Preparing for Coronavirus Pandemic

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International Outbreak

In all likelihood, the World Health Organization (WHO) will eventually declare the 2019 novel coronavirus disease (COVID-19) a pandemic. (They now have done so.) Over the years, the WHO definition of a pandemic has morphed from simply a “worldwide spread of a new disease” to a retired 6-phase scale. It is now a semantic judgment call.

On January 30, the WHO declared a Public Health Emergency of International Concern (PHEIC). That sounds pretty close to pandemic. According to a spokesperson, the agency “may or may not use the word pandemic, but [doing so] does not trigger any extra action.” The World Bank, which holds funds for pandemic relief, uses three criteria:

  1. Outbreak is 12 weeks old;
  2. At least 250 deaths in its country of origin;
  3. At least 20 deaths in a second country.

Fluid statistics challenge any report on the current state of affairs. Already a pulmonology epidemic throughout Asia, and a PHEIC, we are teetering on acknowledg­ment of a pandemic. Over 2,000 people in two dozen countries beyond China have contracted COVID-19. That is every continent except Antartica.

⚠️  March 11, 2020 – WHO Director-General Tedros Adhanom Ghebreyesus: “We have therefore made the assessment that #COVID19 can be characterized as a pandemic.” Furthermore, on March 9th Tedros said it’s “dangerous” to assume COVID-19 kills only older people. —CNBC

View numbers only as a snapshot in time. Between March 3 and March 6, 2020, the number of deaths outside in Iran doubled from 66 to 124. The number of confirmed cases jumped from 1,500 to 4,757. On the same date, Italy was close behind with 197 deaths from 4,636 cases. Three days later, Italy more than doubled with reports of 463 deaths from 9,172 cases, surpassing 7,161 cases in Iran.

Are You Prepared For a Pandemic?
Novel coronavirus symptoms, which are vague enough to be something else, include fever, cough, runny nose, and shortness of breath. COVID-19 can cause pneumonia, severe acute respiratory syndrome, or kidney failure.

Although the symptoms of COVID-19 and the flu can look similar, the two illnesses are caused by different viruses. As of February 26, 2020, the flu is showing much more of an impact on Americans than COVID-19. There is more similarity with the 2002–2004 SARS, which is also a coronavirus. SARS attacked the lungs in three phases: viral replication, immune hyper-reactivity, and pulmonary destruction.

We may or may not use the word pandemic, but doing so does not trigger any extra action.

The international spread—though sparse in most areas—despite rapid Chinese contain­ment efforts is a reason government officials are preparing for what seems to be the inevitable declaration. In the absence of the WHO actually saying “pandemic,” Italy is basically on lockdown, with national travel bans. Some public event organizers within the United States are voluntarily moving in-person venues to online webcasts.

Why Dodge The Word

Declaring a pandemic is associated with pandemonium—especially with tens of thousands infected so far. Financial markets dip (as over past few days); there is a run on medical supplies; people begin stockpiling staples; governments shut down large public gatherings like schools, theme parks and sporting events; fear of foreign nationals multiplies; world travel is scuttled; though illegal, unscrupulous vendors raise prices on essential provisions; healthcare workers are stretched to their limits; there is more pressure to find a cure. All of this hurts the economy.

“If we go by the definition of a pandemic—which means a virus has become epidemic in many different places—then yes, this is a pandemic.” Eng Euong Ooi, a professor of emerging infectious diseases at Singapore’s Duke-NUS Medical School.

Inoculating entire populations is challenging enough. But on this precipice of pandemic, vaccines are still in development. It is as though a mighty hitter is up to bat and no one in the outfield has baseball gloves. Data is insufficient to profile who are most susceptible. Logically, those with chronic pulmonary diseases (COPD), transplant patients taking immuno­suppreso­sive drugs and people compromised immunity should exercise the most caution.

⚠️ Fast-Track Antiviral Clinical Trial

February 26, 2020 – Gilead Sciences, Inc. (Nasdaq: GILD) today announced the initiation of two Phase 3 clinical studies to evaluate the safety and efficacy of remdesivir in adults diagnosed with COVID-19. —Gilead Sciences

Philanthropists and government officials have authorized billions of dollars to find a cure that will initially be experimental and in short supply. “The development of a vaccine is not going to prevent a pandemic here,” says Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research. Getting a vaccine ready for pivotal testing is going to take more than just a few months, he said.

Are You Prepared For Coronavirus Pandemic?

Red Cross in China has been accused of and apologized for mishandling donations. Poorer undeveloped countries and refugee camps without resources will likely suffer neglect.

On a global scale, most COVID-19 cases are mild. The risk of getting novel coronavirus in the US remains low largely due to successful contain­ment efforts. A US Centers for Disease Control and Prevention (CDC) official warned that the agency expects to see “community spread” of the virus in America.

Panic leads to chaos, which makes matters worse. Remain vigilant with good hygiene. As of March 6, 2020, the worldwide death rate is a little over 3 percent of those contracting COVID-19. Of over 300 confirmed cases among United States citizens, 9 have recovered and 14 have died. The remainder are in isolation or quarantine, as is the case in other countries.

Time To Prepare

The WHO website includes a 12-page PDF document entitled: Essential steps for developing or updating a national pandemic influenza preparedness plan. Published in 2018, it lacks specific guidance for what citizens should be doing now. Rather, it outlines how governments can prepare public awareness materials. Scouring the internet for guidance, consider the following empirical list of action items.

