We are in Lockdown

We are on Lockdown till April 7th.

By Dr. Jacqueline S. Chan, D.O.

Formally known as SARS-COV-2 which creates the disease named COVID-19 is stopping the world. As of Monday afternoon, 03/16 the Bay Area is in complete lockdown for non-essential activities as of midnight tonight until April 7th.

What goes through your mind? If you imagine thousands of people dying around you as well as in every country and hospital, you are in panic, hysteria mode and you need to calm down by learning about the facts. The reason we are practicing social isolation and self-quarantining is so that we can PREVENT that from happening and not go through what Italy is going through right now. This is not the bubonic plague which had a mortality rate of 50%. COVID-19 has a mortality rate of 3.4% globally according to the WHO, which is over 17x that of the flu, which has a mortality rate of 0.2%.

If you think it’s no big deal and it’s just the flu, you’re in denial. The truth is somewhere in between. This article is to elucidate fact from myth, what we know from what is yet to be revealed and to give you the best coping strategies that we know to date.

What can you NOT do while on lockdown and what CAN you do?

You can do tasks that maintain health and safety, such as obtaining medicine or seeing a doctor. As well as the essentials of grocery shopping or caring for the elderly or a dependent. Pharmacies, grocery stores, health care facilities, post offices, gas stations, banks, hardware stores and the garbage collection.

As of right now you can still hike, just not ride a bike. You must maintain 6 feet of distance when outdoors or out and about.

For the complete story go here:

https://techcrunch.com/2020/03/16/bay-area-counties-announce-lockdown-through-april-7/ 

The most important information to know is:

• Some victims present mild symptoms while others experience more severe symptoms. 80% of people will have a mild case. 93% of cases in Wuhan have fully recovered.
• To see the number of fully recovered cases please click on this link: https://www.worldometers.info/coronavirus/
• Those with weakened immune systems are most at risk (the elderly, cardiovascular disease, respiratory illness, diabetes, hypertension, cancer and chronic illness).
• The flu claims more lives per year than the Wuhan virus has so far, but you should still be prepared. You do not need to panic – just be safe and be aware.
• The strict quarantine precautions are to slow the virus spread and contain it.

What our office is doing to protect you:

• We will be sanitizing door handles, regularly handled surfaces, and bathroom fixtures regularly. We will ask you to remove your shoes when you enter the premises, so that nothing is being tracked by your shoes. I will be wearing an N-95 mask and will change my shoes once I enter the clinic.
• If you are a patient at Marin Natural Medicine Clinic, we are converting to phone appointments. Patients who want to be seen in person please contact the front desk for further advice: 415-945-3213.
• If you are a patient at Advanced Hyperbaric Recovery of Marin: The patient will be met at the door by a team member who is holding a thermometer in their hand. The patient must use hand sanitizer before they come in the door and touch the doorknob. The patient will have their temperature taken BEFORE entering the building. A fever is defined as 100.4 degrees by the CDC. If they display a normal temperature and deny the symptoms, they will be allowed in our facility for their HBOT.
• Patients will be asked to limit the number of things they bring in with them to our facility. They will be handed a white garbage bag to put their personal items in (including their clothing) this garbage bag will then be put into their cubby.
• Patients will be asked not to bring in more than one caregiver with them for HBOT and this caregiver will be asked to leave our facility once the patient has been safely put inside the chamber until the patient’s HBOT treatment is completed. No guests or visitors are allowed.
• Scheduling will be spaced out to ensure there is extra disinfectant “wipe down” time of anything the patient may have touched (specific door handles and or bathroom)
• Bedding and scrubs will be changed for every patient on a weekly basis being washed at high temperatures using sterilization cycles

Should I keep my appointment?

We are converting to phone appointments at Marin Natural Medicine Clinic. We are still doing IV treatments for those people who do not have COVID-19 at Marin Natural Medicine Clinic. We are taking precautions at Advanced Hyperbaric Recovery of Marin. I will continue to do in person office visits on a case by case basis for Osteopathic Manipulation. All in person visits will be pre-screened by phone.

So, here are some facts:

First of all, what is the coronavirus?

The coronavirus has been studied since at least the 1960’s and is typically transmitted from animal to animal. However sometimes a wild animal can pass it to humans and sometimes a virus can mutate, which has happened in the past with the spread of severe acute respiratory syndrome (SARS) and the middle East respiratory syndrome (MERS). Coronaviruses are named for the crown-like spikes on their surface. There are four main sub-groupings of coronaviruses, known as alpha, beta, gamma, and delta which cause mild asymptomatic infections whereas there are 3 that mutated from wild animals the latest one is SARS-CoV-2 which causes the illness called COVID-19, what we term “coronavirus”.

