Practical Health Protection during COVID-19 outbreaks
Nell Watson at Singularity University's COVID-19 Virtual Summit, March 16th 2020.
The SARS-Cov-19 pandemic is very significantly troubling for humanity. For these reasons, I have joined the Coronavirus Task Force at The American Association for Precision Medicine, to help search for potential solutions using machine learning.Below I have copied a post I wrote originally on the 25th Feb 2020, for reference.I've been monitoring the Coronavirus (SARS-CoV-2, which causes the condition COVID-19) situation very closely since its inception.
In the past few days, we seem to have entered a new phase, whereby there has been a rapid take-off in new cases in multiple nations. It now looks increasingly doubtful whether it can be successfully contained.
We are still learning about this new virus, but we know that it is easily transmissible, and potent. It can be transmitted easily through sneezes, touched objects, and fecal matter. It can potentially travel through the air for several meters, and linger on objects for days.
Each person who gets it will likely infect at least 2 or 3 others, meaning that the rate of transmission continues to grow, doubling at least every week or so. Between 20-70% of the population of most countries are likely to become infected.
However, the virus has a long incubation period, typically around 5 days, but possibly over 3 weeks. This makes it very difficult to contain, as people may appear healthy, and feel fine, and yet be shedding the virus (incubating or asymptomatic cases).
The death rate of infected people is somewhere in the region of 1-4%, but it might grow even higher as medical resources such as ICUs (Intensive Care Units) become full. Between 12-30% of people who get the virus will be in a serious or critical condition, requiring hospitalization: 8-10% need ICU machine respiration, the rest need concentrated oxygen treatment - and not just for a few days. The duration from the beginning of the disease until recovery is 3 to 6 weeks. The other 80% who don't need to be hospitalized will take 2 weeks to recover on average.
The people most affected are older people (progressively more challenged with each decade of age), and smokers. Blessedly (thank heavens), children appear to be spared the worst effects this (though there might be some lingering or latent effects, see below), except in particularly edge cases.
Furthermore, although older people have a much higher death rate, all age groups are at risk of needing hospitalization in order to survive.
Hospitalizations as a proportion of age group:
Age 0-14 / 11.1% severe
Age 15-49 / 12% severe
Age 50-64 / 17% severe
Age >= 65 / 28.7% severe
There is no cure for the virus, although some medicines such as Plaquenil (hydroxychloroquine) and Aralen (chloroquine phosphate) have some evidence of being helpful in treating the infection. Tamiflu (oseltamivir phosphate), and some other meds (e.g. remdesivir, and Kaletra, a combination of the HIV drugs lopinavir and ritonavir) might be helpful also, where they are available.
There is some early speculation that some other HIV and Hepatitis C medicines including Indinavir, Tenofovir Alafenamide, Tenofovir Disoproxil and Dolutegravir, Boceprevir, and Telaprevir might also be useful.
There is no vaccine, and there may not be one for a long time. Although there are some promising candidates being tested, it is very uncertain if they will be safe enough to be released. Attempts at creating vaccines for SARS have backfired by causing autoimmune issues, and making reinfection more dangerous. Thus, we may not have a vaccine in the foreseeable.
You can also try getting a vaccine for pneumococcus (pneumonia vaccine). This won't prevent anyone from catching the SARS-Cov-2 virus, but it might help prevent developing a secondary infection. However, there are also clear risks in attending clinics to get a shot. One might ironically contract SARS-COV-2 in the process.
Although most people who catch it are unlikely to die, you do not want to catch it if you can avoid it.
There may be potential lasting effects (which are *not* verified as yet). SARS-CoV-2's cousin, SARS, has been implicated in damage to gonadal and brain tissue, and can cause lasting lung disabilities in some people. This new virus can act similarly – some people have already needed a lung transplant in order to live.
40% of recovered SARS patients had mental problems, 40% had chronic fatigue, unable to perform normal activities.
One should try hard not to get infected for three reasons:
* (1). It's rather unpleasant, and might put your life on hold for weeks, potentially requiring hospitalization and risk of brain damage during long term intubation.
* (2). Anyone infected is very likely to spread it to others, such as family members and co-workers.
* (3). It might cause lasting effects which are not yet known, and reinfection may be more dangerous than a first infection.
The best way to avoid infection is to shelter in place, if it's safe and feasible to do so.
This means to gradually put together a box of extra food and supplies at home, several weeks worth, so that you can comfortably stay at home for a long time if you need to; at least until the danger has lessened (i.e. drugs become available, it mutates to be less dangerous, or it burns itself out).
I'm linking some info on how to do this.
We should self-isolate as much as we reasonably can, for our sake, and for others, for the public good. That's the only thing that can meaningfully reduce the rate of transmission, infecting less people, saving lives.
The more we keep our distance, and the earlier to choose to do this, the more lives can be saved, and less suffering to be endured by the sick. Many jobs today don't require a physical presence to be effective, and can be done from home.
