[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]
February 26, 2020
What is this new virus that is in the news?
You have probably seen news about the coronavirus outbreak in China which has been ongoing since early January and first reported internationally in late January. It is currently being referred to by the name COVID-19 (Coronavirus Disease 2019), China Coronavirus, or Novel Coronavirus (novel as in “new”). The outbreak in China has been very serious and much of the country is in lockdown to halt the spread of this illness. There’ve been over 80,000 cases reported in China and several thousand deaths there to date. There are also outbreaks in Northern Italy, Japan, Iran and elsewhere with control efforts underway. Currently, there are under 60 cases of COVID-19 in the United States. About 15 of those cases are from people who had traveled from China to the US recently (or had close contact with them when they got here). Another 40 or so are Americans who have been repatriated from China or from one major cruise ship outbreak (the Diamond Princess) who were already known to be ill with COVID-19 when they came back. They are being treated in the United States (primarily with strict isolation) until they are well. Currently there have been no community wide outbreaks in the United States. What should we, as a community, be doing given this information?
I have been following this very epidemic closely in my medical journals and online since it was first reported in mid-January. Although we are slowly getting a better understanding of this infectious illness, it is impressive how much we still do not know. Let me start by sharing with you what we know about this new coronavirus and then we’ll review what we can do about it.
Where did COVID-19 come from?
There are many different types of coronavirus in the world. In fact, somewhere between 25 and 50% of the colds people get in the winter months every year are caused by coronaviruses. Unfortunately there are more virulent strains of coronavirus that have occurred. You may remember hearing about two of the serious international epidemics in the last 20 years, SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome). Both of these were caused by coronaviruses and had significant fatality rates, up to 36% in the case of MERS. COVID-19 is a new or novel coronavirus which likely first infected humans sometime in December 2019 in Wuhan China. It is not clear how it came to infect humans. There are suggestions it was living in bats or other animals in China and then jumped to humans. There is also a high-level virology laboratory in Wuhan China and some have theorized it could’ve escaped from there by accident. No one knows for sure at this point and we may never know for sure.
Coronaviruses are not influenza. Influenza is another group of respiratory illnesses usually given identifiers like H1N1. Flu vaccinations and oral medications for influenza infections like Tamiflu, although very helpful in preventing and treating influenza, do not work against coronaviruses. We are just now beginning to understand the behavior of COVID-19 so let’s review what is known so far.
How infectious is COVID-19?
The coronaviruses tend to spread pretty easily. The transmissibility of a virus is usually expressed as its “replication rate” (epidemiologists call this the R0 or “R naught”) and this tells us how many others each infected patient will likely spread the illness to. A virus that is relatively hard to pass to others would have a replication rate of 1.0 or less. A highly contagious illness like polio virus has a replication rate of 6.0 and measles virus is a whopping 11.0. So for measles, as an example, an infected individual would likely infect 11 other individuals. Typically the influenza outbreaks which occur every winter have a replication rate of about 2.0. COVID-19 appears to have a replication rate of somewhere between 2.0 and 6.0 which is telling us it is at least as contagious as influenza and possibly more so. This is part of the reason that isolation efforts in Japan, Italy and China have been so tightly enforced since COVID-19 is seen as extremely contagious.
Who is getting sick with COVID -19?
With our yearly flu outbreaks anyone can catch influenza with the most serious and sometimes fatal cases occurring in the very young (less than one year old) and in older adults (over 65). COVID-19 seems to be different in who it affects. It is primarily a disease of adults with adolescents and children developing mild cold-like symptoms if they are sick at all. Some of the deaths from COVID-19 have occurred in adults in their 20’s, 30s and 40s but the majority of deaths have been in those over age 65. For people who develop symptoms when infected with COVID-19 about 15% will likely develop more serious disease which may be severe enough to require hospitalization. It appears around 2% of those who develop symptoms with COVID-19 may die from it but this remains a very approximate number. For comparison, the estimated fatality rate during the Spanish Flu pandemic of 1918 which killed many millions worldwide had a fatality rate of 2%. The flu that we are currently treating this year has a much lower fatality rate of about 0.1% which is why you don’t hear more about it.
Not everyone who catches COVID-19 will develop symptoms. Some estimates now are that around 25% of those with the virus infection will have no symptoms. It is not clear how infectious they are to others, however. Curiously, men seem to be slightly more likely to catch COVID-19 than women. It appears that the virus is most commonly spread by close contact with someone who is infected. The virus can live on hard surfaces for at least some hours and possibly a few days. It is also spread by droplets when those infected cough or sneeze and is exhaled into the air as they breathe.
What happens when people get sick with COVID-19?
