There has been a lot written and published about COVID-19 and I don’t want to add to the barrage of information out there. But I thought I could give my friends some indication of what I have learned and what to expect with regard to current status about COVID-19 as it pertains to our Kingston, Canada community.
In some ways, we are lucky that we are farther down the chain. Our Public Health authorities have had the advantage of seeing how this is playing out in other parts of the world and how the virus is behaving so appropriate measures can be taken to limit its effect here.
The numbers around the world change by the hour. For up to date numbers you can see how many people have been diagnosed worldwide and in every country (and their outcome) on this website. https://www.worldometers.info/coronavirus/
This novel coronavirus was unknown only a few weeks ago and currently there are over 100,000 cases and there have been 3600 deaths. Using these figures, gives a death rate of over 3%. The death rate from influenza which causes thousands of deaths a year is 0.1%. In other words, according to current worldwide figures, COVID-19 has about 30 times the death rate of influenza. This figure may be a bit high as there are likely undetected cases in the community which would skew the denominator but even conservative estimates indicate that COVID-19 is at least 10 times as deadly as influenza which causes about 3,500 deaths in Canada and over 50,000 deaths in the USA annually.
Of those who contract the virus, 80% will have relatively mild symptoms – cough, fever and shortness of breath – that will resolve in a few days with symptomatic treatment. Another 10% may develop pneumonia (viral or a superimposed bacterial pneumonia) and require additional support. Another 10% may require hospitalization and 3% will die of complications of the infection.
Currently the highest death rate occurs in people over the age of 70 and particularly those with other chronic diseases like diabetes, COPD, cardiovascular disease and high blood pressure. If you are under 50 and in good health your risk of dying from this virus is minimal but you might have a couple of weeks when you are sick. You will, no doubt, know people who become seriously ill and who die from this virus.
As for your kids and grandkids, for some reason, not yet understood, children either tend not to get this virus or are not significantly affected by it. It may be, however, that children can present a minimally ill or asymptomatic reservoir that can spread the virus to others who are more vulnerable.
The virus attacks and replicates in the lungs primarily and as lung cells are compromised, breathing becomes more difficult. Any illness associated with significant fever also causes malaise, muscle aches, headaches and fatigue.
The virus spreads by droplets from sneeze or cough. Droplets containing virus can also be on hands, phones, desks, coins or any other surface. If you are within a metre or so of people who sneeze or cough without covering their face, or if you handle some object that has been contaminated by infected hands or droplets from sneezes and then touch your face, you may become infected,
The incubation period from exposure until when symptoms appear is about 5-7 days. Most people who have been exposed and will get ill, should show signs of the illness by 14 days.
The test for the virus is a Nasopharyngeal swab. This is done by advancing a swab through your nostril to the back of your throat for a sample. It is uncomfortable but not painful. Currently there there are an adequate number of swabs to test and identify patients who are most likely to be infected and the turnaround time for a test, done in Kingston, is 24 hours. If you require a test, you will be asked to self-isolate until the results are back.
The 95% of people who acquire this virus and recover from it will likely develop immunity, at least for a few years. Only time will determine with certainty how we respond with acquired immunity to this virus but one hopes that it will be like how we react to similar viruses.
There is no immunization yet for this virus and it will take at least a year to get one. longer to have it widely distributed. Having an influenza shot is a good idea if you have not yet done it BUT the FLU shot does not protect from COVID-19 (just as it is not effective for the common cold).
There is no current treatment, other than symptomatic management for the disease in the 80% who are mildly affected. These folks should NOT go to the Emergency Department or even to their doctor’s office. They should self-isolate at home for 14 days, use fluids, and acetaminophen or ibuprofen. Cover their mouth when sneezing or coughing. Avoid close contact with others in the household. Do not go to the store or out to places where you are in contact with others. You might wear a mask to avoid droplet spread to others but masks are now in short supply so you may not be able to get them. Masks in public to prevent getting the disease are not effective and not necessary.
People who are more significantly ill with an Acute Respiratory Illness (ARI) of cough, fever and shortness of breath should call their doctor’s office for information as to where to be evaluated. In all likelihood, there will be Regional Assessment Centres set up in our community where all people with ARI will be evaluated and tested if deemed necessary. This will avoid anyone with COVID-19 passing the virus on to other people who are seeing their doctor for other reasons and may be more at risk for serious complications. Currently the testing in Kingston will likely be for anyone presenting with an ARI and who have been outside Canada in the previous 14 days since person to person spread in our community has not been happening – yet. Yes, this means if you were in Florida for Spring Break and within 14 days develop a cough or fever, you will be sent to the Regional Assessment Centre and be tested. Drive-through testing might also occur. You wind down the window of your car and are swabbed through the open window, thus avoiding contamination of others in an office or waiting room.
Even those who are not ill or are minimally affected should be prepared to be significantly inconvenienced by an outbreak which will inevitably arrive in our community. There may be school closures and cancellations of sporting events or conferences or meetings. Certain travel might be curtailed. Theatres or any place where people may be congregating within a metre of each other may be closed. You may be required to self isolate (stay home) if you have been in close contact with a known COVID-19 case or if you have returned from traveling to a high risk area – and these are increasing all the time.
So, if most people have mild illness, what’s the big deal?
This is a totally new virus and none of the 7.7 billion people in the world will have acquired immunity to it. (Except the 60,000 who have had it in the past month and have recovered.) We are all susceptible.
This virus is readily transmitted by droplet spread.
We have no treatment to cure it.
It will be at least a year before immunization is available.
It has a high death rate for vulnerable people.
It will put a huge strain our health care resources if it comes in a big wave.
We can not prevent this virus from hitting our community but we can dampen the spread by diagnosing and isolating positive cases, avoiding close contact with others in group events, avoiding shaking hands or hugging friends or co-workers, washing hands regularly with soap and water or using a 60% alcohol hand sanitizer (currently not available as it has been sold out), and avoiding touching your face.
If you have symptoms or if you have been diagnosed by swab, you MUST self isolate. This may seem like a bother if you are only mildly ill but you need to avoid spreading this into the community and to others who may be at much higher risk.
If we can flatten the curve of infection in the community using the above measures, we will be able to deal with those who are more seriously ill with the virus. If there is a huge spike in cases all at once, the health care system will be overwhelmed, there will not be enough beds to support those who are seriously ill and health care workers will also be affected and need to self isolate which will cut the number of health care providers who can look after the acutely ill.
If you want to see the restrictions ITALY has put in place today, March 8, 2020, to try to curb spread of this virus for the above reasons, check here : https://johnageddes.com/2020/03/08/restrictions-applied-in-italy-on-march-8-to-curb-spread-of-covid-19/
All this is changing day to day. I have tried to give a current status of how we are or might be affected in Kingston. We have to hope that there will be a slow infection rate so our system is not overwhelmed. If we are lucky, there may be some abatement over the summer (we don’t know if that will happen yet but it does with influenza) but, even if that happens, it will definitely be back with a vengeance next fall as immunization will still not be available at that time and there may be more asymptomatic or mild cases throughout the community.
I hope this information is helpful to you. We will be OK in the long run but there may be some bumps along the way. Be glad that you live in Canada where we have a capable, publicly-funded health care system.
John A Geddes MSc MD CCFP
March 8, 2020