At War with COVID-19

We’ve had a wakeup call. Viral pandemics will be our reality for the foreseeable future. We’re at war with COVID-19. We must change our way of thinking and living. Could this be a good thing for us in the long term even if we suffer in the short term?

Oblivious to Viral Pandemics?

Are you like me? I buzzed merrily through the bird and swine flus. Past pandemics barely registered on my personal radar. Somebody somewhere was managing these for me. I was fine with that. I felt safe.

Picture of a couple driving past a crowded market with the top down on their convertible. Will we be able to do this again when the war with COVID-19 ends?

My sense of safety is shattered. I wonder, “Will this scene be in my future?”

Image by Squirrel_photos from Pixabay

Confused by the Names for the Pandemic?

There are several names for the virus with which we’re at war. Some call the virus a coronavirus. Others call it COVID-19. Still others call it SARS-CoV-2. Each of these terms is correct.

COVID-19 is a type of coronavirus. The term corona is Latin for crown. A corona virus has an oily coating studded with proteins giving it a crown-like appearance. COVID-19 simply stands for coronavirus disease of 2019. SARS-CoV-2 means that the virus is linked to severe acute respiratory syndrome (SARS) caused by the genus Betacoronavirus. SARS-CoV-2 is the term scientists use.

For a short history of COVID-19, go to Wikipedia. https://en.wikipedia.org/wiki/Coronavirus_disease_2019

Were You Prepared to be at War with COVID-19?

If you knew in January we’d be at war with COVID-19, congratulations. You’re a step ahead of the rest of us. I’m trying to sort out fact from fiction, science from pseudoscience, campaign rhetoric from useful information.

Most Important Takeaway Message

We’re at war with COVID-19, and it’s an extremely dangerous virus. If you learn nothing else, remember that COVID-19 is a new serious health threat unlike the flu which spreads like wildfire.

Respiratory drops and contact transmission are considered to be the most important routes of transmission of the 2010 coronavirus, but do not fully account for the occurrence of all coronavirus disease and the reasons for the rapid spread of the virus (Yong et al., 2019)

COVID-19 Is Efficient
Picture of Anthony Fauci, M. D. at a COVID-19 White House briefing.

“It’s an extraordinarily efficient virus in transmitting from one person to another.” Dr. A. Fauci

U.S.S. Theodore Roosevelt: Many Infected Have No Symptoms

The captain of the U.S.S. Theodore Roosevelt, a vast aircraft carrier home to 4,865 people, never expected to become famous, but his ship shows how rapidly the disease can spread among the healthy young living in close quarters and unable to practice physical distancing. See the April 16, 2020 article by Phil Stewart and Indrees Ali in Health News. https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt-idUSKCN21Y2GB?utm_source=Nature+Briefing&utm_campaign=ff928b9a9f-briefing-dy-20200417&utm_medium=email&utm_term=0_c9dfd39373-ff928b9a9f-45281786

Since the COVID-19 invasion of the USS Roosevelt was detected and publicized, 94% of the sailors were tested. Of these, 3,920 had negative test results, but 660 of the sailors tested positive. Sixty percent of these sailors had had no symptoms.

Picture of the USS Theodore Roosevelt being towed into harbor in Viet Nam. Photo from Reuters

[…] we’re learning that stealth in the form of asymptomatic transmission is this adversary’s secret power. — Rear Admiral B. Gillingham

What’s the Takeaway?

  • You can have the virus and spread it to others when you don’t have symptoms.
  • Quarantining yourself or running to the hospital to get a coronavirus test is closing the barn door after the horse has left.
  • Young and healthy people contract COVID-19 and die.
  • We must pay particular attention to close quarter living and working situations such as jails, nursing homes, manufacturing sites, apartment complexes, etc.

Ouch! That’s not Good News!

How do we protect ourselves against an invisible enemy which stalks us 24/7, is highly contagious, and is spread by a large number of people who have no symptoms and have no way of knowing they’re virus carriers?

