Our Federal agencies are telling us we can expect more cases of coronavirus and here in Portland where there are three presumptive cases already, we have to assume that means us. There’s a lot of information inundating our public and online spaces; with 6 deaths in our neighboring state of Washington, it’s normal to feel afraid. In situations of disease outbreaks, acting in the best interest of our community is protective and we’d like to provide some guidelines about how to do that and how not to.
What is coronavirus and what does its illness, COVID-19, look like? Oregon Health Authority has a Fact Sheet available here. In short, this is a new virus strain that is transmitted through droplets that can hang in the air after coughing or sneezing and then can settle on surfaces and stay infective for up to 9 days. The incubation period is anywhere from 2-14 days. An infected person can also transfer the virus to their hands through activities like blowing their nose or touching their face and which they then transfer to other people or surfaces through touch. The illness itself frequently looks a lot like the flu – fever, cough, and difficulty breathing. 10-20% of those who contract the virus will need significant medical care, with the rest of the population able to recover on their own with home supportive care. Some individuals may have very mild cases and never present with a fever, or only develop a fever long after the cough has started. This is why, like flu, coronavirus is more challenging to contain because people who are mildly ill or not showing symptoms assume they are not putting people at risk with their coughs and sneezes.
Why healthcare professionals are on high alert: To put things in context, two previous coronaviruses, SARS and MERS, were highly lethal with a third to half of people who contracted the virus dying. COVID-19 has a 2% rate of being lethal and so far most people who have died have been older or had underlying medical conditions which made them more susceptible to developing pneumonia. This is important because it helps us determine how to focus our social and healthcare resources to best protect those most at risk of serious harm. So far, there is no indication that this virus is the 21st century’s version of the 1918 flu. Neither is it the seasonal flu which currently has a hospitalization rate of 0.05%. (For Oregon’s current flu status, go here.) For healthcare providers, the risk to our vulnerable populations cannot be understated. Right now, there’s a real chance we can contain this virus. Moreover, most of us have someone in our family that we expect may be in that 2 out 100 group. We cannot afford to be laissez-faire about this virus.
What can we do? Since the cases right now are few and far between, the likeliest source of transmission is through touch, picking up the virus on our hands and then touching our eyes, nose, or mouth. Thankfully, this virus is no MRS–cleaning surfaces with regular household cleaners and diligent hand washing with standard soap and water are effective. In fact, hand sanitizer IS NOT as effective as regular hand washing. All of us with little ones know that hand sanitizer is a critical stop-gap before you can get that kiddo’s hands under a faucet. The most effective hand sanitizers are alcohol-based with at least 60% alcohol, but please don’t rely on hand sanitizer exclusively. Hand washing really can’t be overstated. Get educated and prepare to teach.
The second big thing we can do is to contain. If you or yours are getting the sniffles and you can stay home, stay home. I recognize that staying home is the privilege of folks who have paid sick time, aren’t living paycheck to paycheck, or have readily available support people who can watch their kids. If you are choosing between sending your sick kid to school and not having money to pay the rent while wondering how long you can be past due before your electricity gets shut off, I see you. As a community, we need to make a plan to make sure you can stay healthy and safe. For the rest of us, keep an eye out on community forums; there may be folks reaching out there, seeking support. Quarantining active infections of the virus is critical and unfortunately there are a lot of folks for whom a quarantine will ultimately mean homelessness.
The good news is containment is more than quarantine. If you sneeze or cough, COVER IT. Don’t let those droplets get past your own person. Then wash your hands. Be very cognizant of what you’re doing with your bodily secretions. Are you rubbing your eyes and then touching a public keyboard? Wipe that keyboard down. And then wash your hands. Seriously, if there are still jars of hand lotion on the shelves at the local Target, we’re probably not washing our hands enough. If you’re a health worker seeing a lot of sick folks, you may want to consider a face mask even if you don’t have the sniffles. If you are sick, wearing a face mask helps to contain those droplets. BUT if you’re not sick, that face mask is doing nothing to protect you if you’re not washing your hands.
