A friend asked me last week what measures one can take to lower exposure and prepare for coronavirus. It appears likely to me that we are in the early stages of a pandemic, and there are many variables at play.
There is actually very little difference between an epidemic and a pandemic. A pandemic only speaks to the extent and not the severity of the disease. With coronavirus now in 80 countries and with 100,000 cases globally, I think it’s time to call it a pandemic.
As of yesterday, Ecuador had reported 13 cases to the World Health Organization, of which 6 were new. A 14th case was identified last night who was a 70+ age tourist (extranjero), location not disclosed (the first 13 are in Babahoyo (11) and Guayaquil (2)). The likelihood is that there are ten times this number of cases walking around undetected, according to a leading Ecuadorian epidemiologist.
Now is not the time to panic, but to prepare. While you have a clear mind, supplies are available, and you can move freely. I hope states and cities adopt their own measures and let common sense prevail. I also hope that individuals develop their own risk mitigation plans and put in place some simple measures and practices, and are kind to their friends and neighbors and look out for one another, via social media if risks are high.
I have been through epidemics and was UN Technical Advisor for Pandemics and Emerging Infectious Diseases in Indonesia for 3 years and have been through many simulations, as well as real-time responses to avian influenza (highly lethal) and rabies. I am in daily contact with my network, including WHO. And it’s starting to hit close to home. One daughter is graduating as an MD in May and her hospital in Long Island and they have their first case. My other daughter is an epidemiologist at the NYC Department of Health and they’re in an all-out scramble, working closely with the CDC.
In 1918, about 50 million people worldwide and 675,000 Americans died from a lethal strain of influenza, also known as Spanish influenza. 50,000 Canadians died too. It’s too early to know the trajectory of this disease and whether it has the potential to reach such a scale. We do know for a fact that it affects people differently than pandemic influenza. So, vulnerability rises directly with age and underlying conditions.
Older people are twice as likely to get it as others, and about 40 times more likely to die than people under 30 if they do contract it. Children thus far are little affected – less than 500 of the 100,000 cases. We are on uncharted waters. No one can tell you with any degree of certainty, how long this will go on and what impact it can have, whether it will mutate into a milder strain, die down in hotter months, etc., because a coronavirus is a very different creature than influenza. But each day we don’t take action, we compound the risk to ourselves and others.
Individuals can take measures into the own hands and adopt some simple but very effective practices that can reduce their risks:
1. The most basic measure is frequent and thorough handwashing after using the bathroom and before eating as a minimum, as well as changing diapers and before preparing food. Certainly, after a sneeze. A nice long, thorough lather of 20 seconds. Sing happy birthday to yourself twice if you don’t have a good concept of 20 seconds. Do this at least 5-6 times daily. Total investment: 2 mins.
2. Clean your surfaces regularly, especially in the kitchen and bathroom, with disinfectant. A couple of times a day.
3. One very helpful thing that everyone can do is to wipe down their mobile devices with a disinfecting wipe. It should be done 2x per day. This virus lasts on impermeable surfaces for up to 10 days, so your phone is a top candidate. Most folks don’t know this, but mobile devices are generally more prone to carrying bacteria and germs than even the toilet. And they are in close proximity to your mouth, noses etc. So, a simple way to cut transmission is to wipe them down. We are doing the same with our keyboards, touchscreens, landlines, TV remotes, microwave etc. It will also help reduce the transmission of colds and bacteria.
4. Try to keep your hands away from your face. Most people do this subconsciously more than 20 times per hour! Especially, you want to keep your hands (where coronavirus could lurk) away from your mouth, nose and eyes…all of which are entry points to your body. Try an hour of monitoring yourself or having a contest with a friend to see what your actual practices are. If you’ve washed your hands well, chances of contaminating yourself go down substantially.
5. Wash any vegetables and fruits without peels well. You don’t know who’s been handling them. There are disinfectants you might want to buy for this purpose.
6. Cook meat, chicken, and eggs fully.
7. Do not shake hands, kiss (even on the cheek) or hug anyone you think might be sick, maintain a distance (6 ft or 2 meters). In fact, just give these greetings a rest until this passes. Say namaste if you like.