Looking for Leadership in the Land of the Lost

Picture of puzzled woman wondering how to protect herself during the COVID-19 viral pandemic.

Do I go play on the beach or should I wear a hazmat suit?

We tune in to daily briefings hoping to get guidance, but we get a confusing array of information. Even our public health sources provide outdated guidance based upon past similar outbreaks. What we know about pandemics is that each pandemic is unique. What was true for one pandemic doesn’t predict what will happen during another.

One fact is clear: COVID-19 isn’t going to disappear.

Our Missions

We have two jobs. They’re huge, but they’re doable.

  • Keep the virus from entering us and our homes.
  • Keep the virus from leaving us and infecting others.

Understand the Enemy

To defeat an enemy, you need to understand it. Without doing a deep dive into virology (something I’m not qualified to do), we can understand the basics of how a virus attacks the cells in our bodies, how it reproduces itself, and how it moves from host to host (both within and between individuals). Watch this brief video on a day in the life of a virus.

The Viral Life Cycle

A virus is a funny critter. It needs the materials in the cells of a host to make copies of itself. The virus must do the following to multiply:

  • Virion, ineffective form, enters a host.
  • Virus finds a cell which it can open and enter.
  • Virus uses the cellular machinery of the host cell to make copies of itself.
  • Virus produces copies, and new virions exit the host cell.
  • Virions find another host inside the host’s body or outside the host.

Meet Viral Shedding

When we’re infected with a virus, viral cells will circulate through the body looking for other host cells. Some of the newly created virus particles will leave the body and find their way to another host. This process is called viral shedding.

COVID-19 is an encapsulated virus. Watch this video to learn how a virus attacks our cells, hijacks our cells, and creates copies of itself.

Social Distancing: Spread of COVID-19

Pictures of armed protesters outside the capital building in Michigan. They're protesting the social distance order.

Arms bearing Michigan protestors don’t want social distancing

Are these the same folks who didn’t want to stop smoking in restaurants? Do these protesters believe that the rights of all of us are less important than their personal rights? Social distancing saves lives. What these guys (all males by the way) are doing is organizing a super-spreader event, giving the virus to each other and then to any of the rest of us who happen to bump into them.

This graphic shows how social distancing saves lives and prevents the spread of infection. https://www.thesun.co.uk/news/11254353/viral-load-affect-spread-coronavirus/

From The Sun newspaper in the UK. Graphic showing the spread of the virus by an infected person when that person social distances versus doesn't social distance. Social distancing helps.

Do the Math

I count at least 20 guys in this picture. Let’s say one of these gun-toting nitwits is positive for the coronavirus. He can infect approximately 75 people in the next 5 days! Within 30 days, he will infect hundreds of people. If he’d stayed home, he’d pass the virus to 15 people.

Science and Viral Spread

How long can we give the virus to others after we’ve contracted and recovered from COVID-19? You’ll hear all kinds of estimates.

Scientists in Beijing, China studied a group of patients who’d been diagnosed with, treated for, and cleared of COVID-19. All patients passed tests for the virus. All patients were symptom free. After their discharges, the patients were tested frequently to see if COVID-19 could be detected in their throat swabs.

[…] “half of the patients continued to be viral positive even after the resolution of symptoms up to eight days.”

Chang et al., 2020
Chart showing when a person infected by COVID-19 is no longer shedding the virus relative to the end of symptoms. You can shed virus when you don't feel sick.

