Sunday, March 08, 2020

How to Prepare for the Coronavirus

By Sumathi Reddy | The Wall Street Journal

Photo: Coronavirus Outbreak Tests New Vaccine Development Strategy

Americans are grasping for ways to cope with an outbreak of the new coronavirus. What precautions should you take?

Face masks? Zinc? Gloves? Americans are grasping for ways to cope with an outbreak of the new coronavirus.

Public health experts advise staying calm and following the same precautions recommended for preventing flu or any other respiratory virus. Stick with the basics: Wash your hands, cover your coughs and sneezes, and stay at home from work or school when you’re sick.

The Latest on the Coronavirus

  • Italy ordered a lockdown of some 17 million people, or more than a quarter of its population, in the country’s economic heartland
  • China reported its first day without new locally transmitted coronavirus cases outside the city where the pathogen had emerged
  • The WHO urged governments to take decisive action to halt the spread of an epidemic that has infected more than 100,000 people
What do I do if I am coughing or have a fever and wonder if it might be the new coronavirus?

Contact your doctor if you have concerns. Right now the odds are greater that your cold or fever is caused by influenza or another respiratory disease, says Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group in Rochester, Minn. The couple hundred cases in the U.S. compares to more than 30 million cases of influenza this flu season.

What to do will depend on the individual circumstances. If you just traveled to Milan or a country where there is a large coronavirus outbreak, your doctor will likely recommend getting tested. If you haven’t traveled anywhere and are in an area with few cases you should still call your doctor, get tested for influenza and rest at home until you are better.

If my child or anyone else in my household is coughing or has a fever, do I need to keep them home too? For how long?

Absolutely. Of all times to keep children at home when they are ill—when the new coronavirus is spreading and we’re also in a second wave of influenza—now is the time, says Cameron Wolfe, associate professor of medicine in the division of infectious diseases at Duke University health system. This is not the time to give your child some Tylenol and send them off to school, he notes. Be prepared with alternative plans to be able to keep them at home. “The younger the child the less capable they are of keeping their own secretions and snot to themselves so parents have to be mindful of that,” says Dr. Wolfe.

Vanessa Raabe, a pediatric and adult infectious disease specialist at NYU Langone Health, says for any illness children should be home until there is no sign of infection, which is when their symptoms have resolved and they are fever-free without any medications for at least 24 hours.

What are the underlying medical conditions that put people at a greater risk of having serious illness, hospitalization, or death?

The medical conditions that pose a greater risk of serious illness are broad and relatively common: It’s not just people with compromised immune systems, like transplant or cancer patients. The conditions include people with heart disease, diabetes, high blood pressure, and respiratory or lung disease, which includes smokers. Studies from China show that the rate of deaths for those with cardiovascular issues is 10.5% while it’s 7.3% for diabetes patients and about 6% for those with hypertension or lung and respiratory disease. In cancer patients, it was reported as 5.6%.

These are the same underlying medical conditions that cause a greater risk of hospitalization and death for influenza patients, experts say. The older a person is with one of these conditions, the greater the risk.

William Schaffner, a professor in the division of infectious diseases at Vanderbilt University Medical Center in Tennessee, says smoking and potentially air pollution may play a large role in who gets severe infection. “China has a lot of air pollution,” he notes. “People who are older, having lived in circumstances where they are subject to first- and secondhand smoke, as well as pollution, that sets them up for a more severe infection when they get it,” he says. Complications for smokers are not as common in influenza patients, he notes.

What steps can we take to minimize the risk of transmission of Covid-19 on public transportation?

This is a tough one. Experts say keeping your distance from people who are coughing and sneezing may help. Wiping down a subway or bus pole is something that can be done, says Dr. Schaffner, a professor in the division of infectious diseases at Vanderbilt University Medical Center in Tennessee. Better yet, if it’s a short enough distance, walk and get some fresh air and exercise.

Wearing gloves could also be helpful but you need to be careful not to touch your face if you do. Dr. Poland says something he’s seen at the gym which may be applicable to public transport is wearing disposable gloves. That may serve as a cue to not touch your face, he says.