This might not be feasible for everyone – most of us cannot shut ourselves away from the world for long.
It is extremely important to wash your hands very often, and carefully. Hand sanitizer can help, if you absolutely cannot find water and soap nearby, but it's usually only about as 30% as effective as soap and water. Or better still, wear disposable gloves.
You may choose to wear a face mask, to protect yourself and to protect other people, especially if you believe that people in your community may be infected. Ideally, one should use an N95 (FFP2) or N100 (FFP3) mask if you can find one.
These are more sophisticated than a standard surgical mask, which aren't ideal for keeping viruses out as the filters are too big. However, surgical masks are still better at keeping viruses away than nothing, and might help remind you not to touch your face (something very important to remember!).
One should have spare masks at hand also, as germs can build up on the inside that eventually may be bad for your health.
Unfortunately, these masks are now very expensive, and hard to find. Especially because many of them were produced in Asia, where their need at the moment is perhaps even greater.
It's also possible to improvise a mask using paper towels, if you get really stuck.
It's important to be clean shaven (a soul patch might be Ok) – beards can disrupt the seal of a mask on the face.
It's very important to sanitise one's phone also – it's like a third hand that we hardly ever wash. There are a few options:
* 1). You can wash it with soap and water if it is waterproof (IP67 or IP68).
* 2). You can use wet-wipes to clean it. Screen cleaning wipes (so long as they are wet with alcohol and haven't dried out) should be reasonably effective. One may also apply isopropyl alcohol, or regular alcohol around ~70% ABV.
* 3). You can use a UV lamp to sterilize it. I would recommend using a dedicated sterilizer device for this such as PhoneSoap. I don't recommend using an O³ (Ozone) generator, due to safety issues and uncertain effect.
* 4). You can also keep your phone in a ziplock bag if you need to use it in a contaminated environment (please dispose of the bag safely afterwards).
We should try not to travel long distances when it's not essential to do so, and to avoid large crowds as much as possible. Try to keep your distance from other people, whether or not they appear sick, whoever they might be, or how they might look. Perhaps even from friends and family, for their benefit as much as yours. Anyone can have this virus in them and not know it.
This situation now appears unlikely resolve itself, or to go away any time soon. It is creating economic issues due to disrupted supply chains (China makes most of the world's stuff, as well as producing raw materials). Many factories around the world are now halted due to lack of parts and materials.
Other issues going on such as droughts in Australia, wasted produce in China (locked down, unable to get to market), and the locust swarms eating crops in a belt between Western China and Ethiopia, compound these effects.
2020 will be a challenging, yet also survivable year. We will get through it together – as friends, as families, as communities.
A good primer on how to wash your hands properly:
How to improvise a reasonably effective last-resort mask from paper towels:
How to wear a surgical mask (not ideal, but better than nothing)
How to wear an N95 style mask:
How to safely remove nitrile gloves:
I recommend following Dr. John Campbell on Youtube for advice and ongoing updates:
Why you should wear a mask if you feel there is risk: To protect you, and others:
A peer-reviewed paper in Cell announces that two drugs have been found useful against COVID-19. Drug A can stop the progression of the virus in its tracks (to give ones body a chance to fight), and Drug B can help kill it.
Drug A (camostat mesylate) is already available in Japan, licensed for treating pancreatic cancer and kidney disease. In theory it could be fast-tracked by the FDA or equivalent bodies in other territories. Drug B ('agent E-64d') is not on the market, but is already in human trials.
No-one seems quite sure who owns the patent on camostat mesylate, but the molecule looks easy enough to synthesize. I hope that whoever owns it can be persuaded one way or another to open that patent up for a time.
Along with chloroquine (Aralen) / hydroxychloroquine (Plaquenil), these drugs are among the best candidates for a near-term medical solution to this crisis. Our world may be inexorably coming off its rails presently, but there is a new hope for us to quickly end this.
Q & A
If you get a severe condition (pneumonia, ards) from COVID-19, what is the chance that you develop a chronic condition from it when you recover (eg. diminished lung capacity)?
The chances seem significant. About 40% of SARS sufferers reported chronic fatigue, 27% at clinic levels.
Other studies suggest diminished long term lung capacity in both SARS and SARS-Cov-2 sufferers.
Research suggests that SARS-Cov-2 can infect the nervous system, like SARS.
SARS is a much nastier virus in terms of deaths, but we have no idea whether the lasting effects for SARS-Cov-2 will be similarly decreased. We can certainly expect a significant proportion of people with significant complications to be affected in a lasting way from the virus, and also from ventilator care, which is known to cause loss of brain function which may be lasting.
What about the low dose aspirin for heart patients? Is that a problem before symptoms? After symptoms?
This is very much open to interpretation, as research is still coming out, and individual circumstances will vary. Please ask your physician.
And about Brazil, our government are not isolating as they should be? Less are they doing the tests as they should ? The information is not being disclosed. What we can do?
