Specific recommendations for day to day plan with Coronavirus COVID-19

Monday, March 2, 2020

From a professor and doctor of emergency medicine and WHO at Johns Hopkins.

To start with - COVID-19 is coming to the US. We cannot stop it. Currently there is no vaccine and there are no treatments.

It is a virus not unlike the flu (influenza), spread by droplets generated by coughing, sneezing or even speaking. The flu kills 30-65,000 Americans a year, every year (and no one seems to care).

This virus is currently estimated to be 200 times more deadly than the flu (but that is thought to be an overestimate). However, what that means is that without proper precautions COVID-19 could easily kill more than 100,000 Americans (maybe more). There have been very few deaths in children.

There are two major ways to avoid infection - 1) Social distancing; 2) Hand hygiene.

Social distancing means staying away from others - 6 feet is recommended but that's hard. One of the first steps that authorities will take if the infection becomes fairly widespread will be to close schools (be prepared all you parents out there). But it would be best to avoid any crowd - malls, bars, restaurants, church services, etc.

Hand hygiene - Most infections are spread by touching a contaminated surface (cup, table, keyboard, shaking hands, etc) and then touching your mouth, nose or eye. (studies have show that we do that dozens of times each hour). Go buy hand sanitizer NOW. Buy a fair amount, I suspect that it will be gone soon since it's already impossible to buy masks.

Set a hand washing routine - sanitize or wash your hands before you eat ANYTHING, don't eat with your hands, don't eat those chips from a common bowl. Sanitize as soon as you walk in the door when you get home, as soon as you arrive at work, after every meeting you go to, etc. A couple dozen times a day is fine.

It is also reasonable to clean 'public' surfaces regularly, especially at work - doorknobs, desk and countertops, keyboards, your phone, etc. A solution of one part bleach in nine parts water is very effective (it's what we used in Liberia during the Ebola epidemic. It's safe for hand washing, trust me). You can use those chlorox and similar wipes also.

I’ve also thought about what one might need if one was caring for a sick family member. About 80% of COVID-19 patients are not sick enough to require hospitalization (the symptoms tend to be even more minor for kids) and so will just stay home for two weeks. Most patients still feel like they’ve got the flu - fevers, body aches, coughing. So I recommend that you stock up on fever medications like Tylenol (acetaminophen) and/or ibuprofen. There is too much to cover here so read the CDC guidance pages on how to care for COVID-19 patients at home - https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fguidance-prevent-spread.html .

If you are caring for someone who is ill, they should be kept separate in their own room and you should wash your hands every time you enter and exit the room. A well-fitting N-95 mask would be useful when caring for someone who is sick, but good luck finding any. A sick person can wear a regular 'surgical' mask to reduce droplet spread. When caring for someone who is ill medical gloves would be handy but you have to throw them out with every use so I recommend household utility gloves (dishwashing gloves) because each time you finish using them you can dip them in the bleach solution to disinfect them. Read the CDC guidelines for details and there is a ton more on the CDC site.

Specific recommendations

1. Don't panic.

2. Plan for your kids/grandkids out of school for a month or so, and perhaps to tele-work.

3. Cover ALL of your coughs and sneezes in the crook of your elbow.

4. If you have ANY symptoms - STAY home, stay in your room, use a separate bathroom. DO NOT go to the hospital unless it is serious (that's were the really sick people are).

5. Buy - acetaminophen and/or ibuprofen, hand sanitizer, bleach (liquid and wipes), cleaning gloves, maybe some regular masks.

6. You might want to stock up on some staple foods (pasta, rice, canned, cereal, whatever) so that you don't have to run to the grocery store as often.

7. Don't go out partying, stay home and watch TV.

8. No making-out with strangers. In Liberia we didn't shake hands, hug, or even pat people on the back - we bumped elbows as a greeting.

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