By now you are fully aware of the rising epidemic loosely being called 'coronavirus'. This document's purpose is to provide you with known facts and references to help get you, your family, and our community through this event. I'll intentionally avoid conjecture, speculation (unless noted), and conspiracy as these are not helpful in actually informing and protecting you. Before we get into the weeds of this, let's start with the most important part first. Herd Immunity Theory.
We'll take this definition from Wikipedia as they do a pretty good job on nailing down the salient points of Herd Immunity Theory:
In Essence, herd immunity means not everyone in a community needs to be immune to prevent spread of disease. If a high enough proportion of individuals in a population are immune, the majority will protect the few susceptible people because the pathogen is less likely to find a susceptible person. This is why we vaccinate. We build a wall of immunity to contain the threat. If you are not aware of this principle, then I would recommend you read the article and familiarize yourself with the concept.
What to do?
What this means is we must all prevent getting the "SARS-CoV-2" virus and we all must also contain (prevent the spread of) the virus to those that have the disease (named “coronavirus disease 2019” (abbreviated “COVID-19”)) so that it does not continue to infect others. Since we don't know if an immunity exists and why some people get it and some don't, quarantining (containing) is one of the most effective protective measures we can take to protect the herd (humanity).
Avoid close contact with people who are sick.
Avoid touching your eyes, nose, and mouth.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
The above guidelines come directly from the Center for Disease Control (CDC) and are the standard cold and flu prevention steps. These "should" be common sense, but sadly we still see sick people wandering the streets and workplace and coughing all over the place. I would consider the above prevention steps to be our civic duty to protect our nation, our families, and ourselves.
Note: Covering your mouth with your hand and coughing/sneezing or using your arm/sleeve is not helping. You are just contaminating your hand or sleeve. You would then need to wash the hand or clothing item immediately. So use a tissue or something disposable and that you are not going to carry around with you all day.
Why do I trust the CDC?
Well, read their mission statement here: CDC Mission Statement
The CDC "protect[s] America from health, safety and security threats, both foreign and in the U.S."
Plus, we pay their salaries...it is in their best interest NOT to bite the hand that feeds them. They are made up and staffed with teams of doctors who have all taken the Hippocratic Oath and are pledged to honor that oath regardless of politics, fear, or favor. Does this mean they are perfect and won't make mistakes? Nope. Expect mistakes. Expect them to learn, and to correct those mistakes.
If you believe you have been exposed to the "SARS-CoV-2" virus and get the disease it causes, then you really need to do your civic duty and self-quarantine (protect the herd). That is if you are in the 80% that have the disease and have mild symptoms, stay home. If you are part of the 20% that are experiencing severe symptoms, contact or go to your local hospital.
So stop for a moment and think about this. If you are sick, like you might possibly have covid-19, and you go out to a public place willfully knowing that you have a potentiall life threating illness, how are you going to feel if you spread the disease and it leads to one or more people dying? Self-Quarantine!!!
It is important to be well educated and informed as much as one can be. We can only make decisions based on the best information we have, so endeavor to collect as many facts (through the rigors of science and critical thinking) so you can make the best decisions to protect yourself, your family, and our nation.
Let's jump into some facts and other details to get you armed and prepared for the coming months.
Note: I've collected this information from our very own Dr. Disaster, and various resources like the CDC and the WHO. I'll add links to the sources of where some of the information was found so you can assess the source yourself as to if it credible or not. I will also detail why "I" trust the source. We face a constant onslaught of misinformation, scams, trolls, and just plain old idiots who can't think there way out of paper bag and they all post on the internet. So be very careful who you trust and make sure you understand why you trust them. Your life could depend on that.
Yes, the irony is not lost on me.
I won't beat this one to death, as this is pretty well known. The coronavirus is a family of viruses that have existed for some time. Four of these are some of the viruses which cause the 'common cold' many of us get each year. These are the 229E, NL63, OC43, and HKU1. These all cause upper respiratory infections. The ones that are causing us the most trouble are SARS, MERS, and now SARS-CoV-2.
The actual virus is name is "SARS-CoV-2" and it causes the disease “coronavirus disease 2019” (which is more commonly referred to as “COVID-19”). Once again Wikipedia provides a lot of the general details and does so nicely. Lots of pretty pictures of horrible things. Severe acute respiratory syndrome coronavirus 2
Wikipedia describes a virus as "a biological agent that reproduces inside the cells of living hosts. When infected by a virus, a host cell is forced to produce thousands of identical copies of the original virus at an extraordinary rate."
