the facts tell us how to act
prepared for Open Futures Lab
by Gada Jane
INTERVENTIONS ARE ACTIONS WITH OUTCOMES.
This factsheet lays out recommended interventions to manage the spread of COVID-19. What to do and why.
What is COVID19 / Coronavirus? How does it spread? What makes it so serious?
COVID-19 is an infectious disease caused by a new strain of Coronavirus.
There is currently a pandemic of COVID-19.
This page focuses on actions that can affect the spread of the disease, who can take them, and why they work.
The information provided here is meant to encourage responsible action, not cause panic. This is a serious crisis. We need communities to work together to slow the spread of the virus and avoid overwhelming the medical system.
If most cases are mild, why is it such a big deal?
COVID-19 spreads fairly quickly and relatively easily. It is also moderately deadly.
This combination means that even with a relatively low death rate it can do a lot of damage.
If it spreads too quickly cases overwhelm healthcare systems. This has happened already in some regions.
Drastic actions are required immediately to slow the spread and lower the death toll.
See FAQs "How many people are going to die?"
What can we do?
COVID-19 has not been contained. It is a global pandemic and the disease is spreading.
The goal now is to "Flatten the Curve." This means collectively taking community isolation measures to keep the daily number of disease cases at a manageable level for medical providers.
FOR THIS TO WORK, EVERYONE MUST PARTICIPATE.
NOT AFTER THE DISEASE IS OUT OF CONTROL IN YOUR REGION.
Everyday the disease is spreading. Acting quickly is crucial.
The Reasons behind Interventions to Manage the COVID19 Pandemic
Clarifications and Frequently Asked Questions.
HOW DO YOU GET COVID-19?
COVID-19 is spread through respiratory droplets from coughs and sneezes.
Most patients become infected through contact with someone who is carrying the virus. It is also possible to catch the virus by touching a contaminated surface and then touching your face.
WHY IS COVID-19 ALSO CALLED CORONAVIRUS?
Coronavirus is the virus that causes the infectious disease called COVID-19.
There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses like the common cold. COVID-19 is a new disease, caused be a novel (or new) coronavirus that has not previously been seen in humans.
WHAT ARE THE SYMPTOMS OF COVID-19?
According to the World Health Organization:
The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention.
IS IT REALLY THAT SERIOUS?
COVID-19 is the most serious pandemic the world has seen since the flu pandemic of 1918.
The seriousness of any pandemic is determined by how many people are likely to die. Number of deaths depends on both how many people are infected and how many people die for every infected person.
Even though the death rate of COVID-19 is likely less than 1%, because the disease is fairly contagious it is likely to infect a lot of people. This means even with a low death rate, it will kill a lot of people unless people collectively work together to flatten the curve.
WHAT DOES IT MEAN TO "FLATTEN THE CURVE"?
Flattening the curve means collectively taking community isolation measures to keep the daily number of disease cases at a manageable level for medical providers.
Any epidemic has a peak after which number of cases start to decline. If this peak is reached through rapid spread the number of cases flooding the medical system is likely to be way beyond the system's capactity, leading to poor treatment outcomes and more deaths.
The idea of flattening the curve is to use social interventions to slow the spread so that number of cases occur at a rate that is manageable for the medical system.
Slowing the spread is also important because it give doctors and researchers time to develop and improve treatments.
IS COVID-19 REALLY WORSE THAN FLU?
COVID-19 poses a significantly more serious threat than flu for several reasons.
1. The death rate is higher than a flu.
2. There is no vaccine.
3. No one is immune.
In short, it's more deadly and more people will be infected.
You might hear that COVID-19 is the most serious pandemic the world has seen since the flu pandemic of 1918, but that the flu was worse. It was worse at the time because it was a particularly virulent strain of the flu, there was no flu vaccine and no antibiotics to treat secondary bacterial infections. There was also a world war in progress that likely contributed to the spread.
HOW DOES COVID-19 COMPARE TO PAST OUTBREAKS?
Coronavirus is the most serious pandemic the world has seen since the flu pandemic of 1918.
In more recent years we have had pandemics of other serious illnesses but the outcomes were less severe because the disease in question was either less contagious, spread less widely or was less deadly.
For example SARS was more deadly but less contagious. It killed more of the people infected than COVID-19, but significantly fewer people were infected.
On the other hand, H1N1 Flu was very contagious but was less deadly, so it infected a lot of people but killed fewer of them.
This is not to say that people made a big deal out of nothing in these previous cases. These were all serious situations that were managed by experts to prevent them from becoming global crises.
