(featured image is from Johns Hopkins University’s COVID-19 live tracker map on 3-12-2020.)
A lot of people have been asking me questions about the COVID-19 (novel coronavirus) outbreak, in my informal capacity as “local biodefense person”. I’m not an expert in this. I’m just a grad student with a blog. But I have been trying to keep up on the news and research, and in the interests of sharing what I know and saving my emotional energy for more specific responses (and also the rest of my life), I thought I’d share what I’m thinking about the situation right now.
This is an emerging situation. I’m writing this on March 12th, 2020, I expect any specific information or recommendations to be valid for at least the next few days, but after that, they may change a lot. Also, this post is based on the situation in the US, where most of my readers are. Check recent information (especially in your area) and think carefully about what kinds of precautions you should take.
Q: Are you worried about COVID-19?
A: Hell yes I’m worried.
Q: Why are you worried?
A: The death rate is high, the disease is spreading very rapidly and quietly, and we don’t have medical countermeasures. There were a priori reasons to think this was a bad situation as well – novel respiratory viruses are known to be uniquely bad. SARS and MERS were famous high-lethality coronaviruses well before the current outbreak – if I’d made a list of predictions about what kind of new disease outbreaks we should be worrying about (something I’ll probably do now), I almost certainly would have written down “a SARS-like coronavirus”.
Q: Is this really worse than the seasonal flu?
A: Yes. It spreads faster and the death rate is higher.
Q: Should I be worried?
A: Yes. It depends on where you are – you’re in more active danger if you live in a city and live with or come in contact with a lot of people every day, or you’re older or have one of a few pre-existing conditions (e.g. heart disease, lung disease, diabetes). You should also be more careful if you work with elderly people or in a healthcare setting. In any case, you should almost certainly be taking some kind of precaution.
Q: How bad is this going to get?
A: Ha ha ha ha ha. I have no idea.
At the least, based on where we are now and its recent trajectory, it’s going to get worse. I see a couple plausible trajectories for this:
1) Humanity gets our collective $@%& together and contains it. Perhaps a vaccine or effective countermeasure eases the way. COVID-19 is beaten back and eventually vanishes from the human species. This is a notable outbreak for academic purposes, but in a few decades, most people barely remember it.
2) This gets very big. I’ve heard some guesses that everybody will end up getting infected. It may become endemic, meaning that it’s a constant ongoing infection rather than a one-off spillover from an animal. It may stay as deadly as it is, or attenuate, meaning it becomes less harmful but still spreads around. Or maybe literally everyone doesn’t get it, but many, many people do, and this becomes our generation’s version of the 1918 flu. Or worse.
Q: If everyone’s going to get COVID-19, maybe I should just get it now and get it out of the way?
A: You are actively trying to give me a migraine.
Q: I promise I will still try not to get it. Theoretically, though, wouldn’t it still be better to get it early?
A: Okay, so there is something to this. I’ve seen some elegant little charts going around that look like this:
This suggests that yes, there’s something to spreading out infections over a longer period of time, so that in case you need to get hospitalized, hospitals will be kept under maximum capacity, and this will save lives in the long run.
First, however, these graphs assume that we are capable of getting the infection peak to below the point where hospitals are overwhelmed. I have my doubts.
Second, if you can get the disease later rather than earlier, you’ve bought the healthcare system more time to prepare, and perhaps for the market to provide more supplies.
Third, there’s at least some amount of evidence that the virus is not immunizing in all cases – that there’s some chance you could get the virus, recover, and then get it again. Most people I’ve talked to think that this is probably not actually true and that it’s a mistake with the earlier tests (that is, the tests that showed the person no longer had the virus were wrong, and they did still have it.) But in case it’s not a mistake, it’s horrifying, so maybe don’t get it.
Fourth, if the model that “everyone will get it” is wrong, you’ve just gotten the virus and maybe helped spread it for no good reason at all.
If for some reason you still that this is a good idea, note that if you get the disease, you put everyone you live with and interact with at risk. If you think you have it, you need to stay quarantined and avoid interacting with people face-to-face for at least fourteen days + the duration of any symptoms. Otherwise, you are putting people at unnecessary risk.
Just do your best to avoid getting it. Gosh.
Q: How should I be preparing?