Dangers of Close Quarters

If you live and work alone, you’re better able to control your exposure to COVID-19. Some folks live in jails, prisons, or large apartment complexes. Those of us in shared residences must up our vigilance against this virus by the number of people who share our space. Others of us working in close quarters must be aware of our increased risks of exposure and transmission. We’re just now learning of the dangerous conditions in meat processing plants. These places represent an immediate danger to the workers and their communities and a long term danger to the rest of us. See for example a recent article from the Washington Post on chicken processing plants. https://www.washingtonpost.com/local/virus-spread-at-virginia-chicken-plants-alarms-health-officials/2020/04/28/7ef459d4-898e-11ea-ac8a-fe9b8088e101_story.html

Dense Residential Living Accelerates the Virus

Epidemiologists and physicians think of dense residential living and work situations as accelerant or super-spreader situations. In these places, a virus finds its special happy hunting ground. Looking at the world from the viral perspective, a virus doesn’t have to travel very far, brave temperature changes, or risk being killed by a disinfectant to find a new host. There’s a new host coming by every minute. It’s easy to hitch a ride. An uninhabited desert, on the other hand, is the virus’s worst nightmare. Miles of treacherous terrain must be traveled to find a new host.

Picture of a match against a dark background illustrating the point that dense residential situations are to a virus like gasoline is to a fire.

Dense residential, work, or travel situations are to a virus like gasoline is to a fire.

The Sad Voyage of the Diamond Princess

Here are several apocryphal stories which illustrate how quickly a coronavirus is spread in dense residential situations — the Diamond Princess and two apartment complexes in Hong Kong.

The Diamond Princess left Yokohama, Japan on January 20, 2020 with 2,666 passengers on board. The passengers were visiting ports in China, Vietnam and Taiwan. Two weeks later, however, the cruise ship passengers were confined to their cabins and allowed out for only a few hours each day.

People quarantined on the Diamond Princess in Japan are hanging laundry on their balconies.

Laundry day on the Diamond Princess

What happened? Although no one can be sure how COVID-19 got on board, one theory links the COVID-19 outbreak to a passenger who’d traveled to mainland China just before he started the cruise. When he felt ill and disembarked, he tested positive for COVID-19. At that point, the Japanese government quarantined the ship, and COVID-19 testing was done. Of the passengers and crew, 562 tested positive for COVID-19.

Quarantine Failed

Despite the lock down, the virus raged through the cruise ship. How did the quarantine fail? There are several theories. Some believe passengers and crew were exposed to the virus before the ship locked down. Others think that the crowded conditions of the ship prevented adequate quarantine. For example, members of the crew shared quarters and dining rooms. Still others noted that some passengers wouldn’t follow the quarantine rules.

Was there something about the way cruise ships are constructed that caused the spread? Cruise ship compartments share water, sewage, and air supply. Did the air-conditioning system spread the virus? This idea came from the SARS outbreak when the disease spread among people quarantined in a hotel who’d had no direct contact.

Spread of the Virus on the Diamond Princess

The owners of the Diamond Princess preserved several staterooms after the passengers disembarked. Investigators examined the compartments of COVID-19 positive and COVID-19 negative passengers. What the researchers found was sobering and illuminating.

Genetic material from the COVID-19 virus was found on cabin surfaces 17 days after the rooms had been vacated. It didn’t matter whether a COVID-positive passenger had occupied the cabin. Most of the cabins were contaminated with infectious material. Laboratory research had suggested that the viral survival times ranged from hours to days.

What Did We Learn?

  • The survival times of COVID-19 are longer in the real world than in the laboratory.
  • Shared physical layouts pose an additional risk as accelerants for COVID-19.

The Tale of Two Apartment Complexes in Hong Kong

The spread of a severe acute respiratory virus (SARS) in an apartment setting was observed during the SARS epidemic in 2003 and the current COVID-19 epidemic.

Amoy Gardens

In early February 2003, a professor traveled to the site of an outbreak of a novel pneumonia in southern China. Several weeks later and feeling slightly unwell, he traveled to Hong Kong to visit friends and relatives. One day after his arrival, he was admitted to a local hospital (Hung, 2003). Friends from several countries visited him during his stay. He died in that hospital of what came to be called a severe acute respiratory syndrome or SARS. He was “patient zero”, the source of the spread of the SARS epidemic in Hong Kong, Taiwan, and Canada.

Table showing the spread of SARS by a doctor from mainland China to Hong Kong.

