THE ENTIRE WORLD IS THE NEW HOT ZONE
By Steven Stiefel
Here’s what you need to know to protect yourself from COVID-19 — and the virus that causes this illness.
Virtually every year we’ve been warned about the coming plague—in fact Laurie Garrett wrote The Coming Plague (1995), a book that detailed many outbreaks and warned of future ones. In the 21st Century, we’ve been scared by dire predictions for SARS, swine flu, and Ebola that never fully materialized in America.
But now we clearly understand that COVID-19 is the pandemic we’ve been warned about. Three questions you may have are 1) What’s different about this one? 2) Why did it cause a global pandemic? And 3) what can I do to protect myself and those I love? As scary as this virus and the illness it causes are, you can take a handful of simple steps to protect yourself. If we all do this in concert, then this pandemic will subside, and our lives can return to normal.
Here’s an overview of what you need to know based on information that’s currently available as of April 7, 2020:
What is the coronavirus?
Coronaviruses are a specific type of virus that often causes respiratory tract infections when they cross into human beings. Some versions of the common cold are caused by coronaviruses as are more dangerous illness such as SARS and MERS. The new coronavirus is named SARS-CoV-2 and it causes the illness called COVID-19. We’ve been using the term COVID-19 interchangeably to refer to the virus and the illness, but technically the illness is COVID-19 while the virus itself is called SARS-CoV-2. As a point of reference it’s akin to how HIV is the name of the virus, and AIDS is the illness that virus causes. Of note, though, HIV is not a coronavirus; it’s a retrovirus.
The SARS-CoV-2 virus crossed into humans, possibly from bats, and it causes varying levels of responses in individuals that range from asymptomatic, where the person doesn’t know they carry the virus, to those who are mildly ill, to those who are very ill, and to those who die from respiratory overload.
As a category, coronaviruses are “enveloped” viruses, which means that their RNA strand is encapsulated by a lipid membrane to protect it. Think of these viruses as similar to tiny golf balls. Once you get through the shell on the outside you see the RNA string inside.
YOUR TAKE AWAY: COVID-19 is caused by a specific virus in the coronavirus category that causes death by respiratory overload.
What does the coronavirus want?
Viruses don’t “want” anything. They just do what they’re genetically programmed to do, which is to replicate. The virus that causes COVID-19 is built to create more versions of itself. The “perfect” virus is one that can keep going into perpetuity, but the weakness of this coronavirus is that it is a non-persistent virus. This means that once a person recovers (or dies) then the virus can no longer replicate within that person. And so the virus needs to move to another human body to continue to reproduce.
This virus seems to be unusually contagious, able to transfer from one person to another readily while also having the ability to live upon surfaces for an atypically long period—perhaps up to 17 days in some cases, although further study is needed to determine the life span of this virus outside the body. While the death rate is fairly low—somewhere around one percent of those known to be infected—it is quite lethal because it transfers from one person to another so easily.
YOUR TAKE AWAY: The virus is highly communicable, the characteristic that makes it unusually dangerous.
Why is the virus so dangerous?
While the coronavirus that causes COVID-19 is nowhere near the most lethal pathogen humankind has seen in our recorded history, it is one of the biggest threats the modern world has ever faced from disease. How can these two facts be reconciled? The key is to understand how viruses work.
Humans have never been exposed to this coronavirus before and so we have no immunity to it. Those who become infected with it have a lengthy “incubation” period. During this time we can spread it to others without the awareness that we are contagious. Many people have the virus for 7-14 days before showing symptoms. Others have tested positive, meaning they can pass along the virus, without ever developing symptoms themselves.
Those who develop COVID-19 may be ill for as long as 30 days. They may recover or they may die. Once people become ill with symptoms resembling those from this virus it is imperative to isolate until medical attention is necessary.
While the death rate is fairly low, the number of deaths is quite shocking when you measure them in human terms instead of statistics. If one percent of the people on Earth die from this virus, then that equates to about 78 million deaths including almost 3.5 million in the United States.
Other viruses such as Ebola have a much higher death rate, but they do not kill as many people overall because they “burn out.” These deadly viruses are inefficient because 1) they are less contagious than the current coronavirus, and 2) they kill people so quickly that the virus is unable to continue to move from host to host.