A: If the virus is in your area, you should prepare for:
1) Avoiding transmission via social distancing
Avoid large groups. The degree to which you should do this is dependent on how bad the threat is where you are. In the DC area, I would strongly consider not attending even small parties or meetups at this point. As a reference point, Oregon, Maryland, New York, Seattle, and Santa Clara governments have all banned gatherings of more than a certain number of people (250-500).
Avoid crowded areas. Stock up on shelf-stable groceries now so that you have to go to the store less.
Can you work from home, either full or part-time? If so, figure out how to now.
Elderly and immunocompromised people, as well as people with certain pre-existing conditions (e.g. heart disease, lung disease, diabetes) , are at particular risk. Figure out who these people in your life are. Help them figure out plans for reducing risk. And note that these people will be existing and interacting in public, as always, even if you don’t know who they are.
2) Supply chain disruptions
If the disease gets worse, we may see disruptions in supply chains. We are already seeing shortages of e.g. masks and hand sanitizer in grocery stores. Extra stockpiled food and supplies will be helpful if this happens. (I think “at least two weeks” is a good guideline, but do more if you can. I think I have at least a month of food in my house now.)
If you need medication, try to get a larger supply from your doctor now. (You may try asking for a ninety-day or six-month supply, lots of doctors can do this for travelling patients.) China produces a lot of medication precursor ingredients. This FDA list contains an updated list of which meds are in short supply.
Q: How do I tell when to start doing social distancing?
A: If you’re in the US, the US government has been reacting kind of slowly, so you should be planning to do it before official recommendations say to. I would say: start doing some social distancing as soon as there are reports of community transmission in your area. (That is, someone who did not travel to an infected country gets the disease.) Amp up your distancing efforts as more people get it.
Q: I was about to travel. Should I cancel my plans?
A: I would not take a plane or greyhound-type bus anywhere at this point. If you are very sure you are not sick (no cold- or flu-like symptoms for at least the past 14 days, and no close contact with a sick person), and you’re travelling to a place without community transmission, this is less risky. If you’re planning on driving, it’s even less risky. …But I’d still be careful, and if there’s a lot of community transmission where you are, I think it’s best to stay home.
Q: Actually, I was going on a cruise ship –
A: Do not go on a cruise ship.
Q: What should I be stockpiling?
A: My suggestions:
- At least two weeks’ worth of shelf-stable food (ideally a month’s worth).
- Including coffee or tea if you caffeinate (it’s cheap and will make your life much better should you need it).
- Including food that’s easy to prepare and eat, like canned soup and powdered drink mix, in case you get sick.
- Including protein and vegetables.
- Potentially: a multivitamin. In particular, there is some evidence that Vitamin D supplements help prevent respiratory infections.
- Plenty of hand soap (wash your hands a lot, especially when in public or coming home).
- Plenty of hand sanitizer (start using this now).
- If you can’t do that, you might try this DIY recipe using rubbing alcohol and aloe vera gel.
- Other consumables you need to live – laundry detergent, dish soap, toilet paper, etc.
- Disinfectant wipes (start using these now. They are largely safe for phone screens).
- Things you like when you have the cold or flu (painkillers, cough drops, honey, etc) in case you get sick.
- Extra supplies of essential medication and supplements.
- Things to do so you won’t get bored out of your mind if you have to start spending most of your days (or spare time) inside – craft supplies, books, whatever. I also got a yoga mat so I could exercise (via youtube videos) indoors.
- Extra pet food and supplies, if you have a pet.
- A digital thermometer. COVID-19 infections often come with a fever. If you get a fever, stay home.
Q: I don’t have enough space to stockpile supplies.
A: I live in a studio apartment and still have a couple boxes of calorie-dense dried and canned food and cleaning supplies tucked away. You can probably figure it out. (If you are my friend who lives in a car, you can still do a little but yeah, okay, that kind of blows. Ask a friend if you can keep supplies in their shed.)
Q: What about masks?
A: For preventing you from getting sick, I’m confused about masks. I think they must be beneficial, but also that mask production doesn’t seem to be ramping up quickly and there are already shortages for groups in need. Some groups are saying not to use them to protect yourself, but I think that’s a response to the shortage, and the fact that healthcare workers and immunocompromised people and sick people need them more than you. If you have a mask already, it will probably help you avoid getting sick.
If you are sick, masks will definitely help prevent you from infecting other people. But if you’re sick, try and avoid other people anyway.
I hear that there are DIY masks out there and think it makes sense that there should be some effective ways to make them with common materials, but I haven’t looked into this and have no idea how to assess this.
