The COVID-19 Coronavirus Hotsheet

General Information

This page was created to help you survive the COVID-19 crisis.

I wanted to create a place where I could provide you with factual scientific-based information and provide links to that reference material.  I have provided links to medical studies where possible.  I have also provided links to news stories as it relates to people that have been affected by COVID-19

I am going to dispel the “fog of war” that is surrounding this disease.

Here are some important things to understand when looking at information in articles, news reports and on the web…

SARS-CoV-2 is the virus that causes the disease COVID-19.

Be careful not to confuse the SARS-CoV-2 virus with the SARS-CoV  virus that caused the SARS pandemic of 2002-2003.  They are genetically similar but different coronaviruses.

SARS-CoV-2 is not the flu.  Correct anyone that says that. They are minimizing the danger of this virus.

It causes a disease with different symptoms, spreads and kills more readily, and belongs to a completely different family of viruses. This family, the coronaviruses, includes just six other members that infect humans. Four of them—OC43, HKU1, NL63, and 229E—have been gently annoying humans for more than a century, causing a third of common colds. The other two—MERS and SARS (or “SARS-classic,” as some virologists have started calling it)—both cause far more severe disease.

The Most Important Principle In Epidemiology: The Precautionary Principle

After the infection and death of health care workers (HCWs) during the SARS outbreak in 2002-2003, the province of Ontario, Canada established a commission to look at what happened.  They looked for lessons to be learned.

One of the lessons learned was that “The Precautionary Principle” must be heeded when dealing with something with a novel (new) virus.

In its final report, Commissioner Justice Archie Campbell wrote that: “We cannot wait for scientific certainty before we take reasonable steps to reduce risk”.

Because we’re dealing with a novel virus (“novel virus” refers to a virus not seen before), the precautionary principle is key to defeating COVID-19.  We cannot wait for the scientific community to conduct studies and research — before making a decision.

  • We don’t know if the virus is transitted through an aerosol (airborne). But it has been detected and is able to survive in the air for three hours. So using the precautionary principle, assume it is.
  • We don’t know if the virus can be transmitted by asymptomatic persons. So using the precautionary principle, assume it can be transmitted by asymptomatic people.
  • We don’t know how long a person sheds coronavirus after infection.  The longest documented case so far is 37 days.  Using the precautionary principle, assume an infected person is able to shed virus significant longer than 37 days.
  • We don’t know how long the virus shed by an infected person is contagious. So using the precautionary principle, assume any amount of shed virus is contagious.

These are just a few examples of how the precautionary principle is applicable to the COVID-19 pandemic, in the absence of scientific certainty.

The precautionary principle is the same reason that military units going into a suspected contaminated area, wear their full protective equipment until testing and scientific evidence shows that the area is safe for a lesser level of protection.

What Are The Effects Of The Virus On Victims

Sepsis was the most frequently observed complication, followed by respiratory failure, Acute Respiratory Distress Syndrome, heart failure, and septic shock. Half of non-survivors experienced a secondary infection, and ventilator-associated pneumonia occurred in ten (31%) of 32 patients requiring invasive mechanical ventilation.

SOURCE:  The Lancet: “Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study” Published: March 11, 2020

Incubation period

The American College of Physicians said 97.5% of people infected with the new coronavirus will show symptoms within 12 days of catching the virus.  The median incubation time is five (5) days.

Asymptomatic Infection and Spread of SARS-CoV-2

There are medical studies documenting asymptomatic infection in people.  In other words, they display no symptoms but test positive for presence of the virus.  And according to medical studies asymptomatic people are contagious.

According to the CDC, 392 of the 705 positive coronavirus cases on the Diamond Princess cruise ship were asymptomatic.

Because of the lack of widespread testing in western countries like the United States, Canada, Australia and the UK — it is still unknown how many asymptomatic individuals are spreading the virus.

Therefore, use the precautionary principle and assume asymptomatic infection is widespread and are capable of infecting others.

There is an unconfirmed news report coming from China…

The number of “silent carriers” – people who are infected by the new coronavirus, but show delayed or no symptoms – could be as high as one-third of those who test positive, according to classified Chinese government data seen by the South China Morning Post.

Viral Shedding As Long As 37 Days

So once you are sick, how long can you shed the SARS-CoV-2 virus? According to this Chinese medical study in The Lancet (one of the most prestigious peer-reviewed medical journals in the world)…

Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.

A 14 Days Quarantine Is Insufficient To Stop or Slow The Spread

In research published Monday online in the academic medical journal Annals of Internal Medicine, the scientists calculated that the median incubation period of the virus is 5.1 days. All told, about 97.5% of those who develop symptoms will do so within 11.5 days of exposure, the scientists said.

Even so, they cautioned that, as a matter of statistical probability, the 14-day monitoring and quarantine period likely would miss some cases. By their calculations, they estimated that for every 10,000 people quarantined for 14 days, slightly more than 100 or so would develop symptoms only after being released from isolation.

[SOURCE: Wall Street Journal – “Coronavirus Symptoms Start About Five Days After Infection, New Research Finds” ]

That means a 14-day quarantine is insufficient to atop the spread of COVID-19.  Because within 20 days, those 100 “squirters” that escaped detection in quarantine would have reinfected another 10,000 people.

