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March 9, 2020 Corona virus updates - Facts and Updates

   


Hello! My name is Dr. Mikiko Murakami and I work at Spine and Sports  Medical Group in Campbell, CA. We would like for you to be informed  about the Coronavirus situation.


When the Coronavirus was first identified in Wuhan, Hubei Province,  China, I have to admit, I was not as worried about the impacts of this  virus as I am today. Things have changed very quickly.


Although I am not an epidemiologist, an infectious disease expert, or  a virologist, I see many patients every day where I get questions on  the Coronavirus. There has been a slow response (in the US) for  detection and yet a rapid increase in the patients who have now tested  positive in the Bay Area.  Globally, my friends and family that live in  China, Italy, Japan, Iran and Korea have greatly been impacted.  Now  with the cruise ship with more than 3,000 preparing to dock at the Port  of Oakland tomorrow (March 9, 2020), this issue is very, very real.


I have consolidated research from various physicians, scientists and  health organizations in hopes of informing you so that you can be  prepared.  Outline below:


  • WHAT WE KNOW
  • WHAT WE DON’T KNOW
  • PREPAREDNESS: HOME SUPPLIES
  • STOP TRANSMISSION
  • WHEN TO GO TO THE ER
  • TREATMENTS
  • VACCINATION
  • OTHER LINKS


WHAT WE DO KNOW


This new Coronavirus (COVID-19) is exactly that. It is NEW. We don’t  know enough about this virus yet so facts that are true today, may  change tomorrow.  


It is not the same as the coronaviruses that commonly circulate among  humans that cause mild illness, like the common cold. A diagnosis with  coronavirus 229E, NL63, OC43, or HKU1 is not the same as a COVID-19  diagnosis, with evaluation and treatments being different for these  patients.


  • DETECTION: The Chinese sequenced the entire DNA sequence of  Coronavirus. On January 10, 2020 they shared this with the world. Like  SARS, the genome sequences suggest presence of a virus closely related  to the Severe Acute Respiratory Syndrome (SARS)-related CoV, where we  had a 2002-2003 outbreak in humans. The virus has also been detected in  many bats. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.3.2000045.  


  • Real-Time PCR is an easy lab technique that can be used to detect  the virus and has about 95% sensitivity, meaning it will pick up the  active virus if you have it, along with a high specificity, meaning cell  cultures with other endemic human coronaviruses will not be picked up. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988269/ If you test positive, you are most likely positive.
  • The problem is, that PCR only detects an active and replicating  virus. There are plenty of cases where negative patients turned positive  and positive back to negative. This means that there is a period where  positively affected patients have been roaming around infecting others,  and that some people don’t even know they have/had the virus. There was a  study done in China, published on February 26, 2020, which followed  1014 patients.  This showed that CT scans of the chest had better  sensitivity for detecting the lesions in the lungs due to the virus  before RT-PCR could detect the virus, and that patients showed  improvement in chest CTs before RT-PCR results turned negative https://pubs.rsna.org/doi/10.1148/radiol.2020200642
  • Unless you test for anti-bodies, which are created once your body  encounters a virus, we don’t know who was infected (ie. a carrier that  spread the virus around without knowing).


  • DETECTION IN THE US: 


  • There have been several reasons why US has been slow at detecting  Coronavirus in infected people: 1) Regulatory limitations; 2) CDC  Manufacturing flaw; 3) Lack of foresight. For the first 6 weeks of  Coronavirus testing, the CDC only allowed testing of certain people who  had recently returned from China. Now, the CDC has different guidelines,  recently revised on March 4, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fclinical-criteria.html.    In addition, despite the entire DNA sequence being shared with the  world, and other countries such as Korea being able to test 140,000  people, the US has not had access to test kits. Why? The CDC had a  manufacturing flaw related to one of the reagents (used for PCR) which  caused a lack of availability for this test https://www.cdc.gov/coronavirus/2019-nCoV/summary.html#cdc-response.   They are working to address this issue. In the meantime, academic and  commercial labs are creating their own testing. Stanford Clinical  Virology Lab has deployed a test, with the plan of being able to test  100-150 patients per day (limited to sick patients) https://med.stanford.edu/news/all-news/2020/03/stanford-medicine-COVID-19-test-now-in-use.html.   UCSF has also created a test, with the capability of testing 30-100  patients per day.   Unclear where it came from, but “there was clear  lack of foresight,” Nathan Grubaugh, an epidemiologist at the Yale  School of Public Health, says. “We were very slow to roll out testing  capacity to individual places…” and we are now trying to catch-up.   Despite academic and private institutions creating means for testing,  the demand will continue to exceed the testing capacity in the Bay Area  in the short-term.


