You MUST read this!
I have been keeping an eye on the developments of the last month and the common theme is that we don’t know enough to be able to give accurate advise about how easy it is to catch and what the health impacts are.
There are a few common themes that are health and immunity facts:
- A strong immune system is always your best defence
- Stress reduces your immune response
- Individuals with sub-optimal health “the at-risk groups” should be extra cautious.
I heard an interview with Leigh Garrett at the end of last week that was a great insight to epidemics and how 2019 Novel Corona Virus (COVID-19) looks with the current data.
Leigh Garrett is a Pulitzer Prize winning Science Journalist who has actually been at Ground Zero of all of the major epidemics in the last 30 years. She is very knowledgeable in the whole area of epidemics and public health. What is interesting is that she hasn't ever contracted the illness that she was covering.
What we do know to date. Late February
The Corona Viruses are a family of viruses and account for roughly 50% of all the “common colds”.
So a question might be asked “Commonly how long does it take to catch a cold from a family member who comes home coughing and sneezing?” - 24hrs is a window that seems to have common experience.
What precautions do you use in this situation to NOT get sick with the same cold?
We can ask the same question if someone at work has a cold, or someone on the train or bus is coughing and sneezing. Do you always get sick, and if so how long was it since the train ride?
Things you can do at home straight way to reduce transmission risk.
A shared towel is a perfect way to infect each other. That moist environment full of bacteria viruses and dead skin cells is a “petri dish” to support both bacteria and viruses. Then we will either dry our face and put the bugs in our eyes, nose and mouth. If we don’t dry our face after we have dried our hands we then will often put our hands on our face, rub an itchy eye, sniff as we brush our nose. You are now infected!
At work, paper towels will reduce the germ transmission, as will air towels.
Door handles at home and work are a major way to transfer bugs. We cough, cover our mouth with our hand and then open a door a short time later. A perfect transfer of bugs from the mouth to the door knob. A virus can be live on the door knob for 3 or 4 hours depending on the temperature. You open the door and pick up the virus and then infect yourself with a eye rub, or nose scratch.
If it is warm - summer temperature and the surface is in the sun the ultraviolet light will kill the virus faster. In a darker and cooler surface the virus will survive longer, that is the upper limit of 4 hours and a little more.
Shared objects is another way that a virus can be transmitted. From an infected hand onto the... (phone, tablet, cup/glass, utensil, food - a piece of fruit). It seems that nearly everything can spread germs and viruses, and that would be true!
If your hand has the infection on it, then every time that you touch your face, you have likely infected yourself. If you have washed your hands regularly, then that risk is much lower.
What is the hand washing guideline when there is a virus/bacterial around your environment? Hot - more than warm - water and soap and thoroughly work the soap around your hands and between your fingers for as long as it takes to sing “Happy Birthday” twice. That’s easy to teach children!
Face masks? Do they work - well, yes and no
Everyone working at LA airport had one on and 1/2 the people at Sydney airport when I came back from the US in the 1st week of February.
The Sloane Foundation did a big study a few years ago looking at the efficacy of face masks in light of a Flu Pandemic. They looked at all masks with the focus on the N95 surgical quality masks. The findings in brief was that even the best quality mask has a serious drop in efficiency after 4 hours. The moisture that we breathe out denatured the fibres in the mask and the weave opened allowing virus sized particles to pass through.
The main benefit of a mask is that it makes the people looking at the mask wearer nervous and they will take appropriate precautions. This leads to the MOST protective thing which is “Social Distance”. Say a minimum of 2 steps apart (1m from WHO) simply means that a virus can’t cover the distance on a body fluid. The only exception might be a violent coughing fit, that would give the person coughing a certain projection of their bugs!
How easy to catch?
Talking of transmissibility, what is the current understanding? Generally a Corona Virus needs to be in a droplet of liquid. It can be microscopic, that visible vapour that we breathe out on a cold mountains morning. There is a recent paper that has come out of China suggesting that the COVID19 virus can be transmitted on the air. This changes things a lot and makes this more akin to influenza. If the aerosolised transmission is correct, then the virus can circulate in the air currents in a room for a limited period of time. This is not an absolute confirmed feature of the COVID 19 virus.
Who can give you the virus? Initially the story out of China was that the individual had to have a fever of over 38c and you had to be in very close contact. That has since been debunked as people with just the mildest of symptoms, just a tickly throat, have infected others. They would not think that they were sick. You can see that this has the potential to really increase the spread of the virus.
There is however proven survival of the virus in faeces of an infected individual. This just increases the need for thorough hand washing. This makes this virus more akin to a Cholera or the Dysentery virus.
How Virulent is COVID-19?
