What the hell do we do!?

As we all navigate this extraordinary new normal of life amidst a pandemic, it is natural to ask ourselves and others “what the hell do we do?” I think there are two important ways of answering this question. The first involves the logistics of what we need to do in order to help quell the spread of this virus. And the second answer involves what we need to do in order to keep our spirits high and nourish our souls while some of our favorite pastimes momentarily disappear (sports, concerts, raucous nights at the bar, etc…).

To begin to address the second answer to the question of “what the hell do we do?” I’ll simply say this: reach out and continue to connect to the people you love (even if you can’t do that physically). And continue to do the things you love at whatever capacity you can.

I for instance, currently do not have access to the amazing studio at Man Made Music where I work, because we are taking the very responsible route of working from home during this time. However, that is not going to stop me from completing the ridiculous resolution that I made at the beginning of this year. I’m going to keep recording and producing music every week from my tiny bedroom! See! Check out these tracks! Boo ya!

Ivan – March 8, 2020

Night Shift – March 15, 2020

And to answer the far more difficult and urgent question of what the hell do we do to stop the spread of this virus, I want to kick it to my very talented, educated, and intelligent cousin Sarah. She is currently completing her Master’s in epidemiology at Columbia and has been sharing an incredibly useful, straight-forward, informative letter with her friends and family about the current situation with this coronavirus. I asked her if I could publish it here and she said of course. Here are her words:

Hello all,

As we navigate these unfamiliar waters together, I would be remiss if I did not take this opportunity to share my insight with friends and family, or really anyone that is willing to listen. Hopefully this information can aid in your decision making in the upcoming weeks, or at least equip you with the knowledge to filter through the abundance of misinformation that is circulating. I can substantiate the following advice with two years of infectious disease epidemiology training, and if that does not reassure you I have confirmed my own uncertainties with my professor, a leading virologist in the field. The world has not experienced a pandemic of this magnitude since the Spanish Influenza, 100 years ago, and it will require a learning curve. This is a fluid situation, and much is subject to change as we learn new information, but here is what I know right now…

The virus has been officially named SARS-CoV-2. You will start to hear this more often. It is NOT the same virus that caused the SARS outbreak in 2002, but they are related. They are both severe acute respiratory viruses in the family Coronaviridae.

The virus has an incubation period of 5 days, on average, but it has been observed up to 14 days in some. This is the period from exposure to onset of symptoms.

The infectious period is believed to begin before the appearance of symptoms. This is an unfortunate property, as it inherently adds an element of complication to control. For this reason, quarantine and social distancing is an integral part of limiting spread. Our movement is no longer just our business- whether we are concerned for our own health or not, we have to be cognizant of how we can serve as a vector to vulnerable individuals if we have been unknowingly exposed.

What should I do if I’m experiencing symptoms? Unless you need to seek medical attention, you should stay home and self-quarantine. If you have roommates, it would be wise for them to stay home as well, because they have most likely been exposed.

Should I get tested if I have symptoms? Yes, if tests are available in your area. However, we have yet to see a mass dissemination of testing kits, a critical fault of our early response. DO call your health care provider and ask about testing in your area, DO NOT frantically turn up at urgent care facilities asking for a test, they will almost certainly not have them. The administration just announced that google will launch a website where you can list your symptoms, and if consistent with clinical signs, you will be pointed towards the nearest testing facility. Drive through testing facilities are setting up as we speak. Be on the lookout for this site.

 Should I limit my contact with older or immunosuppressed family members? I cannot answer that for you, but I will tell you what I would do. If I was flying, or coming from an area with any confirmed cases, I would distance myself from vulnerable individuals. Five to six days of distance if you are aiming for the average time it takes to develop symptoms, 14 days if you want to be on the absolute safe side. This one is TOUGH. It negates our primal instinct to seek the proximity of loved ones in times of crisis, but the nature of the situation demands this. You can take comfort in knowing it is only temporary.

Who is vulnerable? The elderly (65+ years of age by definition) or anyone with comorbid conditions that could result in immunosuppression. However, ‘elderly’, is a very relative term, not a one size fits all kind of situation. Chronological age does not always reflect biological age- I know many people in their sixties that are very healthy (shout out mom and dad) and likely at minimal risk. The virus does not abide by our social constructs of age, who you designate as vulnerable is up to your discretion.

