Pandemic, Chronic Illness, and Us

This project is a work in progress. Expect it to be continuously updated. If you have something you’d like added, contact me here. Last updated March 26, 2020; 9:02 PM EST.

Table of Contents

The Coronavirus vs “The Flu”

Coronaviruses and flu viruses are not the same. The differences are very important.

  1. Flu and coronaviruses are both spread via droplet infection contact, which means that hand washing, social distancing, etc. are all useful for preventing these viruses. But it appears that COVID-19 might also be spread via airborne infection. Why does this matter? Droplet infection means that the microorganisms with the infection stay in the air for only a brief time and transmission generally happens in the presence of a person with the virus. Airborne infections stay in the air (and thus transmissible) for a longer period of time, meaning that the infection can be spread even outside of the presence of a person with the virus. This makes COVID-19 easier to catch and harder to prevent transmission.
  2. There are antiviral medications that can treat the flu virus, such as rimantadine (Flumadine), zanamivir (Relenza), and oseltamivir (Tamiflu), and there are annual flu vaccines. But so far, antiviral medications have not been confirmed to adequately address the symptoms of COVID-19. As yet, there are no vaccines for COVID-19.
  3. The incubation period for the flu tends to be 1-4 days, while COVID-19 is up to 14 days. This leaves more time for COVID-19 to be spread by people who are asymptomatic.
  4. The flu’s symptoms are generally multi-systemic and COVID-19’s symptoms are primarily respiratory.
  5. Additionally, the mortality rate of flu for 2019-2020 has been approximately 0.1% in the USA. The World Health Organization is estimating that so far, the mortality rate for COVID-19 is 3.4%.

How The Coronavirus Spreads

COVID-19 uses the receptor ACE2 to enter our bodies. This means it uses this enzyme as the entryway into our cardiovascular system. In humans, ACE2 is an enzyme that impacts blood pressure. This is why COVID-19 primarily impacts the cardiovascular system, causing inflammation.

According to the CDCthe virus spreads by respiratory droplets (saliva, mucus) produced when a person coughs or sneezes. It is airborne for up to three hours.

The CDC believes that COVID-19 spreads as easily as the common flu virus.

The virus can be spread from someone who is asymptomatic.

There have been reports of COVID-19’s presence in the stool of some of the people infected with the virus. As such, transmission through food from people infected with the virus may be possible.

Avoid handshakes as the virus is easily transmitted from hand to hand contact. Some people are recommending fist bumping instead, but that may be faulty advice. If someone has sneezed or coughed into their unprotected hand and not disinfected their hand afterward, the virus may be on the sides of someone’s fingers or even the backs of their hand. Therefore, it’s best to avoid touching hands at all.

The virus is active on hard surfaces and soft surfaces. According to the World Health Organization, coronaviruses may remain active on surfaces anywhere from several hours to several days. It is viable on plastic and stainless steel for 2-3 days, cardboard up to 24 hours, and copper for 4 hours. As such, it’s best to bring, use, and disinfect your own eating utensils (anything that goes directly into your mouth such as forks, knives, spoons, chopsticks, straws) when you eat out. Use straws and do not share food or beverages with other people. Read J. Kenji Lopez-Alt’s Food Safety and Coronavirus: A Comprehensive Guide for more information.

Coronavirus Symptoms

According to the CDC, symptoms of COVID-19 can show up 2-14 days after initial exposure, with the average time being five days. Currently acknowledged major symptoms are dry cough, high fever, sore throat, shortness of breath or other trouble breathing, and fatigue. These symptoms are due to respiratory inflammation. Symptoms that are not associated with the virus are a runny nose or other symptoms of a common cold.

People with mild symptoms may recover in just a few days. A study published in Science on March 16, 2020 estimates that 86% of the cases of COVID-19 in China were undocumented, “many of whom were likely not severely symptomatic.” Because this is a virus, it may turn into viral pneumonia, which is when the infection is considered mild to severe. Pneumonia can take weeks for recovery. If the pneumonia becomes severe, it can take months for recovery. Patients who develop severe pneumonia can develop acute respiratory distress syndrome (ARDS), which can cause permanent scarring of the lungs (pulmonary fibrosis). People with symptoms of pneumonia need to get tested for the virus. A severe infection by the virus is pneumonia that requires oxygen (assistance with breathing), while a critical infection by the virus is organ failure. 80% of cases are “mild,” which can mean “walking” pneumonia. 20% of cases are severe or critical. It is common to have a “mild” case with little to some breathing difficulty until the second week of infection, when patients often “crash” and then require oxygen.

If your symptoms are not as severe, you can likely care for yourself at home. Call your primary medical provider first to get their recommendation. If you care for yourself at home, you must self-isolate for two weeks (14 days) to be certain you have cleared the virus. You may have been carrying the virus for two weeks prior to symptoms starting, so be sure to inform anyone you have been in close contact with over the prior two weeks that you are now ill.

Kaiser Family Foundation study determined that about 4 in 10 adults (18+) in the United States have a higher risk of developing a serious illness if they get the infection, either due to their age (60+) or because of an underlying health condition. That’s 105.5 million adults in the United States who are at greater risk from the virus.

The virus has reappeared in those previously thought to have cleared the virus (those discharged from hospitals), but it may not be contagious then. Coronavirus is most contagious before and during the first week of symptoms.

