Daily COVID-19 Briefing: 3/16/20

  1. UPDATE: CNN reports at 5:40 that the White house is now advising the public to avoid groups of more than 10. People are also asked to stay away from bars and restaurants.
  2. The U.S. epidemic is moving rapidly in the mid-west, deep south and Atlantic coast.
    The number of COVID-19 cases acquired in the U.S. on Sunday (March 15) increased by 722. That’s a larger number than were reported on Saturday (660) but it’s a smaller increase compared to the three days before that. It’s too early to say for sure, but it may be the first sign that the pace of the outbreak is starting to slow. The states with notable one-day increases in cases were Colorado (30%), New Mexico (31%), Illinois (45%), Michigan (61%), Minnesota (67%) Ohio (42%) Alabama (83%), Georgia (50%), Louisiana (34%), North Carolina (39%), South Carolina (47%), Connecticut (30%), Maryland (142%), New Jersey (42%), and Pennsylvania (34%). The remaining states saw lower percent increases in total cases, or they have fewer than 20 total cases, making these percentages unstable. These numbers show that there are some stark patterns of regional spread beyond just state-to-state. The Midwest, Deep South and Atlantic Coast states were especially hard-hit on Sunday. It’s now clear that the COVID-19 outbreak is not respecting state borders. Americans should no longer think it’s just a problem in California and Washington State.
  3. This virus survives on surfaces for hours or even days.
    WIRED reports on a study due for publication shortly by researchers at Princeton, UCLA and the NIH. They sprayed the SARS-CoV-2 (the virus that causes COVID-19) on different surfaces and looked carefully at how long the virus survived. You can read the details, but it shows that the virus remains viable (with the potential to be transmitted) for up to 24 hours on cardboard and up to 2–3 days on plastic and stainless steel. While this is just one study, and it might not be exact, it makes sense now to assume that the virus is hearty and that any surface touched by a sick person should be considered risky for 1–3 days. The good news is that while this virus survives well on surfaces, it’s pretty much a wimp when exposed to alcohol, soap and water, and other good disinfectants. I won’t bore you with the technical details; the bottom line is that we need to regularly wipe down and clean surfaces in our homes, offices and cars. Don’t assume that if a faucet handle hasn’t been touched in three hours, the risk has gone.
  4. What to do if someone in your home is sick?

I have been thinking a lot about this. Someone in my household is returning today from a trip to California. I’ve been doing all the right things in my home with just my cat, but it’s time to get busy and up my game.

If you or someone in your home develops symptoms of a cold or “flu”, the elephant in the room will be the fear that it’s COVID-19. The first thing to say is that most likely, finding out if it is or is not will take time, so don’t wait to take these steps. Until you talk to a doctor, the best thing to do is to assume that any illness that looks like COVID-19, could be COVID-19 and should be treated that way.

Here is a list of steps you might take. This list comes in two versions. The whole list applies to everyone. The highlighted parts apply if you or someone in your home is in a high-risk group. These steps apply if you or someone in your home has symptoms, or if a new person enters your home after being somewhere that they might have had in contact with the virus.

Don’t think you have to do all these steps perfectly. Do the best you can with the resources you have and know that you and your loved ones will get through this. Feel free to send me comments and questions.

  1. Separate the sick:
    The first step is to physically separate the sick person. That starts with increasing physical distance inside the home to avoid spreading the disease (whatever it is). The separation I mean is physical and not emotional. The whole point here is to get through this together. Designate a room (and a bathroom if possible) in your home that will be just for the sick person. Put a sign on the door to remind everyone that special steps need to be taken there. Anyone going into that room should have a good reason. When possible, leave food and treats and medicine outside the door. Don’t think of this space as a prison cell. The point is to have a space just for the sick person (where others don’t go without a reason). Just as important is to designate those rooms where the sick person should not go (like other bedrooms and bathrooms). That will cut down on the need to clean every room as thoroughly. The rest of your rooms are then shared spaces where all can spend time. Complete seclusion is unrealistic, so try to find a balance by following the rest of these steps. If the sick person is in a high-risk group, or someone else is, then follow the isolation rules more thoroughly.
  2. Stay home:
    I know it’s inconvenient, but if you are sick, the only reason to go out is to go to the doctor or hospital (see step 4). This is the most important thing you need to do. Even if you are having mild symptoms or you believe it won’t be that bad for you, the bottom line is that going out risks spreading the illness to grandparents, people who have health problems and the people that have contact with them. Remember that phrase, “It takes a village to raise a child”? Well, it takes a whole community, state and country to control an epidemic!
  3. Family meeting:
    For these things to work, everyone has to buy in and feel a part of the collective effort to keep everyone safe. Have a family meeting and decide together on a set of household rules. Write them down and post them around the house to remind everyone what you have agreed to. Let everyone talk about their fears and frustrations. Try to talk together about what will be the biggest challenges of following these rules. Remind yourselves you are all in this together. If the sick person is high-risk or someone else in the house is, use the phone to include that person, but don’t have them physically present for the meeting.
  4. Call your doctor, don’t rush to urgent care:
    Under normal circumstances, if someone in your home is ill, the first thing we want to do is go to urgent care, or our doctor’s office, or to the ER. But, in times of an infectious disease outbreak, that is not a good idea. You can bet most healthcare settings are already pretty stressed. More importantly, they are filled with people who could be infected. Don’t help the virus by jumping into the fray. COVID-19 is caused by a virus. There is no magic pill that will treat it; antibiotics are useless. For that reason, going to a hospital or doctor’s office should only happen if the symptoms get severe. If the sick person has a fever of over 104°F, or if they have a hard time breathing (breathing very fast, fingernails turn blue, neck muscles strain with each breath) then this is an emergency and you should dial 9-1-1.