The incubation period (the time from exposure to when the person develops symptoms) may be up to 2 weeks and possibly longer. During the incubation period the individual feels normal and has no symptoms. It is not clear whether someone during the incubation period can infect others. Once they develop symptoms they are definitely infectious to others. Typically initial symptoms include significant fever, severe fatigue, and cough. Runny nose may be a less common symptom. It seems most cases of symptomatic COVID-19 will resolve within about 2-3 weeks unless they have other complications. In severe cases, after about a week, the virus can move into the lungs and cause a viral pneumonia which is quite visible on a chest x-ray. Patients with COVID-19 pneumonia can become increasingly short of breath. Many of these patients will need oxygen supplementation and some will end up on mechanical respirators in the ICU. More serious cases eventually cause not only respiratory failure but kidney and liver failure as well. These are the patients who may not survive.
How do we treat COVID-19 infections?
There are no proven medication treatments for COVID-19 just yet. However, there is some optimism on this front. One medication typically used to treat HIV infections is being studied in Japan, China and the United States in patients who have laboratory confirmed infections and are ill. It is showing some promise. We will likely know much more about this in the next few weeks.
If someone is ill with COVID-19 and is too sick to remain at home, supportive care with intravenous fluids and oxygen supplementation can help. Some patients develop bacterial lung infections on top of the COVID-19 as a complication and this may respond to standard antibiotics. Antibiotics have no effect on the COVID-19 virus itself.
Currently there is no vaccine available for COVID-19 although progress is being made. The soonest we are likely to see a widely available vaccine is 12-18 months from now and that is a very approximate estimate and may take longer.
Is there a test for COVID-19?
Currently in the United States there is limited testing for COVID-19 all done through the Public Health Department system in cooperation with the CDC in Atlanta. Currently, the test is being reserved for those who are at high risk for having been in contact with the virus so little testing has occurred here in the United States (under 500 tests done so far). There is a major push to develop a widely available test and we are likely to see that within the coming weeks. Ideally, it will be like influenza testing which can be done in 5 minutes in the doctor’s office and there is some hope that this could happen relatively soon.
Will this virus eventually just go away?
Since this is a new virus we don’t know quite how it will behave over time with the change in seasons. With influenza, for example, November through the end of March is the peak time of infection every winter with few cases outside of that. This virus could follow a similar pattern but we simply don’t know yet. If infections become much less common this summer it may return in the fall.
What should I be doing now?
There are some prevention measures which are proving to be very helpful in limiting the spread of the disease. Most of what is suggested is similar to the way we would stop the spread of other respiratory viruses such as influenza. Here are some commonsense guidelines that you might want to start following just to get into good habits in case they become required in the coming weeks:
*Pray for the world and all those affected daily. Pray too for those who are health care workers and are caring for the sick since they are very high risk of infection themselves. Meditate regularly as this will help no matter what happens.
*If you are sick, stay home. Limit your contact with others. Even if you don’t feel that unwell always think first of protecting others. If you must go out while you are symptomatic, wear a disposable surgical mask when you are around others and keep your trips as short as possible. Try to avoid touching your face (the mask helps with this). The mask also alerts others that you may be sick so they can keep their distance. Use hand sanitizer liberally and wash your hands regularly to prevent spreading it to others. Avoid being in group situations where you could possibly transmit the virus. So, attending Sunday Service online and working from home (if at all possible) would be recommended when you have cough or cold symptoms.
*If you are well (and not working in a healthcare environment) wearing a surgical mask for prevention won’t likely help much (although it does encourage you not to touch your face which is good). Wash your hands regularly multiple times a day (soap and water for at least 20 seconds—pick a chant you like that will help you wash the full time). Use hand sanitizer liberally. (I have started carrying a small bottle of hand sanitizer in my pocket at all times so I use it regularly). Keep your distance from those with respiratory illnesses (some researchers suggest about six feet separation for safety based on the evidence).
*Right now the risk within the United States remains low, however, this could change very quickly if there is a broader outbreak (look at Northern Italy as an example). Since outbreaks are now being treated by local authorities with isolation and limiting travel you may want to start buying extra food to have a full pantry and make sure you have all your needed medication. Fill your car’s gas tank whenever you go to town. You might want to have a little more cash on hand than usual for you emergencies. This all might save you some future trips to town if things gets more serious. How long should you prepare to isolate or quarantine in place? I would suggest you prepare mentally for at least 14 days although up to a month might be required, we just don’t know yet. I would expect we will have electricity and water if we needed to be isolated but that is just my guess.
*You may want to look at your travel plans for the next three months. I would mentally prepare to make such trips contingent on what is happening with the virus and let others know this. Having trip insurance can be helpful or at least be willing to sacrifice any deposits if it is unsafe to travel.
Do you want to know more?
You may find that mainstream news sources may give conflicting information. There are regular updates on the CDC.gov website which you can read and they have check lists you can use. On YouTube the J-IDEA foundation in Britain has updates every few days which are very informative and CNBC is carrying HHS (Health and Human Services) updates from Washington DC which you can watch. Remember, there is simply a lot we do not know yet.
I will try to put out further updates intermittently if there is news worth sharing.
In Master’s Service,