How virulent is the Corona Virus? The Rnaught is a mathematical value given that quantifies how many people you are likely to give the virus. A Rnaught of 1 would mean that the virus is not growing; you give it to only 1 person, not to all 6 people in the room with you. This is currently hotly debated. There is a lack of accurate data from China, but some say the Rnaught is 1. In a town in China, not Wuhan, where there has been an outbreak there is an insistence that it is 4.5. This is huge and far beyond a regular flu. The Spanish flu of 1918 had an R0 of less than 2, killed between 75 and 100 million people and circumnavigated the globe 3 times in 18 months all before commercial air travel. That does give us some perspective!
Time to get worried?
Gabriel Leung is the Dean of Hong Kong University Medical school. He has huge experience in dealing with recent epidemics of SARS and Bird Flu so he has relevant experience in this area. He is very widely published and is very highly regarded. He released a report 2 weeks ago and he predicted that the Virus would become a Pandemic and infect up to 60% of the world population with a 1% mortality rate.
This is not supported by the current WHO statements.
Politics, Power, Priorities
I have listened to a number of commentators over the last month and the common thread is that the quality of information coming out of China is poor. The death and infection statistics are all aggregated, so that it is hard to see if there is a profile that is at risk.
The Communist party and Xi Jinping is under considerable pressure from within China and the party. He recently fired the head of Epidemic response and replaced him with the head of security. That means that the epidemic has shifted from a public health issue into a public security issue.
We will have to get our data from Singapore, HongKong and Japan. Iran is a centre of the outbreak, but we are not sure how freely the Iranian regime will share all the relevant information.
The information that the health authorities need to determine appropriate actions depends on things like the Rnot value and the incubation period. If the Rnot is high and the incubation is long then we can be sure that the spread will be exponential. Currently the incubation period is officially about 3 days, but the recent experience from the cruise ship in Yokohama is that it might be 24 days.
What does a long incubation period mean?
What does a long incubation period mean?
- You have a longer period where in you could unknowingly infect others
- You are likely to cycle in and out of the medical system being checked increasing the load on the medical resources
- Each time you go back into a medical setting for further testing you have an opportunity to infect others in that medical environment.
How fast is the testing? It is in the order of several magnitude faster for a woman to find out if she is pregnant. The current testing takes 8 hours at a minimum and has a false negative result, that is not fully quantified. That means that you will likely be called tomorrow with your results. There is now a shortage of test kits in China with samples backed up waiting for testing.
The long incubation period carries a much bigger risk that an individual can unwittingly infect others while they are not symptomatic, but still carry the infection. This is a public health worst nightmare.
The current Chinese approach of CoVid19 management is based on the SARS experience, which was based on fever checks. There is now evidence that people are infected without a fever. In China during the SARS epidemic a person might be checked 12 times as they moved about a city in a day. On a 500km road round trip Epidemic reporter Laurie Garrett was pulled over for a fever check every 10kms. That strategy was very effective in its containment as fever was a reliable predictor of infection.
Can it be STOPPED?
Can it be stopped?
The time to stop any outbreak is when the numbers are very low. This is what is happening in the UK, Canada and Australia. By the time the numbers are up in the several hundreds, the battle is lost.
It is much the same in a body. If you can act to take your medicine in the very early stages of a cold, just when you get the tickly throat, then you can win. Both the germs and the immune system work on a logarithmic multiplication. So if your body gets the upper hand on the bug when there is only a few, then you are good. If however you don’t get the jump on the bug, it grows faster than your immune system can muster the army, and you get sick.
That is the concept of the prior exposure/vaccination. You have met this bug before and your immune system has some specialised weaponry to kill off that particular virus or bacteria.
Leigh Garrett is very pessimistic if the virus gets into SubSaharan Africa. There is virtually no health infrastructure or resource there, and it will be very serious. The Chinese Belt and Road initiative is likely to be the way that the virus could be introduced to that part of the world.
Will there be a Vaccine?
So is there a vaccine? Looking at the recent history of vaccine development post epidemics, SARS happened in 2003 and we don’t have a SARS vaccine and MERS emerged in 2013 and we don’t have a MERS vaccine. Both these viruses are close cousins to COVID19. If there was a partially developed candidate then it might take 1 year to get it to market with clinical trials completed etc.
The long and the short of it is that it is EXTREMELY unlikely that we will get out of this crisis with a vaccine.
So Now What?
That means that our precautions have to be using existing, mostly natural resources.
This comes in 3 major forms:
- Boost your body’s ability to fight an infection - your immune response
- Take things that are anti-microbial
- Change your behaviours
Things to boost your immune response:
- Reduce stress -
- Right foods for you
- Anti Microbial
- Hand sanitiser
- Spray air with anti-microbial
- The most potent protections would fall into what would be classed as human behaviour. We have looked at a number of these already.
- Social distance - greater the better, no less than 1 meter
- Don’t share towels
- Wash your hands frequently particularly before preparing food and before eating
- Don’t shake hands
- Dilution is a key to low infection risk.
- Outside in fresh air is better than indoors
- Open the windows in your car during a drive with others in the car
- The latest updates on the COVID-19 are here on this WHO resource: www.who.int
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