The coronavirus has made it to Oregon. The first COVID-19 case was announced Friday and by Monday a third presumptive COVID-19 case had been confirmed. Supermarkets clogged as residents scrambled to prepare, and toilet paper, canned food and frozen veggies flew off the shelves. There's a lot of misinformation out there — some of it from official sources — so let's set the record straight. We'll start with the most pressing question:
Should we be scared?
If you’re scared, that’s OK. If you’re not scared, that’s OK, too. This virus isn’t the apocalypse, but it is serious, and it’s important to be cautious and prepared. If you have children, it’s possible their school will be cancelled. Make sure you have childcare arranged if you can’t stay home. Make sure you have shelf-stable food and toiletries and basic necessities in case stores close. Buy them sooner, not later, so that stores have a chance to restock if they run out of something.
For now, treat this like you would a natural disaster. Ask your doctor for a three-month supply of any prescription medications.
Make sure your earthquake kit is stocked. Fill up your pantry, but don't be a hoarder. And take some advice from this writer, who has lived through far too many blizzards and hurricanes: treat yourself. Get a few luxuries. You don't want to be eating plain pasta and beans for weeks if things get really bad. Go buy some chocolate.
What can I do to avoid getting sick?
The same things you would do for the flu. Get enough sleep, drink enough water. Cough into your elbow. Avoid touching your face. Wash your hands often with soap and water. And you're probably doing it wrong, so follow these tips: wash the front and back, between your fingers and under your nails for at least 20 seconds. Sing Happy Birthday or Mary Had A Little Lamb twice. Or try this list of 20-second-long catchy choruses.
It's a good idea to use hand sanitizer when hand washing isn't available. It's not quite as effective, but it does help. If your local drugstore is out of hand sanitizer, don't panic: you can make your own.
What about masks?
There's no need to go crazy buying masks. Masks are great at preventing people from spreading disease, but not so good at stopping people from getting diseases. Unless you're sick or caring for someone who is sick, washing your hands works much better. If you do get a mask, use it properly.
Who needs to worry about this virus?
Like the flu, elders, people with underlying health conditions, and people with compromised immune systems are most at risk. But there have been fatalities in younger, previously-healthy people.
Unlike the flu, the majority of cases in children seem to be more mild. There’s actually two mild coronaviruses, unrelated to this one, that are responsible for about a quarter of all common colds. They’re very common in daycare centers. Some scientists think that children might have some residual immunity because they get coronavirus-caused colds so often.
How fast is the disease spreading, and how bad is it?
It’s pretty bad. It’s not time to panic, but worries that the media is over-hyping this outbreak are unfounded.
Right now, scientists think the COVID-19 virus is more contagious than the flu. Scientists measure contagion with something called an R0, pronounced r-naught. It's a number they can plug into models to see how diseases spread, and basically it just represents how many people one person can pass the virus on to. Estimates for COVID-19 vary widely, but current consensus is that it's around 2 or 3, making it roughly twice as infectious as the flu. The Centers for Disease Control has said we should prepare for a pandemic.
What about the fatality rate?
Right now, the estimated fatality rate is about 2%. In Hubei province, where the coronavirus outbreak started, it’s between 2% and 4%. In other parts of China, it’s about .7% — that’s probably because hospitals in those areas were less stressed and could provide better care, since there were fewer patients. World Health Organization officials are worried that countries without good healthcare will have widespread fatalities.
Some scientists have hoped that the fatality rate of 2% will go down as previously-undiagnosed mild cases are counted. But Bruce Aylward, an expert at the World Health Organization, said in a press briefing that evidence suggests most of the mild cases in China were, in fact, counted. Others disagree.
A common piece of misinformation is that coronavirus "has a 2% fatality rate, about the same as the flu." That statement is false, and it has been repeated by President Donald Trump and his administration officials. Scientists have criticized his comments and called his statements "dangerous."
This year’s flu outbreak had a fatality rate of .05% in the U.S. Even if the COVID-19 fatality rate falls, it’s much more severe than the flu.
If the outbreak does get bad, what should we be worried about?
The biggest concern would be overtaxed hospitals. The death rate for coronavirus was much higher in Wuhan, and surrounding areas than it had been in other provinces. That’s because hospitals in Wuhan were so packed that they ran out of important equipment and supplies like respirators and oxygen.
There were also reports of people who needed routine but life-saving medical care being turned away. The South China Morning Post reported about patients with kidney disease, for example, who couldn't get into the hospitals for dialysis. Same with cancer patients. So folks who need this type of care should make sure that they'll be covered and get routine appointments taken care of now rather than later.
And, of course, treatment for severe cases is expensive and requires long stays in the hospital. At a time when 27 million Americans don't have health insurance, that could be a huge financial hit.
SARS-CoV-2, 2019-nCoV, COVID-19, “the new coronavirus.” What on earth is this disease actually called?
COVID-19 is the name of the disease, while SARS-CoV-2 and 2019-nCoV are names for the virus. Sometimes, viruses and diseases have different names. It’s like how human immunodeficiency virus (HIV) causes AIDS.
Where did the virus come from?
At this point, most of us have heard that the novel coronavirus was first detected in a cluster of cases around a Wuhan wet market. That’s a place where a ton of different live animals are sold and slaughtered. But pretty quickly, health officials noticed that some early cases couldn’t be linked to the wet market at all. Wuhan does appear to be the epicenter; it has more cases than anywhere else, so that’s as good of an answer as we have.
Some of the recent cases in Oregon, California and Washington couldn’t be connected to people who visited infected countries. They’re called “community acquired.” What does that tell us?
It tells us that the virus has been in the Northwest, circulating for longer than we think.
Do we know how long?