The best advice, experts say, may be to avoid touching your face, including your eyes, as much as possible while on public transport and washing your hands or using hand sanitizer as soon as you’re off.

Is Covid-19 more contagious than influenza or other viral respiratory diseases?

It appears to be. Both are very contagious. The R0—pronounced “R naught”—is an estimate of how many healthy people one contagious person will infect. The R0 for Covid-19 is estimated to be 2.6. “That’s a lot,” says Dr. Schaffner.

In comparison, for influenza the figure is somewhere around 1.2 to 1.8, says Dr. Poland.

Will Covid-19 circulate less in the spring and summer, as is the case with influenza?

This is the million-dollar question. Experts say it’s impossible to know since this is a new virus. Coronaviruses in general are not as seasonal as the flu. So though they are less prevalent in the spring and summer, they have more of a presence than influenza.

A different coronavirus strain called SARS (severe acute respiratory syndrome) started in November of 2002 and was gone by the summer of 2003, notes Dr. Poland. But that didn’t happen with the MERS (Middle East respiratory syndrome) strain.

Covid-19 has circulated in some areas with warmer climates, such as Hong Kong and Singapore. But in general there have been relatively few cases in warmer climates.

Are there any precautions or steps different in coronavirus prevention than in influenza prevention? What about treatment?

No. Both illnesses are infectious respiratory illnesses caused by different viruses but spread the same way, says Dr. Raabe. They are transmitted through droplets from a sick person sneezing or coughing or talking within 2 meters or 6 feet. If such a droplet enters your eyes, mouth or nose, you could become infected.

There is some concern that the new coronavirus can also be transmitted by tiny fine droplets that remain suspended in the area after an ill person leaves, but Dr. Raabe says that it’s not believed to be the main way it’s transmitted and it’s more of a worry in the health care setting.

Antibiotics don’t work for either virus. The symptoms of both viruses can be treated by over-the-counter medications like Advil or Tylenol. There are no antivirals or vaccines currently for the new coronavirus. The flu has both a vaccine and antivirals, which can lessen the duration.

For public health officials, strategies to contain the novel coronavirus inside the U.S. will likely shift as the number of new cases and deaths increase. WSJ’s Brianna Abbott explains several challenges the country faces. Photo: David Ryder/Reuters

Is taking a common, over-the-counter cold medication helpful?

Experts say this is helpful for controlling symptoms, which is the mainstay of treating the new coronavirus. But it isn’t a cure and won’t prevent you from infecting others.

Are there any special precautions pregnant women should take?

Experts say pregnant women fall into the vulnerable category of people more likely to get seriously ill with the new virus. Though the precautions are the same, pregnant women need to be especially vigilant. Avoid large public gatherings if you’re in an area with new coronavirus cases, says Dr. Poland. “The precautions should be heightened,” he says.

Dr. Wolfe says to make sure you have an influenza shot if you’re pregnant and reach out to your doctor to see if they have contingency plans if new coronavirus cases escalate, such as conducting a virtual visit through telemedicine when possible.

How long do new coronavirus germs live on surfaces?

Dr. Poland says it depends on the surface. If it’s a surface exposed to sunlight outside, it likely only lives for a few minutes or up to an hour. But if it’s indoors and a dry environment, germs can live up to a day or two.

Do allergy and asthma sufferers have a higher rate of illness contraction?

There is no evidence that allergy sufferers have a higher rate of getting the new coronavirus. But asthma suffers do. The groups with the highest risk of fatalities are the elderly and those with diabetes, heart disease, lung disease, including respiratory illnesses, and smokers, according to a new study.

How does the mortality rate of the new coronavirus compare to the flu?

Mortality rate estimates for the new coronavirus are often cited as about 2%, though estimates have ranged from 1.4% to 3.4%. In comparison, the mortality rate for severe seasonal influenza is much lower, at 0.1%.

But once the number of asymptomatic or minimally symptomatic cases is known the real fatality rate for new coronavirus may be less than 1%, says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in a New England Journal of Medicine article published recently.