By April 2003, 50 medical staff were on medical leave because they’d contracted SARS, 7 patients from his ward fell ill, and one of these patients spread the infection to Amoy Gardens where 239 of the residents in Block E were diagnosed with SARS and 33 succumbed to the illness. Many of these residents had no direct contact with each other.

How Did the Virus Spread?

An investigation led by the Hong Kong Department of Health found the following environmental factors:

  • Each apartment block shared 8 vertical waste stacks which collected waste from all floors.
  • The soil stacks collected waste from toilets, basins, tubs, and bathroom floor drains.
  • Residents used the same elevators, stairs, and mailboxes.

The investigation concluded that the virus was spread by the shared waste stacks. The virus-contaminated waste from the toilet U-joints was pulled into the air by exhaust fans. These fans then spread the infection onto bathroom surfaces.

“Early evidence shows COVID-19 may be more contagious than the flu.” […] “Transmission is through respiratory droplets, feces, and bodily secretions.”

https://www.healthline.com/health-news/how-deadly-is-the-coronavirus-compared-to-past-outbreaks#Novel-coronavirus-(COVID-19)
Residents’ Feces Contained SARS

Two thirds of the residents of Amoy Gardens who’d contracted SARS had diarrhea. When tested, the stools of these residents contained the live virus. Dr. Hung stated,

“[…] so a very substantial virus load would have been discharged into the sewage of Block E.”

Other Mechanisms of Spread Kick In

Dr. Hung suggested that sewage wasn’t the only mechanism causing the viral explosion in the apartment complex.

Probably the index patient infected only a small group of block residents, with the remainder acquiring the disease via sewage, person-to-person contact and shared communal facilities such as lifts and staircases. These residents subsequently transmit the disease to others both within and outside […]”

Hong Mei Apartment Complex
Picture of Hong Mei apartment complex in Hong Kong. The virus spread among people in one block and across ten floors.

A picture is worth a thousand words. The Hong Mei complex is gy-normous.

On February 11, 2020, two residents of an apartment complex in Hong Kong fell ill with COVID-19. The residents had no contact with each other, and their apartments were separated by 10 floors. As a precaution, all residents of the building were evacuated, but health authorities wondered if the cases were connected. After a preliminary investigation, they concluded that the virus might have been transmitted through the apartment’s plumbing system.

For more information on viral shedding, read a related post. https://carbohydrateconfessions.com/obesity-increases-risk-of-dying-covid-19/

Is COVID-19 Spread Through Feces?

We know a closely related virus, SARS, can be transmitted through plumbing because the stools of infected people contain living copies of the virus. Scientists have recently identified live specimens in the stool of COVID-19 patients (Yong et al., 2020).

Electron microscope photo of a COVID-19 live virus in a stool sample of a person infected with the disease.

“COVID-19 patients have live virus in stool specimens, which is a new finding in the transmission routes […]”

Other Ways in which COVID-19 Spreads

Zhang and colleagues (2020) collected nasal swabs, rectal swabs, and blood samples from a series of coronavirus patients in Hong Kong. Although health information on the spread of COVID-19 through the intestines is not being discussed in the media, two quotes illustrate the severity of the risk of being exposed to the fecal matter of infected persons.

“We detected the virus in oral swabs, anal swabs and blood, thus infected patients can potentially shed this pathogen through respiratory, fecal-oral or body fluid routes.”

[…] “patients infected with 2019 and Co-B may harbor the virus in the intestine at the early or late stage disease.”

Risk of Infection from Fecal Material Is Persistent

Living COVID-19 viral RNA is found in 20% of patients after standard respiratory tests for the virus are negative. Testing for the virus in feces should continue until both feces and respiratory test results are negative (Xiao et al., 2020).

What Have We Learned?

