Common Questions:

1. How infectious is it?

R0 (how infectious it is) of 2-2.5 was prior to quarantine/social distancing measures. Though interventions (vaccines, behaviors, etc) and other factors (cruise ships, location) will change this number. Higher viral production/shedding make the R0 higher than the flu and SARS.

https://www.ncbi.nlm.nih.gov/m/pubmed/32007643/

MOST contagious BEFORE and during the first week of symptoms!

https://www.sciencenews.org/…/coronavirus-most-contagious-b…

Household transmission 3-10% and close contacts 1-5%.

2. Illness severity

About 80% of patients had mild disease.

About 14% have more severe disease (SOB, symptomatic lung involvement)

About 6% have critical disease (Organ failure, shock, etc)

3. Mortality rate by age – overall – and will significantly change with interventions and additional diagnosis of mild cases!

– >80 22%
– >70 8%
– >60 3.6%
– >50 1.3%
– >40 0.4%
– 10-39 0.2%

4. How does it spread?

Droplet/fomites. Airborne spread has not been reported in normal situations – can be aerosolized.

5. What’s the incubation period and time to recovery?

Average incubation 5-6 days (range 1-14)

From onset to max illness – usually about a week.

Recovery is about 2 weeks for mild to moderate disease but 3-6 weeks for severe disease.

UPDATE* Additional evidence supporting the 14 day quarantine with avg 5.1 days exposure to symptoms.

https://annals.org/…/incubation-period-coronavirus-disease-…

6. Who is it affecting?

Mostly older patients and those with comorbidities having a more severe course.

Likely underdetected in younger patients due to the low complication rate in these patients. See kids under #10 below.

7. What are the symptoms?

Based on 55,924 lab confirmed cases symptoms were seen as follows:
– Fever (88%)
– Dry cough (67%)
– Fatigue (38%)
– Sputum production (33%)
– Short of breath (18%)
– Sore throat (14%)
– Headache (13%)
– Muscle/joint aches (15%)
– Chills (11%)
– Nausea/vomiting (5%)
– Stuffy nose (5%)
– Diarrhea (4%)
– Coughing up blood (1%)

Lymphopenia also has been very common in “severe” cases.

8. What should health care professionals do?

General use of masks is not recommended. Follow great hand washing and universal precautions. Get fit tested if you are likely to be involved in care of critically ill patients. Know and follow your local public health or ID protocol. Feel free to share yours for those who are developing.

9. Reinfection?

It is relatively unlikely, but not completely ruled out as a possibility. More likely prolonged shedding. At least short term immunity is noted: https://jamanetwork.com/journals/jama/fullarticle/2762452

10. Immunosuppression? Pregnancy? Kids?

Immunosuppression is a risk for more severe disease. Specific details for each illness are not currently available.

https://www.thelancet.com/…/PIIS1470-2045(20)30150…/fulltext

https://www.rheumatology.org/announcements

Pregnant women do not appear to be at higher risk for severe disease.

https://www.ajog.org/article/S0002-9378(20)30197-6/fulltext

http://www.nationalperinatal.org/COVID-19

Kids can get and carry. It is usually much milder, for a variety of speculated reasons. Theoretical risk of transmission even if they aren’t showing much for signs.

This article references several studies currently on kids, severity and possible explanations:

www.wired.com/…/kids-can-get-covid-19-they-just-dont-ge…/amp

11. Travel Plans?? Should I cancel?

Though this is a personal choice based on area of risk, flights, health condition and also the implications of exposure and possible quarantine, the general consensus is DON’T TRAVEL!

Social distance is what saves lives. Decreased exposures will “flatten the curve” and likely help with stretching resources over time. Also, several hospitals/institutions have implemented their own policies.

12. What kills Coronavirus? Surface lifespan?

It can likely survive on surfaces for around 9 days – but some strains show longer and temp/humidity matters. Different surfaces have different timeframes. Not currently airborne unless aerosolized – then can survive 3hrs in air.

https://www.journalofhospitalinfection.com/…/S0195…/fulltext

List of things/chemicals that work against Covid19:

https://www.epa.gov/…/list-n-disinfectants-use-against-sars…

UV light has been effective but it is slower – up to 30 min for effect.

13. Diagnosis?

Tests are in short supply but noncontrast CT has proven useful. Lymphopenia and ESR have been predictors of disease severity.

CT
https://pubs.rsna.org/doi/10.1148/radiol.2020200823

Lymphopenia
https://staticapp.icpsc.com/…/860268a95e4e72f980012fd272ac8…

14. Treatment options?

Critical care:

Intubation, prone positioning and higher PEEPs have been used.

ICU OnePager:
https://www.onepagericu.com/

https://emcrit.org/ibcc/covid19/

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Medications:

Cepharanthine, selamectin and mefloquine hydrochloride are potential drugs for treating 2019-nCoV infection.

https://pubmed.ncbi.nlm.nih.gov/32149769-repurposing-of-c…/…

Chloroquine, arbidol, remdesivir, and favipiravir are currently undergoing clinical studies.

https://www.sciencedirect.com/…/artic…/pii/S0166354220301145

Vaccine Study in Canada: Also a human trial in Seattle.

https://www.narcity.com/…/coronavirus-vaccine-made-in-saska…

Glucocorticoids are limited in effectiveness.
Ibuprofen should be avoided per the WHO.

https://www.bmj.com/content/368/bmj.m1086…

IVIG:

TAK-888 from Takeda and regeneron (synthetic version) are in the works but not tested or available.

Public Mitigation:

Quarantine and social distancing.

https://www.thelancet.com/…/PIIS0140-6736(20)30567…/fulltext

15. What do I tell my patients?

1. This is new and evolving – but most people will be fine.
2. Do what you can with hand hygiene and staying home when sick or exposed. Protect those at highest risk in the same way. #flattenthecurve. Social distancing!
3. Follow the most recent information via reliable sources – WHO, CDC, public health professionals, etc
4. If you think you have been affected or could have the virus, call your local hospital for help before going to the clinic or ER – unless it is an absolute emergency. They can direct you where to go and what to do to prevent additional exposure to others.
5. If and when a vaccine or treatment become available, seek it.
6. Share the information we know – facts always help!

Resources:

CDC information: https://www.cdc.gov/coronavirus/2019-ncov/index.html

WHO – much of our info comes from the numbers in China.
https://www.who.int/…/who-china-joint-mission-on-covid-19-f…

https://www.jhsph.edu/covid-19/index.html

https://www.fda.gov/…/mcm…/coronavirus-disease-2019-covid-19

And PubMed – it’s an evolving disease and thus scientific information continues to come quickly!

Additional Links:

CROI:
https://special.croi.capitalreach.com/…

Taiwan Experience:
https://jamanetwork.com/journals/jama/fullarticle/2762689…

Stat Pearls:
https://www.ncbi.nlm.nih.gov/books/NBK554776/

Spread and projections:
https://medium.com/…/coronavirus-act-today-or-people-will-d…

Faq news:
https://www.usatoday.com/…/coronavirus-reader-q…/5012457002/

For surgeons:
https://www.facs.org/abou…/covid-19/information-for-surgeons

Cardiology:
https://www.acc.org/…/acc-issues-covid-19-clinical-guidance…

Protocols:
https://covid-19.uwmedicine.org/Pages/default.aspx

Comprehensive Review:
https://www.alibabacloud.com/channel/preview_pdf…