This is going to be a very long post, and for that I apologize. The situation with the novel coronavirus, which causes the disease known as COVID-19, has been both fluid and unclear. I’ve avoided posting anything specific to this point, simply because we didn’t know enough.
Today we do, and the situation has focused to the degree that I can be comfortable making specific recommendations. As recently as this last weekend, such was not the case. That’s how rapidly this is changing.
The length of this post is due to the amount of information that needs to be disseminated to help you prepare for the possibility of a coronavirus pandemic in the United States.
Part of the issue with getting the information needed to make preparedness recommendations has been the political situation where the virus originated. Chinese officials have not been forthcoming since this contagion started, and as a result we have not been able to trust the data they’ve made public. Their delay in allowing American members of a World Health Organization (WHO) team to enter their country to help with the response was particularly telling.
As a result, to get a clear picture of the progression of the disease we had to wait until sufficient cases had occurred in countries where we could trust the data. That is just now happening.
While there are still a lot of unanswered questions, we’re starting to get a better sense of what this virus is and what it does. Even so there is still a lot of speculation, but now the speculation is at least partially informed.
In this country, many people have been quick to spread false information — on both sides of the issue. However, it’s the naysayers who are the most dangerous, because they convince people to avoid preparing.
The most common myth being promoted is “this is no worse than the flu”, with the implication that we don’t need to do anything beyond normal preparations for flu season. This is most assuredly UNTRUE.
There are several things which differentiate the novel coronavirus from typical flu strains. These are not trivial differences:
- The novel coronavirus has a much longer incubation time than the typical flu; 14 days seems to be typical, and there are credible reports of incubation times stretching as long as 24 days. This means potential cases are very hard to detect.
- What makes that long incubation time particularly concerning is the potential for asymptomatic (not showing any physical symptoms) carriers to transmit the virus to others. While this was initially disputed, recent data shows it to be the case: someone can contract the virus and infect others while showing no symptoms themselves. Combined with the long incubation period, this means that an infected person could potentially infect others for two to three weeks before they know they even have the disease. This makes community infection (infections from people who themselves have not been to an infected area) much more difficult to track and control.
- The novel coronavirus is also much more infectious than the flu. Numbers are very hard to come by, but the best I’ve found say that this is 2-3 times more contagious than the flu. This means that it can spread between individuals much easier than the flu does.
- The initial symptoms of COVID-19 and the common flu are similar, causing people to put off seeking care until the symptoms become severe. This means they stay in the population longer, infecting others.
- The novel coronavirus appears to have a particularly long life outside of a body. Again, data on this is hard to come by, but the research I’ve seen suggests a life of many hours on non-porous surfaces. Some research has said that in ideal temperature/humidity environments, the virus can live on surfaces for 2-3 days. This means that anything an infected person touches can be a possible source of transmission to others, and for a relatively long time. Some of the cases in Italy have been traced to Catholics dipping their fingers into holy water, perhaps days after an infected person. This is a very persistent bug!
- This virus is spread via common methods (sneezing, coughing). However, it’s been confirmed to be present in the feces of an infected person, and there is some indication that it can be present in urine as well. This means that restrooms may become a particular source of infection. At this point there is no confirmation of air transmission (I.e., travel through the air as opposed to being in physical contact with the expelled bodily fluids from sneezing and coughing.) This may change as we get better information from infected areas in Europe, where governments are more forthcoming with their research data.
- The coronavirus is particularly virulent. The most recent numbers I’ve seen say that the overall death rate for COVID-19 is in the 2-3% range, which is MUCH higher than the .1% for the common flu. What’s more, the hospitalization rate (confirmed cases requiring hospital-level care) is about 18% of cases, and of that set of patients 9% will die. This, too, is orders of magnitude higher than the flu.
- Information has recently come to light that reinfection after initial recovery is possible, and that the mortality rate for re-infected patients is much higher than that for primary patients — some initial numbers suggest the mortality of such reinfections may be over 30%. This is something I’m watching very closely, because there is still a lot of doubt about how reinfections actually occur and how they kill patients.
- Finally, what is particularly concerning are the people who die from a coronavirus infection. A typical flu tends to kill people primarily in high risk categories (children, the elderly and those with compromised immune systems). COVID-19, however, is proving to be lethal even to healthy people of 30 and 40 years of age, where deaths from flu are unusual. In other words, this infection kills people the flu barely touches. This means everyone is at risk.
In short, while the absolute numbers aren’t as high as the average flu, both the chances of infection and the consequences of infection are much worse. Should COVID-19 become as widespread as the flu, we’ll see far more dead bodies around. This is not something to be complacent about, and it IS NOT less dangerous than the flu.
Symptoms of COVID-19
According to the CDC, symptoms can appear as early as 2 days after infection. They include:
- Feeling short of breath
- A cough that gets more severe over time
- A low-grade fever that gradually increases in temperature
Since these are similar to the flu, they can be easily mistaken. Pay close attention to any change in your symptoms, or those of others.
What is the probability of the novel coronavirus causing a pandemic in the U.S.? This is particularly hard to judge, because of the lack of solid data to support the assumptions necessary to make predictions.
However, I think we can look at what’s happening around the world and get some measure of the risk.
- China has literally shut down their economy because of COVID-19. Economic activity in the second-largest economy in the world has come to a complete stop. I doubt the Chinese government, which is very keen on hitting their economic growth forecasts at all costs, would have taken such steps if the virus were not deemed a severe threat. Their actions tell us more than words could.