  • COVID-19 is spread in many ways. The respiratory system is only one way.
  • COVID-19 is spread when we breathe, pee, poop, eat contaminated food, or blow our noses into a tissue.
  • We haven’t been getting adequate information about the many ways in which the virus spreads. The information from our government has been overly focused on respiratory spread.
  • The COVID-19 virus persists, particularly in the digestive system, long after we begin to feel like we’ve recovered.
  • Individuals in high density housing and those who live in complexes with outdated or poorly repaired plumbing systems are at high risk of contracting the virus and spreading it quickly and widely into the community in a very short time. Crowded work situations pose the same risk of community spread.

The Super Spreader

You may hear about super spreaders — people who’ve contracted COVID-19 and then infected an extraordinary number of others. Don’t worry about this mythical super spreader. There’s no “COVID Mary”. Worry instead about super-spreading events like bars, concerts, sporting events, and yes, crowds of protesters.

So Much to Say and so Little Time

When I started writing this blog, I did so because I wanted to make others aware of some good ways to track their own health and the health of their community. Along the way, I learned so much about how to prevent the spread of COVID-19 that I couldn’t fit it into a blog. I’m going to create a pamphlet. Keep tuned to this space for updates.

Keeping Updated, But Doing It Safely

There are scam artists everywhere trying to capitalize on our fears. I want to feature two safe ways to keep updated.

  • Kinsa Smart Thermometer
  • University of California Davis Tracking application

Join the Kinsa Revolution

Buy and use a Kinsa Smart Thermometer. I bought mine from Kinsa for $39.95. I had to wait a few weeks for delivery. https://www.kinsahealth.co/

To take your temperature data, you need two things– a smartphone and a Kinsa smart thermometer. The thermometer connects to an application on your smartphone. Detailed installation instructions are on the Kinsa website. It took me 5 minutes to set up my account, download the app, and take my temperature.

The Kinsa App Is Free

You can use the application to look at Kinsa maps for your city or any city in the United States. My favorite feature is the tracking map. The incidence of high fevers in your area is mapped relative to the expected level for the time of year. I live in Duval County, Florida, and I was pleased to learn that a time series chart of my area shows that the fever readings in my area are dropping. To get readings for your area follow this link. http://kinsahealth.co/research

Kinsa Smart Thermometer Time Series Chart for Duval County Florida from February 15 through April 20, 2020.
Time series chart compares influenza-like illness level in country in orange and red against where we’d expect them to be, in blue, and see how that relationship has changed over the past few weeks. Data current as of: April 27, 2020

This tracking information will help me decide whether to go to the grocery store, etc.

How Does the Smart Thermometer Work?

Image of a smart phone with the Kinsa application loaded and the Kinsa Smart Thermometer.

Kinsa Smart Thermometer

Fever is a symptom of influenza.
Fever in a population rises and falls depending upon the general health of the population. During an influenza outbreak, the average recorded temperature of the population increases.
Once baseline data have been collected, the fever level in an area can be compared with the level expected for a given time of year.
Expected fever levels and recorded fever levels can be compared and mapped.
Users can check the fever map for his or her region to decide if there is an increased risk of influenza.

What Kinsa Data Tells Us that the CDC Can’t

States and municipalities collect influenza data and submit it to the Centers for Disease Control. The CDC then compiles a report. The CDC relies on data from hospitals and schools, so there is a lag time between when a virus appears and when the CDC gets out its report. The virus is busy doing its work during the lag time. In some ways, the CDC data is an influenza autopsy. It tells us where the flu has been.

Kinsa data is a forecast. A Kinsa map tells you what is happening in your region before the disease becomes an epidemic. You can start safe health practices weeks before the wave of illness hits. How good is that?

Scientific Support

Kinsa has been collecting and comparing temperature data from millions of users in China and the United States for several years. Although using smartphones to measure population body temperatures is a new technology, there are studies you can read (Ackley, 2020, Miller et al., 2018, Miller et al., 2019).
In a nutshell, these are the main findings.