The fact that SARS was not a more devastating crisis is due to its management by healthcare professionals. These are the same people who are now saying the only course of action that will work is to collectively practice careful hygiene and social distancing. They saved us before. This time we have to do our part.
WHO CAN BE INFECTED WITH CORONAVIRUS?
It is a new strain of the virus which nobody it immune to.
HOW LONG DOES IT TAKE FOR SYMPTOMS TO APPEAR AFTER EXPOSURE?
2-14 days (CDC)
Time between cases is generally less than a week.
ARE MOST CASES MILD?
Most people who become infected will have mild to no symptoms.
Note: This actually makes the virus easier to spread because people with mild or no symptoms might be walking around spreading the virus without knowing they have it.
IF I AM YOUNG AND HEALTHY, COULD I STILL GET SICK?
Most deaths occur in the elderly and people with underlying medical conditions, but serious illness and death do occur in younger and otherwise healthy people.
Also note that men seem to be getting more sick, perhaps due to more exuberant immune responses (Sam Harris 191).
CAN I BE CONTAGIOUS WITHOUT SYMPTOMS?
According to a recent study, more than 10 percent of patients are infected by somebody who has the virus but does not yet have symptoms. (Daily science)
WHAT SHOULD I DO IF I THINK I HAVE COVID-19?
Check your local recommendations for testing and engaging with healthcare.
Monitor your symptoms.
Do not take ibuprofen or antibiotics, except under the advice of a doctor. Use acetaminophen/paracetamol for pain. (WHO recommendations)
SEEK MEDICAL CARE IF YOU EXPERIENCE FEVER, COUGH, AND DIFFICULTY BREATHING.
IF POSSIBLE, CALL BEFORE GOING TO THE DOCTOR.
CAN I GET COVID-19 BY TOUCHING A SURFACE?
You can get COVID-19 from a surface or object if someone coughed or sneezed directly onto it or on their hands and then touched it.
It’s not clear how much the disease has spread this way but it is believed to be possible.
HOW LONG DOES CORONAVIRUS LIVE ON A SURFACE OR OBJECT?
Up to several days depending on the surface.
The virus lasts up to 24 hours on cardboard to up to two or three days on plastic and stainless steel. (WIRED)
It is easily deactivated by household cleaners (Amish)
It’s also still difficult to say how much “fomite” transmission is actually happening—that’s the term for when a bug is left on an object, which is then picked up by others. But this is more evidence to continue playing it safe.
CAN YOU CATCH IT THROUGH FOOD?
COVID-19 does not seem to spread through food, however good food prep hygiene is very important.
Harvard Health recommends staying away from restaurants and not sharing food outside your immediate family. Most sources simply recommend very careful attention to hygiene in the preparation of food.
Sources and Resources.
IS COVID-19 AIRBORNE?
Transmission through the air might be possible but it's not clear if it has happened.
There is not clear evidence that COVID19 has been transmitted this way, but it might be a factor in certain areas in hospitals.
Scientists have shown that the it can live in the air for 3 hours in an aerosol mist. These were under lab conditions designed to keep the virus in the air. The scientists specifically aerosolized the virus for this study, so the study showed only that the virus can live in the air. It did not show that the virus is likely to be lingering in the real world in one spot for 3 hours. (Wired)
In general, is known to transmitted via droplet, for example through contact with an infected sneeze. When people sneeze they generally produce droplets rather than fine aerosol mist. These fall to the ground more quickly. Some viruses do actually linger in the air and are therefore much genuinely airborne. Measles, for example, does stay in the air for some time. (SH 191)
There is some evidence of the virus lingering in certain areas of hospitals.
Experts disagree about how to respond:
“We shouldn’t be waiting to figure out the exact split between transmission modes before we act—we should be taking an ‘all-in’ approach,”
“The guidance for hospitals already includes bringing in more fresh air and enhancing filtration. It strikes me as inconsistent that the public is not getting a similar message.”
Joseph Allen, professor of public health at Harvard
“There's currently no evidence that the general public needs to worry about aerosol transmission of SARS-CoV-2, but there plausibly could exist risks in specialized hospital settings,”
Dylan Morris, researcher at Princeton who coauthored the study on aerosol Covid-19
Summary: spread through the air is unlikely but not impossible. If it is a risk at all, it is probably only a risk in closed environments and specific zones of high-risk areas of hospitals.
IS THERE A VACCINE?
Vaccines are being developed but will not exist for 12-18 months. Probably closer to 18. (Sam Harris 191)
WHAT DO THE RECOVERY STATISTICS MEAN?
The official count of the number of recovered patients generally means: fever free for certain number of days and 2 clear diagnostic tests.