YOUR TAKE AWAY: This virus is particularly lethal because it is extremely contagious and causes death, albeit at a fairly low rate compared to viruses such as the ones that cause or caused Ebola, black plague, smallpox, and Spanish flu.
What should you do to prevent “catching” this virus?
Here are the steps you can take to avoid contracting the virus:
- Self quarantine. The more you remain at home, staying away from those you don’t live with the better. Recognize that every trip outside your home presents a new set of risks for contracting the virus. This is true of shopping expeditions to the grocery store and exercise in the park—or even getting takeout or picking up food at a drive-thru restaurant. Make sure to avoid touching your face before you get home, and then wash your hands immediately and thoroughly.
- Wash your hands thoroughly with soap and water multiple times a day, especially after contact with others or surfaces such as those you encounter at the grocery store. This virus and other coronaviruses are particularly vulnerable to soap because it destroys the lipid layer that protects the virus. Washing your hands vigorously with soap and water for 20 seconds destroys the virus. Make sure to do this several times a day, especially after contact with anything outside of your quarantine environment.
- Maintain social distance. If you need to go out, then it is imperative to stay as far away from others as possible. At least six feet is recommended for safety.
YOUR TAKE AWAY: Stay home as much as possible, wash your hands frequently, avoid touching your face, and make sure to maintain at least six feet of distance between you and all others if you go out.
How do you know if you or others have the coronavirus?
We already know that many people have contracted the SARS-CoV-2 virus without developing COVID-19 symptoms. Some people remain asymptomatic, making them particularly dangerous to others. Yet these people are unaware that they are carries of this lethal virus. The key is to treat everyone as though they have the virus (including yourself) and keep at least six feet away from them.
In a perfect world, everyone would test themselves at least once a day to see if they had contracted the virus. At this point that is not possible because tests lag well behind the need for them. Eventually supply will rise to meet demand, but for the foreseeable future it’s imperative that you act as though everyone you encounter has the virus (including yourself).
One lesser-known symptom of infection is a noticeable decline in your sense of smell and taste. These two senses are closely interlinked, and those who have the virus but not the illness have reported a decrease in these senses. Often these people do not develop fever or the harsher symptoms, but this can also be a harbinger that the illness may develop. It is essential that you stay home (and away from those in your living space) if you notice a decline in these senses.
Those who do develop classic symptoms of COVID-19 often seek testing to ascertain whether or not they have the illness. At this time it is difficult for many to get tested unless they have a severe case.
YOUR TAKE AWAY: Tests will become more available in the coming months, but for now it is best to assume that you have the virus if you exhibit any of these symptoms whether or not you develop the illness.
When will this pandemic end?
This is directly related to how effective everyone is in preventing the spread of the COVID-19 virus. Those who are casual about social contacts cause the length and severity of the pandemic to increase. It’s crucial to avoid socializing with others and direct contact for at least the next 30 days or so. Likely it will take considerably longer to eradicate the virus because our country has had a scattershot response to the outbreak. While the pandemic grows worse with each passing day as of the beginning of April, the response to it has become more effective.
This means that we will eventually flatten the curve, ultimately bringing the rate of transmission down to zero. Some countries such as Taiwan, Singapore, and South Korea have been effective with this after varying levels of initial cases. Now these countries are all trending in the right direction. Eventually the U.S. will join them, but this will only happen after the country as a whole employs social distancing and other protective measures for at least 30 days.
You can check out other websites to see how the pandemic is trending in various countries. https://www.worldometers.info/coronavirus/
YOUR TAKE AWAY: The pandemic will end, but it depends very much on how effectively each of us follows the established guidelines for social distancing and cleanliness.
What does it mean to flatten the curve?
As of April 7, the United States (and worldwide) number of cases continues to grow day over day. When you graph these total cases the line begins to look fairly vertical. When the number of new cases per day begins to decrease (even though they’re still increasing in total) the curve will begin to bend. As cases further diminish, the curve will begin to flatten towards horizontal. Then, as people begin to get well (or die) at a pace faster than new cases are added, the curve will begin to decrease, eventually returning to zero.