What’s up with that 2.5% case fatality rate? This an average, observed value, it is not an intrinsic property of the virus. It is highly variable and more than anything reflective of the population demographics and health care capacity in any one area. In China, the average fatality rate was 0.2% or less for those age 40 or younger. The average is still relatively low for those below 70+ years of age. I personally believe these values are gross overestimates, given the inevitability of underreporting. These values are NOT cause for mass panic, but they are higher than many of the infections we regularly encounter, and we have an obligation to protect our vulnerable.

How long can it remain on surfaces? This virus can remain infectious outside of the body for days at a time, especially on hard surfaces. All the hype behind maximum handwashing and minimal face-touching is absolutely true. Soap and water is actually better at breaking down this virus than ethanol-based sanitizers, but hand sanitizer is better than nothing.

Should I wear a mask? No, if you are a healthy individual from a low risk group. There is a severe shortage of masks for healthcare workers worldwide, leave them for the people that truly need them.

Can we expect to see seasonality? This virus does not have a confirmed seasonality, but SARS-1 demonstrated seasonal preference similar to that of influenza, so it is reasonable to suspect the same of this virus. Seasonality is not entirely understood, but it is suggested that in cold, dry, climates virus particles can travel farther through the air and become more efficiently aerosolized. In warm, humid climates, our respiratory particles become weighed down and cannot remain suspended in the air as long.

Why are kids at a lesser risk? Kids are still getting infected, but they are displaying milder cases on average. To put it simply, viruses elicit an immune response which stimulates a pro inflammatory response. This occurs in the lungs during acute respiratory infections, and it can cause severe damage when the response is prolonged or exacerbated. Children have underdeveloped immune systems, so the idea is that their lessened immune response may actually be protective against this virus.

If I get infected, can I get infected again?  I spoke extensively with my professor about this, because I personally have encountered many rumors of people getting re-infected. If you get infected, you should NOT get infected again. This is why vaccines work. Speaking of which…

Will there be a vaccine? It is very likely we will see a vaccine for this virus, but probably not during this outbreak. However, when one emerges it can hopefully aid in suppressing future outbreaks of SARS-CoV-2.

How long will this last? No one can say for sure, but I assure you this is not going away as soon as Trump will have you believe. To give you some perspective, let’s calculate the herd immunity. The reproductive number for this virus (R0) is believed to be between 2 and 3.5. This means that at best, the epidemic will die out once 50% of the population becomes immune (either via vaccination, infection, or genetic insusceptibility). At worst, 71% of the population will require immunity to stifle the spread. This number is not static- meaning we can reduce these values through concerted control measures, and hopefully the seasons will be on our side.

Herd Immunity =

Do we have the medical capacity to manage this outbreak? Yes, IF we implement sufficient control measures. It is estimated that roughly 10% of SARS-CoV-2 infections result in hospitalization *I cannot attest to the accuracy of this value. If we spread the cases out over a longer period of time, we have the hospital capacity to manage. If all the cases surge at the beginning, we will NOT have the staff, space, or resources to provide care for everyone. TIMING IS EVERYTHING IN EPIDEMIC INTERVENTIONS. Restrictions on travel, events, activities, etc. are unfavorable, but they will be critically important in preventing us from surpassing this threshold.

How do I prepare? Limit non-essential travel and social interaction. If you choose to partake in these activities, you must be willing to under-go quarantine if need be (and not just if you become a case but if you are exposed to a case), and maintain a heightened awareness of your presence around vulnerable people. Maintain enough resources around your house to last 2 weeks in case you need to self-quarantine. At this point, you risk being stuck anywhere you travel, take this into consideration when planning.

This is yet another symptom of an unbalanced planet. I will be the first to admit that I underestimated the progression of this outbreak, but I did so in anticipation of a response from our leaders than never materialized. Things are going to change for everyone, not forever, but they will get worse before they get better. If you have not felt the presence of the epidemic in your respective areas, you will very soon. This letter is not intended to incite panic, but to promote awareness as you go about your lives. I believe knowledge is one of the strongest armors, and we must be mindful not to let fear impede logic. This will subside in a few months, but it will require some personal sacrifice and collective effort. Don’t forget to thank your friends, family, or acquaintances that work in healthcare, because this burden may fall the heaviest upon them. Remember, you are not alone in your confusion, anxiety, and loss of normality. Be an advocate of your own health, and others.

Feel free to email me for additional guidance or answers that were not presented here. smunro122@gmail.com

Stay Sterile,

Sarah Munro