For a printable pdf of this click here.

The Q & A video is available here.

I’ve been updating information in brackets since we held this interview on March 18, 2020. Things are changing so quickly that I added an overnight development in brackets about the hospitalization rate for younger people. Other new developments include new cases in China and the loss of smell and/or taste as potential signs of infection, even in people without symptoms.

About me: I have a masters’ degree in Infectious Disease Epidemiology from UCLA, a bachelors’ degree from Wheaton College in biology with a certificate in International Community Development, and a masters’ in Greek and Hebrew Exegesis from Gordon-Conwell Theological Seminary. Usually, I am writing and posting bible studies on the Redemptive History Facebook page, but these are not normal times.

 

1. What are the symptoms for Covid-19?

Fever, cough, shortness of breath can occur 2–14 days after exposure. Most cases are mild. In serious cases, people have the fever and cough for about a week before breathing problems develop. The virus works by shutting the immune system down and stripping away the lung lining. In some people, the immune system then kicks in with what is called a “cytokine storm.” It can be as deadly as the virus.

If you are sick and think it might be Covid-19, call your doctor. Do not just go to the clinic, as you will infect others. Check the second link below for specific information.

[Emory University has developed an online tool to check whether what you are experiencing matches the symptoms for Covid-19. It’s available here.]

[Should you develop emergency warning signs for COVID-19 get medical attention immediately. These include difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse, and bluish lips or face.]

[One potential sign of infection even in people without symptoms is a sudden loss of smell and/or taste. If you experience either of these, you should behave as if you are infected.]

https://www.cdc.gov/coronavirus/2019-ncov/about/

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

https://www.uab.edu/news/research/item/11176-covid-19-do-not-forget-the-host-in-treating-this-disease

https://www.jwatch.org/fw116476/2020/03/23/covid-19-loss-smell-taste-healthcare-workers-mental

 

2. What do we know about how Covid-19 is transmitted from person to person?

Respiratory droplets fall within six feet, surface contact –

https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html

This virus can survive for 3 days on plastic, 2 days on stainless steel, and 1 day on cardboard. Note in this study, jets of air kept the virus from falling to the ground. Aerosols are uncommon –

https://www.nejm.org/doi/10.1056/NEJMc2004973

What to wipe down daily in your own home: remote controls, alarm clocks, phones, cabinet and drawer handles, doorknobs and door locks, light switches, desk surfaces, keys, credit cards, garage door opener, and refrigerator handles. Keep wipes in your car and use every time you get back in. Be aware that a pet can carry the virus on its fur or skin –

https://www.washingtonpost.com/travel/tips/what-you-should-shouldnt-do-stay-healthy-hotel/

https://www.cdc.gov/coronavirus/2019-ncov/prepare/animals.html

[Click here for an excellent video on how to safely bring groceries into your home and how to transfer take-out food from the packaging to your plate. Restaurant and prepared foods which you can heat are much safer than those eaten cold. Note that he corrects his claim that the virus survives on cardboard from “one hour” to “one day” later in the video.]

https://www.washingtonpost.com/opinions/2020/03/26/dont-panic-about-shopping-getting-delivery-or-accepting-packages/

[Here’s a helpful post concerning how to do laundry when someone in your household is sick or may have been exposed to the virus:

https://www.consumerreports.org/laundry/prevent-spread-of-covid-19-while-doing-laundry/.]

 

3. Who can transmit the virus?

People without symptoms can transmit the virus before getting sick or without getting sick at all –

https://www.cnn.com/2020/03/14/health/coronavirus-asymptomatic-spread/index.html

In South Korea, where 270,000 people have been tested, 35% of cases are in people aged 10–29. Most of them would not meet the standard for being tested in the US—as in Italy—where it’s 5%. It is likely that a similar percentage of young people are infected here with few or no symptoms. Keeping everyone home is critically important, even when they don’t feel sick –

https://www.sciencemag.org/news/2020/03/coronavirus-cases-have-dropped-sharply-south-korea-whats-secret-its-success

https://www.statista.com/chart/21134/age-distribution-coronavirus-italy-south-korea/

 

