Covid 19

The Spanish flu was caused by a strain of influenza, type A H1N1 (A/H1N1). If you received your flu vaccine this year you were vaccinated against (at least in the US) influenza types A/H1N1, A/H3N2, B/Victoria, and B/Yamagata. All flu vaccines in the US for the 2019/20 flu season are quadrivalent (meaning they cover all four types). What do those names and numbers mean? There are four types of influenza: A, B, C, and D. Influenza types C (which cause mild symptoms and are not associated with epidemics) and D (which primarily infects cattle and is not known to infect humans) are of little concern. Type B is associated with seasonal epidemics (the flu season) and is divided into two lineages, B/Yamagata and B/Victoria. Type A is also associated with seasonal epidemics and is the only type associated with pandemics when a new strain emerges (a novel virus). The H and N mean hemagglutinin and neuraminidase. These are proteins on the surface of the virus. There are 18 different H and 11 different N subtypes. While that maths to 198 different combinations only 131 subtypes have been detected. H1N1 also caused the Swine flu pandemic of 2009. The avian bird flu of 2013 and 2003 were A/H7N9 and A/H5N1 respectively. The 1968 pandemic was caused by the A/H3N2 virus. From 1957-1958 there was a pandemic caused by the A/H2N2 virus.

How does that relate to Covid-19? Well, Covid-19 (the disease) is caused by SARS-CoV-2 (the virus), which is a coronavirus. SARS-CoV(1) caused the 2002/03 SARS epidemic in China. MERS-CoV caused the MERS outbreak in the Middle East in 2012. Coronaviruses are a large family of viruses that generally cause mild to moderate upper-respiratory tract illnesses, such as the common cold, but there are a few strains, such as those mentioned, that can cause a much more serious upper-respirator tract infection.

Influenza is an RNA virus in the family Orthomyxoviridae. Coronavirus is an RNA virus in the family Coronaviridae. Coronavirus is not influenza. They are completely different animals (so to speak).

Yes, during the 2019/20 US influenza epidemic millions of Americans became sick and thousands died, and that's with vaccines (that not enough people get), anti-viral treatments (Tamiflu), and without adequate social distancing/quarantines (people will go to work if their symptoms are mild and don't generally quarantine long enough). We have no vaccine or anti-viral treatment for SARS-CoV-2. In 2012 SARS (SARS-CoV) quickly spread around the globe infecting more than 8,000 and causing over 750 deaths. SARS-CoV-2 surpassed those numbers in two months. This is not the flu.

Social distancing is one way to prevent communal spread, but only works if performed in conjunction with other precautionary measures, such as proper hand washing (which is far more effective than alcohol based hand sanitizers). But while droplet protection is sufficient for influenza (a mask worn when within 1m (3ft) of the patient), SARS-CoV-2 can be aerosolized (although that is likely only in health care settings and not in everyday settings), meaning that it can potentially travel much farther and put it in the realm of tuberculosis for communicability. This is why health care professional need to employ more strict PPE (personal protective equipment) and follow expanded airborne precautions (respirator, eye protection, gloves, and gown) when treating patients. In general, an N95 respirator is sufficient for airborne precautions. Surgical masks, the loose fitting masks that most people have been buying, are completely insufficient for protecting against infection by SARS-CoV-2. N95 respirators filter out at least 95% of airborne particles. Surgical masks only provide barrier protection against droplets, which includes large respiratory particles like when you cough or sneeze. This is why they put a mask on you if you're sick.

So why all the PPE? I bet you though respiratory particles were the only mode of transmission for SARS-CoV-2. Allow me to introduce you to the term "fecal shedding." In SARS-CoV high concentrations of the virus were found in fecal and respiratory specimens during the illness, but patients continued to shed the virus for up to 26 days post onset of symptoms in their *****, and like SARS-CoV, SARS-CoV-2 has been found in the ***** of patients in Wuhan. So what's the big deal, you say. Ever flush your toilet? You just spread aerosolized fecal matter into the air, which spreads all across your bathroom, and aerosolized particles can get deepest into your lungs, which is linked to more serious respiratory infections. Closing your toilet lid before flushing helps to mitigate some of that spread.
*The language filter has decided that clinical information must be censored. Use context to fill in the blanks.