There is some question whether the virus is a "lifeform". The common belief is that they are not truly "alive" as they do not have self-generated or self-sustaining actions and rely on the host to replicate.
Viruses should not be confused with bacteria. From the Mayo Clinic, "Bacteria are single-celled micro-organisms that thrive in many different types of environments. Some varieties live in extremes of cold or heat. Others make their home in people's intestines, where they help digest food. Most bacteria cause no harm to people, but there are exceptions."
You will note that bacteria are "single cell" organisms and viruses are biological agents that live "inside the cells of living hosts". Thus, viruses are much, much smaller than bacteria. Here's a nice picture for you get an "idea" of how small we are talking about:
We'll come back to "why size matters" in a little bit...
Also, bacteria can be controlled with antibiotics. Viruses require a vaccine. There is no vaccine as of yet for COVID-19. The best estimates I have heard are around 6 to 18 months for one. That is a long window of time. Things change rapidly so this may change as well over the coming days and weeks.
In short, very serious!
But we need to put this in context, so you don't go all "end of the world" on us all. It’s not time to board up the house and stick the gun out the window, but it is time to take action...preventative action (see above).
To put this in perspective, the common cold infects about 45,000,000 people in the US each year and kills about 45,000 of those people (both numbers are on the high side). It has a very low Case Fatality Rate (CFR) of between .001% and .002%. This is one of the values we need to pay attention to. The CFR is also tricky to accurately account for. Many, many cases go unreported for a myriad of reasons, and remain un-accounted in the overall collection of statistics. Think about how many people catch a cold every year and never see a doctor? I personally have never been to the doctor for a cold.
The COVID-19 disease had an initial estimated CFR of 2%. On March 3rd, WHO adjusted the CFR to 3.4% saying "Globally, about 3.4% of reported COVID-19 cases have died" (source). That is way higher than the flu and means the potential for bad things is much higher. If we look at the statistics, we can see that it kills about 1 in 30 people that get it. If we extrapolate that to hypothetically include every one of the roughly 300 million people in the US; it would kill about 10 million people. That's bad! Again, we don't have an accurate CFR so the numbers we have are really a best estimate. At 2%, it's really bad. Even 1% is going to be pretty bad.
For COVID-19, also note that it has a very high survivability rate. Roughly half the people that have acquired the disease are now fully recovered. So try to focus on that.
(updated March 6, 2020) We were getting a lot of our stats from the John Hopkins University, but their website, pardon my phrasing, went viral and was not designed to scale to the volume of traffic it started to get. They had shut it down to the public while they revamped it. It's back online and looks great!!! Check out there COVID-19 Dasboard here: Johns Hopkins CSSE. I still very much like like World-O-Meters as they break down the informaton very granulary and have a running source list of every infection/death/change that occurs so you can follow it and check for yourself. Not as pretty, but very effective in conveying information. It also has a lot of the raw statistics that I care about.
The next thing we need to look at is the R0 or R-naught value. The 'R' is for replication or reproduction. This is an attempt to calculate the reproduction number of the virus. An R value of 1 means that for every one person infected, they will get one other person infected. This is borderline containable. Ideally, we want to see an R value of .9 or less (much less)...which means the virus is self-containing and will slowly die out. Anything of above 1 is bad. Here's a nice article from the University of Michigan that goes into more details: R0: How Scientists Quantify the Intensity of an Outbreak Like Coronavirus and Its Pandemic Potential
The SARS-CoV-2 virus has an estimated "official" R value of between 2 and 3. If any of you have ever done MLM (Multi-Level Marketing), you can see how this will pyramid or fan out. THIS is the dangerous part...this virus has the potential to spread rapidly and get out of control very quickly if not aggressively contained (see prevention steps above).
A couple of points on the R value. There is a lot of guess work and assumptions that go into calculating the value (like the CFR). I trust the science, math, and scientists doing the work, but the R value could be much higher than 2-3 as it is now estimated at. The UofM article above has it at between 1 and 4+. If you want to dive into how the R value is calcualted, then here you go:
In short, it is difficult to calculate. Just understand that this virus is prolific and spreads rapidly.
Next thing we need to look at is the incubation period. This is how long a person could be infected with the virus before they show symptoms. These people are called asymptomatic. This is the hidden danger and why you are seeing reports of "not if, but when" and "we have already lost containment in the US" etc. One of our members who is fairly well versed in micro-biology pointed me to this virologist at Fred Hutchinson (Fred Hutchinson Cancer Research Center is HQ's in Seattle) who is working on the problem:
He expresses what many of us have already speculated with US patient WA-1 entering Seattle. He was on board a plane for 8-10 hours...I can't imagine anybody not getting infected. With an incubation period of 2 to 14 days (with some outliers as high as 27 days), it's no wonder we are seeing more cases pop up.