4. Who gets sickest?

For people over 80, as many as 1 in 4 diagnosed with the virus have died; for 70–79, it’s 1 in 12 patients; for 60–69, it’s about 1 in 28; for 50–59, it’s down to 1.3%; less than half a percent for younger people. [Only a few people younger than 18 have died in the US.] 13% of cardiac patient died, compared to 9% of diabetics; about 8% of those with COPD, hypertension, or cancer have died. Obesity and kidney disease also seem to carry increased risk of death –

https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

https://www.acc.org/latest-in-cardiology/articles/2020/03/01/08/42/feature-coronavirus-disease-2019-covid-19-provides-potent-reminder-of-the-risk-of-infectious-agents

[This shows how fast information is changing. A study just released shows up to 20% of patients 20–44 years old in the US require hospitalization: https://thehill.com/policy/healthcare/488325-cdc-data-show-coronavirus-poses-serious-risk-for-younger-people]

[On March 30, 2020, the FDA gave emergency approval for the use of chloroquine and hydroxychloroquine in hospital settings. Please be aware that these drugs can have life-threatening side-effects for some people, and do not attempt to prevent or treat infection by using them on your own.]

[Taking a vitamin D supplement appears to boost the protective immunity of people with weak immune systems and decrease the strength of autoimmune reactions. It may help prevent infection and, should the virus establish itself in a person’s body, may decrease the likelihood of the severe reaction caused by a cytokine storm. The Recommended Dietary Allowance is 600 IU for people under 70 and 800 IU for people over that age.]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

https://ods.od.nih.gov/factsheets/VitaminD-health%20Professional/

[It is safe to take NSAIDs like ibuprofen and naproxen while sick with Covid-19. The French Health Minister suggested it might not be and that idea took off. No scientific evidence supports that assertion.]

https://www.medscape.com/viewarticle/926940

 

5. What does “flattening the curve” mean? How do we do that?

Right now, the number of new cases is starting to double rapidly. If that continues, we will have one hundred million cases in the US by May. We have about 20 ventilators per 100,000 people. That means 1 in 50 people with the virus will have a ventilator available. The best estimate is that 1 in 22 patients will need ICU care, so less than half of those who need it will have access. That’s happening in Italy now; doctors are having to choose who might live and who will die.

The goal is to have fewer people get sick at once to avoid overwhelming our medical system. Those who recover will be immune, also making spread of the disease less likely. It also gives us time to develop a treatment or vaccine –

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

https://www.ncbi.nlm.nih.gov/pubmed/21149215

https://www.healthaffairs.org/do/10.1377/hblog20200317.457910/full/

https://www.nejm.org/doi/full/10.1056/NEJMp2005492

Although experts are testing a vaccine now, we will not have a safe and effective one for 12–18 months. Allowing the disease to spread through our population will result in about 80% of Americans getting infected, resulting in 2.2 million deaths.

A combination of the entire population staying home (social distancing), quarantining entire households of sick people, and closing schools and universities provides the best chance of slowing the infection rate to a manageable level until a treatment or vaccine becomes available. There could still be 1.1–1.2 million deaths, about half the number from doing nothing to distance ourselves from each other.

[Some confusion has developed due to the British researcher who developed the mathematical model downgrading the pandemic’s severity in the UK. He clarified that the change arose because the government there began to use better practices, not because his original estimate was incorrect.]

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

https://twitter.com/neil_ferguson/status/1243294815200124928

[A CDC map enables you to hover over a state to see the number of reported cases there. Clicking on it will take you to that state’s health department web site for additional information.]

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html#reporting-cases

[The US government is using a newer model which accounts for social distancing practices in each American state. It concludes that the first wave of the pandemic will end in June, when the weather warms. However, 97% of the US population will remain susceptible when a second wave arrives in the fall. This model has a state-by-state breakdown of the expected number of deaths; the peak date of the first wave; and the number of hospital beds, ICU beds, and ventilators needed during this phase.]

http://www.healthdata.org/covid/faqs#length%20of%20the%20epidemic

https://twitter.com/neil_ferguson/status/124329481520012492

https://twitter.com/neil_ferguson/status/124329481520012492

6. What is the difference between social distancing and self-quarantine?

Social distancing is for everyone. It includes working from home instead of at the office, closing schools or switching to online classes, visiting loved ones by electronic devices instead of in person, cancelling or postponing conferences and large meetings, and enjoying recreation at home or in open spaces in groups of no more than ten people with at least six feet between individuals. For example, you can still walk your dog if you and your pet stay at least six feet away from other people and don’t allow your dog to touch someone else’s dog.

