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Coronovirus Information from an ICU Doctor

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Wanted to pass along information the Milan ICU doctors have been passing along to us to limit the spread of misinformation. 

 

Background: 

Coronoviruses are a class of viruses that have been previously characterized.  The 2019 novel coronavirus (SARS-Cov-2) is genetically similar to bat coronaviruses. Originally thought to originate from animal-human transmission at a local meat market in Wuhan, China, in mid-December 2019, less clear now as there were a few cases in early December that seem to predate that outbreak.  

 

Transmission:

Still learning more about this and there are some new articles challenging this but most likely transmission is via respiratory droplets from infectious individuals. Functionally, this means that regular masks (not special airborne masks we use for diseases like TB) should be sufficient. In hospitals, we are still using N95 masks, but this is out of an abundance of caution. Transmission is more like what we see with the flu and not what you see with measles. Someone with measles would infect the entire auditorium, someone with coronavirus or the flu usually has an infection radius of about 3-6 feet, and it requires direct contact with the infected respiratory droplets. The difference between the coronavirus and the flu on this front is that unlike the flu which cannot survive for more than 30 minutes on open surfaces, the coronovirus can stay active for 3-4 hours. This makes it much more transmissable and is why hand hygiene is essential and why you want to avoid touching your face until after you have washed your hands when you are out and about. This is also why we want people avoiding large congregations (i.e. airports, classrooms, etc.). Lastly, coronavirus is probably out in your community at this point. The reported cases far underestimate the actual cases. My hospital already has as many cases as the reported cases for the entire state. It's out there. Does not require travel history. 

 

Do I Have Coronavirus?

1. If you don't have a fever AND dry cough, you probably don't have coronavirus 

2. If you are worried about an exposure and you get sick the next day, you probably don't have coronavirus. 

 

Symptoms: 

~95% of people present with fever. If you don't have a fever, you probably have a regular respiratory virus (these still exist and are way more common). 90% of people have a dry cough. People are usually well for 4-5 days from exposure when they are asymptomatic. Despite news reports, unlikely that you are infectious at this point without producing infected droplets. Symptoms usually start day 5-7 before people either recover or develop more serious sequelae. 

 

Timeline: 

Day 0 - Exposure

Day 0-5 - Asymptomatic (unlikely that you are infectious)

Day 5-7 - Flu like illness with fever + dry cough (you are infectious when you cough - this is when you need to wear a mask to protect others)

At this point you recover or things get worse

Day 7-10 - ARDS requiring hospitalization and ICU transfer (~20% hospitalization, ~10% ICU level care)

Day 10-13 - people start to recover

Day 14 - post infectious cardiomyopathy - rare, but this is what kills people

 

Morbidity / Mortality: 

Flu kills ~1 in 1000

Coronavirus kills ~1 in 200

 

Primarily sparing children, pregnant women. Targets people >80 yo and people with heart and lung disease. And it's killing those people. Still can affect younger people, particularly with the post-infectious cardiomyopathy. 

 

What Should I Do: 

- Put masks on a person coughing before putting a mask on yourself

- Wash your hands frequently with soap, especially before touching your face

- Don't panic over cold like symptoms if you don't have a fever. No fever ~ no coronavirus

- Avoid congregating in highly frequented areas - the virus hangs out for 3-4 hours 

- It's probably already in your community - be vigilant

 

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