Trevor Bedford might be a good person to follow: https://twitter.com/trvrb
This was inevitable though as the initial information on the virus itself was extremely limited and most of the recommendations were based on past experience with MERS and SARS. So it is what it is. We can't just hold up in our compounds and avoid the shopping malls and restaurants because then the virus wins. After all, that’s what the virus wants. It hates us for our freedom! Sorry, an attempt at levity. Still, absolute containment of the virus was a Sisyphean task and was never going to happen.
If prevention fails, and you get exposed to the virus, it doesn't mean you will get it. That will depend on your constitution, health, immune system, pre-existing conditions, genetics, age, etc. There are lots of reasons unknown to me why some people get infected and the person next to them doesn't. If you know a virologist that would talk to us and explain it, I'd love to hear about it.
Also note that roughly 80% of those that do get infected have mild symptoms.
Part of prevention is to avoid unnecessary gatherings or groups for higher risk people. So if you are elderly, poor health, or have preexisting conditions that make you more susceptible to the flu and cold, you may want to plan your activities around non-peak hours. Do your shopping early or late at night. Avoid crowds at the mall or theater, etc. For the rest, follow the prevention prescription above and go about your lives (see second order effects below).
The coronavirus family are RNA viruses. Wikipedia tells us that an RNA virus is a virus that has RNA (ribonucleic acid) as its genetic material. This nucleic acid is usually single-stranded RNA (ssRNA) but may be double-stranded RNA (dsRNA).
This is opposed to a DNA virus. Apparently, RNA viruses are much better at mutating and causing mayhem than other types of virus. This is all way outside my wheelhouse though, so I will need to consult with a virologist about what this means.
Now, on Feb 27, 2020, Japan reported that a woman who had recovered from the disease was found to have disease again after a few weeks. This lead to immediate specuation that the SARS-CoV-2 had mutated. After further review, most virologists and other experts reject this idea. They suspect errors in the testing process and they further suggest that virus went into a dormant state and then reactivated. (source) (source).
Further, I can find no evidence that the virus is or has mutated. In fact, we see quite the opposite. This WHO report states clearly that it is not mutating:
"Whole genome sequencing analysis of 104 strains of the COVID-19 virus isolated from patients in different localities with symptom onset between the end of December 2019 and mid-February 2020 showed 99.9% homology, without significant mutation"
(Updated March 6th, 2020) I came across this interesting research paper On the origin and continuing evolution of SARS-CoV-2.
To sumamrize, it says that there are two strains of SARS-CoV-2, the L
strain and the S strain. The S strain is the original varient and is
less aggressive, while the L strain is very aggressive and is the main
varient that was found in the intial WuHan outbreak. This is not
unexpected or even unusual. We know viruses mutate. It does not indicate
that SARS-CoV-2 is mutating today, only that it had at least one time
post-bat and in the early stages before it was identified. Both varients
are still very similar (Source). Please also check out the rebuttle to this claim which refutes some of the work Response to "On the origin and continuing evolution of SARS-CoV-2"
Addtionally, the geniuses (and I mean genius in every sense of the word) over at NextStrain.org have mapped out a ton of varients Genomic epidemiology of novel coronavirus (HCoV-19). I don't fully understand what this means as the information seems conflicting. From what I can gather, RNA viruses alter themselves with pretty much every infection, but the core virus itself has not changed. That is, it's function or feature set is the same. This should not change vaccine requirments or the ability to synthesize one in the (hopefully) near future. I sure wish I could sit down with Trever for an hour...maybe two or three, but he's busy.
The CDC comments on masks:
CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.
Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
A couple of things to expand on here so we can understand why. First off, masks won't stop the virus. The virus is just to small (remember that size matters bit earlier?).
Viruses are between 0.004 to 0.1 microns in size, which is about 100 times smaller than bacteria.
That is small!!!
The best air filtration systems use HEPA filters. HEPA or High Efficiency Particulate Arrestance (or Air) filtration, is a system of filters than can remove particles down to .3 microns. Oops...not quite enough to get the virus.