This classification is useful for determining who might spread the disease.
Recovery in the practical sense might happen more or less quickly. People might return to feeling normal before being classified as recovered or still have things to recover from after being classified as recovered. Some patients might bounce back in a week, others might be left with lasting lung damage. (Sam Harris 191)
DOES AMOUNT OF EXPOSURE MAKE A DIFFERENCE TO HOW SICK YOU GET?
According to Amesh Adalja, infectious disease specialist at the Johns Hopkins University Center for Health Security, higher dosages of the virus might make people sicker than lower ones (Sam Harris 191). This means just because you have been exposed doesn't mean you are safe to continue being exposed. It might also mean that young healthy people in medical professions that expose them to the virus are more at risk of getting seriously ill.
ARE WE ALL GOING TO GET IT EVENTUALLY?
Estimates suggest between 30 and 60% of the population will become infected.
Social distancing and other interventions can lower the ultimate number to some degreee. Interventions also slow the spread of the virus (aka flatten the curve) which makes the number of cases occur at a rate that is manageable for the medical system.
Slowing the spread is also important because it give doctors and researchers time to develop and improve treatments.
HOW MANY PEOPLE ARE GOING TO DIE?
It depends on how people respond now.
But estimates are sobering.
Amesh Adalja, infectious disease specialist at the Johns Hopkins University Center for Health Security suggests that 35,000 dead from Coronavirus this year would be an optimistic number. By comparison, about 40,000 people die in the US yearly from automobile accidents.
He says 300,000-800,000 deaths this year in the US is not an unreasonable estimate. This would make it one of the top killers. (SH 191)
Francis Collins, the director of the National Institutes of Health says "There are estimates that if nothing goes right and if we fail to flatten the curve and if health systems are overwhelmed, we might see the deaths of as many as a million and a half people in the United States.” ("NIH Director: ‘We’re on an Exponential Curve’" The Atlantic). That is a worst-case scenario.
In the US alone, there is likely to be somewhere between 35,000 and 1,500,000 deaths in the next year from COVID-19. What the actual number is depends on flattening the curve through social distancing and other interventions.
WILL COVID-19 GO AWAY IN WARMER WEATHER?
Based on the behaviour of related viruses, it is suspected that COVID-19 will stick around, spreading more during cold weather months but that does not mean it is impossible to become sick with these viruses during other months.
IS THERE ANY GOOD NEWS?
Most people with COVID-19 will be fine.
Most people in the world will be fine.
We have the ability to significantly improve the outcome by acting now.
Handled well, this crisis can be managed.
WHY ARE SCHOOLS CLOSING?
School closures are an effective measure to prevent the spread of infectious disease.
In many regions, schools are closing as a preventative measure before the outbreak gets out of hand. Studies show this is a very effective way to flatten the curve and save lives.
There are two kinds of school closures.
Reactive School Closures (ie. school closures once someone is sick within the community or once there is community transmission)
Proactive School Closures
(ie. school closures once someone is sick within the community or once there is community transmission)
Research shows that reactive school closures are effective. Proactive school closures are more effective.
Empirical results on reactive school closures in Japan and Italy as well as computer models suggest that reactive school closures lowered cumulative attack rate by 24 % and delayed the peak of the outbreak by 13 days.
A Study of 43 schools in 1918 flu epidemic suggests proactive closing lowers death rates significantly over reactive school closures. (Sam Harris 190)
HOW LONG WILL THIS LAST?
It depends on a lot of factors including on what actions people in your region and other regions take and when effective treatments are developed.
CAN I GO OUT?
Check local recommendations and restrictions. Some regions have placed restrictions on leaving the house.
Regardless of region, the general rule is if you can stay home, then stay home.
In every case, avoid people you do not have to see. Practice social distancing.
Sources and Resources.
CORONAVIRUS TRACKING SITES:
Nicholas Christakis on Making Sense with Sam Harris 191. https://samharris.org/podcasts/190-respond-coronavirus/
Amesh Adalja on Making Sense with Sam Harris 191. https://samharris.org/podcasts/191-early-thoughts-pandemic/.
https://tincture.io/covid-19-the-state-of-play-from-the-front-lines-9ebf2513ed74 (Good summary of symptoms, definitions of terms, etc)
FAQS & REFERENCE MATERIAL
SOURCES OF GOOD INFORMATION ON TWITTER
https://twitter.com/mlipsitch (Twitter Account of Harvard Epidemiologist Mark Lipsitch)
https://twitter.com/NAChristakis (Twitter Account of Sterling Professor of Social & Natural Science at Yale, Nicholas Christakis)