COVID-19 Recommendations
As you know, a novel coronavirus known as SARS-CoV-2 or COVID-19 has recently emerged from China and is rapidly spreading into other countries with health, economic and political consequences. This is the third highly pathogenic human coronavirus that has emerged in the last two decades after Severe Acute Respiratory Syndrome (SARS) coronavirus and Middle East Respiratory Syndrome (MERS) coronavirus. Below are my recommendations based on my reading and speaking with experts at the CDC and WHO.
Incubation Period
The incubation period is estimated to be 2-14 days. However, in my personal communications with expert virologists, they postulate the incubation period may be as long as 21 days. This means that people may be infected and walking around spreading the virus unknowingly. Consequently, once the virus enters a community, the number of people infected doubles every 6 days.
Transmission
COVID-19 is transmitted from person to person through respiratory droplets entering our nose, eye, or mouth. Typically, transmission occurs from self-inoculation by touching contaminated surfaces and then touching our face. It can also occur through direct inhalation of these respiratory droplets when an infected person is sneezing or coughing.
Two Important Facts:
We touch our face dozens of times per day. With proper use of N-95 masks, you may reduce transmission via respiratory droplets. Given these masks are in short supply, I would recommend you purchase surgical masks since they do an excellent job at reducing self-inoculation, which may be the primary route of transmission.
Coronaviruses (e.g. SARS, MERS) have been shown to remain viable on inanimate surfaces for 9 days (counter tops, door knobs, handles, etc.)! Therefore, you want to use gloves and/or wipes, and hand sanitizers (see below).
Virulence
While there is significant concern about the current situation, it’s important to keep in mind this class of viruses (coronavirus) includes viruses that cause the common cold. Most everyone has been infected with coronavirus strains previously as there are several types that cause the common cold. The vast majority of people who become infected with this virus do just fine as they will experience transient symptoms similar to the common cold and recover with ease.
A WHO consultant, Dr Bruce Aylward was dispatched to China to study the epidemic. He stated in his media briefing that China did an excellent job containing the epidemic and as a result the number of new cases are declining. He reported 80% of cases in China were mild, 14% were severe, and 6% became critically ill requiring hospitalization. The mortality rate was between 2% and 4% in Hubei province, and 0.7% in other parts of China. In comparison, the estimated mortality rate was 10% during the SARS epidemic, and has been 0.1% for influenza in the US with 30,000-60,000 deaths each year.
Seasonality
Everyone is hoping that with the arrival of spring and summer, transmissibility will decline and less people will be infected (similar to seasonality with flu). They don't know yet if this will be the case, but we will find out as we enter into spring.
Global Projections
Jeremey Farr led a discussion during the Wellcome Trust COVID 19 conference call on February 25, 2020. He reports the prevalence doubling every 6 days wherever there is un-contained community-based transmission. In the first weeks of March, it will likely be in every major country. He estimates 25-40% of the world’s population will be infected over the next 12 months. To put that in perspective, in 2009 the H1N1 flu infected 16% of the world’s population.
Infection Prevention and Control
Be vigilant with regular anti-flu measures, protect yourself as you would during a bad flu season. You may consider keeping a 2-week supply of water and food in the house in the event that the illness emerges in your community and quarantining is mandated. Be prepared for the possibility that schools will close and that workplaces may request people work from home.
Reduce probability of being exposed:
Limit travel and social engagements.
Convert pharmacy to mail-order to avoid the need to visit the pharmacy.
Reduce probability of becoming infected if exposed:
Avoid shaking hands and fist bump, bow, wave, or elbow tap instead.
Frequent hand washing is the most powerful method to avoid becoming infected. You will inactivate the virus by washing your hands with soap for 20 seconds or using > 62% alcohol-based hand sanitizers for 1 minute. Engage in hand washing after touching others and objects others are touching.
Use ONLY your knuckle to touch light switches, elevator buttons, etc. Lift the gasoline dispenser with a paper towel or wear a disposable glove.
Open doors with your closed fist or hip; do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
Clean inanimate objects (door handles, shopping carts, counter tops, etc.) with disinfectant wipes. Ingredients should contain > 62% ethanol, > 0.5% hydrogen peroxide or > 0.1% sodium hypochlorite. 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective.
Avoid touching your face – eyes, mouth, and nose! Unknowingly, we touch our face dozens of times each day.
Encourage good cough etiquette in others. Cough into tissue and if not available then into your elbow.
Purchase N-95 masks if available to reduce transmission via respiratory droplets. If these are unavailable, then purchase surgical masks. Surgical masks do an excellent job to reduce self-inoculation which is likely the primary route of transmission. Please read this CDC document describing how to properly put on and remove masks and personal protective equipment.
Enhance your immune system to reduce likelihood of becoming infected and reduce severity of illness. Optimize lifestyle through improved sleep, reduced workload, high vegetable intake, regular exercise, and daily contemplative practice (meditation, yoga, etc.) Recommended supplements: Stamets7 – 2 pills (2 droppers) daily to improve immune system response and throat spray with propolis and echinacea if exposed will reduce virus viability in throat.
Treatments
There is no proven treatment or effective vaccines approved by the FDA. Care is supportive. Keep on hand the following dietary supplements regimen:
Stametz7 – 3 pills (droppers) twice daily for acute infection.
Andrographis Plus or Viragraphis 3 – three times daily for 5 days, then 2 pills twice daily.
Propolis/echinacea throat spray – 2-4 sprays in back of throat, 4 times daily.
Elderberry – as directed.
Oscillococcinum – 10 pellets dissolved in 8 ounces water. Must shake first then sip throughout the day.
Vitamin C – 3 grams daily (can be divided; 1 gram three times daily).
Zinc lozenges – as directed.
Supplies To Purchase
Latex or nitrile latex disposable gloves – for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas. Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land is infectious for about a week on average – everything that is associated with infected people will be contaminated and potentially infectious. The virus is frequently on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs). The only way for the virus to infect you is through your nose or mouth via your hands by touching your face or an infected cough or sneeze onto or into your nose or mouth.
Disposable surgical masks – These masks prevent you from touching your nose and/or mouth. We touch our nose/mouth dozens of times per day without knowing it! This is the only way this virus can infect you – it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth – it is only to keep you from touching your nose or mouth.
Hand sanitizers – must be alcohol-based and greater than 60% alcohol to be effective.
The medical community at large has made tremendous progress understanding the molecular, genomic, and epidemiologic nature of this virus already. However, to prevent a pandemic, public health and infection control measure must be deployed in earnest. China was able to get ahead of the epidemic thus far because they mobilized mandatory diagnostic testing, contact tracing, and large-scale quarantines. I am concerned that other countries will not have the resolve and/or resources to deploy such measures.
Wishing you well,
Brad Jacobs MD