  • DETECTED CASES (as of March 7, 2020): 


  • United States: 164 detected cases, 11 deaths, per the 19 states that are reporting. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
  • Santa Clara County: 37 https://www.santaclaraca.gov/i-want-to/stay-informed/current-topics/coronavirus-updates
  • San Francisco: 8 https://www.sfcdcp.org/infectious-diseases-a-to-z/coronavirus-2019-novel-coronavirus/#1511206332173-94eb250b-d1fa
  • For reference the flu has 291,000-646,000 deaths worldwide with 12,000 to 61,000 deaths in the US per year https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu.
  • In comparison to other viruses, we have detected many more cases  within the first month of outbreak. Note we also have better ways to  detect, but the number is pretty significant. https://www.sciencealert.com/this-chart-shows-how-the-wuhan-virus-compares-to-other-recent-outbreaks


  • TRANSMISSION 


  • AIRBORNE: The virus can be transmitted through aerosol droplets  (when people cough or sneeze). The average infectious droplets size is  around 5 microns, fairly heavy and therefore not able to travel more  than 6 feet. In comparisons, other viruses, such as the Rhinovirus (a  simple cold), can travel in smaller particles for more than ~10 feet.
  • SURFACE SURVIVAL: The virus lives on the surface for 2-10 days. The  coronaviruses, including COVID-19 have a fat-layer that protects the  viral particles. The higher humidity, moderate temperature, solid  surface and low wind aid in its survival.
  • COVID-19 is spread primarily through contact with respiratory  droplets. For example, if someone with the virus sneezes, and you touch  the respiratory droplets and then, adjust your makeup, pick your nose,  and eat it while driving because (you think) nobody can see you, you can  get the virus. I have read some articles that suggest it can also be  airborne https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu. Emily Landon says that most Coronaviruses are not generally airborne. https://www.uchicagomedicine.org/forefront/prevention-and-screening-articles/wuhan-coronavirus

WHAT WE DON’T KNOW


  • WHEN WILL THIS SLOW DOWN? 


  • We do not yet know if warm weather will stop the outbreak like SARS https://www.cdc.gov/coronavirus/2019-ncov/faq.html


 

  • WILL THIS TURN INTO A PANDEMIC? 


  • The WHO has been very cautious to use the word pandemic.  Nonetheless, this virus is spreading rapidly world-wide, and there have  been many comparisons to the Spanish Flu Pandemic in 1918, that lasted a  few months and affected 50-100 million people world-wide and 675,000  people in the US. There’s a big difference from that 1918 outbreak, in  that within 2 weeks, scientists identified the Coronavirus and sequenced  its genome and discovered the likely origin.  In 1918, they also had no  antibiotics, which can kill bacterial infections that can follow viral  infections.  We also have hospitals with ICU, faster detection methods,  and ways of supporting very sick patients. These are positive things!
  • The problem is, that our health care system does not have “surge”  capacity”, meaning during this flu season where ICU’s are already often  at full capacity, we will not be able to keep up with the addition of  severely ill people from the new Coronavirus https://www.wbur.org/commonhealth/2020/03/02/infectious-disease-doctor-coronavirus
  • Whether “pandemic” is the term that the WHO decides to use for  current Coronavirus status, we have a problem that is going to grow  exponentially before it gets better.


  • FATALITY: 


  • The top Chinese health official, Liang Wannian stated that in China,  the fatality rate was 3-4%. However, if you factor out all the data  from Hubei province (where Wuhan is located), the fatality rate in China  drops to 0.4%. Wuhan was one of the first places that got affected, and  health care providers did not know what they were dealing with

https://www.npr.org/sections/goatsandsoda/2020/03/03/809904660/why-the-death-rate-from-coronavirus-is-plunging-in-china. 


