Covid-19 Missive One, March 8th

My name is Robin Schoenthaler, I’m a long-time Boston cancer doc. I have been trying to translate information about COVID-19 into easy-to-understand facts.

We are about to move into a catastrophic health care crisis and I will periodically post updates. This is not about blame, or controversies, or politics and please don’t comment about those issues. This is about the facts I have been able to tease out of the medical literature and scientific sources.

Please note that I am a cancer doctor. I am not an infectious disease specialist or epidemiologist. But I have been immersed in this epidemic since Day One and this is my best interpretation of the facts.

Please – again – don’t comment on blame or politics.

Please contact your PCP for questions about your own health.

Here is a quick primer on COVID-19

This post is directed towards people in MA but applies to the whole US.

Without question this disease is already here and will soon be everywhere in days, and all the concerns about travel will no longer matter in that it’s already right here In the next few weeks the numbers will leap up. With that leap will come a huge huge crunch on the health care system.

As is true with all epidemics, fear leads and science follows. The science is coming, but what we have now is mostly based on China and now Italy.

First off, in both countries, children seemed mostly unaffected. In China, about 2% of the cases were under 20. As of Feb 29, no children under 10 in China died of the disease and the mortality rate for people 10-40 was 0.2%. In Italy, kids are also rarely getting sick. There is no reason to think they are not carriers.

In Italy and China about 80% of people had mild (or asymptomatic) cases. 15% required hospitalization. 5% needed ICUs. Our hospitals will be overwhelmed within a few weeks. Try to do everything you can to stay well and not catch this so you don’t become a person trying to get into one of those ICU beds.

The best thing you can do to protect yourself is hand washing, cleaning surfaces, and social distancing – which is now recommended by CDC for elders and those with medical issues (which they define as heart, lung, kidney) and I would add active cancers.

How do you social distance? Work at home, no big gatherings, don’t touch, and only the most absolutely essential travel.

Now, as to specifics:

Best info is at the following websites

1) CDC information: https://www.cdc.gov/coronavirus/2019-ncov/index.html
2) WHO - much of our info comes from the numbers in China. (and soon Italy) https://www.who.int/…/who-china-joint-mission-on-covid-19-f…
3) Johns Hopkins Public Health Overview https://www.jhsph.edu/covid-19/index.html
4) Massachusetts State Government https://www.mass.gov/…/covid-19-cases-quarantine-and-monito…

Testing so far

Testing is still barely being done in MA or anywhere. As of last week only ~2500 people had been tested in the US.

It is possible and maybe probable that more tests will be available in MA in the next few days but it will take time to ramp up. Expect a lot more testing in the next couple of weeks. And then a lot more positives.

In the meantime, if you have fever, cough and shortness of breath, call your PCP and see what they say. They may recommend regular flu testing first. They may check with their ID person (Infectious Disease doc) to see if you meet their criteria for COVID testing. These criteria will expand as tests become available.

What are the symptoms?

Fever (88%)
Dry cough (67%)
Fatigue (38%)
Sputum production (33%)
Short of breath (18%)
Sore throat (14%)
Headache (13%)
Muscle/joint aches (15%)
Chills (11%)
Nausea/vomiting (5%)
Stuffy nose (5%)
Diarrhea (4%)
Coughing up blood (1%)

What kills Coronavirus? Surface lifespan?

It survives on surfaces likely around 9 days - but some strains show longer and temp/humidity matters.

https://www.journalofhospitalinfection.com/…/S019…/fulltext…

List of things that work against it:

https://www.epa.gov/…/list-n-disinfectants-use-against-sars…

Mortality rate by age - WORLDWIDE - this may or not change in the US.

over 80 22%
over 70 8%
over 60 3.6%
over 50 1.3%
over 40 0.4%
10-39 0.2%

Immunosuppression? Pregnancy?

Cancer and is a risk for more severe disease. Specific details for other diseases are not currently available. So far pregnant women do not appear to be at higher risk for severe disease and don’t appear to transmit the virus to their babies but this is based on very small numbers.

https://www.thelancet.com/…/PIIS1470-2045(20)3015…/fulltext…

https://www.rheumatology.org/announcements

My suggestion is that you band together in neighborhoods to look out for each other’s needs. Brace yourself for lives very disrupted over probably the next couple/few months. Don’t get your info from headlines. Be kind to yourselves and each other and remember that everyone is struggling with all this uncertainty. And take care of the health care workers you know and love. They are about to become your heroes.