Practical pandemic preparation:
  • Have enough non-perishable canned goods, cleaning supplies, and medications for 7–30 days.
  • Frequently clean communal surfaces at least daily with Lysol* or diluted bleach. This includes door handles, computer keyboards, mobile devices, light switches, plates, drinking glasses and eating utensils.
  • Cover your mouth and nose when coughing and sneezing. Try using the crook of your elbow or your shoulder for cover, instead of hands.
  • Throw away used tissues right away. If you use tissues to cover your cough or blow your nose, dispose of them in the nearest waste bin immediately after use.
  • Wash hands more frequently with soap and water. Hand sanitizers with 60–95 percent alcohol with glycerine and aloe vera are best when you do not have access to running water. Antiseptic wipes are generally effective for cleaning environmental surfaces but not so much for hands.
  • If you are sick, do not go to work or associate with groups of people.
  • Following government shutdown advisories, limit unnecessary travel plans.

The CDC does not recommend face masks outside of medical environ­ments. However, the agency warns against facial hair that could inter­fere with the hygienic seal around the nose and mouth.

⚠️ Nosocomial transmission of severe acute respiratory syndrome coronavirus

The toilet bowl, sink, and bathroom door handle of an isolation room housing a patient with the novel coronavirus tested positive for the virus, raising the possibility that viral shedding in the stool could represent another route of transmission, according to Dr. Ong and colleagues. —JAMA

Remediation

How To Deep Clean Your Home By CDC

Surfaces
  • Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.
  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.
    • Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.
      • Prepare a bleach solution by mixing:
        • 5 tablespoons (1/3 cup) bleach per gallon of water or
        • 4 teaspoons bleach per quart of water
    • A list of products with EPA-approved emerging viral pathogens claims, maintained by the American Chemistry Council Center for Biocide Chemistries (CBC), is available at: americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf. Products with EPA-approved emerging viral pathogens claims are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
  • For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:
    • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely, or
      Use products with the EPA-approved emerging viral pathogens claims (examples) that are suitable for porous surfaces.
Clothing, towels, linens and other items that go in the laundry
  • Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.
    • If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.
    • If possible, do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.
    • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.
    • Clean and disinfect clothes hampers according to guidance above for surfaces. If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered.

A more comprehensive, but preliminary, CDC guide for medical facilities is entitled: Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID–19 in Healthcare Settings.

😷 Interim preparation guidelines for hospitals include:

Schedule appointments in advance of infected patient visit. Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) with reminders to adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. Ensure that patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care. Facilities should have policies and procedures describing a recommended sequence for safely donning and doffing PPE. —CDC

Are you ready for an emergency? Do not run to the market and hoard supplies without regard for neigh­bors. Get what you need for your family progressively. Reach out to friends and neigh­bors who may not have access to transpor­tation. Keep calm and help one another to remain A Bit More Healthy.

To support the writing of useful articles about this topic, ClinicalPosters sells human anatomy posters, scientific posters and other products online. You may sponsor specific articles, remit a small donation, or leave an encouraging comment to keep the work going. Stay safe and A Bit More Healthy.

* Lysol products have been proven effective in protecting against other human coronaviruses. Keep in mind COVID–19 is novel, as in new. Several Lysol products have been approved to make off-label emerging viral pathogens claims for efficacy against the novel coronavirus. “Definitive scientific confirmation” that the wipes can defend against this specific virus can only come after it has been tested against the strain.

Statistics updated March 6, 2020.

References
  1. Is the coronavirus a ‘pandemic’? The World Health Organization can’t seem to make up its mind. fortune.com
  2. Interactive Coronavirus map. maps.arcgis.com
  3. Coronavirus Symptoms. cdc.gov
  4. Coronavirus Disease 2019 vs. the Flu. hopkinsmedicine.org
  5. Here’s what coronavirus does to the body. nationalgeographic.com
  6. Coronavirus vaccines are far off, FDA official says, but drugs to treat patients could come sooner. statnews.com
  7. Pandemic Influenza Preparedness and Response: The Who Pandemic Phases. nih.gov
  8. The classical definition of a pandemic is not elusive. who.int
  9. Coronavirus: Restaurants struggle amid fears of outbreak. usatoday.com
  10. Billionaires are donating millions to fight China’s coronavirus. But where is the money going? fortune.com
  11. China's Red Cross is under fire for not getting supplies to hospitals fighting coronavirus. cnn.com
  12. Alcohol, Hand Sanitizer Or Antiseptic Wipes? What Actually Protects You From Coronavirus? yahoo.com
  13. Can Lysol and Clorox products kill the novel coronavirus? The answer is ... complicated. cnn.com
  14. The CDC has thoughts about soul patches and mutton chops. And they have to do with preventing coronavirus. cnn.com
  15. Pandemic preparedness. who.int
  16. Pandemic flu planning checklist for individuals and families.
  17. 2019 Novel Coronavirus Healthcare Professional Resources. publichealth.lacounty.gov
  18. Coronavirus May Cause Environmental Contamination Through Fecal Shredding. medscape.com
  19. Interim Environmental Cleaning and Disinfection Recommendations for U.S. Households with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19). cdc.gov
  20. Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID–19 in Healthcare Settings. cdc.gov
  21. Daily COVID–19 Updates. gov.ie

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Kevin Williams is a health advocate and writer of hundreds of articles for multiple web­sites, including: A Bit More Healthy, KevinMD (WebMD), and Sue’s Nutrition Buzz. He is a prior 15-year con­sul­tant for Neutrogena Research and Scientific Affairs.

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