COVID Facts that deserve emphasis

March 30, 2020

I would like to share with you some facts about the coronavirus and COVID that I think are not being emphasized enough in the media.

COVID can cause a GI illness.

COVID is typically described as weakness and fatigue followed by cough and fever, and sometimes shortness of breath. This implies that the illness is respiratory in nature.

In a study of over 200 COVID patients in China (1) about HALF had GI symptoms including loss of appetite, diarrhea (loose stool 3 or more per day), vomiting, or abdominal pain. And about 1/30 (3% or so) COVID patients had ONLY GI symptoms, typically diarrhea. The virus can be found in the stool of infected patients. Again, this emphasizes the need for extraordinary hand-washing diligence.

COVID is mainly contagious by virus getting on someone’s hands and then that person touching their own face, eyes or nose.

Thank you to Dr. David Price a Lung Doctor (pulmonologist) in NYC. His 1,200 bed hospital is almost 100% dedicated to treating COVID patients. He recorded a video (2) emphasizing certain key points. Based on their expert understanding of this disease transmission, the virus is mainly transmitted in clusters. One person in a home or facility gets sick and then people in close contact get infected. His video is here: https://www.youtube.com/watch?v=YitWZj9QhdQ

Unless someone coughs or sneezes on you, the virus is getting into your system because it got on your hands and then you touched your face. He emphasizes, many times, to wash or sterilize your hands and to NOT touch your face. Wearing a plain mask: cloth, inexpensive paper, whatever - is to help you avoid touching your own face, it is not to prevent you from breathing virus out of the air, which is not how most people get sick. Do not wipe amazon boxes, just wash your hands after handling them.

If someone in your home is sick, they must wear a mask when others are near them. Minimize contact with them. Wash or sterilize your hands after tending to them and wear a mask in their presence. Gloves do not help generally, unless wearing them serves to remind you to not touch your face. Hands are easier to wash with soap and water or sterilize than gloves. Do not use N95 masks. If you have any, please donate them to medical care providers.

The total number of cases is not the most useful number.

If you want to understand the trajectory of this infection, the most useful number is the percentage increase of new cases from one day to the next, which is called the growth factor*. If the growth factor is above 1 (greater than 100%), then the rate of infection is increasing.

If the ratio of the number of new cases from one day to the next is less than 100%, this might be the sign that the number of new cases is slowing down. This is called an inflection point. On March 29, this number was 90%. This is the first sign of a slowdown in the rate of growth of new cases. If this continues, we might be at an inflection point. If you like math, the video on Dr Feld’s web page (3) is excellent. (www.feld.com/archives/2020/03/exponential-growth-and-covid-19.html).

If the virus shows up 5-6 days after exposure, and people are sick for about 2 weeks, then by isolating everyone as much as possible the rate of growth of new cases should decrease 2-3 weeks after the social distancing became widespread. We are just starting to see this. Social distancing must work because the virus is transmitted from one person to another. If asymptomatic people are not out in public unknowingly infecting others, we must see a drop in NEW infections by that time frame.

The media likes to report the TOTAL number of cases. This number can only increase. As more people get tested this number might increase a lot. There are potentially millions of people with COVID in the US who have recovered or are mildly ill and who have not been and will not ever be tested.

The media should report the daily number of new diagnoses as a percentage of total cases. They should report recoveries. Out of close to 700,000 infected in the world as of today there are almost 200,000 people already recovered (4) that we know of. They report the total because it is scary. It can only go up.

https://www.worldometers.info/coronavirus/coronavirus-cases/#daily-cases

Most people do NOT need to be tested for COVID.

If you have weakness and muscle aches and feel ill, ASSUME you have COVID. Immediately begin to take ALL necessary steps to isolate yourself at home and prevent others in your household from getting infected. With proper techniques, this is absolutely possible. Over 90% of the time you will recover in 7-14 days and then you will be forever immune. Not everyone gets a cough and fever. Some people get diarrhea. Others get heartburn. Some lose their sense of smell. Err on the side of being cautious and perhaps a bit paranoid, for now.

Having a negative test is close to worthless. Why is that? Because you can still get the virus right after the swab was collected. Healthcare workers with possible infection should be tested so they know if it's safe to come back to work. People with NO symptoms should not be tested. You can test negative one day and 3 days later develop full-blown COVID. The asymptomatic phase of this illness is maybe 2 days. If you think a negative test means you are safe, you might become overconfident and then spread the virus to others.

If you feel sick but the symptoms are not classic for COVID and if you really need to know if this is COVID or not, because testing negative would change your day to day life compared to testing positive, then you should try to have the test.

Only go to the ER if you think you are sick enough to be hospitalized.

For the most part, this means you are almost certain that you have COVID, you have been managing at home and now you have shortness of breath with minimal exertion such as walking to the bathroom. In the hospital you can get supplemental oxygen. There are NO medical treatments for COVID. The hospital’s approach is to watch you to see if you get sick enough to need a ventilator. If you start to recover and feel better, which is almost always the case, you should go home. Even if you end up on a ventilator, most of the time you will recover, although it is a longer recovery.

Non COVID emergencies have not gone away so you should call 911 or go to the ER for any non COVID emergency such as possible heart attack, stroke, appendicitis, kidney stone, severe vomiting or diarrhea, or other potentially life-threatening conditions.

REFERENCES AND LINKS

  1. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf
  2. www.youtube.com/watch?v=YitWZj9QhdQ
  3. www.feld.com/archives/2020/03/exponential-growth-and-covid-19.html
  4. www.worldometers.info/coronavirus/coronavirus-cases/#daily-cases

*The magic number is the growth factor, which is the number of new cases today divided by the number of new cases yesterday. We want to see this below 1, and the lower the better! This is how we can start to determine if things are getting better.

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