- Our own Centers for Disease Control (CDC), which is generally very circumspect, said three very disturbing things this week:
- “It’s not so much of a question of if this will happen in this country anymore but a question of when this will happen.”
- “Disruption to everyday life may be severe.”
- “We are asking the American public to prepare for the expectation that this might be bad.”
- One CDC official went so far as to suggest that the novel coronavirus could end up infecting “40% to 70%” of Americans.
- Borders are being closed all over Asia and now in Europe, in an attempt to halt the spread of the virus. This is unprecedented, at least in my lifetime.
- Italy has imposed quarantine on at least one town as this is being written.
- An effective vaccine is generally agreed to be nearly a year away. It’s possible that, with great effort, one is developed in the 6-9 month timeframe, but I’m not counting on it. If one does become available before the U.S. Is hit with a large number of cases, we stand a chance of avoiding a pandemic. It’s a big “if”, however.
I think it’s reasonable to conclude that this virus now has a better-than-even chance of turning into a pandemic. This is my “tipping point” for sounding the alarm, and the reason for today’s blog entry.
As of today, normal preparedness levels should have you in good shape as the situation currently sits. If you’ve taken preparedness seriously, you’ll already have most of what you need to deal with an outbreak of novel coronavirus.
At this point, I’m adopting the following posture and suggest you do as well:
- Have no contact with anyone who has traveled in or through a known outbreak area, or anyone has had any contact with people who have done so.
- Use hand sanitizer whenever you touch anything in public, and wash your hands often. Learn the “surgeon’s scrub” for washing your hands, and use it every time: wash the thumbs, between every finger, the backs of the hands and up to the wrists, with plenty of soap and water. Doing in properly takes about a half-minute; if you’re getting it done in 5 seconds, you’re not getting clean.
- Do not touch your mouth, nose, or eyes with hands that have not been sanitized. You’d be surprised how often we all do that, and it’s the #1 avenue for viral infections.
- Carry sanitizing towlettes with you, to wipe down public toilet seats before use (the tissue covers are not sufficient)
- If you’ve heeded my many calls to be prepared, you should already have at least a month of food & drinking water stored; if you don’t, now is the time to do so. A 6-month supply is better. Don’t forget your prescription medications!
- This is the time to make sure you have a supply of disposable facemasks available. Also get some cheap goggles (safety glasses) if you don’t wear glasses; wearing a mask while leaving your eyes exposed is counter-productive!
- No foreign travel for any reason; yes, I suggest you cancel any planned trips abroad, at least until it looks as though the situation has stabilized. Understand that might be 6 to 12 months, if not more.
- Limit cross-country travel unless necessary; if a large number of cases should be reported in a specific area, do not travel there.
- Wash or disinfect everything you bring into your house (packaged food included).
- If you develop any symptoms of COVID-19, immediately self-quarantine and contact your doctor. It may be simply a case of the flu, but better safe than sorry.
If community transmissions start to be reported around your region (say, within a 100-200 mile radius), I suggest you escalate your response to include:
- Limit attendance at all discretionary gatherings — those with large numbers of people, particularly indoor gatherings. This means no movies, concerts, graduations, sporting events, etc.
- Limit your travel to your local area only. Do not use airlines or trains.
- Do not eat in restaurants.
Should community transmission be reported in your locality (say, within a 25-50 mile radius), it’s time to:
- Limit all local travel to necessity only
- No public transportation of any kind
- Always wear facemask and goggles in public
- Limit work, school activities, and religious observances to small groups only. This may mean splitting up school classes or work teams to reduce the number of daily contacts. Monitor group members for any signs of infection.
- Be aware that religious activities pose a particular danger, because of the proximity of fellow worshippers for long periods. Aside from the aforementioned cases of infection from holy water, a religious group in South Korea has over 200 cases traced to their close proximity in worship for hours at a time.
If cases should occur in your town:
- Don’t go anywhere unless absolutely necessary; stay in your home except for emergencies
- Start eating your stored food; avoid going to the grocery store
- Absolutely no school, social gatherings, or religious services
- Work from home or take vacation time
- If you absolutely feel that you must go to work, wear goggles and a facemask 100% of the time. Try to avoid interacting with the public. If it can’t be avoided, wear gloves and sanitize anything touched by the general public. Insist your co-workers do so as well.
The cases so far reported, and the reactions of governments all over the world, almost guarantee a significant recession this year — probably occurring in the next couple of months. Given the drop in economic activity of powerhouse China, all sectors of the U.S. economy will be affected.
Should widespread infections occur in this country, an extremely severe recession is likely. Should a true pandemic erupt, with deaths over 100,000, it’s a certainty.
If you’ve included an economic slowdown in your preparedness, now is the time to look at your plans and be ready to put them into action.
It’s possible that, should a severe outbreak occur, our government could close borders and quarantine entire towns, much as other governments around the world have done. While I don’t think it’s likely, I do think that dealing with such actions should now be part of your preparedness planning. How would you handle a quarantine of your town or city? How would that affect your life? What new hardships might you face?
I don’t want to perpetuate panic or fear-mongering, but here is an article I think is worth reading for a look at what might happen should the situation spiral out of control. I normally wouldn’t share something like this, but I think the plausibility is now great enough that we should at least be thinking about these things:
Here are just a few of the sources I’ve used in my analysis. These are the better (more reasonable and fact-checked) articles I’ve been able to find, though they still have a range of opinions — that’s just a function of the uncertainty that this virus carries.
Should something change dramatically, I’ll update you. Stay safe, stay well, and don’t panic!
- Posted by Grant Cunningham
- On February 27, 2020