As an internal medicine physician, I have gotten so many questions about COVID-19 that I would like to share the data I have about it, as of this moment (and we all know that information is changing rapidly).
An article published this past week by MMWR/CDC shows the transmission rates to 445 individuals who were either household contacts (sharing a home) or close contacts (healthcare workers, those within 6 feet) of some of the first patients diagnosed with COVID-19 in the U.S.
You may find it reassuring that the transmission rates were found to be 10.5% for household contacts (but with a confidence interval ranging up to 31%) and up to 1.6% for those with close contact (within 6 feet, household contacts are closer than “close” contacts)). So, even those who lived with someone with COVID-19 did not usually contract the virus.
The graph shows the mortality rates by age of COVID-19 compared to seasonal influenza. Although the absolute numbers are smaller than the flu, this data shows part of the reason for concern about this virus is that a higher percentage of those infected with COVID-19 are dying of the disease, especially the elderly.
The other part of the hysteria about COVID-19 I believe is due to the unknown. We know that this illness is spread by respiratory droplets (coughing and sneezing), but we do not know exactly how long respiratory droplets may linger in the air and therefore how much it is airborne, although risk is felt to be reduced if 6 feet away, and these can land on surfaces. So it is theoretically possible to contract the virus without being in contact with someone known to have the disease, especially given the long incubation period (average 5 days, but can be 2-14 days).
However, rates are low as shown in the MMWR article but social distancing is a good idea given this, especially for those over age 60 or with certain chronic medical conditions. Is this virus concerning? Yes!
Should we be practicing good hygiene and responsible social practices as outlined by the CDC? Yes!
Should we be hoarding toilet paper and hand sanitizer and depriving it from those who may really need it? No way!
California is starting the steep portion of the bell curve in COVID-19 cases, so I thought I would share some information about what I plan to do to stay well and help others around me to stay well also. As an internal medicine physician, I do not have the option of staying home but will be implementing and continuing some practices that I believe will help me, my family, and my patients during this crisis.
1. Unless you are a health care worker or other essential personnel where going to work is required, STAY HOME. I can’t emphasize this enough. Don’t go out in public except when absolutely required for food or medication, etc. Hopefully everyone has at least 2 weeks’ worth of food and supplies in the home. Going out for a walk in the fresh air is fine--please see below.
2. If you do have to go out for an essential reason as above, make sure to avoid touching surfaces as much as possible. Respiratory droplets from coughing/sneezing land on surfaces and the virus can survive for a week or more, causing much of the unknown threat. This is why some have used gloves when going out. If you use gloves, make sure to discard them in a trash can before you get back in your car. You can also use hand sanitizer or wash your hands at this point if possible. Refrain from touching your face, as the virus gains entry through the mouth, nose, and eyes. If you need to go to work, I plan to do the following as a health care worker: wear scrubs or easily washable clothes (no need to be fancy right now). When you come home, take your shoes off at the door and go straight to the shower. Place your clothes in the laundry and put on fresh ones. Even if you are able to stay home, you may choose to do this if you have to go out in public at some point.
3. Take care of yourself. Since there is no specific treatment for COVID-19, the best thing you can do is keep your own immune system as strong as possible. This is done by adhering to the basics: adequate rest and nutrition, and physical activity out in the fresh air or at home. You don’t need expensive supplements that aren’t proven to work. Yoga is excellent for the body and the mind, and I would highly recommend it right now. There are many great videos out there that you can do at home or out in the fresh air. I like Yoga with Adriene on You Tube. There are hundreds of videos to choose from and many for beginners. Walking or biking outside in the fresh air are also great activities. Just don’t touch surfaces/objects or other people you encounter. Don’t turn to excessive alcohol or any drugs to help deal with the stress. Get help if you need it by calling a friend or medical professional.
4. Take care of others. Since people over 65 have been ordered to stay at home by our Governor, there will be many people who are not able to get their own food and supplies easily. Find ways to help them if you can. Many communities are setting up pages to help with this. Some kind people in my community have already done this. Get involved. When you go out for groceries, perhaps buy extra with them in mind. You can drop things off in a contact-free fashion since they are at higher risk. Don’t hug them even though you may want to. Waving and the hang loose sign are good alternatives right now.
5. Don’t panic. The following information was sent out this weekend to UC San Diego Health employees:
“Given the current scope of news coverage, we understand that the idea of coronavirus exposure and developing COVID-19 is unsettling, but remember that the actual risk is small: Only 1 out of 10 household contacts and 1 in 200 close community contacts, such as sitting next to a COVID-19 case, actually results in contracting COVID-19, based on the Report of the WHO-Joint Mission on Coronavirus Disease 2019 (COVID-19), published in late-February 2020.
In addition, 80 percent of people with COVID-19 have mild to moderate symptoms that do not require hospitalization. While much of the news being disseminated by media discusses the threat of the virus, it is important to know that poor outcomes are generally seen only in older patients or those with significant, underlying co-morbidities. “ There are always exceptions, which is part of the reason for the extreme measures we are taking, but these are the general facts.
Stay well, my friends. Now, I need to get to work. My patients need me more than ever. Share if you want to. Peace out.