In early March, I moved up my visit to my elderly mother by six weeks to help her gather supplies and to show her how to protect herself. I taught her to disinfect counters daily, wash or wipe her hands every time she touched something away from home, elbow bump rather than shake hands, and shower at night if she has walked out of her gate, even just to get mail.

My second night there, a woman died in her local hospital. We decided getting haircuts was too risky. After getting supplies at times when we knew few people would be shopping, we treated ourselves with a visit to an antique store we knew would not be crowded. Then, we visited my brother without touching him, except for an elbow bump.

Self-quarantine is for those who suspect they have been exposed. The current guideline is to remain in quarantine for fourteen days. It involves using standard hygiene and washing hands frequently, not sharing things like towels and utensils, staying at home, not having visitors, and staying at least 6 feet away from other people in your household.

Since a possible exposure in mid-March, I’ve been doing this. The incubation period is 2–14 days, so I bought cleaning supplies, groceries, and plants on Days 0 and 1. In addition to educating people about this virus, I’ve been doing lots of gardening. My gym is closed (as it should be), so I am trying to come up with alternative ways to exercise. Wearing my hair in a ponytail helps me touch my face less often.

[With such widespread infection in our community, I’m assuming everyone I meet has been exposed. So, I’m repeating the process by remaining in quarantine until Day 14, doing necessary errands on Days 0–1, and returning to quarantine until Day 14.]

Infected people must be strictly isolated from others, either at home or in a treatment center. Viral shedding lasts for 8 to 37 days, with an average of 20, so patients must remain in isolation even after they feel better–

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-social-distancing-and-self-quarantine

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext

 

7. How long will this last?

We really don’t know. It could be as much as 12–18 months, when we have an effective vaccine or treatment. China just reported their first two days with no new cases after eight weeks of strict quarantine enforced by their government. In our society, it’s going to be difficult to accomplish eradication that quickly. [Note that the latest WHO situation reports show new cases in China.]

https://www.washingtonpost.com/health/2020/03/19/coronavirus-projections-us/

https://fortune.com/2020/03/19/coronavirus-hubei-province-no-new-cases/

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

[For those of you wondering why it is taking so long to develop tests, treatments, and vaccines, I recommend this journal article: https://www.nejm.org/doi/full/10.1056/NEJMp2002125.]

[This outstanding article delves into many aspects of the pandemic which await the world in the months and years ahead: https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/.]

 

8. What should we do and what should we avoid?

Wash your hands often for at least 20 seconds. In a public restroom, use a paper towel to dry your hands, turn off the faucet, and open the door before throwing it away. If using hand sanitizer, use one with at least 60% alcohol.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Do not reuse it.
Clean and disinfect frequently touched objects (Can use 70% alcohol if necessary)
Stay home when you are sick.
Contact a health worker if you have symptoms; fever and a dry cough are most common. If you don’t have a fever, you probably don’t have Covid-19.
DO seek emergency care if you have been sick and develop difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse, and bluish lips or face.
DON’T touch your face. The virus can enter through your eyes, nose, or mouth.
DON’T travel if you have a fever and cough.
• DON’T wear a face mask if you are well. DO wear one if you are sick.
DO let people know if you are coughing from an allergy or something else that won’t kill them.                                                                    • DO have a plan in place in case someone in your household develops symptoms and needs to be quarantined at home away from others.

 

https://www.vox.com/science-and-health/2020/3/17/21181694/coronavirus-covid-19-lockdowns-end-how-long-months-years

“If it looks like you’re overreacting, you’re probably doing the right thing” (Anthony Fauci).