Common coronaviruses:

1. 229E (alpha coronavirus)
2. NL63 (alpha coronavirus)
3. OC43 (beta coronavirus)
4. HKU1 (beta coronavirus)Other coronaviruses

Rare coronaviruses:

1. MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS)
2. SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or SARS)
3. SARS-CoV-2 (the novel coronavirus that causes coronavirus disease 2019, or COVID-19)

The bubonic plague had a fatality rate of 50% and the flu has a fatality rate of 1% in the elderly. The big question everyone is thinking in the back of their head is:

How likely is it that you will DIE of the coronavirus once infected?

The WHO states that compared to the other coronavirus types:

The 3.4% mortality rate has been a moving target, it has gone down to 2%. Depending on the country, how many cases were tested and when as well as the age of the patient this number has shifted. We will take a closer look at this number later on in this article. However even if you use the lowest mortality rate number of 2%, 2% of the United States population would mean more people than we have enough hospital beds for. This is why we are wanting to slow the curve of infection rate.

What are the symptoms of CoVID-19?

These are based on the Wang et al study as posted in the CDC:

Emergency symptoms are shortness of breath, persistent pressure in the chest, confusion and bluish lips. This is when you need medical help. Death can occur rapidly.

Symptoms not found in COVID-19 but that could indicate allergies, the common cold, bronchitis, pneumonia, exposure to mold or the flu are:

Likely NOT coronavirus: sneezing, sore throat, runny nose and a wet cough that produces mucous. Remember this is naturally cold and flu season, there are many viruses that we can be affected by that are NOT the COVID-19 virus. Stress can cause us to catch the common cold more likely.

The big difference is that in 98% of cases of coronavirus there is a FEVER. No FEVER and no cough or shortness of breath means it’s very unlikely that it’s coronavirus.

How long do symptoms last?

Using available preliminary data, the Report of the WHO-China Joint Mission published on Feb. 28 by WHO, which is based on 55,924 laboratory confirmed cases, observed the following median time from symptom onset to clinical recovery:

Mild cases: approximately 2 weeks

Severe or critical disease: 3 - 6 weeks

Time from onset to the development of severe disease (including hypoxia): 1 week

Among patients who have died, the time from symptom onset to outcome ranges from 2 - 8 weeks.

How is it spread?

Both coronavirus and the flu are spread by respiratory droplets. Coronavirus, however, spreads incredibly fast. In fact, for those who died of the coronavirus it took only 10 days for them to die in some cases. The number of viruses drops by 10,000 in 2 days on a plastic surface. It can be killed by UV light and it lives one day on paper. A new study indicates COVID-19 can survive in the air for up to 3 hours, and several days on surfaces, depending on the surface (up to 3 days on plastic, up to 2 days on metal, up to 1 day on cardboard)

Incubation period is 2 -14 days. A person can be infected and not have any symptoms for the first several days or have a very mild response. They will usually have some symptoms by the 4th day because the virus duplicates every 4 days. Not yet accepted by the scientific community and awaiting peer review is a study showing that:

There now appears to be evidence the virus can spread through breathing from people who are symptomatic. Michael Oster Holm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota: "The findings [of the study] confirm that COVID-19 is spread simply through breathing, even without coughing. Don't forget about hand washing, but at the same time we've got to get people to understand that if you don't want to get infected, you can't be in crowds. Social distancing is the most effective tool we have right now."

Epidemiologists predict through their mathematical estimations that the pandemic of coronavirus could infect 40-70% of the adult population. If this fact makes you swoon into even more panic, then learn a few more things about viruses.

Viruses do one thing really well. They spread. However, many of us, in fact almost all of us are permanently infected with all kinds of viruses … for life. Some of these viruses have been known to cause Gulf War Syndrome, Infectious Mono or Chronic Fatigue Syndrome. Yet millions of us do not suffer from these diseases. This is because of our immune system. Which is important to bolster as I will discuss later in this newsletter.

Putting the pandemic into perspective with other viral infections:

Every year an estimated 290,000 to 650,000 people die in the world due to complications from seasonal influenza (flu) viruses. This figure corresponds to 795 to 1,781 deaths per day due to the seasonal flu. . The CDC just announced that the US had 20,000 flu deaths this season with 350,000 hospitalizations. Today in just one day 48,219 people will die of heart disease. Whereas, today there are just under 6,000 deaths from the COVID-19, 8 times less than the flu.

The mortality rate of the seasonal flu in the USA is less than 0.1%.

Please also take a look at other death rates of other infections:

https://en.wikipedia.org/wiki/List_of_human_disease_case_fatality_rates 

"Supposing a tree fell down, Pooh, when we were underneath it?' 'Supposing it didn't,' said Pooh after careful thought. Piglet was comforted by this." ~ A. A. Milne

You can see that even though the infectivity is high and the speed at which it spreads is very high as well as the speed at which it can lead one to death, still the overall mortality rate is not anything like the bubonic plague or other viruses that we have seen. One of the issues is the number of people that have been tested. The United States is making more tests available now, but we are still short on testing and we only had 26 tests available per million people on March 2nd, whereas South Korea had 4,099 tests available per million people. As more testing gets done, we will have more data as a nation and things will look different. The story is still unfolding.