It’s not only crucial to flatten the curve to reduce the number of people who become infected with the COVID-19 virus, but it is also essential in helping health care providers deliver better medical services. When huge numbers of people flood into hospitals at the same time, the doctors and nurses become overwhelmed and are unable to deliver quality care to every patient. Many people grow sicker and die due to a surge and the lack of resources to attend to them. Flattening the curve allows health care providers to deliver better medical care, helping to prevent death in many cases.
YOUR TAKE AWAY: Measures such as sheltering in place, social distancing, washing your hands with soap and water, and wearing a mask in public help to flatten the curve, allowing health care providers to help a greater percentage of those who are ill.
What actions do you need to take to prevent contracting the virus?
In addition to sheltering in place, you should take great care to make sure that your home environment is as virus free as possible. In addition, you want to protect yourself as much as you can when you make necessary trips to get groceries, gas and other necessities.
- Wear a mask when you go out. While this was initially considered to be unnecessary, we now understand that masks provide a small reduction in the risk of breathing in the virus. The virus lives in water droplets that can hang in the air for a few seconds—it’s one of the most common forms of transmission. More importantly, masks prevent you from breathing (or coughing) water droplets into the air that contain the virus. Eventually, guidelines will likely forcefully encourage or require the wearing of masks in public. While it’s crucial to allow health care workers to have the N95 masks they need, it’s also important to understand the growing role masks will play in helping to prevent the spread of COVID-19. Many websites demonstrate how you can make a mask from a bandana or a similar-sized piece of cloth.
- Wear gloves when you go out. Then remove them when you come home. Remember that gloves may have the virus on them. Either throw them away or wash them thoroughly with soap and water. Remember not to touch your face while wearing gloves—that defeats the purpose of wearing gloves.
- Clean all surfaces thoroughly with soap and water. This is especially important after you return from a shopping trip, which creates an opportunity for the virus to enter your living space and potentially you as well. Remember that the virus can live on grocery bags and packages, and a host of other surfaces such as your counter tops and toilets. You can also use bleach and other chemical cleaners that kill viruses to disinfect surfaces, but keep in mind that using soap and water is the most effective way to destroy the virus because it breaks down the lipid layer that protects it.
- Avoid enclosed spaces when in public. These include small rooms and elevators. If you must use an elevator, try to avoid riding with someone else—and especially do not use elevators with more than one other person. When you’re in enclosed spaces avoid touching surfaces as well as your face. Then wash your hands with soap and water as soon as you can.
- Use heat to kill the virus. It is thought that transmissibility of the virus will reduce as the weather warms, but this doesn’t mean the virus will be entirely destroyed. Cooking your food at high temperatures is likely to kill any virus that may have come in contact with it. At this point, the virus that causes COVID-19 appears to be particularly sensitive to moderate heat (dying when exposed to temperatures at about 80 degrees and above), but more study is needed on this point.
YOUR TAKE AWAY: Follow the prescribed guidelines when you must venture out.
What can you do to boost immunity to prevent catching COVID-19?
While you’re sheltering at home, you can take steps to prevent acquiring COVID-19. In addition to social distancing when you must go out and keeping yourself and your environment clean, you can also take several steps to boost immunity and to reduce the chances of a severe case of COVID-19. These include:
- Stay hydrated. Drink fluids, especially water, throughout the day. Other beverages such as coffee and tea provide antioxidants that fight free radicals (harmful chemicals that tax your immune system). The influx of fluids not only keeps your body well hydrated, but it also helps to prevent a dry throat, which is a breeding ground for the virus. In addition, drinking fluids helps flush this virus into your gut where it is less likely to cause the illness.
- Get in electrolytes. Electrolytes such as sodium and potassium help to make sure that your fluid balances are well regulated. It’s important to get these in through foods, drinks, and supplements.
- Boost intake of antioxidants. These include vitamin C, vitamin D, zinc, vitamin A and turmeric. These may help prevent developing the illness after exposure or reduce the severity of symptoms if you do develop the illness. Supplementing vitamin D in particular has been shown to be effective in fighting respiratory infection for those who are deficient in vitamin D, which is about half of all Americans. Those who are not deficient gain no benefit from supplementing vitamin D, but no harm as well. Vitamin D deficiency may be higher now because of the season and reduced sun exposure over all.
- Sleep at least 8 hours a day. Most of us who are not on the frontlines of fighting this contagion have plenty of time on our hands. If that’s your case, then make sure that you’re getting plenty of sleep each night. This also supports your immune system to better fight off the illness should you be exposed to it.