  • The mortality rate estimate per the WHO as of March 3, 2020 is 3.4%.  It is important to note that there are lots of kids and healthy people  running around with no symptoms or light symptoms.  Taking this into  account, the rate is likely lower (in my opinion).


  • HOW SICK WILL I GET? 


  • Around 80% will have mild symptoms: Based on a publication by China  on the Chinese CDC, where 72,314 individuals diagnosed with COVID-19 as  of February 11, 2020 were included in this analysis. The data shows that  children < 10 years of age do not die and 81% of those exposed get  mild cases. 1.2% of the cases were asymptomatic http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51.   There is a chance that there is a greater percent of people that will  only get mild symptoms, as we have not been able to detect everyone who  has the virus and there are asymptomatic patients roaming around.
  • Symptoms: Similar to the flu, the Coronavirus can cause fever,  cough, body aches, fatigue, and sometimes vomiting and diarrhea. Both  can result in pneumonia https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu.


PREPAREDNESS: HOME SUPPLIES


Santa Clara County has recommendations on having supplies, prescription medications, non-prescription medications.


  • Santa Clara County Public Health https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/home.aspx
  • Public Call Center: 408-885-3980


Below are suggestions of what to have what to have at home:


  • Minimum 2-4 week supply of water and food. We have an earthquake  food supply bucket, but in addition, stocked up on Annie’s Organic  Soups, nuts, sauces, gluten-free and glutenous pastas, Emergen-C, teas,  dried fruit, tuna, organic chicken bone broth, vegetables with a long  shelf life (ex. Squash, potatoes, carrots). Probiotic foods (anything  fermented). Think: easy food you will want to eat if you are sick or in  lockdown.
  • 1 month supply of prescription drugs (running out of your life-supporting meds during a lockdown would be terrible)
  • Tylenol, ibuprofen, electrolyte packets, vitamins (Vitamin C, Vitamin B Complex, Zinc)
  • Household supplies: soap, antibacterial wipes, hand sanitizers,  bleach, rubber gloves, disposable face masks, tissues, toilet paper,  ladies’ sanitary napkins.
  • Disinfectants: To disinfect, ethanol > 70% should be used or a  1:50 dilution of bleach should be used. Look at the bleach % on the  bottle. Think: how to sanitize your house if your loved one tests  positive.
  • Plan: Come up with a plan for if someone does become sick in your  household. If you have elderly parents without caretakers, stock them up  with supplies in advance.


STOP TRANSMISSION


  • If you are >50 (with highest risk category people > 80),  immune compromised, have respiratory issues, avoid crowded areas. This  virus can travel 6 feet, so you can be friendly from a distance.
  • Work from home if possible and minimize travel.
  • Masks: I have read “don’t wear a mask unless you know you are sick.”  This makes no sense to me since many people have minimal symptoms and  don’t know they are infected. I would like to counter-propose, if you think you are sick, wear a mask! Yes, the virus can still be transmitted through mucosal membranes (such  as your eyes) but we know that your virus-containing respiratory  droplets are contagious so why not cover your nose and mouth which is  more than half the entryways from your face? Masks are sold out or too  expensive? Wear a scarf.
  • Cough into your elbow, not your hand.
  • Start practicing not touching your face (I just touched mine after I typed this). It’s not easy.
  • Wash your hands for 20 seconds, as if you have the virus on your hands, in your fingernails and on your arms.


DISINFECT


  • The SARS virus, which is similar to COVID-19, at a temperature of  68F (20C), lasts 2 days on steel, 4 days on wood/glass, 5 days on  metal/plastic/ceramics. These researchers also found that one strain of  SARS lasted up to 9 days on plastics. SARS survives 2-8 hours on  aluminum, less than 8 hours on latex. It can survive for 5 days on  Teflon (your pots and pans). A concentration of 70% ethanol,  or a standard bleach dilution of 1:50, or a dilution of 1:100 of 5%  sodium hypochlorite (final concentration 0.05%) is effective in  disinfecting small surfaces https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext. We can extrapolate that if it’s good enough for SARS, it’s good enough for COVID-19 (till further notice).
  • Many alcohol-based hand sanitizers do not have an alcohol content high enough to disinfect from COVID-19. Check if there is >70%.
  • Disinfect: phones, keyboards, door knobs, sinks, toilet handles,  things that you touch every day at work and at home. Doctor’s don’t  forget about your stethoscopes!