Please share as much info as you can on the lamentation of nations who waited too long, and the crucial importance of early interventions.
Do you have any recommendations for a large population like India, with a relatively poor public healthcare system? How do we bring such a large behavioral change as well as introduce simplified processes for such large populations, with remotest locations not having access to basic healthcare?
Jugaad. Find local solutions that work, built out of anything you have to hand, using open source techniques. Apply local ingenuity – it’s the only way to provide distributed care at scale.
Why not go to the hairdresser? Only because of close contact to others?
Indeed. Lots of potential for infection via droplets, etc.
Technically not a question, more a comment.. but locust storms??? Really? you've got to be kidding me.
It never rains but it pours. Ordinarily, whilst locally devastating, aid and trade can help to offset a crisis. However, in a locked-down world, this becomes a lot more challenging.
Have virologists sequenced sars-cov-II in different countries and noticed any mutations in places where the mortality is high (eg. italy) (apart from the s vs l strains)? Is there any difference between sars-cov-2 in mildly affected cases vs severe ones?
Research in this area is still very much open to interpretation. There are many strains, but the divergence doesn’t seem to be very high, nor is it mutating very quickly. The S vs L strain preliminary research is intriguing but still quite controversial. We don’t know yet whether the variances in outcomes in differing geographies may be dependent on strains.
How do we deal with dogs? When coming back home, etc?
It should be reasonably safe to take a dog for a walk now and then. This is allowed in places like France, though it wasn’t in Hubei. However, dogs can indeed catch COVID-19, and recently a dog that caught it has died in mysterious circumstances. Cats can also catch SARS (and so can ferrets), though it seems unlikely that they can then pass it on to humans. Animals may carry the virus on their paws and fur, though it likely doesn’t last long on fur.
Can the virus survive on plastic?
Yes, it seems so, for several days. “Through a series of recent experiments, researchers tracked the virus’ viability on different surfaces, discovering that its half-life covers a wide range of time periods. On copper, for instance, the virus survived just four hours. But on some surfaces, its longevity was much greater — lasting for up to one day on cardboard, and up to two or three days on plastic and stainless steel.”
I know about differences in COVID mortality based on age; is there similar data showing differences in SEVERITY based on age? ie: if you are 30 and get this what likelihood is there you'll have a severe condition vs 50 vs 80 assuming no pre-existing conditions?
As far as we can tell the rate of severe cases follows a similar pattern as fatality rates, i.e. it heavily skews upward with age and comorbidities.
Realistically, homemade masks will not protect you from the virus. Should we really be promoting this?
Homemade masks absolutely can protect one. Firstly, they make it much less likely to have direct contract with one's mucus membranes. Secondly, although they are not as sophisticated as a factory-made version, even cotton and paper can make a significant reduction in viral load. The paper mask, for example, is estimated by the scientists who designed it to be about 80% as effective as a real mask. These are clearly masks of last resort, but this is where we are today. Perfection is the enemy of better.
Moreover, even if one is infected, being infected with a smaller load of virus gives the body more time to prepare its defenses. This is one reason why young healthy clinicians are at such risk (along with exhaustion).
Are there any studies on the relationship between initial viral load (ie: how much initial viral amount you are exposed to) vs how severe a condition you ultimately get? ie: specifically for covid-19 or generally (ie: for the common cold)
Yes, see above. Even if infection seems inevitable, reducing it can make a huge difference in clinical outcomes.
Can Nell say anything about when it may be safer to travel by air - in 2 weeks or one month or longer?
Fewer people travelling on planes may reduce risks somewhat, but it seems very inadvisable to travel at all if one can possibly avoid doing so. This is likely to remain the case for the foreseeable. Having access to PPE such as masks, goggles, and gloves may make it a little more feasible, but for anyone without such equipment it’s a bad idea.
What about to go to your country house and avoid urban cities?
If you have an option to get out of cities, do so. The risk in cities is much higher from pathogens but also disorder, forcible containment, and crime.
Has this covid 19 crisis proved work from home is possible?
We must adapt, there’s nothing else for it. Some jobs require a physical presence, but most can be significantly automated. Whether this is likely to increase or decrease organizational efficiency is an open question, however.
Are they testing blood donors/blood for Covid?
They should be, and they will be if they have test kits available. Blood shortages are critical, and it seems inevitable that some contaminated blood will get into the supply eventually.
What are the solutions to support the mental and physical health of our global community that not used to stay at home, now need to follow the protocol of social distancing and self-quarantine?
Please refer to the handbook, and add in any new resources you find.
How often do we should wash our hands and disinfect surfaces?
Any time you encounter an object that is new to you, such as food delivery, etc, you should wash your hands. If you are out of your home, touch as little as possible, and wash as frequently as you can. If you are just sitting around at home, I wouldn’t worry too much, just do as normal, but wash before meals and thoroughly after visiting the bathroom.