schools may be closed, mass gatherings may be canceled, and people who are able should work from home. Planning for these things is key: Speak with your boss now to see if you will be able to work from home. Be prepared to be able to stay home by having a two week supply of food and water, an ample supply of prescription and non-prescription medications and an emergency kit/plan (see the CDC website https://www.cdc.gov/cpr/prepareyourhealth/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffeatures%2Fstockpile-zpk%2Findex.html for recommendations).
Do not travel to places identified as potentially problematic by the CDC unless it is absolutely necessary.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.