This site offers a good overview of HEPA filters: (source) https://www.sylvane.com
The CDC is saying that the mask is not going to protect you. But...you will notice that all the healthcare workers dressed in their PPE (Personal Protective Equipment) all have masks...and they have the "good ones", either the 3m N95's or the 3M P-100's. So what is going on???
Well, the reality is that masks do help prevent getting the virus by breathing it in, but you need to read on to understand why.
Number one reason the CDC does not want you to buy (horde?) masks?
These masks are now in short supply and are needed for healthcare workers who actually work with infected patients and need protection. They are not going to protect you in your daily activities. Some of them also require special care and handling to maintain. Every mask you buy takes one away from someone who actually needs it. The CDC understands this threat very well and is preparing for the worst. They are trying in a roundabout way to make sure that healthcare workers, 1st responders, and other medical personal have enough protection to deal with the coming volume of infections without causing a panic.
When faced with a threat to the herd, the time to think about one's self is gone...it is time to think about the herd. What is best for humanity. I know many of you will disagree. That's fine and sadly expected in this day and age. Just ask yourself, who is going to benefit more from a mask? You? Or the person working to stop the spread?
Ok, fine. Whatever. But the masks work, right?
Well, yes,they work awesome, but with some caveats.
They cannot filter the virus itself, but the virus is almost always going to be in a water vapor (or droplets) from when an infected person coughs or sneezes. The mask will prevent the water vapor from being breathed in by the healthcare worker. It doesn't mean the virus won't somehow work its way through the filter and get them anyway, but it does significantly lower the risk. Like by a LOT! So yes, they work. Keep in mind that nothing is 100% though.
For the average Joe, if you are not near an infected person coughing on you, your mask is not going to help. It might make you "feel" safer. For the mask to work (i.e. be useful and a worthwhile expense), you would need to be near an infected person or in a contaminated environment so you would be "exposed" first. Then you would still have to avoid doing something stupid like touching everything in sight and then sticking your fingers in your mouth, nose or eye. That said, we don't really know who is infected now do we?
Keep in mind that the virus attack vector is through any available muccus membrane. So eyes, nose, and mouth are going to be the highest on the list. Most masks only cover the mouth and nose. You can still infect yourself by touching or rubbing your eye.
How can a mask help?
The good news here is that a common surgical mask is great for reducing the spread of the disease. That is, it won't filter the virus, but it will make you "think" before touching your face. So the mask works by making you aware of your actions and that you should go wash your hands (for 20+ seconds) vigorously with soap and hot water BEFORE scratching that itch or picking your nose.
If a mask makes you feel safer and less prone to panic, then all the better. Panic is the bigger enemy here.
If you are already sick, then a surgical mask will help to lessen the exposure of those around you by containing most of your cough.
Again, the goal here is prevention. Stay away from infected people, wash your hands frequently (because we are handsy and touch everything in sight and then seem to stick our fingers in our mouths like little kids), and cover your mouth when you cough. Stay home if sick.
Q: I still want a mask, what should I get?
Here's a good site for some background information on masks: (PK Safety) The key here is how masks and respirators are rated.
"The National Institute for Occupational Safety and Health (NIOSH) is a division of the CDC. They determine the ratings that allow people to choose the right mask for the job. Because government agencies determine ratings for masks, purchasing more expensive brand name [...] masks won’t necessarily provide 'better' protection" than a non-brand name that meets the same criteria.
So with that, let's look at NIOSH.
We see we have the type N, P, and R types as well as different number versions 95, 99, and 100. The numbers are easy. Down to .3 microns, they filter out 95%, 99% and 99.97% of particulates. Note: there is no 100%.
The less clear part is the N, P, and R and this 'resistance to oil' part. Look here for a decent explanation:
"N-Series particulate respirators are NOT resistant to oil and therefore provide protection against solid and liquid aerosol particulates that do NOT contain oil."
"R-Series particulate respirators are resistant to oil, which means they provide protection against both solid and liquid aerosol particulates that may contain oil. R-series respirators, however, are only certified for up to 8 hours of service life."
The "resistant to oil" would primarily for paints and oil aerosols
"P-Series particulate respirators are similar to the R-series in that they provide protection against both solid and liquid aerosol particulates that may contain oil. The service life of P-Series particulate respirators, however, is substantially longer, with NIOSH recommended disposal after 40 hours or 30 days of use, whichever comes first."
So we would want the 'P' series first, then the N series. It is not likely you will be working with paints and aerosols that have a virus in them, but hey, go big or go home, right?Note that in almost every photo or video of healthcare workers (outside of infectious disease controlled environments) that I have seen, they are wearing the N95 masks. The 'P' series are a more "cover all your bases" approach. So if this whole epidemic thing blows over, you can paint your house safely.