Those At Greatest Risk

  1. People with hypertension or other cardiovascular disease, particularly elders
    1. Especially those who take ACE inhibitors
    2. Correction of above: People who take ACE inhibitors should continue to take them as there is currently no evidence that they help or harm COVID-19.
  2. People with diabetes, particularly elders
  3. People with cancer, particularly elders
  4. Healthcare workers and caregivers
  5. Possibly, people with blood type A

How to Prepare

Be Active About Prevention

Disinfect frequently touched objects and surfaces whether or not you are sick

There’s a difference between cleaning and disinfecting. Learn the difference and how to properly disinfect common household items.

The New Coronavirus Can Live On Surfaces For 2-3 Days — Here’s How To Clean Them.

Laundry in a time of COVID-19.

Things to focus on frequently disinfecting:

  • Bathroom and kitchen fixtures
  • Door knobs and handles
  • Light switches
  • Makeup brushes and applicators
  • Mops and brooms
  • Devices such as your phone, laptop, keyboard, tablet, mouse, etc.
  • Things you handle frequently such as your ID, steering wheel, pens and styluses, bags and purses, mobility devices, ear plugs and headphones, remote controls, etc.

If you have a case on your phone, remember to take the case off to clean in the crevices of the case. This can be done with tools made specifically for this purpose, or with Q-Tips.

If you use a water bottle, be sure to completely disinfect the bottle (and straw!) at the end of every day and/or use different bottles as frequently as possible.

Wash your bath and kitchen towels after every use if you can, and if you can’t, wash them once a week in hot water. Dry them on hot, too, if you have access to a dryer.

If you’re not sick, wash your bedding once per week. If you do get sick, try to wash your bedding as soon as you’re feeling well enough.

If you do get sick, be sure to change to a new toothbrush once you no longer carry the virus (have symptoms).

Spend more time washing your hands

  1. Wash your hands with soap and water for at least 20 seconds whenever you return home, after coughing or sneezing, after caring for or being around people who are sick, before eating, after using the toilet, and after handling animals or animal waste. Air dry or use a paper towel.
  2. Learn how to wash your hands properly by watching this video made by three nurses in Oaxaca, Mexico, or this video, which uses paint to show the need for the different steps in handwashing.
  3. Remember, handwashing will strip your hands of the natural oils that our skin produces to keep us naturally moisturized. As such, lots of handwashing will cause dry skin, and dry skin can crack, leading you open to infection (though not of COVID-19). So, after you wash your hands, remember to moisturize! Check out The Most Moisturizing Creams for Diligent Hand Washers.
  4. If you cannot wash your hands, use alcohol or an alcohol-based sanitizer that is 60-95% alcohol. You can also douse your hands in 70% rubbing alcohol (91% evaporates too quickly, so stick with 70%).
  5. If you have supports on your hands such as braces, splints, tape, bandages, or compression gloves, spray the supports with any spray sanitizer, including rubbing alcohol.
  6. Be sure to scrub under your nails! You can run a Q-Tip covered in alcohol under your nails to be sure that area is clean.
  7. At the stores that offer hand wipes, use them when you enter the store (and wipe the handle of your cart or basket if you’re using one) and when you leave.
  8. At home, make paper towels available in your bathroom(s) and in the kitchen. Not everyone might be washing their hands to the extent that is needed so it’s best to allow everyone to use their own disposable hand towels.
  9. Be sure to use a different towel for your face than for your hands.

Stop touching your face if you can

  1. Keep your hands away from your face, particularly your eyes, nose, and mouth.
  2. When coughing or sneezing, use the crook of your arm to cover your mouth or use a tissue. Throw the tissue in a closed bin, and then wash your hands. Later on, be sure to use hot water and soap to wash the crook of your arm.
  3. Avoid touching your eyes, nose, and mouth with unwashed hands.
  4. Use disposable tissues (versus handkerchiefs) as much as possible and if you’re using a handkerchief, don’t share it with anyone.
  5. One way to cut down on the frequency of touching your face is to wear a bandanna or mask (it need not be a respirator mask).
  6. If you’re working at your laptop or other device with a front-facing camera, you can use Do Not Touch Your Face to help prevent you from touching your face.

Avoid close contact with people who are sick

  1. The CDC believes the virus can spread within 6 feet, so keep at least that much distance between yourself and someone showing symptoms.
  2. Remember, some people may be asymptomatic, so it’s really best to keep your distance in general.
  3. Avoid large gatherings of crowds, as well as air travel and other forms of mass and public transportation. This includes taxi cabs and ride services such as Lyft.
  4. If you must be out in public, it’s a good precaution to wear gloves (specifically, nitrile or latex gloves).
    1. Learn how to put on gloves correctly.
    2. Make sure to not touch the gloves to your face.
    3. Take the gloves off and dispose of them when you have arrived at your destination.

Stay home if you’re sick (unless your symptoms are severe)

  1. If you are sick, don’t go out until you’ve been fever-free for 24 hours without the use of fever-reducing medications.
  2. Set-up a sick room to contain the infection, even if you live alone (this will make disinfecting your home an easier task).
  3. People who may be contagious should have access to their own bathroom if possible.
  4. The sick room and the bathroom should be cleaned with bleach on a daily basis.
  5. If you or someone in your household can’t be exposed to bleach, use your antimicrobial alternatives such as certain essential oils and white vinegar.
  6. To figure out when to seek help about your symptoms, read COVID-19: Home Care and When to Seek Help by Kate Paxton, Certified Nurse-Midwife.