We have a good guess. The first case of the virus found in the U.S. was reported in Washington state by a person who had visited an infected area. That person’s sequence was uploaded to GenBank, and it had a very specific mutation that most of the other sequences didn’t have. One of the recent community-acquired cases in Washington was also sequenced, and that virus had the same specific mutation. If all of these cases did come from the first one, then the virus has been spreading in Washington since late January.
Why didn’t we see it until now?
Not long after the outbreak, a lot of Western countries started widespread screening for the virus and testing basically anyone who came into a hospital with respiratory symptoms. But we haven’t been doing that in the U.S. The Centers for Disease Control wanted to prioritize people who had contact with those who were confirmed to be infected.
And then, the initial round of test kits sent out by the CDC were faulty. We’ve only just recently started getting reliable tests for the virus. And now the CDC has changed its testing guidelines and given states and hospitals authority to conduct their own tests.
That means we'll probably see a bit of an uptick in cases in the next few days as patients that hospitals had been monitoring and suspected of having the virus can now be tested and confirmed. In the meantime, all those undetected mild cases will keep on spreading coronavirus. As of Sunday, a disease modeler thinks there are between 300 and 500 cases in Washington, but maybe as many as 1,500. At that time there were only a handful of confirmed cases.
What do we know about the virus?
We know it’s a coronavirus, which means it’s in the same family as SARS and MERS - Middle East Respiratory Syndrome. We know it’s nowhere near as deadly as those viruses, but way more contagious. There are also two other coronaviruses that circulate the globe. Those viruses aren’t a big deal, and cause roughly a quarter of all common colds.
Beyond that, there are a lot of theories and predictions, but they’re all based on what we know about other respiratory viruses.
We don’t know how the COVID-19 virus spreads, but we have a good guess. Measles, for example, spreads in the air — you can get measles just from being in the room with someone else with measles. The other coronaviruses don’t spread this way, they spread in droplets of water we release when we cough or sneeze, just like colds and the flu. Scientists think that if the COVID-19 does spread in the air, we’d be seeing a lot more cases. So that’s good news.
We don't know how long the virus can survive on surfaces, which is why they temporarily closed the school in Lake Oswego, where Oregon's first confirmed coronavirus patient worked. That's also why in addition to washing hands, you should keep your house extra-clean and sterilize surfaces.
Is it possible the virus was just circulating for a long time, and no one noticed it?
We actually have a pretty good idea of when the virus started circulating, even if we don’t know precisely where. When scientists are investigating outbreaks like this, it sort of becomes a forensic puzzle, like a crime case.
First, some background:
There are two types of genes, RNA and DNA. We have both in us right now, and some viruses have one or the other or both. The details aren’t important, but you should know that RNA viruses (like the flu, the common cold or rhinovirus) are way more likely to mutate. RNA is not very stable. That’s part of why RNA viruses like the flu are so good at jumping between species. Remember bird flu and swine flu? They’re both RNA viruses. Coronavirus is an RNA virus.
Each time a virus is replicated, it copies that genetic material. And no copy is ever perfect, so there are mutations. There's a massive, free, publicly-available online database of genetic sequences called GenBank. It's run by the National Library of Medicine. Scientists all over the world have been sequencing the virus' genes and uploading them to GenBank. By looking at those genetic sequences from a bunch of different coronavirus samples we can figure out how long the virus has been around by seeing how similar or different their genes are. We do this same thing all the time in evolution — when scientists say they think humans and chimpanzees branched off from each other about 6 to 8 million years ago, they're calculating that using a genetic clock like this one.
Right now scientists think this virus first started circulating in humans sometime in November. But the virus wasn't officially reported in China until Dec. 31.
What does the future of the outbreak look like?
Most scientists are looking to the flu for some idea of how the new coronavirus might spread. When a new type of flu breaks out, like swine flu, it usually causes a big spike in cases at first because no one is immune to it. But eventually, a lot of people become immune. The viruses cycle between the northern and southern hemisphere, spreading where it’s coldest and vanishing in the summer.
So will it just become more mild and cycle seasonally, like the flu and the two other common coronaviruses?
It’s a definite possibility, but honestly we have no clue. We don’t know, for example, if having had the virus a previous year will make us less likely to get it the next year. We also don’t really know how it’ll survive in heat. But a lot of people suspect that might happen — the good news is that if it does start cycling seasonally, a lot of people will get infected at first, but “herd immunity” might kick in and make later outbreaks much smaller.
We can also look at the flu again. Some years, the strains of flu circulating are more deadly than other years. And again, we’ve never seen this virus before — so there’s still a lot up in the air.
Are there any risks of drug shortages?
So far, things aren't too bad. But they could get worse. Pharmaceutical production is a global trade, and that has people worried. Roughly 80% of all pharmaceutical ingredients are made in China. The U.S. already has shortages of one drug — the Food and Drug Administration won't say which one — because key ingredients aren't making it here from China. Major pharmaceutical companies like Merck and Pfizer have released statements saying that they expect more shortages to come. There are concerns that we might run low on antibiotics that help treat secondary infections, like bacterial pneumonia caused by the coronavirus.
If you take regular medications, call your doctor and ask if you can get a three-month prescription filled. You want to make sure you won’t run out.
What is a “presumptive” case? How is that different from a “confirmed” case or a “suspected” case?
A suspected case is someone who is being monitored for coronavirus with suspicious symptoms, but has not been tested. A presumptive case has been tested in ways that meet the CDC guidelines, but were not done by the CDC. Because of delays distributing testing kits, the cases initially announced in Oregon were presumptive or “presumed coronavirus” cases. Once the CDC gives its stamp of approval, it’s confirmed.
Any last advice?
I wasn’t kidding, self-care is important. Buy some chocolate. I bought brownie mix and too many Girl Scout cookies.