8. If you feel sick, don’t go to work, coffee shops, restaurants, gatherings and infect your colleagues/friends/poker buddies, etc. Stay at home. If you’re not sure, stay at home.
9. If you feel like sneezing, and don’t have a tissue, sneeze into your elbow, not into your hand. If you do use a tissue, dispose of it well. If you do sneeze into your hand by accident, head straight to the bathroom and wash those hands well.
10. If there is an outbreak in your community, your best bet is to see the fewest number of people possible and to effectively ‘shelter in place’. In fact, the CDC is recommending this now in the US for people over 65 and those with severe medical conditions.
“Older adults and people who have severe chronic medical conditions like heart, lung or kidney disease seem to be at higher risk for more serious COVID-19 illness. Early data suggest older people are twice as likely to have serious COVID-19 illness. This may be because:
• As people age, their immune systems change, making it harder for their body to fight off diseases and infection.
• Many older adults are also more likely to have underlying health conditions that make it harder to cope with and recover from illness”
The reality of the matter is that we could already have cases in Cuenca, and if not, it’s a matter of time.
11. Take measures to stock up on at least 2 weeks of essentials if you need to stay at home – medicines, food, and water, pet food, toilet paper, etc., and make arrangements to work remotely. This is called social isolation. Your safest place is home alone during a pandemic.
12. Make sure your first aid kit includes: decongestants, anti-inflammatories and Tylenol. Make sure you have a reliable thermometer – that would be a key piece of equipment if you start to get sick. Pharmacies might close, as I think is the case in parts of Italy right now. So, have supplies on hand that could address a bad case of the flu/cold. This would be like a mixture of both, with respiratory symptoms.
13. If you get symptoms like fever (can escalate rapidly), cough, shortness of breath, call 171 (Ministry of Health), they will screen you and refer you to an isolation facility if necessary. Ecuador appears to be well-organized in terms of its public health emergency structure, but I do not know about the availability of things like test kids. Do not go to your doctor’s, you can contaminate everyone in the waiting room as well as the medical staff. Any medical personnel interacting with Covid needs to have Personnel Protective Equipment like hazmat suits and masks on and a disproportionate number of them are dying.
14. If you end up in isolation or quarantine, do it gracefully. Maybe prepare a “go pack” just in case of your essential items…my daughter who will be MD in 60 days and who is working in affected US hospital, is telling me that amoxicillin and augmentin is what they are using to treat related respiratory infections and erythromycin if it turns into pneumonia. There are also some other drugs that they’re using in field trials, including a drug that was developed for ebola, that wasn’t so effective, but seems to have some promise against COVID19.
15. If you need to see a doctor about something else, or are not sure, think about first contacting him/her or a teleconference, rather than exposing yourself to a clinic, depending on your medical issues.
16. With or without symptoms, avoid touching public stair banisters, light switches, doorknobs directly. You might want to hit them with your elbow or use disposable gloves and throw them away.
17. If cases are detected in the community, avoid crowded places like cinemas, restaurants and conferences, big meetings, pool parlors, pubs, etc.
16. Also avoid congested public transportation like buses, subways, planes. If you do have to fly, the safest place is a window seat. Bring disinfecting towels and wipe down any surface. Factor the possibility of getting quarantined into your decision-making.
17. If you have school-aged kids prepare to home school them. All schools in places like Japan , Italy and Seattle are all closed right now. So, plan in advance, make arrangements with work, get your supplies.
18. Think of a scenario in which electricity fails – quite unlikely but possible. So, buy flashlights and things like external chargers for your phone. In a real-time pandemic, utility companies can be affected by a high number of sick employees.
19. Be kind, think of the elderly and most vulnerable, check up on your friends. Do not hoard. For example, if you see 15 hand sanitizers, don’t grab all 15. Maybe 1-2 would do for your family, leave the rest for someone else.
20. If you are a medical worker, insist on personal protective equipment! N-95 masks and hazmat suits. Wash your hands frequently and keep on proper gloves. Dispose of them well, don’t reuse them. Get familiar with your isolation facilities, follow the Ministry of Health protocols and don’t take unnecessary risks.
Please don’t panic, but use this window to prepare. Be practical. Get in front of the curve.
Brenda: firstname.lastname@example.org .