A false sense of calm is recipe for chaos

When CDC officials declared that spread of the new coronavirus disease (COVID-19) is inevitable I actually sighed in relief. To conquer pandemics we need data, preparation, and not rosy reassurances.

That spread is inevitable became clear when the nature of transmission started to emerge. Let me explain: In some diseases people are contagious only when they’re sick. In that case, halting the spread by isolating people with symptoms is challenging but theoretically possible.

But in diseases in which people are contagious without exhibiting any symptoms eliminating the spread is virtually impossible once the genie’s out of the bottle. The most ‘successful’ viruses are those that don’t make their hosts too sick, and are subclinical, mildly symptomatic, or even asymptomatic in some infected people.

Infection can spread silently.

And that’s quite likely the case with COVID-19. It started in China in 2019 and has already spread to many countries. We now know that people can harbor the virus for 14 days (maybe even more) before they show any symptoms, and can be contagious during that time. There’s now a first report of a 20 year old spreading the virus and never developing the illness at all.

When a virus can be transmitted before the onset of symptoms, control of spread is very challenging. The rate of asymptomatic spread of COVID-19 is yet unknown, but the fact that it exists at all made the White House’s reassurances that everything’s under control worrisome. Even if all flights into the US were to cease the virus’ spread isn’t likely to be over.

The reason there are so few cases in the US is probably because as of Feb 26 2020 only 445 people were tested. As more people will be tested the number of infected people will likely grow.

To be prepared you need facts, methodical scientific analysis, and realistic expectations.

Unrealistic expectations lead to panic, panic has its own side effects, and panic magnifies any problem manifold.

How bad is it going to be?

The truth is that it’s unknowable, and fear of the unknown is unsettling

It’s perhaps worthwhile to imagine a worst-case scenario, a best-case scenario, and once you consider those, think about the in-between, because an intermediate severity scenario is the most likely.

The worst-case scenario people can imagine is an epidemic like the 1918 Spanish Influenza, which infected one-third of the world, and killed 2-3 percent of patients (bear in mind that supportive care has advanced tremendously in the last century). The best-case scenario is that the disease is contained quickly, spring and warm weather halt the contagion, anti-viral medications are effective, and a vaccine is developed quickly, before the next wave of disease hits.

Let’s be optimistic – always a good idea – and at the same time careful.

What to do

Be well informed:

Do turn to trusted sources, such as the CDC and WHO websites.

Don’t overdose on the overwhelming amount of coronavirus coverage in the media and especially on social media. It seems like a tenth of what I see out there is about the new virus, and the anecdotal stories and constant coverage stir emotion and anxiety rather than clear thinking.

And don’t fall for the myths around the disease: there are no drugs, vaccines, antibiotics or supplements approved for COVID-19, letters from China don’t spread the disease, spraying your body with disinfectant won’t help and can only irritate your skin and eyes, and I’m sure there are many more fables spreading faster than the virus itself.

Prepare:

Put your concern to work: Stock some food at home (emergency preparedness is always a good idea) and if you use medications have a few extra-week’s supply of that at home too. There’s nothing special to buy beyond emergency–preparedness: the CDC doesn’t recommend masks for healthy people for protection.

Have a plan for how to cope in case daily routines (such as school, public services) are disrupted – in the same way you do when you think of an impending snowstorm or hurricane.

Be prepared mentally by keeping your cool.

And after you’ve done that, go on with your life, unless you’re told otherwise.

Keep healthy:

I know you’re sick of hearing the wash-your-hands advice, but it’s really important. Wash your hands frequently and well especially before eating, after using the bathroom, after blowing your nose and after touching other people and places they’ve touched. To wash hands properly do so with water and soap, and for at least 20 seconds. Try not to touch your nose and eyes. Cover your mouth and nose when you sneeze. Keep your distance from people who are coughing and sneezing. Clean surfaces that are touched frequently.

This advice is boring because it’s the same advice you’ve heard regarding all respiratory viruses, and many other communicable diseases. That’s because it’s critical.

Take care of yourself: Every disease, and especially an infectious one, is an interaction between the host and the pathogen. COVID-19 tends to be worse in people with underlying illnesses. Now, as always, be good to yourself: eat well, exercise, get enough sleep, get the flu vaccine if you haven’t done so already (influenza is a nasty disease, and COVID-19 on top of it is something I don’t want to imagine).

Keep calm:

Life has always been fragile and risky, and if you ever felt totally safe now’s the time to realize that your sense of control was inflated.

Serious situations call for cool minds, good information, positivity, and supporting one another. We are literally all in this together.

Keep safe,

Dr. Ayala