COVID-19 brief for friends and family

Peo­ple have been say­ing all kinds of wild stuff about the new coro­n­avirus. I work in biose­cu­rity and have been fol­low­ing the out­break since the be­gin­ning. What fol­lows is my best at­tempt to com­mu­ni­cate what we know about the virus, and how to pre­pare, with my fam­ily and friends. I thought I would share in case oth­ers have been look­ing for a similar doc­u­ment.

This is *NOT* in­tended to be a de­tailed, rigor­ous jus­tifi­ca­tion of the prepa­ra­tion mea­sures I’ve out­lined, nor an au­thor­i­ta­tive state­ment on the best cur­rent es­ti­mates for epi­demiolog­i­cal pa­ram­e­ters. In­stead, I try to be as straight­for­ward as pos­si­ble, cite only the ac­tion-rele­vant de­tails, and al­ign with the best recom­men­da­tions I’ve heard from the EA biose­cu­rity com­mu­nity as well as ex­perts writ large.

Caveats aside, I’d be in­ter­ested in feed­back on this pur­pose, in­clud­ing whether I am miss­ing sen­si­ble prep mea­sures, have the right tone for shar­ing widely, or am wrong about the facts. I’m happy to provide more tech­ni­cal jus­tifi­ca­tion in com­ments.

Here is the draft. I’ll be up­dat­ing it as we have more info and I have more time to in­clude sources, so go there for the most re­cent ver­sion. The first draft is in­cluded be­low for con­ve­nience.

If you’d like, please feel free to copy, mod­ify, etc and share with your own fam­ily.

Coron­avirus in brief (work in progress)

Bot­tom Line.

  • Coron­avirus is sig­nifi­cantly worse than the flu, but not the zom­bie apoc­a­lypse. No need to panic, but it prob­a­bly makes sense to pre­pare.

  • It is go­ing to af­fect day-to-day-life in west­ern coun­tries, in­clud­ing the U.S.

  • You and your fam­ily will prob­a­bly face per­sonal risk of ill­ness by the end of the year.

  • You can pre­pare by

    • Stock­ing ~1 month of non­per­ish­able food and other ne­ces­si­ties, and 3 months of med­i­ca­tions.

    • Re­lo­cat­ing away from dense cities and/​or shift­ing to work­ing from home, if pos­si­ble.

    • Learn­ing how to prop­erly wash your hands, and prac­tic­ing not touch­ing your face.

    • Avoid­ing travel af­ter March of this year, and/​or plan­ning with can­cel­la­tion op­tion.

    • Mak­ing plans to care for and pro­tect the el­derly from ex­po­sure to the virus.

    • Buy­ing and car­ry­ing hand san­i­tizer, and us­ing it fre­quently (ev­ery 30 min out­side your home, be­fore you eat or touch your face).

    • Wiping com­monly con­tacted items (phone, key­board, head­phones etc) down with dis­in­fec­tant reg­u­larly.

    • Avoid­ing crowded places (e.g. con­certs, sub­ways, the­atres, buses, air­ports etc) with­out pro­tec­tion.

    • For es­sen­tial travel, buy­ing N95 res­pi­ra­tors, if you can, and learn­ing how to use them, in­clud­ing shav­ing fa­cial hair.

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What does the virus do?

  • The virus causes cough­ing, sneez­ing, fever, pneu­mo­nia, and in se­vere cases kid­ney failure and death.

  • 80% of cases are rel­a­tively mild. The rest look like mod­er­ate to se­vere pneu­mo­nia.

  • Ap­prox­i­mately 1% of peo­ple who catch the virus die.

  • After symp­toms show, it takes 3 weeks − 1 month for se­vere cases to re­solve.

  • Risk is much higher for peo­ple over 40.

  • Chil­dren ap­pear to be rel­a­tively un­af­fected.

  • Men may be twice as sus­cep­ti­ble as women, al­though it is too early to tell with con­fi­dence.

  • Im­mu­nity may not last long, and no-one has it to start with.

Where is the virus now (Feb 28)?

  • 80,000+ cases wor­ld­wide, most in China. 2,800+ deaths.

  • 23 coun­tries have more than 10 cases out­side of China.

  • Ja­pan, Iran, Italy, and South Korea all had an ex­po­nen­tial growth of cases from 10s to 100s in less than a week.