A few relevant studies are summarized here, with equivocal results. Note that just slapping e.g. a t-shirt over your face will not help much. Either way, look up how to make sure your mask is fitted properly, and how to take it off safely.
Q: I get my groceries or [INSERT IMPORTANT THING HERE] delivered. Does that work?
A: I wouldn’t count on it. Your deliveryperson or anybody who interacts with your products beforehand might be sick. Stockpile anyway, and if the situation gets really dire, either shut down deliveries or think of ways to disinfect sealed packages first. If you rely on deliveries, I’d order those deliveries in bulk now and reduce deliveries later.
Some of my friends are thinking about ways to disinfect normal postal mail. I don’t know enough to say if this is important yet. I think it’s worth considering. The virus potentially survives for up to 9 days on surfaces (but this likely depends on the surface.) Bleach, alcohol, and quaternary ammonia all seem to kill the virus.
Q: Do I need to stockpile water, or prepare for power outages?
A: Probably not. Utilities, especially water, tend to be relatively easy to keep running even if many people become sick. (In Wuhan, for instance, the power and water supplies never shut off.) That said, it’s never a bad idea to have a few days’ worth of water on hand for disasters, or a backup system for an electronics you absolutely need. Or if you rely on fuel or deliveries for water or power, you may want to store extra. (Note that the US Department of Homeland Security recommends having a 2-week supply of water on hand in pandemics.)
Q: What about people who can’t work from home, or afford to social-distance themselves, or afford to stockpile supplies?
A: They are at higher risk. This just sucks and there’s no great answer. Broadly, these people will still be better off if other people decide to stay at home, stockpile food from the grocery store rather than going every week, etc. If you can do social distancing, keep in mind that you’re not just reducing risk to yourself, but also to everyone else you come in contact with.
Q: Isn’t stockpiling bad because it will deplete supplies for other people?
A: If you stockpile early, you send a signal to the market that they need to provide more food and supplies. If you stockpile too late, yyyesss. I’m not sure what to do about this, aside from noting that you’re probably not the only one doing it. If you’re worried, just stockpile earlier.
Q: We’ve already been seeing xenophobic/racist attitudes towards Chinese people emerge as a result of this. Is it possible this is the real danger?
A: It is a danger, but the stance that stoking racism is “the real danger” is misguided. In the aftermath shortly after 9/11, I think it would have been fair to say that “the social ramifications that this incites will be worse than the attack itself.” But this is not 9/11. This is a lethal disease that has spread worldwide. It has already killed more people than 9/11 and may well kill many, many, many more in the coming months, including in the United States (where most of my readers are). People are afraid and they are right to be fearful.
This does not excuse xenophobia. People should be afraid of the disease – we owe all the compassion we can muster and more to other people. You ought to combat racism where you see it, think about your own attitudes, and certainly not uphold racist ideas like “maybe I should avoid Chinese people” – but you should also be preparing and treating the disease itself as a real threat.
Q: I’m young and have no no pre-existing conditions. I don’t need to be worried, right?
A: You don’t need to be as worried as other groups. But COVID-19 might still have a ~0.2% mortality rate for young, healthy adults. If you were offered the chance to do something really cool for free (hang-gliding, an amusement park) but it came with a 1-in-500 chance you’d be killed, you wouldn’t do it, and you shouldn’t.
Arguably, you should be more scared for other people with worse conditions, but you’re allowed to be scared for yourself too. Do you, personally, need permission to be selfishly afraid? Here it is. I am young and healthy and afraid for my own health. Death is really, really bad, and a 1-in-500 chance of dying is awful, even if other people have it worse. This is a horrible situation.
Also: The worst is yet to come. Pneumonia and hospitalization are deeply unpleasant and still fairly probable outcomes. If hospitals become overloaded, your chance of surviving severe pneumonia goes way down.
Q: Are there reasons for hope?
A: Yes. At least a couple different groups are now doing human trials on candidate vaccines. After a ~3 month span, this is literally unprecedented in vaccine development.
The virus’ genome was also sequenced faster than any other novel disease.
Also, while the media has been spreading a lot of misinformation and undirected panic, the modern media environment also means that more people can be informed and prepared than ever before.
We’re in this together. Stay strong, readers. ❤
(Thanks to friends for reviewing this piece, especially Glenn Willen / @gwillen.)