There are several kinds of mask to look at. I am using the term "mask" in the common venacular. The correct term for most of these is actually a "respirator".
These are the basic run on the mill masks you see doctors wearing and what not. These provide gross level protection and filter dust, bacteria, drool, cough vapors, etc. These work to stop YOU from spreading the filth. They don't stop it though, just limit it. They won't offer any real protection against an airborne virus. The prevention benefit is it makes you more conscious about touching your face.
Example (Amazon Surgical Masks/)
Basically the same as the surgical mask, but they cover the whole mouth and nose and offer better sealing. These are far better than surgical masks. Harder to breath and less comfortable to wear. The prevention benefit is it makes you more conscience about touching your face and it makes it harder to do so.
Example: (Amazon Dust Masks)
Particulate Respirators Mask (HEPA):
These are going to offer the "best" protection. This is what most of the healthcare workers are using for their PPE. However, due to mass hysteria and misunderstanding of these mask, there is a massive shortage and of course price gauging. If you have them, you will want to learn how to maintain them for maximum life due to their costs and availability. Probably also want to save them until you are in an area of likely exposure. Back to Cooper Safety: "Disposable dust masks and particulate respirators are not designed to be washed or cleaned. Because of their cloth-like construction disposable respirator masks should be disposed of if they become wet and/or damaged."
Example: (Amazon 3M N-100 Mask)
Example: (Amazon 3M P-100 Mask)
Gas/Vapor Respirators Masks (HEPA):
And the Cadillac of PPE equipment and sure to be a conversation starter, is the full mask Respirators with changeable cartridges. The effectiveness is going to depend on the replaceable filters used. So P100 filters. These offer full face protection. There are half-mask models that don't offer eye protection, but hey, go big or go home, am I right?. These do require servicing and maintenance as well as cleaning. So there is some added effort to use these.
Example: (Amazon Full Mask Respirator)
Example: (Amazon Half Mask Respirator)
These are all just examples of the types of masks you can get. There are plenty of options once you know what to look for. So don't restrict yourself to the medical aisle...check out hardware and painting supplies.
Also, ask someone who works in an environment that requires them to wear one of the above types of masks all day. I'll sum it up for you: It's not a fun or comfortable experience. At all.
This is basically the unforeseen consequences of an event. Right now, these are playing out in the manufacturing space as China and many Asian countries are the world's main manufacturing hubs. Just about everything is "Made in China" these days. So expect long delays for that new iPhone. But that is just the surface. Many US companies rely on parts manufactured in China. Tools, equipment, supplies, etc. With much of China's manufacturing halted, there are going to be massive delays in shipping. This will have larger effects on our economy over the coming weeks and months. I'm already seeing in my industry. This could become a global recession if travel and manufacturing are slowed globally. So look out for the signs. No industry is safe from these second order effects.
Now locally, what could happen? Well, if a general panic sets in, people will stay home. How often do you eat out at a restaurant? Well, if nobody is going out to eat like normal, then guess who suffers? Restaurant and other businesses still have employees to pay, rent to pay, and bills to pay. That is just one industry. We could hobble our own economy badly if we all cower in fear. Costco seems to be doing quite well.
(Updated March 7th, 2020) This weekend I have begun receiving all sots of updates from companies I do business with. Everyone is monitoring the situation. Airlines tickets are super cheap! Also, two flights I'm scheduled for in the coming weeks have suddenly opened up a lot of seats. I have heard more reports of Ghost Flights. More than usual anyway (but this is rumor, as in not substantiated yet). Hotels are offering me more points to stay. In short, it looks like with all the conferences being cancelled, it is starting to hurt mant businesses already. I've been asked to post information on how to deal with the potential recession that may come out of this. We'll see.
So keep the prevention steps in mind and go forth and live! If you are sick or at risk, stay home. Uber delivers.
I, and many others, believe the answer is yes and we have been in a full-blown pandemic for at least about a week (as of this writing). If you look at the World Heath Organizations (WHO) phases of a pandemic (WHO Phases of a Pandemic), it seems pretty clear that we have reached Phase 6, Pandemic in Progress.
So why not announce it? Well, likely because it brings with it a lot negative connotations and could incite panic. Panic only makes any situation worse. There is already enough fear and emotion surrounding this virus and we don't need more. We need more rational thought and action, not less.
That's it for now. We'll update as more information comes out. Good luck!