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Corona Virus Update #3 (3/14/2020)

First, as I once saw imprinted on the toilet tissue in an English public restroom, “Be Calm and Wash your Hands”. In other words, be careful but not crazed.

Corona virus, in the vast majority of cases, causes few or no symptoms or is like the flu, with normal recovery. Only in a minority of people does the illness progress to pneumonia or Acute Respiratory Distress Syndrome and require hospitalization. The majority of people recover without treatment, health care involvement, or adverse consequences.  We are already gaining knowledge from the experience of the Chinese and others, including that a commonly used medicine called methylprednisolone may help treat the most severe cases.

In a study from China, most cases occurred in people 30-79 yrs old (87%), 1% in people 10-19 yrs old, and 3% in people 80 and older. Most cases (81%) were mild (no or mild pneumonia), 14% were severe (shortness of breath, respiratory rate 30/minute or over, pulse ox 93% or lower, or chest xray finding within 24-48 hrs). 5% of cases were critical.

Of 72,314 cases (as of February 11, 2020) in China, there were no deaths in those 9 yrs and younger and no deaths in the mild and severe cases, no matter the age. The only deaths occurred among the critical cases. Patients 70-79 yrs old had an 8% fatality rate and those 80 and older had a 14.8% fatality rate, especially those with other illnesses.

Although I hope that the latest public health measures will be effective and that the treatments now being tried will be effective, this is probably a good time for our older patients to plan to remain isolated as much as possible.

The virus is now appearing to be mainly spread by respiratory droplets, as from coughing or sneezing so wearing a mask may be helpful. Most often respiratory droplet transmission has been from close contact in families or from droplets spread by people within a 6 ft diameter space. There have been no documented cases of spread from fomites (clothing, tissues, or furniture) although the virus may be viable for hours to days on surfaces.

If you are in close contact with a family member or anyone who may be infected, isolate the ill person to 1 room as much as possible. Wash dirty surfaces first with soap and water (wear disposable gloves). Then disinfect surfaces using 4 tsp bleach per quart of water. Clean and disinfect high-touch surfaces daily and after the sick person uses it – tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks. 

To clean soft, porous material, like clothes and linens, wash them in the warmest possible water with one of the detergents listed in Use gloves while loading the laundry, don’t shake the clothes, and clean out the laundry basket with the bleach solution.

Wash your hands well after removing cleaning gloves, after using a tissue, coughing or sneezing, after using the restroom, after contact with pets or animals, before eating or preparing food, as soon as you get home, and before and after caring for an ill person.  

See our next email for updates on our office policy and testing.

Margaret S Lytton Physician

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