Which brings us to what doesn’t help. Hoarding supplies. You don’t need a year’s supply of Lysol wipes. Your neighbor who runs in-home adult foster care for elderly or disabled folks definitely needs them more. Remember, these are the people most at risk of serious harm. There are large numbers of at-risk individuals living in Mom-and-Pop style care facilities who rely on Costco, WinCo and Bi-Mart to keep their clients’ home environments clean and safe. You need 1 or 2 large hand sanitizer bottles, not 20. My niece who gets hospitalized every-other illness due to physical disability needs to be cocooned in a bubble of disinfectants with an emergency supply of food and diapers. My kid who bulldozes through a 103 degree fever needs to wash his hands.
What else doesn’t help? Bringing my sick kid to the doctor’s office. This is a harder one to swallow. My kid has a tendency to sometimes develop breathing difficulties with respiratory illnesses. When there’s something scary circling around, we all want to know that this cough isn’t the scary one. We want to be sure there isn’t something more we can be doing. Prolonged coughing fits send my heart right through my chest, too, and my sleep is just as disrupted as I lie awake listening. But what if my sick kid does have the coronavirus? I already have albuterol inhalers and ibuprofen at home. There’s no medicine to shorten the illness or make it less severe and any venture out into a public space is risking the spread of infection, possibly to someone less able to fight it off. Most people who contract the illness can beat it back on their own and quarantining the virus is one of the best tools in our kit. Our doctors and nurses are available by phone. We can provide you with supportive care strategies and help you sort out when a higher level of care is needed. We’ll figure out the safest way for you to get care that reduces risk of exposure as much as possible. So please, call first.
I want to take a moment now to talk about stress. This is a lot of information and suddenly just going outside carries an extra layer of uncertainty. We’re all just a little bit more on edge. Sometimes overtly and sometimes subtly. We may relax into our work, get in the groove of our routine, when suddenly someone coughs and the word coronavirus pops unbidden into our minds. Some days you may have space in your world to absorb the added stress-burden. Other days you may not. Most days someone around us will not have the bandwidth to absorb more stress. Even 2-3 minutes of quiet, deep breathing can help lower levels of stress hormones in our bodies. Consider setting aside time to check in with yourself, step into the sunshine for a minute, sit with a cup of coffee and just watch the steam rise. Let’s be gracious with each other. And wash our hands.
-Coronavirus causes fever, cough, and breathing difficulty but sometimes is infective without all the classic symptoms.
-The highest risk for spread is through touching contaminated surfaces and then touching eyes, nose, or mouth.
-The virus is readily disinfected with household cleaners and hand washing.
-Hand washing is better than hand sanitizer, but hand sanitizer that is at least 60% alcohol is still useful.
-Most people who get sick can convalesce on their own safely, 10-20% will need higher levels of care to treat breathing difficulty and/or pneumonia.
-Please don’t hoard, self-isolate illnesses as much as possible, keep your secretions to yourself, and call first.
-Oh yeah, and WASH YOUR HANDS.
To follow along with Oregon’s tracking of Coronavirus, go here.
To follow along with Washington’s tracking of Coronavirus, go here. Note: due to the high number of cases in Washington State, the department of health has set up a dedicated call center.
For the most up-to-date recommendations from the CDC, go here.
For hand washing guidance and ideas for recruiting your kids to good hand hygiene, go here.
Our clinic phone number is 503-255-3544. You can call that number 24/7 and speak with an advice nurse or a doctor. Depending on our call volume, we may need to take a message and we may not be able to get back to you right away. We triage phone calls and call back those messages that raise the highest concern first. Your patience and graciousness at this time is most appreciated.
Resources for talking with children:
A short comic for kids
A video for kids
World Health Organization resources for talking with children
New York Times article for talking with children
New York Times article for parents
Vietnam’s amazing public service music video on preventing the spread of coronavirus (translation in the notes)