    It’s normal to think the first order of business is to go get tested, but while testing is really important for disease surveillance, it won’t be that easy to get a test for some time and the results won’t change what needs to be done for the patient in most cases.
  5. Separate some stuff:
    Pick a set of eating utensils (dishes, glasses, silverware, etc.) that will be only for the sick person. Label them if you can. Do the same for pens/pencils, towels, toothbrush, soap, and anything else you can think of that is touched often. Pay special attention to things in the bedroom and bathroom because they could have blood or poop on them, which is worse than snot! Dispose of things the sick person has used or touched while wearing disposable gloves (if you have them) into separate sealable trash bags. Pick and label a place to put that person’s trash, dirty clothes and bedding.
  6. Wipe-it-down:
    Set up a schedule so that someone (not the sick person) agrees to go through the house and clean and wipe down touch spots with a disinfectant (such as soap, alcohol, Lysol, or a mix of water and bleach). This should include: door handles, light switches, handrails, tabletops, bedside tables, computer keyboards, cell phones, kitchen counters, faucet and toilet handles, TV remote controls, chair arms, oven and microwave handles, and anything else that we put our hands on. Make sure you include surfaces outside your home such as handrails, exterior door handles, mailbox doors, and high-touch surfaces on your car. Figure out who will do this chore every day and make a checklist to keep track. Make sure this is done at least once a day. We now have studies that show this virus can live on surfaces for up to 1–3 days. Thankfully, it is also fairly easy to kill with disinfectant. If someone is in a high-risk group, aim to do it every three hours.
  7. Don’t touch, don’t share:
    Put all the cloth towels and napkins you normally use in the kitchen in the laundry basket and don’t use them for a while. Use paper towels and disposable items when possible. Try to minimize unnecessary touching of surfaces and sharing of anything that could carry the virus. Designate one person to work the remote or turn on lights so that fewer hands are connected. Don’t touch the garbage cans, used rags or towels, dirty dishes, or other surfaces that have been touched or used by the sick individual.
  8. Keep food separate:
    Designate food that will be just for the sick person and mark it. Don’t share anything that person has touched. Avoid putting food like chips or popcorn in a bowl to share; serve everything on separate plates and in separate glasses. Any trip to the kitchen should mean a trip to the sink to wash hands before touching food, surfaces or utensils. If you have a high-risk person, everyone should prepare their own food and clean their own dishes. It’s OK to have someone who has washed their hands make food for the sick person. Have them eat in their designated room.
  9. So, what about masks?
    If you have surgical masks, remember that they don’t help much to prevent the spread of disease if worn by those who are not sick. They can actually make things worse because the mask makes you touch your face more. But, if someone is sick, and especially if they are coughing or sneezing, then THEY should wear a mask when not in their own designated room, or if they are going out to a doctor’s appointment. If you don’t have any masks, they will be hard or impossible to find. I recommend a cloth scarf if you have no masks or run out, but only for the person who is sick. The purpose of the mask is to keep the respiratory droplets in sneezes and coughs from spreading around your home. If there is a high-risk person in the house who is not sick, that person should wear a mask if they are in the same room as the sick person. If you happen to have plenty of masks, then anyone going into the sick person’s rooms should also wear a mask; keep in mind though that it’s better to stay out of those spaces.
  10. Keep your distance:
    The steps I am describing are called isolation (or self-isolation). It’s what to do if someone is sick. That is different from quarantine (which means separating and isolating someone who might have been exposed to the virus but hasn’t yet had any symptoms. The same rules can apply to both situations, but how long you do them and how careful you are can vary. The main idea behind both isolation and quarantine is to keep people separate from each other to prevent disease transmission. That can be very difficult at a time when people are frightened and want to be close to the those they care about. If at all possible, try to keep a personal distance of about 3–4 feet between people in your home. Respect the interior borders of your home (sick people stay out of healthy bedrooms and bathrooms; healthy people stay out of sick-person spaces).
  11. Follow the regular rules (or pay a ‘booger tax’):
    Everyone should be taking regular precautions all the time (see Top 10 Everyday Precautions). Wash your hands, cover your cough, don’t pick your nose, and avoid unnecessary trips out. That is true whether someone is sick or not. It’s even more important that everyone do these things if someone has symptoms. But, some of these things are pretty hard to do. Good luck not touching your face! The point is to keep trying and do your best until these things get to be a habit.

    One way to do that is to make it a family game. Get a big jar and put a sign on it that says “BOOGER TAX”. Anytime someone is caught touching their face, forgetting to wash their hands, neglecting their wipe-down duties, someone yells, “BOOGER TAX!” and the offending party must put a coin, or a poker chip into the jar. When this is all over, you can use the money to have a party! The game sounds silly but there is a method to the madness: it will help keep everyone accountable and reinforce the idea that we’re all in the same boat.

    So how long should this go on? This is a bit simplistic, but if you are doing self-quarantine, the CDC and others recommend waiting 14 days before deciding someone is not sick or infectious. Keep checking because the recommendations have been changing.

    If it’s isolation, talk to your doctor about when to stop these special measures!

    Updated 3/16/20 at 5:38 pm EDT.
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