Managing Personal Risk by Understanding the Threat
One of the most fascinating conversations during our recent Live Long & Flourish (LL&F Club) event at Stanford University last week was on Coronavirus. Dr. Gary Schoolnik, a Stanford Professor emeritus of infectious disease (who’s working recently on the rapid development of diagnostic tools and antivirals for the threatening Coronavirus and following the topic closely with his colleagues at Fudan University and with the Shanghai CDC) shared insights about the virus, its trajectory, and the magnitude of its threat. With a very engaged group of Club members we also discussed a bunch of science backed Healthy Hacks⁺ that can help members and people everywhere avoid the Coronavirus. To shed some light on the global view of the threat, Dr. David Katzenstein, another Stanford Professor emeritus of infectious disease, joined our conversation by video from Zimbabwe, and Dr. Ziad Khatib, an Epidemiologist and Associate Professor of global health at the Karolinska Institute, joined from Vienna.
Dr. Schoolnik started his presentation by telling us that the new Coronavirus (2019-nCoV) likely originated from bats and that the first human infections can be traced to the exotic animal market in Wuhan.
Researchers are testing the assertion that there was another animal host that the bats infected that transmitted the virus to humans (likely the Pangolin). Once people are infected (now mostly by other people), Coronavirus typically manifests in a runny nose, headache, cough, sore throat, and fever. Dr. Schoolnik shared with us that in average, for every 100 people who are infected, about 80 of them experience mild respiratory infections, 15 of them are sick enough to be hospitalized and 5 of them need to be admitted to the ICU. If you’re curious to learn more, here’s what Coronavirus does to the body.
According to an Online tracker by John Hopkins CSSE (data compiled from WHO, CDC, ECDC, NHC and DXY) the number of people infected with the 2019 novel Coronavirus (2019-nCoV) is more than 71,902. The death toll is more than 1,775, and the number of patients who recovered is now more than 11,396 (as of 02/15/2020). Interestingly, a modeling study published in The Lancet on February 3rd estimated that up to 75,800 individuals in the Chinese city of Wuhan alone may have been infected as early as January 25th. Dr. Schoolnik explained that based on data from previous epidemics, for every one documented case there are approximately 10 undocumented cases, therefore the actual number of people carrying the Coronavirus in China right now is likely to be around half a million people.
We also learned that (non-surprisingly), the Coronavirus is spreading, how shall we say… virally… The spread of the virus is quite rapid: every individual infected infects on average ~2.5 other individuals (which is a much higher rate than the spread of influenza for example, where the infection rate is only ~1.1.)
A precise estimate of the fatality rate is very hard to calculate at present. However, according to the available data, the worldwide fatality rate of Coronavirus ranges between 2% (according to the WHO) and 15%. Even according to the more aggressive approach, the fatality rate outside of Mainland China is only 3.5%. The first fatality from the coronavirus in Europe was recently reported in France and the first case of an infected individual in Africa was reported in Egypt.
To put things in perspective here are some numbers from previous epidemics:
What’s Really Done to Tackle the Spread?
According to Dr. Schoolnik it seems that the Chinese authorities are doing a lot of work and investing heavily in the containment of the disease. In addition, LL&F Club members agreed that it would be good to have all the best experts/expertise, regardless of country of their origin, come together to find the best solutions. Global collaboration on the ground close to where the epicenter of the epidemic is, as well as remote collaboration, will help China and the world stop the spreading faster.
Also, it was clear in the conversation that there’s a dire need for more rapid and more accurate diagnosis of the disease, as well as the development of new curative and preventive solutions. Dr. Schoolnik told us that Gilead Pharmaceuticals has developed two compounds that can help fight HIV and may be repurposed to battle Coronavirus as well. Johnson & Johnson is also conducting a major effort to create a vaccine (and so is Moderna and another dozen smaller pharmaceutical and biotech companies who have engaged in a similar effort since January.) J&J expects this process will more closely resemble its response to the Zika virus, which took one year between initiation and beginning human trials, than its response to Ebola, which took six months.
Dr. David Katzenstein, who joined our LL&F Club event by video livestream from Zimbabwe shared with us that the scientific and medical communities are very concerned about the potential spread of Coronavirus into Africa and to India. Dr. Katzenstein mentioned a press conference last week where the WHO declared the 2019-nCoV as a global health emergency. The WHO cited not only what’s happening in China, but also it’s serious concern that the virus is spreading to countries with ill-prepared, “weak” health systems.
It might be controversial, but it appears that the heavy-handed Chinese response has somewhat limited the spread of the disease. In contrast, at that aforementioned press conference, the WHO expressed its concern of the disease spreading to countries like India and Africa, which are quite unprepared to contain a potential spread. This concern has certainly contributed to the WHO’s decision to declare them as A Public Health Emergency of International Concern (PHEIC)
What Can I/You/We Do?
In the vibrant conversation we had during the event at Stanford after the experts shared their opinions many LL&F Club members were interested to know what can be done on an individual level to try and avoid the Coronavirus. Dr. Schoolnik had addressed some of it in the conversation when he shared a few Healthy Hacks+ including the importance of disinfecting surfaces that multiple people touch (Healthy Hack+ #1), and regular (thorough) handwashing, and not merely using disinfectant gels like Purel etc. (Healthy Hack+ #2.) Apparently, there’s some debate about the efficacy of hand sanitizers, which fits well with our LL&F culture, and caused us to park this topic for now and revisit it in one of our upcoming events.