  • 60 cases in the U.S. 1 case, in North­ern Cal­ifor­nia, is likely the first spread with­out link to China, sug­gest­ing the virus is spread­ing un­de­tected in the United States.

What do we know about the virus?

  • It likely arose from a crossover, or “zoono­sis” from an­i­mals in China, some­time in late Novem­ber early de­cem­ber of 2019.

  • It is most closely re­lated to a virus called SARS which caused a small epi­demic in 2002. It is also re­lated to viruses that cause the com­mon cold.

How does the virus spread?

  • Prob­a­bly similarly to the flu. Be­ing within 6 feet of a cough or sneeze, touch­ing a sur­face that has been coughed on and then touch­ing your face, or eat­ing food that has been coughed on are all ways to spread the virus.

  • Rel­a­tively quickly. Ap­prox­i­mately dou­bling the num­ber of in­fected peo­ple ev­ery week.

  • The virus can prob­a­bly sur­vive on many types of sur­faces for 2-7 days.

  • Some peo­ple who are in­fec­tious and can spread the virus do not show visi­ble symp­toms.

  • It takes ~5 days for symp­toms to de­velop.

Can we treat it?

  • Not right now. No vac­cine or ap­proved med­i­cal coun­ter­mea­sure.

  • Sup­port­ive care like me­chan­i­cal ven­tila­tion can sig­nifi­cantly de­crease risk of death if ICU rooms are available.

  • An an­tiviral, called remde­sivir, is in clini­cal tri­als and shows some signs of effi­cacy.

  • His­tor­i­cal timelines for new drug /​ vac­cine rol­lout sug­gest mass availa­bil­ity in 2021.

Shouldn’t I be more wor­ried about the flu?

  • No. This is worse.

  • The flu kills 0.1% of in­fected peo­ple. This kills ~1%. That is 10X worse.

  • The coro­n­avirus spreads a lit­tle faster than the flu.

  • You have some nat­u­ral im­mu­nity to flu even though each sea­son the strain is differ­ent. You prob­a­bly have no im­mu­nity against this coro­n­avirus.

  • We have a re­li­able vac­cine against sea­sonal flu. We will not have a vac­cine or effec­tive treat­ment for coro­n­avirus for some time.

  • Sea­sonal flu is very well char­ac­ter­ized and un­der­stood. This virus is still un­der in­ten­sive study, and all the num­bers I give have un­cer­tainty, which means that it may be worse than our best guess. Long-term effects of catch­ing the virus are un­known.

How can I think about my and my fam­ily’s risk?

  • Look at these charts for risk of death by age group.

  • Con­sider risk fac­tors (source) which make the dis­ease more dan­ger­ous, such as car­dio­vas­cu­lar dis­ease, di­a­betes, lung con­di­tions + smok­ing, high blood pres­sure, and can­cer.

  • Think about the pop­u­la­tion den­sity of places you go to reg­u­larly. Ask your­self: “How many peo­ple have been here in the last week?”. Avoid places where that num­ber is large, and/​or take ex­tra pre­cau­tions.

  • Think about ex­po­nen­tial spread. In the early stages, it will be dou­bling ev­ery week ap­prox­i­mately. Really think about that- it means the risk is about 2X higher each week this con­tinues. So it’s twice as safe to travel April 1 than April 7. And twice as safe on April 7 as the 14th. I find that ex­tremely counter in­tu­itive, and chances are you will too.

This all sounds crazy.

  • Yeah, it does. The info I’ve pre­sented above makes this look like prob­a­bly the worst pan­demic since the 1918 Flu.

  • How­ever, what’s pre­sented above is an ag­gre­ga­tion of facts and high-qual­ity es­ti­mates from the sci­en­tific liter­a­ture and ex­pert recom­men­da­tions, as best as I could find them.

  • The out­look pre­sented here is largely shared by ex­perts at: the CDC, the World Health Or­ga­ni­za­tion, the Har­vard School of Public Health, the Johns Hop­kins Cen­ter for Health Se­cu­rity, a biose­cu­rity sum­mit I re­cently at­tended, and by most of my col­leagues in the biose­cu­rity space.

  • Un­for­tu­nately, I think this is the world we live in.

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