Glutton for Punishment? A Primer on Coronavirus

It's impossible to avoid reading, hearing, or talking about coronavirus or COVID-19 right now. There's a lot of conflicting information out there that can make your head spin. So I thought I'd do a quick summary of what this #coronapocalypse is and how you can help #flattenthecurve.

What is coronavirus/COVID-19?

People are using these terms pretty interchangeably, but they don't mean exactly the same thing. Coronaviruses are a family of RNA viruses (first identified in the 1960s) that cause upper respiratory infections. Typically that looks like a cold (up to 30% of common colds are thought to be caused by coronaviruses) - though sometimes they can cause fatal reactions. Coronaviruses get their name from the glycoprotein spikes that stick out past the main enveloped viral particle - because the spikes look sort of like a crown.

SARS-coV

Credit: Dr Linda Stannard/UCT/Science Photo Library

There are quite a few that only infect other animals (like pigs, cows, chickens, dogs, cats, etc.), but there are 7 known to be able to affect humans. The virus that is currently causing a pandemic is called SARS-coV-2 (for severe acute respiratory syndrome-coronavirus-2). The term COVID-19 refers to the disease caused by SARS-coV-2 - AKA coronavirus disease 2019.

So why is this coronavirus such a big deal?

On December 31, 2019, the Chinese government alerted the World Heath Organization (WHO) that an outbreak of a novel SARS-like pneumonia was going on in Wuhan. It is believed that the SARS-coV2 virus originated in either a bat or a pangolin population, mutated and hopped into our species. Unlike the most commonly circulating coronaviruses, this strain has a death rate anywhere from 2-15% (it's hard to say because of variability in testing around the globe). Some studies even suggest the real death toll will be more like 1.4% of infected individuals. Thankfully, it's no where near as deadly as MERS (about 34% of those patients died), but it is more virulent - meaning it is able to spread from host to host more efficiently.

Virulence is usually described using the term R0 (r-naught) - where R represents the reproductive rate of the virus. The R0 value tells us how many people one sick person might go onto infect - the higher the number, the quicker the spread of the disease. The H1N1 virus of 2009 had an R0 about 1.4 to 1.6. The virus that caused the 1918 flu pandemic is estimated to have had an R0 of 1.4 to 2.8. As many as 50 million people died in a single year as a result of the 1918 flu pandemic. Early data suggests that SARS-coV2 has a R0 between 2-3. This means that for every one person who is infected, we can expected them to go on and infect another 2 to 3 people.

Source: Vox

A lot of people keep saying "The seasonal flu kills as many as 50,000 Americans a year. Why the overreaction to a few thousand people dead from in the whole world?" This is very dangerous thinking.

Seasonal influenza viruses - there are many strains circulating which is why sometimes you can get sick even after getting vaccinated - typically kill 0.1% of those infected. If we assume that 50,000 people represent 0.1% of infections - that gives us 50 million influenza infections in a single season in the United States alone. Let's imagine, for argument's sake, 50 million Americans become infected by SARS-coV2. Considering that it has an R0 higher than seasonal flu that's not a huge stretch of the imagination, how many people would die? Approximately 1.5 million people. 

Let that sink in.

COVID-19 can be a mild infection for those who are young and otherwise healthy. Some people don't even show symptoms while they are infectious. But we know that the elderly, the immuncompromised or others with underlying health conditions are extremely vulnerable to this disease taking a fatal turn.

So how is COVID-19 spread? And how can we stop it?

Like other respiratory infections, COVID-19 spreads when viral particles are shed by an infected person through coughing, sneezing, or even talking AND then are inhaled by an unwitting bystander. There's also some research to suggest that SARS-coV2 can "live" up to 3 days on surfaces - raising the possibility of transmission by touching a contaminated object and introducing the particles into our respiratory system. The worst part is that the incubation period can be as long as 14 days - meaning you could be infectious and not know it, all the while shedding virus as you go about your business.

So to stop the spread we need to be proactive. We need to act like we've been infected in order to protect ourselves and our communities.

Cleveland Clinic: Recommendations based on CDC Guidelines

That means the following:

1. Do NOT travel anywhere unless you absolutely need to! (Yes, this means don't go to stores or hang out with friends. Just #staythefhome.)
2. Wash your hands FREQUENTLY with soap and water. (The soap helps destroy the membranous envelope around the virus so it can't get inside your cells. Alcohol based hand sanitizer is good to have if you are out and about for some reason, but washing is best.)
3. Do NOT touch your face - your eyes, nose, and mouth are exactly what the virus is hoping to come into contact with. (I know it's hard not to - we do it unconsciously - so focus.)
4. Cover your mouth and nose if you cough or sneeze. (Ideally - do the dab. Try not to cough or sneeze directly into your hands.)
5. Avoid contact with people who are sick AND stay home if you suspect your are sick. (See #1.)
6. CLEAN EVERYTHING! 

But understand that even following all this advice, it's too late for containment. COVID-19 is in 154 countries and all 50 states. There's a very good chance that a lot of us will become infected - thankfully a vaccine trial is already under way. How many people are affected and die depends on the actions we take now though. Check out this Washington Post article about exponential growth and how social distancing can impact how many people are impacted.

And then... Stay the F home.