The numbers fluctuate depending on the number of confirmed cases and deaths, which changes daily. So the exact rate won’t be known until experts know the true denominator, which is the total number of people infected, including those who are asymptomatic or never got tested.

What steps if any are you taking to prepare for an outbreak of the new coronavirus? Join the conversation below.

What steps should I take to prepare for the possibility of a wider outbreak?

For now, make provisions, says Stephen Morse, professor of epidemiology at Columbia University’s Mailman School of Public Health. Arrange to telecommute if there is an outbreak in your area. Check your sick leave policy in case you get sick. Arrange child care for your children in case schools close.

And have the appropriate amount of medications you need for any health conditions you have, says Aneesh Mehta, associate professor in the division of infectious diseases at Emory University School of Medicine.

If and when the virus starts circulating in your community then consider taking action, like telecommuting.

Scientists racing to find a vaccine for the Wuhan coronavirus are hoping a cutting-edge approach called “rapid response platforms” will quickly yield a breakthrough. WSJ’s Jason Bellini explains what these are and how they work.  

When should I go to the hospital?

Experts say you should go to a hospital if you’re sick enough that you think you should be admitted. The telltale sign is difficulty breathing or shortness of breath combined with a high fever, says Wilbur Chen, an associate professor of medicine at the University of Maryland School of Medicine.

Dr. Chen, an infectious disease specialist, says shortness of breath and difficulty breathing is a sign that the lungs are being affected and the virus has moved from being an upper tract respiratory illness to a lower tract one. Upper tract illness is usually defined by a runny nose, congestion, and sore threat. Once a virus moves to the lower tract symptoms can include shortness of breath and a lot of coughing that produces mucus. A high fever would be 101 or higher, he says.

Should I buy a mask or gloves?

Not unless you or someone in your household comes down with the new coronavirus. Dr. Raabe says there’s no evidence that masks help if you’re healthy. While the N95 masks used in hospital settings can be effective, experts say they need to be fitted for the individual. That occurs for health care workers in hospitals but not when people buy such masks online or over-the-counter.

You could consider wearing a mask, Dr. Raabe says, if you’re sick or in close contact with an ill child or loved one.

Gloves also are only useful if you’re taking care of an ill child or loved one and are in contact with bodily fluids. So wear gloves if you’re changing an ill child’s diaper or cleaning up vomit. But wearing them on a day-to-day basis for prevention is not helpful as we touch our hands, eyes, and mouth frequently.

What about taking zinc or other medicines as a preventive measure?

Public health experts say there’s no known substance we can take to decrease our chances of contracting the new coronavirus. The best prevention is washing your hands frequently for at least 20 seconds and staying home when you’re sick for at least 14 days.

Do I need to buy any specific cleaning products?

Regular household disinfectant wipes and cleaners should suffice. Anything with alcohol or bleach works. If someone at home is sick the CDC recommends cleaning surfaces that are touched frequently—like doorknobs and countertops—every day.

What should I do if a family member comes down with the virus?

Try to have them isolate themselves as much as possible. Dr. Raabe says have them sleep and rest in a different room and use a different bathroom, if possible.

How do you distinguish the new coronavirus from the flu or the common cold?

It’s impossible to do based on symptoms alone, says Dr. Raabe. The main symptoms of the new coronavirus are fever, cough, shortness of breath, and general fatigue and muscle aches. These overlap with the symptoms of the flu or any other respiratory virus. The only way to know for sure is to get tested by a doctor. Experts recommend calling your doctor ahead of time as they may recommend a virtual visit first or take specific precautions if you go to the office to prevent potential exposure to others.

Any precautions I should take for my young children?

The good news for parents is so far the virus appears to be less serious for children, says Dr. Raabe. Only 2% of reported cases so far have been in children, according to a new study. Children who have gotten the virus have had milder disease, she says, and there have been no reported deaths in children under age 9. Still, children may play a role in transmission of the virus so they should follow the same restrictions to prevent passing it on to others. And keep your kids out of school and away from others if they are infected.