March 10, 2020

[Ed.: To learn more about Dr. Peter, a long-time meditator, Ananda minister, and researcher into the benefits of yoga and meditation on physical and mental health, see his bio]

Although there is much we do not know for certain about the COVID-19 virus there has been improvement in our knowledge base in the last 2 weeks. There is some positive news to report amidst the bad. There is also a better understanding of the approaches that may actually work in slowing transmission.

What do we call it now?

In the news and common usage calling it the Coronavirus for simplicity is fine. You will also see Wuhan Coronavirus and Chinese Coronavirus. WHO and government organizations seem to like COVID-19 and say it is a more politically correct term. Scientists and medical researchers prefer SARS CoV-2 since that is the accepted scientific name (because of its structural similarity to the original SARS virus.) You will see all these names being used. There may be two subtypes of the virus with “S” and “L” the current nomenclature. The latter of these two may be more highly infectious and cause more serious disease.

What do we currently know about it?

It still appears that it started in Wuhan, China. Whether it was a virus in an animal that jumped to humans or escaped from the Level 4 Virology lab in Wuhan by mistake may never be known for certain.

The incubation period (after the patient has been infected but is still symptom free and feels fine) seems to be about 5–9 days based on patients in the US but most researchers say it is somewhere under 2 weeks for COVID-19. This is considered an improved estimate range. For comparison, influenza’s incubation time is 2 days (the range is actually 1–4 days).

During the incubation period a person may actually be infectious to others even though they have no symptoms. This remains controversial. It is one of the real concerns since it would make spread within a community much harder to control. We do know that a patient becomes highly infectious to others when they finally get symptoms (fever, aches, malaise, and some respiratory symptoms) even when the symptoms are mild. However, some percentage of the population may get SARS CoV-2 and have no symptoms at all. But, they may still may be infectious to others but we do not know with any surety yet. I have seen very few estimates of this but the percentage of cases with no symptoms may be as high as 25%. We just do not know.

Of the patients who become symptomatic about 80% will have mild to moderate symptoms well handled at home. About 15% will have more severe symptoms with the most worrisome one being a viral pneumonia and they may need hospitalization. About 2–5% may need an ICU setting for at least part of their hospital stay.

For more serious cases, at around a week after the start of fever and other symptoms patients may start having shortness of breath. This may develop into a full blown viral pneumonia with falling oxygen levels within the following 24 hours. These are the patients most likely to need hospitalization.

In mild to moderate cases of the SARS CoV-2, as the symptoms are resolving at somewhere around 10 days into the symptoms phase the patient may start to become less infectious to others (in one study at least so this remains just an estimate). In serious cases, there is no definitive information about when an infected person stops shedding the virus and it may be longer than this 10 days and as long as 37 days.

What about transmissibility?

The replication rate (R0 as epidemiologists would say) is how many others an infected person will likely pass the virus to. For influenza this R0 number is about 2. It appears that COVID-19 is somewhere between 2 and 7 currently. The R0 is not a fixed, defined, unchangeable number that is just inherent to the virus but is greatly affected by the measures a population takes to reduce transmission like social distancing. Remember during the original SARS outbreak in 2003 it started with an R0 of over 3 but in the end was like 0.02. That is why it finally died out. This drop happened because there were so many interventions to stop the spread. Most transmission is by droplet but the virus can stay stable on surfaces for at least a few hours and perhaps up to 9 days.

Fatality Rates are in a broad range now

The fatality rate ranges are between 0.5–5% in countries which have transparent reporting like Italy and South Korea (about 5–20X that of the typical annual influenza for comparison). This number can be much higher if the hospital system breaks down under to the load of severely sick patients when they cannot care for everyone adequately.

The severity of illness and chance for death appear to be age related. The higher the age, the higher the risk. Unlike influenza, COVID-19 does not kill babies and young children which is one bright spot. Older children and teens also seem to have no fatalities. Although some younger adults have died from the virus it is the older patients that are at higher risk of severe disease and hospitalization. Risk starts to accelerate at about age 60 and is worst for those about age 80. Having other health issues like heart disease or asthma makes the risk even higher.

What is happening worldwide?

We do not know for sure what is actually happening in China. We may never know. But it appears to already be an epic catastrophe there. Some epidemiologists are estimating that China is underreporting substantially and suggest we should multiply their published number by a factor of at least 10X.

There are some good international things to report. Both South Korea and Singapore have made great strides at slowing the spread of the disease within their borders. Some key takeaways are that widespread testing and carefully tracking down all contacts of infected cases really helps. The population in those countries is largely just staying home and limiting interaction. Not all cultures will be willing to impose these restrictions and their citizens may resist compliance. In Singapore they have imposed steep fines (about $100,000) and jail time for those who are known to be infected or recently exposed and who then break quarantine, so there is high compliance with isolation orders.

