Coronavirus

Understanding COVID-19

Bringing information together from various sources to understand more about COVID-19, why we should be concerned, how to avoid it and what to do if you think you have it.

Why Coronavirus COVID-19 is different from flu

Transmission methods

Flu

Transmission period

According to the US Center for Disease Control & Prevention (CDC), the prime time for transmission for flu is in the first 3 to 4 days of illness though it is possible to spread it a day before the illness becomes evident and up to 7 days after it starts.

Transmission methods

It is transmitted by respiratory droplets – from coughs, sneezes or normal speech landing in the mouths or noses of people nearby.
It can also be transmitted by contact with a surface that has such droplets on it. Contact with the skin is not enough and the recipient would then need to touch their mouth, nose or eyes.
Combined this means that Flu is reasonably difficult to catch provided the following sensible precautions are taken:

  • don’t visit someone who is displaying symptoms unless it is necessary
  • always wash your hands before touching your face and eating
  • encourage others to cough into the crook of their elbow, where any germs are less likely to be passed on.

COVID-19

Representation of Covid-19

Transmission period

Is transmittable for up to two weeks before the person is showing signs of the disease as well as when there are symptoms. Some people are atypical meaning they will never develop symptoms but will be carrying and transmitting COVID-19.

Transmission methods

It is acknowledged that COVID-19 can be transmitted by respiratory droplets. Evidence is also emerging, unusually for the family of viruses known coronaviruses, that it might be possible to transmit through the following methods, as well:

  • Fomites – surfaces on which the virus can survive, such as furniture, sheets, tools and clothes. The latest NHS advice is that ‘Viruses like coronavirus cannot live outside the body for very long.’ However, studies have demonstrated similar viruses surviving for up to 9 days. Thankfully they are easily killed with disinfectant. This has a low risk of infection. (click here for report)
  • Fecal-Oral: essentially touching something that has been touched by someone who has not washed their hand properly, for instance on a toilet door handle and eating. Though this is a new method of transmission for a coronavirus the Wuhan Institute of Virology has found the virus in oral swabs, anal swabs, and blood. (click here for report)
  • Airborne (aerosol), which does not need immediate or recent proximity to an infected person. Though it has a lower risk of infection, if this is true, visiting someone infected at home would carry a risk even if you did not touch anything.
    This has a low chance of contagion but has been noted in China’s clinical guidelines since late last month. (click here for report)

Contagion

The variety of ways that COVID-19 can be spread along with a substantial period when someone can be inadvertently spreading it makes the virus highly contagious. Though we are still learning about the virus, Marc Lipsitch, a Harvard epidemiologist, estimates that within the coming year 40-70% of people will be infected with the virus.

Direct effects of COVID-19

After infection, some people will remain atypical and not show any sign of infection. This is known as some countries have mass screened citizens rather than just those suspected of having the virus.

Early-stage symptoms are fever, cough and shortness of breath. There are many causes of such symptoms and few of us have got through life without experiencing this combination of symptoms, so if they occur follow the latest NHS advice but don’t panic.

With COVID-19 this can persist and develop into pneumonia meaning 20% of those infected will need hospitalisation.

Approximately 25% of those will need intensive care for respiratory support.

Ultimately there are two outcomes from contracting COVID-19, recovery or death.

Mortality rates are very difficult to ascertain as treatment methods improve. It appears that overall mortality is 1-2% but this is hugely skewed towards the older population. Figures released on 29th Feb show no deaths below the age of 9 years, less than 0.5% to the age of 50 and then rising to 14.8% among over 80’s. This is unusually skewed as most viruses have higher mortality rates among both the young and the old.

Flu has 5-7 times the mortality rate in an 85-year-old compared to a 50-year-old whilst COVID-19 is more like 30 times as lethal.
As there are roughly 2.8m people over the age of 80 living in the U, if 40% of them contract COVID-19 that is approx. 1.1m people and could lead to 150,000+ deaths due to the virus, in this age group alone.

To put this in perspective, the report Surveillance of influenza and other respiratory viruses in the UK Winter 2018 to 2019 – Public Health England expects annual deaths due to flu, for all age groups, are generally between 6,000 and 15,000.

Wider effect on Society – side effects

The Government is planning for many possible effects and though they have not yet implemented any changes in behaviour and are encouraging people to carry on as normal, it is highly likely that instructions will have to be issued in the coming days and weeks which mean it will no longer be ‘business as usual’.

Schools may have to close and young children will need to be looked after and parents given time off work to do that so many other areas of life might become short-staffed. The NHS will have a huge burden placed on an already busy service, as potentially thousands of people need intensive care, and may not be able to respond as it normally would to other medical needs.