How do you remain calm?

Shift your focus from the number of new infected cases to the number of recovered cases. Let’s start with the current statistics taken from the United Nations and U.S. Census Data on March 13th which is updated daily Monday-Friday and put these into perspective. Since the disease can last as long as six weeks at the longest there is a time lag between numbers of cases showing infection and numbers of cases showing recovery or death.

Worldwide: 182,240 cases, 7,140 deaths and 78,340 recovered cases (93% of people), 96,760 active cases of which 94% are mild.

In the USA we have 4,597 cases, 86 deaths, 74 totals recovered, and 2,730 active cases.

Check these numbers daily by going to this website: https://www.worldometers.info/coronavirus/ 

Going a little deeper into the numbers what about death rates according to age?

COVID-19 Fatality Rate by COMORBIDITY:

The percentage shown below does NOT represent in any way the share of deaths by pre-existing condition. Rather, it represents, for a patient with a given pre-existing condition, the risk of dying if infected by COVID-19.

I’ve heard it’s far worse in Italy than what these stats are showing?

This is my opinion, here and not scientifically proven or spoken about by the CDC or WHO. First, we have to realize that the people dying in Italy now may have gotten the infection 10 days ago to 6 weeks ago, prior to the quarantining. What do people do in Italy more than in any other country? They kiss each other on each cheek when they greet each other, and they hug. A lot. Not just immediate family but also new people who are they are introduced to. Perhaps this is why their rates are so much higher than other countries. As I said, my opinion here.

What about some rumors that you can get re-infected?

By now you have learned that viruses do a couple things really well: they spread, and they can change.

Up to 14% of people are getting the disease again. Scientists at Peking University’s School of Life Sciences and the Institute Pasteur of Shanghai have discovered that there are 2 strains of the virus: L-type is the more severe type which was present in 96.3% of cases in Wuhan. 3.7% had the milder form S- type. However, outside of the Wuhan 37.8% of the cases have been the milder strain.

The WHO is confident that we can slow down the spread of this virus through containment. However, because the virus spreads so fast and so easily there is a concern that this pandemic would overwhelm a hospital and medical system that is not able to handle the sheer numbers of sick people. Here’s the math they are looking at:

If 1 in 12 people age 70-79 who get the virus and 1 in 7 people age 80 or older who get the virus die, and the virus spreads to 20%, 40% or 70% of the population, we’re talking massive death tolls, the likes of which we have never seen before in our lives.

Epidemiological experts keep talking about the need to “flatten the curve.” What they mean by that is that we need to slow the speed at which new cases are reported. We may not be able to stop the spread of the coronavirus, but we have to try to manage it. If 1,000 new cases happen over a month instead of a week, the health care system is more able to handle them.

Here’s why this is a worry: Overall, our hospitals have fewer beds than other developed countries, according to recent data from the Organization for Economic Cooperation and Development. The United States had 2.8 beds per 1,000 residents. By comparison, Germany had 8 beds and China 4.3 per 1,000.

The United States looks better when it comes to intensive care beds, but there’s tremendous variation between regions and states. If we experience what parts of China and Italy saw, we won’t have anywhere for sick patients to go. We will quickly run out of capacity.Even if we have the capacity, we may not have enough supplies. In a crisis moment, supplies like ventilators and N95 face masks will be key. “Three hundred million respirators and face masks. That’s what the United States needs as soon as possible to protect health workers against the coronavirus threat. But the nation’s emergency stockpile has less than 15 percent of these supplies,” the magazine reported. And if that weren’t enough, there’s another problem. Health care workers who have been exposed to the virus are now quarantining themselves, further reducing available staff at hospitals. Kaiser Health News reported on the effects of this:

“In Vacaville, California, alone, one case — the first documented instance of community transmission in the U.S. — left more than 200 hospital workers under quarantine and unable to work for weeks.”

We can’t stop COVID-19 without protecting our health workers. Globally, it is estimated that personal preventative equipment supplies need to be increased by 40 %.

How Can You Protect Yourself From Coronavirus?

When it comes to defending yourself against coronavirus, it’s best to take a two-pronged approach: avoiding potential contact with the virus and bolstering your natural ability to fight infection. I will go into more detail later but the bottom-line things you can do for yourself are load up on Vit. C, drink plenty of water and nasal rinse daily. This virus doesn’t like water. If it gets rinsed from your nose or mouth to your stomach, your stomach acid will kill it.

Take Precautions with Self-Quarantine:

These tips may sound simple, but they’re powerful, and just doing these things will go a long way. I suggest incorporating these healthy habits into your daily routines – coronavirus or not.

Wash hands frequently and immediately after you come home. The Centers for Disease Control and Prevention recommend washing with warm soap and water for at least 20 seconds.