  • There is an impressive relationship between the actual influenza-like illness and the Kinsa averaged temperature data. The correlations between the data sets range between .7 to .9. (i.e., a strong correlation).
  • Kinsa is finding new information about influenza including data which shows that children are more likely to transmit influenza than adults and there are some previously unknown intra-individual fever patterns.

Safe Resource for COVID-19 Tracking Information

You won’t fall victim to a scam artist if you go to this site. You can read the press release for the tracking application on the UC Davis website. https://www.ucdavis.edu/coronavirus/news/uc-davis-researchers-launch-new-covid-19-tracking-application

COVID-19 tracking map released by UC Davis.

The COVID-19 tracking map as of 4/25/20.

Taking Stock

Its time to take a moment and look at the COVID-19 pandemic in perspective. Are you thinking of COVID-19 as a glass half empty? Nothing but doom and gloom in our futures. Yes, our response to COVID-19 has been flatfooted and confused. Or, do you realize that this terrible crisis will teach us how to build a better future?

I’ll close with some words written by Dr. Hung as he looked back on several months of Hong Kong’s struggle with SARS. Paste these words on your refrigerator.

On the plus side, the epidemic created an unprecedented sense of unity among all sectors — government, non-governmental organizations, medical and nursing personnel — in the struggle to contain the epidemic. Various foundations were set up by non-governmental organizations and by public-spirited citizens to provide financial support to victims of SARS and their families. The devotion and self-sacrifice of medical and healthcare staff drew praise and appreciation from all sides, and strengthened the city’s resolve to cope better with the challenges of infectious diseases in the future. In this way, Hong Kong can be said to have turned the threats of the SARS epidemic into opportunities.

Hung, 2003.
Image of a wind swept desert with a saying from the movie Dune. The sleeper must awaken.

This sleeper has awakened. Are you ready to wake up?

References

Ackley, S. L., Pilewski, S., Petrovic, V. S., Warden, L., Porco, T. C. . (2020). Assessing the utility of a smart thermometer and mobile application as a surveillance tool for influenza and influenza like illness. Health Informatics Journal (January 23, 2020), 1.

Chang, Mo, G., Yuan, X., Tao, Y., Peng, X., Wang, F., Qin, E. (2020). Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection. Am J Respir Crit Care Med. doi:10.1164/rccm.202003-0524LE

Hung, L. S. (2003). The SARS epidemic in Hong Kong: what lessons have we learned? Journal of the Royal Society of Medicine, 96(8), 374-378. doi:10.1258/jrsm.96.8.374

Miller, A. C., Peterson, R. A., Singh, I., Pilewski, S., & Polgreen, P. M. (2019). Improving State-Level Influenza Surveillance by Incorporating Real-Time Smartphone-Connected Thermometer Readings Across Different Geographic Domains. Open Forum Infectious Diseases, 6(11). doi:10.1093/ofid/ofz455

Miller, A. C., Singh, I., Koehler, E., Polgreen, P. M. . (2018). A smart-phone driven thermometer application for real-time population- and individual-level influenza surveillance. Clinical Infectious Disease, 67(3), 388-397.

Smith, G. D., Ng, F., & Ho Cheung Li, W. (2020). COVID-19: Emerging compassion, courage and resilience in the face of misinformation and adversity. Journal of clinical nursing, 29(9-10), 1425-1428. doi:10.1111/jocn.15231

Xiao, F., Tang, M., Zheng, X., Liu, Y., Li, X., & Shan, H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. doi:10.1053/j.gastro.2020.02.055

Yong, Z., Cao, C., Shuangli, Z., Chang, S., Dongyan, W., Jingdong, S., Wenbo, X. (2020). Isolation of 2019-n-CoV from a Stool Specimen of a Laboratory-Confirmed Case of the Coronavirus Disease 2019. China CDC Weekly, 2(8).

Zhang, W., Du, R.-H., Li, B., Zheng, X.-S., Yang, X.-L., Hu, B., Zhou, P. (2020). Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging Microbes & Infections, 9(1), 386-389. doi:10.1080/22221751.2020.1729071

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