Bearing in mind the infectiousness of COVID-19 it is not just about treating patients but treating them in isolation to minimise cross-infection. This is a heavy burden and other NHS services that are normally available could suffer as a result.

If interaction with other people is kept to a minimum that will impact the ability of stores to restock and may have knock-on effects into whether interaction that is considered non-essential can continue.

There is a chance that many people will be asked to self-isolate either as they are showing symptoms of COVID-19 or as a quarantine measure as in China. All sorts of services which we expect to be available could be short-staffed and unable to operate as normal.

What can we all do about it

PREVENT

Contact

If you don’t come into contact with the virus you cannot contract the disease. However, as the virus is highly transmittable this is difficult to achieve. You might try to lessen opportunities for infection though.

  • You might like to consider what activities are necessary for you – including those that are needed to keep your spirits up.
  • Walking, alone or with friends, is relatively risk-free and could be a better option than meeting up for a coffee where there are more communal surfaces and items the virus could be transmitted on.
  • Try not to touch anything outside of your control, e.g. let the person hold the photo and show you rather than passing it around.
  • If you have to take things to someone in quarantine, try not to touch anything you haven’t brought. Use your mobile phone to say when you have arrived and get them to open the door rather than touching the door furniture. If you want to greet with physical contact would an ‘elbow bump’ work?
  • Keep some hand sanitiser with you so if there is contact you can wash it immediately.
  • If you are losing regular contact, consider how to make sure you don’t end up isolated in an emergency. Just because COVID-19 is active you will not be less likely to have any of the other illnesses or accidents that would need help. If you have the Assure you can get help easily, but if you don’t you might want to make sure you have methods in place to make sure you don’t end up languishing.

Full advice is available from the World Health Organisation, here.

Plan as if you were going into quarantine

If you do have to isolate yourself do you have what you need to remain comfortable for up to a fortnight? Think about what would happen if the person who normally looks out for you was also in quarantine and unable to visit.

This includes thinking about:

  • Enough canned and dry goods to get you through.
  • Consider what you might use in your bathroom in a fortnight.
  • Think about your pet’s needs.
  • Always having a fortnight’s store of essential medicine (ask your doctor).
  • Entertainment – if you are a very social person how are you going to fend off cabin fever?
  • Letting people know you are OK. If visits become difficult or impossible phone calls can help and the Assure’s I’m OK function is a great way to confirm you are OK periodically throughout the day, you choose the times for the wristband to vibrate and just press a single button to confirm you are OK.

Hygiene

This is general advice but you might be particularly vigilant whilst COVID-19 is active:

  • don’t visit someone who is displaying symptoms unless it is necessary.
  • always wash your hands or use hand sanitiser before touching your face and eating.
  • encourage others to cough into the crook of their elbow, where any germs are less likely to be passed on.
  • mobile phones harbour germs and avoiding contact with your face can help, though it might feel odd speaking on handsfree this could help. You could even turn a phone call into a video call and improve the experience.

If you think you might have COVID-19

Get the latest advice from the NHS.
This is available by calling 111 on your phone or by visiting https://111.nhs.uk/covid-19

DO NOT visit your GP
GP’s surgeries have many medically vulnerable people visiting them and we all have a responsibility not to behave in a way which is likely to spread COVID-19 or any other virus.

Living in isolation

If you are in quarantine it may be that you have tested for COVID-19 or that you are at risk from it. Either way, the following advice stands.

DO NOT take antibiotics for COVID-19
Many of us have spare antibiotics in our homes, perhaps from old prescriptions. Whilst antibiotics can be very effective against bacterial infection, they have no benefits in treating viruses. Use of antibiotics when you don’t need them may lessen their effectiveness when you do need them.

Eat and drink well
Make sure any food you have is sustaining. Though it is a cliché, chicken soup does seem to have curative properties (see New York Times article). Make sure you remain hydrated.

Exercise and sleep
Don’t be a couch potato. Whilst you don’t have to go as far as one person in China who ran a double marathon in laps of his living room, it is worth making sure you compensate for the lack of outdoors activity. Perhaps look for an exercise programme online (perhaps on youtube) or crack out the Jane Fonda DVDs.

Sleep is also important as this is when your body has a chance to recharge and continue its fight to recover.

Looking after each other

Please look out for others in your community who may be self-isolating. You are probably already aware of your family situation but look out for neighbours. There may be some shopping they need, and leaving shopping by their front door does not break their isolation.

Bear in mind that in ‘normal’ times there are many illnesses/mishaps that can befall a person, so just checking they are OK is valuable. You could do this by knocking on their door, phoning them or – if you have an Assure system – checking on their dashboard.

Informative links

CDC latest information: click here

Johns Hopkins University interactive map showing the latest stats: click here

Informative article with loads of references: click here

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