So, how do you prevent it? Wash your hands. The generally accepted guideline is to wash with soap and water (the water does not have to be very hot, in fact hot water can make the situation worse as it irritates the skin of your hands) for at least 20-seconds. Medical personal are generally advised (unfortunately the advise does not seem to be universal), during their universal precautions training, to wash for at least 40-seconds. While studies have shown that the difference between using soap and not using soap is not as large as most people think in cleaning one's hands it is important to use soap (aside from the fact that it is more effective than just washing with water) because SARS-CoV-2 has an oily surface that, once disrupted, prevents the virus from infecting a host. Proper technique is important, too. You want to ensure that you get every part of your hands and wrists. The CDC and WHO have several resources, from visual guides to videos. Printing a copy of one of their visual guides and placing it at each wash station can help remind people how to properly wash their hands. Social distancing doesn't just involve keeping a minimum 2m (6ft) bubble around you (not that the people in my city know what that is). SARS-CoV-2 can potentially survive for hours in the air (it depends on the particle size) and up to 72-hours on some surfaces (plastic and stainless steel, although concentration will have fallen significantly by then). If someone in the house is diagnosed with Covid-19 they can help to mitigate the spread by wearing a mask when around others, or severely limiting their time in communal areas. Use a separate bathroom if possible, don't share dishes, and isolate in a separate room. Surfaces can be disinfected with commercially available disinfectants, but be certain to follow the printed directions. Most are only effective if the surface being disinfected remains wet for 4-mins. Bleach is often the go-to for a disinfectant, but it is most effective when diluted (DO NOT use undiluted bleach and DO NOT combine bleach with anything other than water). Remember that sanitation is not the same as disinfection, but both can be useful. Here is how to mix bleach for sanitation and disinfection.

• Very mild bleach solution (for sanitizing dishes only) - a 1:400 ratio - 10 ml (2 tsp.) of bleach to 4 L (1 gallon) of warm water
• Mild bleach solution (for sanitation and low level disinfection of non-porous surfaces and objects) - a 1:100 ratio - 5 ml (1 tsp) of bleach to 500 ml (2 cups) of water
• Strong bleach solution (for disinfecting blood and body fluids) - a 1:10 ratio - 50 ml (1/4 cup) of bleach to 500 ml (2 cups) of water

When disinfecting wear gloves and properly ventilate the area. Wash the surface with soap and water then spray with your disinfectant spray and allow to air dry. Do not wipe away. You want the surface to remain wet for as long as possible (approx 10-mins for disinfecting). Be certain to follow manufacturer instructions and to test any surface before using a bleach solution on it (ex. don't use bleach on wood, if in doubt, Google it). It is generally sufficient to disinfect once a week, such as your kitchen, and not more than twice. Using a sanitizing solution in between will help reduce surface bacteria between disinfecting. If someone is sick disinfect high traffic surfaces (such as doorknobs) daily. If the sick person can not have a dedicated bathroom then the bathroom should be cleaned after each use (paying particular attention to areas such as the toilet and sink). Remember that bleach breaks down quickly in light and water. Do not store for longer than 24-hours and only store in opaque bottles. Best to only mix up bleach sanitation and disinfecting solutions as needed. Label all bottles accordingly in large letters "Bleach" and include the solution used. Only use that bottle for that purpose.

If you live with someone and have been diagnosed with Covid-19 isolate yourself from others in a separate room that is well ventilated. Keep the door closed as much as possible but open a window. If you have access to a surgical mask(s) wear it whenever you need to leave your isolation room. While it is best if they are single use supplies are short, so make due as you can, but do not use it if it becomes damaged, worn, or wet. Be sure to put it on before you leave your room and only take it off after you have returned and closed the door to your isolation room. In the absence of a surgical mask a scarf or shirt can work, although less effectively. Make certain that your mouth and nose are completely covered. Your primary goal is to capture any droplet spray. Be certain to not share anything: dishes, clothes, bedding, towels, etc. If the sick person has touched it it should be thoroughly cleaned before anyone else uses it. If someone else is doing laundry for the sick individual they should be careful to not shake dirty laundry, wear gloves if available while handling the laundry (especially if the laundry is soiled with body fluids of any kind), and thoroughly wash their hands after handling anything that has been in contact with the sick individual. If you're sick, drink plenty of fluids and take ibuprofen or acetaminophen as advised by your doctor. The "warning" that is going around that ibuprofen can make Covid-19 worse or be deadly is a hoax. There is no empirical data to support such a claim. Here is what the Harvard School of Medicine has to say on the matter:

And the WHO posted this to their Twitter feed: https://twitter.com/WHO/status/1240409217997189128