I love the analogy of playing football. You want to place the ball where the other player is going to be, not where he or she is now. Public health works the same way. We anticipate what will happen in the future and act accordingly.

https://thehill.com/homenews/sunday-talk-shows/487639-fauci-if-it-looks-like-youre-overreacting-youre-probably-doing-the

In general, these are sources you can trust:

1) Anthony Faucihttps://www.niaid.nih.gov/about/director
2) US Center for Disease Controlhttps://www.cdc.gov/coronavirus/2019-ncov/index.html
3) World Health Organization Situation Reports – These tend to be one day behind. Some nations are not keeping their information up-to-date, so do be aware of that: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
4) Johns Hopkins Universityhttps://coronavirus.jhu.edu/

Here is a reflection by Kelly Ladd Bishop
Friends:
Schools and gatherings are closing left and right around us. Life will be disrupted for a bit. People will be sick. Hopefully people will also get well! We pray to God for this! God is good.

We cancel gatherings and we stay home, NOT to preserve our own health (although that may be a happy side effect), and NOT because we are afraid, but because we care about those who are vulnerable, who are elderly, who may not have access to health care, and because we don’t want our hospitals overrun, and our doctors unable to help those who need help. This is simple math and science. Fewer vectors, fewer sick people.

What affects “the least of these” affects all of us. Maybe it takes a pandemic to make us realize that we are all on this rock together – doctors, epidemiologists, teachers, students, bus drivers, pastors, babies, homeless people, politicians, weak, strong, all of us.
In my city there is a percentage of the population that experiences food insecurity. Many students receive free meals at school twice a day. When the community closed schools, people began to talk about how to help. A local restaurant gave away free meals today, no questions asked. A group of residents put together a Facebook page offering to pick up groceries or supplies for anyone quarantined (MANY families in our community are currently under quarantine). People have started asking, “how can we help?”

Sometimes life stinks. But when it does, the heart of God can often be seen in those who desire to care for “the least of these,” the vulnerable, the sick, the poor, the scared. Take heart friends, God is always moving. God is moving in our communities. God is drawing us together despite these challenges. God is good, and this will end. And when it does, I pray that we don’t forget the importance of caring for “the least of these,” and that we don’t forget that we’re all in this together.

“Then the righteous will answer him, ‘Lord when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?’ The King will reply, ‘Truly I assure you that when you have done it for one of the least of these brothers and sisters of mine, you have done it for me.'” Matthew 25:37-40

________________________________________________________________________________________

Here is an outstanding summary in written form I found on Facebook:

Julie A. Bettencourt is at Brigham and Women’s Hospital.
March 14 at 10:50 PM · Boston, MA

From one of the doctors here at Brigham and Women’s Hospital, Dr. Julie Silver and her friend Dr. Reem Ghalib. Please read the whole thing, it is an important summary about COVID19, flattening the curve and what will happen if we don’t take strict precautions now:

Julie said, “It has been years since I have posted anything on this page. As a physician at Harvard Medical School, I have amazing access to the best information and resources for Covid19. I know people are getting a lot of information, and not all of it is accurate. My friend Dr. Reem Ghalib summarized the situation in one of the best social media posts to date on this topic (copied/pasted below). Please read what she has to say and share with your loved ones, friends, and colleagues. Urge people to be calm and logical in their decision making. Err on the side of caution. Re the info below–note that “coronavirus” is used generically to mean the specific strain Covid-19. I will apologize in advance for not responding to comments as work is very hectic right now:

Dear Friends,

So much confusion, misinformation and denial is bouncing around on social media about the coronavirus that I thought I would try to explain, in plain language, why the experts see this as such an emergency.

You will see the claim online that this virus is a lot like the viruses that cause colds, and that if you get it, it will probably just seem like a bad cold and you are very unlikely to die. Depending on who you are, these statements are probably true. But they are incomplete, and the missing information is the key to understanding the problem.

This is a coronavirus that is new to the human population, jumping into people late last year from some kind of animal, probably at a wildlife market in Wuhan, China. It is related to the viruses that cause colds and acts a lot like them in many ways. It is very easy to transmit through the respiratory droplets that all of us give off. But nobody has ever been exposed to this before, which means nobody has any immunity to it.

The virus is now moving explosively through the human population. While most people will recover, about 20 percent of the people who catch it will wind up with a serious disease. They will get pneumonia that causes shortness of breath, and they may need hospitalization.