WHEN TO GO TO THE ER


  • “Only people with symptoms of severe respiratory illness should seek  medical care in the ER. Severe symptoms are rapid heart rate, low blood  pressure, high or very low temperatures, confusion, trouble breathing,  severe dehydration. Call ahead to tell the ER that you are coming so  they can be prepared for your arrival.” Dr. Todd Ellerin, Harvard  Medical School https://www.health.harvard.edu/blog/as-coronavirus-spreads-many-questions-and-some-answers-2020022719004
  • The incubation period, the time between catching the disease and  beginning to have symptoms disease is estimated from 1-14 days (other  sources say 2-14), and on average 5 days, per the WHO. The at-risk  population are the elderly, people with other medical conditions (ex.  Lung disease, heart disease, cancer, diabetes). https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
  • For clinicians, here are the guidelines from the CDC for reporting persons under investigation https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fclinical-criteria.html


TREATMENTS: ANTI-VIRALS


  • Antiviral medications are currently being tested to see if they can  address symptoms. There are various pharmaceutical companies looking  into this.
  • The WHO says that Gilead’s Remdesivir (the drug developed for  Ebola), may have efficacy in treating COVID-19. There are two trials at  the moment with results anticipated in April 2020. Other sources claim  there is a 50/50 chance of success https://www.bloomberg.com/news/articles/2020-03-05/gilead-analyst-sees-only-50-chance-that-coronavirus-drug-works
  • The University of Chicago found drugs previously in development for SARS that could be effective for COVID-19 https://www.uchicagomedicine.org/forefront/prevention-and-screening-articles/wuhan-coronavirus
  • Tamiflu (used to shorten the flu symptoms) is not a treatment for COVID-19. Also, antibiotics will not work to treat COVID-19!


VACCINATIONS


  • Per Infectious Disease specialist, Dr. Amy Landon, the vaccinations can be expected around spring 2021 at the earliest https://www.uchicagomedicine.org/forefront/prevention-and-screening-articles/wuhan-coronavirus.
  • This is a good opportunity for me to put in a plug for other  vaccinations, for those parents still on the fence about vaccinating  their children from preventable diseases!


OTHER LINKS


  • UCSF guidelines for the San Francisco Community https://www.ucsf.edu/coronavirus
  • Kaiser Facts vs Fears: https://khn.org/news/facts-vs-fears-five-things-to-help-weigh-your-coronavirus-risk/
  • HARVARD FAQ’s: https://www.health.harvard.edu/blog/as-coronavirus-spreads-many-questions-and-some-answers-2020022719004
  • CDC’s PRE-PANDEMIC CHECKLIST: https://www.cdc.gov/nonpharmaceutical-interventions/tools-resources/planning-guidance-checklists.html
  • CDC Global Planning to reduce the impact of a pandemic https://www.cdc.gov/flu/pandemic-resources/planning-preparedness/global-planning.html


Know your facts, have a prevention plan, have a plan in case someone in your household gets infected.



Here is to everyone staying healthy,

Dr. Mikiko Murakami

Spine and Sports Medical Group


Author  Mikiko Murakami, DO Physician   


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  • Back Pain
  • Low Back Pain
  • Mechanical Back Pain
  • Herniated Disc
  • Joint Pain
  • Knee Pain
  • Ablation
  • Arthritis
  • Neck Pain
  • Radiculopathy
  • Regenerative Medicine
  • Sciatica
  • Shoulder Pain
  • Spinal Cord Stimulation
  • Facet Pain
  • Spinal Stenosis
  • Sports Medicine
  • PRP Therapy
  • Stem Cell Therapy
  • PAY BILLS / FORMS
  • CONTACT US
  • FAQ