Italy, as you may have heard, has a strict lockdown of the north with no one allowed in or out of the region. Their Prime Minister yesterday asked the entire country to stay home and not travel internally to stop the spread. Their health care system is under serious strain and may have had some local collapses already. You may have noticed that the number of cases in Italy recently surpassed South Korea, which had quite a head start initially. Italian cases and deaths have continued a rapid climb.

Iran’s reported numbers are likely not accurate with significant underreporting by the government and are likely much worse than the current tallies.

The US has over 800 confirmed cases now but this may underestimate the actual number of current cases in the US because of problems with the test originally used. There have been several cases in the Auburn, California area. There have been no confirmed cases in Nevada County where Ananda Village is.

Johns Hopkins has a Coronavirus COVID-19 global case report site which is constantly updated if you want to follow the worldwide impact. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

The Office of Emergency Services for Nevada County will report any cases locally on their website which is updated frequently. https://www.mynevadacounty.com/2924/Coronavirus

What is happening with testing in the US?

Initially, the CDC chose a complex test format which was felt to be more accurate than other countries were using. It was a real failure and put our testing weeks behind. That is why less than a thousand SARS CoV-2 tests had been done in the US as of just a week ago. Testing is starting to ramp up strongly and millions of test kits will be distributed by the end of this week. Commercial laboratories like Quest and LabCorp are also offering tests and rapidly ramping up availability on top of this. Depending on the lab, results are available in 1–2 days.

Medicare has just announced they will cover the testing without any copay. We don’t know how other insurances will handle this. It is likely that MediCal will cover the test.

It is not clear when private physicians’ offices, urgent care clinics or community clinics like Sierra Family Health Center will offer onsite testing. Unfortunately, the testing is potentially hazardous for the staff collecting the sample and many clinicians think that means they should be in a full “bunny suit” style protection outfit not just a face mask. Quest and LabCorp will not take samples directly from patients at their blood draw stations for COVID-19. Only medical providers can submit samples containers to them for processing. I did see that there are efforts by some labs to offer mail in samples that anyone can collect at home and submit for testing.

For patients with symptoms, it is recommended that they first have a standard influenza test which can be run in 10 minutes in the office. It appears very unlikely that anyone will have influenza and SARS CoV-2 simultaneously. If they test positive for influenza it should be treated and no COVID-19 testing done.

Some very good news is that the CDC is starting surveillance testing. This is terrific news. This means they will go into areas with no reported cases and test significant numbers of people who are without symptoms. This may lead to identifying hot spots that we can corral early to limit spread of the disease. This kind of surveillance testing has been part of the success story in Singapore and South Korea.

As a comment, I feel the CDC is doing their best with a tough scenario and will do better as we know more. They train hard for these situations. They never had any of their funding cut in recent years, it has only increased despite what some news report say. Many politicians and news reporters are getting the medical details of this crisis incorrect so I would not believe them without confirmation from a medical source.

What can you do?

Keep your spiritual practices strong. Exercise daily and get plenty of sleep as these help immunity along with sensible diet.

Social distancing of 6’ or more does help. Limiting in-person attendance at classes or workplace can help especially if you are older. Wearing disposable gloves (I like the food preparation disposable ones, 500 for under $10) can help prevent contact with contaminated surfaces if you are out. Hand sanitizer can also be used but is sold out or very expensive. You can make your own. Just follow a recipe from a recognized source so it has enough alcohol would be my suggestion. Wiping down common surfaces at home and work at least once daily with a standard disinfectant is a good idea.

Hand washing: You probably feel you have heard enough on this already. It really does help. All soaps work against viruses since it destabilizes the fat outer layer of the particle. Just be sure to wash long enough. Antibacterial soaps are no better than plain soaps since viruses aren’t bacteria.

Alcohol hand sanitizers and disinfectants destroy the virus protein.

What about face masks?

It is not clear whether N95 is really any better than standard surgical mask for protection but they are still what is recommended for health care providers and those caring for ill family members.

Those with respiratory infections should wear a standard surgical mask (N95 not needed) if they can get one to protect others if you go out in public.

Unfortunately masks are hard to get and expensive if you find them. At Sierra Family Health Center we have an adequate supply for in-clinic use.

Because there are not enough masks, they are currently not being recommended routinely for well people out in the community and workplace. Those who care for the sick and those who are sick are the ones who should use facemasks.

In the next update, I will discuss decreasing the R0 and flattening the illness trajectory, so stay tuned.

Blessings on us all, Peter VH