- Exercise regularly. You can perform some version of exercise at home, or you can get out of your house for a walk or jog so long as you maintain distance from others. Regular exercise supports a strong immune system. Keep in mind that exercise is a stressor itself, and your body needs to recover from each session. Performing lengthy bouts of strenuous exercise requires a recovery response, so moderate levels of exercise may be best during this time.
- Avoid overeating and drinking. It’s tempting to eat everything you want and drink sugary and alcoholic beverages, but these calories cause inflammation and reduce your immune response. Cutting back on these supports a better mindset and improved response should you come in contact with the virus. You can have a cookie or a drink here or there, but try to avoid binges of either.
YOUR TAKE AWAY: You can take many positive steps to improve your body’s immune system and thus its potential response should you contract the virus.
What should you do if you suspect you have contracted COVID-19?
At this time, testing is not widely available for all those who think they have the virus. The best course of action is to assume you have the virus and behave accordingly. This includes self-quarantining—staying home at all times and only making purchases for delivery. Avoid contact with all other people as you fight the infection.
If your symptoms become severe, then you should go to an urgent care facility. Call ahead to tell them that you’re coming. After they examine you, they’ll determine if you should go to an emergency room—many people do not need to go to an ER unless they are having trouble breathing. And it’s best if you don’t show up at an ER unannounced. Because ER staffs are overburdened, they are simply sending many people home, telling them to seek additional care if their symptoms worsen.
Continue to follow the guidelines for boosting immunity. Include acetaminephine (Tylenol) to help reduce fever.
YOUR TAKE AWAY: At this time emergency rooms are only treating people with severe cases of COVID-19. Continue to educate yourself about ways to treat your illness by checking in with your doctor and following updates about COVID-19 treatment. Seek medical attention when your symptoms rise to that level.
What are antibodies and how do they affect the virus?
When you contract a virus, your body begins to fight against the invader. It eventually creates a blood protein that kills that specific virus, and these blood proteins are called antibodies. Those who contract the virus and survive eventually are left with no virus but they continue to have antibodies for that specific virus.
This virus is called a “novel” virus because no human had COVID-19 virus antibodies before the pandemic began. And this is what left us particularly vulnerable to this virus. Now that many people have recovered, this decreases the chances of widespread outbreaks. One weakness of viruses is their susceptibility to “herd immunity,” which means that when enough people have antibodies to kill the virus, that particular illness spreads much less readily. Over the course of the next several months and years, as the number of people with antibodies increases, the chances of contracting the virus reduces. That’s true for those who don’t have the antibodies as well as for those who do. The reason for this is that the odds of encountering an infected person reduce as more people develop antibodies.
It is thought that we’ll have the ability to test for antibodies within the coming week or two. While the tests will need to ramp up for all who want to get tested, this is a very important step in helping to eradicate the virus. It will inform people that they had the virus, and it will let them know that they likely have a level of immunity. That level of immunity is unknown at this time, but it is likely to be significant. Those with immunity will then be able to participate more directly in efforts to stop the spread because they are at significantly lower risk of contracting and spreading the contagion.
YOUR TAKE AWAY: The more people who recover from COVID-19, the less likely the rest of us are to “catch” this illness based on antibodies and how they provide “herd immunity.”
THE PROGNOSIS FOR THE PANDEMIC
Dr. Fauci initially stated that between 100,000 and 240,000 Americans were likely to die from COVID-19 in the coming months as a best-case scenario based on practices in March. As of mid-April, that guidance has been revised down to about 60,000 deaths in America based on the actions that have been taken since the initial guidance.
This demonstrates that human intervention can effectively reduce the lethality of COVID-19. These numbers also include deaths from flare-ups in additional rounds of infection, which are likely. It’s not uncommon for non-persistent viruses to become seasonal because they continue to replicate during semi-dormant periods.
It takes an enormous concerted effort to entirely destroy a virus. This was accomplished with the Spanish flu virus and the smallpox virus. We have learned how to destroy a virus, but it takes a huge commitment from healthcare workers, scientists, and every citizen of the world. It is likely that the virus that causes COVID-19 will eventually be wiped from the earth, but we are probably a few — if not several years — away from that.