Some of those people will get so sick that they cannot be saved and will die of the pneumonia. The overall death rate for people who develop symptoms seems to be 2 or 3 percent. Once we have enough testing to find out how many people caught the virus but did not develop symptoms, that might come down to about 1 percent, optimistically.

This is a large number. It is at least 10 times higher than the mortality rate for the seasonal flu, for instance, which in some years kills 60,000 or 70,000 Americans. So just on that math, we could be looking at 600,000 or 700,000 dead in the United States. But it gets worse.

Older people with existing health problems are much more vulnerable, on average. The mortality rate of coronavirus among people over age 80 may be 15 or 20 percent. It appears to have 7 or 8 percent mortality for people aged 70 to 79. Here is the terrible part: If you are a healthy younger person, you can catch the virus and, without developing serious symptoms yourself, you can pass it along to older people. In other words, as the virus spreads, it is going to be very easy to go out and catch it, give it to your grandmother and kill her, even though you will not die yourself. You can catch it by touching a doorknob or an elevator button.

Scientists measure the spread of an epidemic by a number called R0, or “R naught.” That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer infectious? The R0 for coronavirus, in the absence of a control strategy, appears to be a number close to 3 – maybe a bit higher or lower, but in that ballpark. This is an extremely frightening number for such a deadly disease.

Suppose you catch the virus. You will give it to 3 other people, and they will each give it to three others, and so forth. Here is how the math works, where you, the “index case,” are the first line:

1

3

9

27

81

243

729

2,187

6,561

19,683

59,046

177,147

531,441

1,594,323

4,782,969

14,348,907

So, in just 15 steps of transmission, the virus has gone from just one index case to 14.3 million other people. Those 15 steps might take only a few weeks. The index person may be young and healthy, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in one person’s throat.

The United States is not at this point yet, with millions infected, as best we can tell. We don’t really know, because our government has failed us. We are many, many weeks behind other countries in rolling out widespread testing, so we don’t really have a clue how far the thing has spread. We do know that cases are starting to pop up all over the place, with many of the people having no known exposure to travelers from China, so that means this virus has escaped into our communities.

We do not have approved treatments, yet. We do not have a vaccine. The only tool we really have now is to try to slow down the chain of transmission.

This can be done. In other words, R0 is not fixed – it can be lowered by control measures. If we can get the number below 1, the epidemic will die out. This is the point of the quarantines and the contact-tracing that you are hearing so much about in the news. But the virus is exploding so fast that we will not have the labor available to trace contacts for much longer, so we have to shift strategies. This has already begun, but we are not doing it fast enough.

It is now likely that the majority of Americans will get this virus. But slowing it down is still crucial. Why? Because the healthcare system has limited resources. We only have about a million hospital beds in America. We have well under a million ventilators. If millions of Americans get sick enough to need treatment, we will have a calamity on our hands. What will happen is a form of battlefield triage, where the doctors focus on trying to treat the young and allow the older people to die.

This is not theoretical. It is already happening in Italy, where people over 65 are being left alone on hospital gurneys to suffocate to death from pneumonia. They basically drown in their own sputum. There is simply not enough medical capacity to take care of them. The United States appears to be about two weeks behind Italy on the epidemic growth curve.

What do we need to do now? We need to cancel all large gatherings – all of them. You have probably seen that the N.B.A. has postponed the rest of its season. Other sporting events, concerts, plays and everything else involving large audiences in a small space – all of it needs to be canceled. Even if these events take place, do not go to them. No lectures, no plays, no movies, no cruises – nothing.

Stay at home as much as possible. Stay out of restaurants. I would cancel any travel that is not absolutely essential. Work from home if you possibly can. You may have to go buy groceries and medicine, of course, but make the trips quick and purposeful. Wash your hands assiduously after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers. Sunlight and alcohol will kill the virus.

And please stop passing around statements on social media claiming that the situation is not serious or is being exaggerated. This is a national crisis and conveying misinformation to your friends and family may put their lives in danger.
__________________________
A final note: We’re all in this together. At this point, the best way I know how to love my neighbor is to take the proper precautions.

Image via Wikimedia Commons