The World Health Organization (WHO) also recommends a few important Healthy Hacks⁺ everyone should consider in preventing the spread of Coronavirus and other viral epidemics:
- Covering mouth and nose when coughing and sneezing (Healthy Hacks⁺ #3)
- Thoroughly cooking meat and eggs (Healthy Hack⁺ #4)
- Avoiding close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing” (Healthy Hack⁺ #5)
Dr. Ziad Khatib who joined our video livestream from Vienna mentioned that an early cluster of Coronavirus infection in Europe (Germany) was apparently transmitted by a Chinese traveler from Shanghai who flew in from the Mainland for a meeting and appeared to be asymptomatic (but it was clarified later that she actually was symptomatic, and the researchers had not spoken to her. However they did eventually send a clarification message to the New England Journal of Medicine (NEJM) to correct this information.)
Although there isn’t yet scientific evidence that asymptomatic people can transmit the Coronavirus (just like they can in the case of the flu) many experts, including Dr. Schoolnick, say it’s very likely the case.
Given all of that, and the fact that Risk Management is an important Pillar of the LL&F Club, it’s worth taking a more in-depth look into additional scientifically proven Healthy Hacks⁺ that we’re happy to share with you here:
To explain further Healthy Hack⁺ #2, it’s recommended to wash hands for at least 20 seconds in order to fully rid your skin of germs (it’s also quite fun to discover the science behind washing hands published here by the CDC.) In addition, the CDC advises to avoid touching your eyes, nose and mouth with unwashed hands.
Can wearing a regular surgical mask protect from the Coronavirus? According to Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University in Tennessee the answer is “no”! And he’s not the only one thinking that way. However, the more robust N95 respirator may be more effective in protecting against Coronavirus (Healthy Hack⁺ #6.) But here are two things to remember:
- It is very challenging to wear face masks for long periods of time, and may impose its own health risks!
- Health care specialists go through annual training on how to properly fit the N95 respirator around the nose, cheeks, and chin to ensure wearers don’t breathe around the edges.
And a quick backpedal to the plain surgical masks — they actually CAN protect against the common flu (influenza virus.) According to the CDC, between October 1 2019 to February 1 2020 there have been at least 12,000 flu deaths in the U.S, while there have been no deaths as a result of the coronavirus in the country. Therefore, simple math and common sense can make a case for protecting against flu by wearing a plain surgical mask where risk is higher.
Surface & Objects cleaning
Healthy Hack⁺ #5: clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. This is very easy to do, and during the conversation we had at the LL&F Club event members particularly recommended this tactic when flying in commercial airplanes and other forms of public transportation, in high turnover restaurants, and when using shopping carts.
Not all “hacks” are created equal, and we see our role at the LL&F Club as distilling the evidence based substance from the pile of unsubstantiated myth. We’re happy to share a few myth busters that the WHO published about the Coronavirus:
Is it safe to receive a letter or package from China?
Yes, it is. According to the experts who joined our LL&F event the Coronavirus can only survive on a surface outside of the body for a few hours.
Can pets spread the new Coronavirus?
We talked about this at the event as well: currently, there’s no evidence that pets (dogs/cats) can be infected. However, it is always a good idea to wash your hands with soap and water after contact with pets. This protects you against various common bacteria such as E.coli and Salmonella that can pass between pets and humans.
Can rinsing nose with saline help prevent infection?
Can gargling mouthwash protect from infection?
And, on a lighter note:
Can eating garlic / rubbing sesame oil on your body prevent infection?
It might make your body more flavorful, but the Coronavirus wouldn’t really mind that…
More resources for those who want to dive deeper
- The Lancet has put together a comprehensive Coronavirus Resource Centre “to assist health workers and researchers working under challenging conditions to bring this outbreak to a close.”
- A research paper published in Jama about the epidemiology and characteristics of the Coronavirus.
- A research paper published in the NEJM by Chinese researchers about the Novel Coronavirus from Patients with Pneumonia in China
- Real-time online tracker of the spread of the coronavirus by John Hopkins CSSE
- In-depth statistics by WorldOMeter on the number of infected people and the number of deaths
MORE ABOUT THE LIVE LONG & FLOURISH CLUB (LL&F)
The LL&F Club is an invite-only gathering of curious people discovering and trying the most effective and scientifically validated Healthy HACKS⁺, Motivating TRICKS* & Science MAPS^ that can help everyone flourish by living happier, healthier, and longer lives.
Like in the Homebrew Computer Club and in the Leather Apron Club, members of the LL&F Club convene regularly to learn, teach, get inspired, and have fun! Together, we’re creating a database of Healthy HACKS⁺, Motivating TRICKS* & Science MAPS^ we choose to try and validate, the ones that actually work, and for whom and when they work best. Feel free to read more about our values and our credo here and let us know if you’d like to join us in living life at its healthiest best!
Live Long & Flourish!