Routes Of Transmission

A sneeze can travel 23-27 feet!

Respiratory Droplet

According to the US CDC…

The virus is thought to spread mainly from person-to-person, who are in close contact with one another (within about 6 feet). The SARS-CoV-2 virus spreads through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

MIT mathematical epidemiologist Lydia BOUROUIBA, PhD has proven in fluid dynamics experiments that the 2 meters (6 foot) social distancing ‘rule of thumb’ is not enough.  A sneeze can easily travel 7-8 meters (23 to 27 feet) and droplet nuclei (aerosols) can stay airborne for hours!

Fecal Transmission

As I pointed out in a previous blog post, aerosol transmission through feces occurred during the SARS outbreak of 2002 and was suspected in a Hong Kong COVID-19 outbreak.

Singapore has done an outstanding job in identifying, contact tracing and containing their COVID-19 outbreaks.  They have also done outstanding in researching the SARS-CoV-2 virus.  During their research published in the Journal of The American Medical Association doctors identified viral shedding likely due to fecal transmission…

There was extensive environmental contamination by 1 SARS-CoV-2 patient with mild upper respiratory tract involvement. Toilet bowl and sink samples were positive, suggesting that viral shedding in stool could be a potential route of transmission. Post cleaning samples were negative, suggesting that current decontamination measures are sufficient.

There are also medical studies that document SARS-CoV-2 near the toilets in a Chinese hospital

Room ventilation, open space, proper use and disinfection of toilet can effectively limit aerosol transmission of SARS-CoV-2. Gathering of crowds with asymptomatic carriers is a potential source of airborne SARS-CoV-2. The virus aerosol deposition on protective apparel or floor surface and their subsequent resuspension is a potential transmission pathway and effective sanitization is critical in minimizing aerosol transmission of SARS-CoV-2.

These scientific findings means strict attention should be paid disinfecting floors (especially bathroom floors) and toilets.  It also means that the clothes you wear while cleaning (or caring for a sick family member) should be removed when done, and immediately washed.  It also means immediately removing clothing when you return home after being outside your house and washing it.  Any virus on contaminated clothes can become resuspended (airborne) and infect people.

We do not know how significant fecal transmission is overall.  Most scientists, doctors and health officials are guessing that it is a less important transmission route than droplet.

Fomite Transmission

Fomites are objects or materials which are likely to carry infection, such as clothes, utensils, and furniture.  The US CDC says…

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

However fomite (and airborne) transmission is entirely plausible according to a recent medical study in the New England Journal of Medicine, looking at the survivability of SARS-CoV-2 on various surfaces and in the air…

Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events.

So how long can SARS-CoV-2 survive on a surface?

According to the CDC: it survived for 17 days inside the Diamond Princess cruise ship.  It is not known if the amount of discovered virus could infect someone, but using the precautionary principle assume it can until scientifically proven otherwise.

Airborne Transmission

Listen to this admission my Dr. Anthony FAUCI is an American immunologist who serves as director of the National Institute of Allergy and Infectious Diseases (NIAID).  This is what he says about airborne transmission:

In a recent article on Live Science, a reporter brought up a key point.  Just because there is evidence that live SARS-CoV-2 virus can be airborne for 3 hours, doesn’t mean that it is transmissible…

We still don’t know how high a concentration of viable SARS-CoV-2 is needed in practice to infect a human being, though this is something we are looking to model in the future,” co-author Dylan Morris, a graduate student in the Department of Ecology and Evolutionary Biology at Princeton University, told Live Science in an email.

The finding that SARS-CoV-2 survives for 3 hours in the air is pretty significant given that SARS-CoV-2 seems to be far more contagious than SARS and MERS — both of which are proven to be transmissible as an aerosol.  It is important to note that the survivability of SARS-CoV-2 in the air is in line with the Dr. Lydia BOUROUIBA’s recent article saying that a sneeze can stay airborne for hours.

How Contagious Is SARS-CoV-2?

The term that epidemiologists use is “R0”.  It is pronounced “R naught.”

It’s a mathematical term that indicates how contagious an infectious disease is. It’s also referred to as the reproduction number – and it tells you the average number of people who will catch a disease from one contagious person.

It specifically applies to a population of people who were previously free of infection and haven’t been vaccinated. If a disease has an R0 of 18, one infected person will infect an average of 18 other people.  If a disease like influenza has an R0 of 1 — one person will pass it on to one other person.

The R0 of SARS-CoV-2 is estimated to be 2.2 — however with the lack of testing and asymptomatic spread, the R0 number is likely to be far higher.

Death Rate

Researchers from China’s Center for Disease Control and Prevention today describe the clinical findings on more than 72,000 COVID-19 cases reported in mainland China, which reveal a case-fatality rate (CFR) of 2.3%.

However, that number is ridiculously low given the videos of overwhelmed hospitals and morgues.

According to the most accurate stats we have… of the cases that have an outcome the death rate is a whopping 17%.

A case is resolved in only one of two ways… the person lives (recovers) or dies.

How Long Is A Person Contagious?

Duration of viral shedding ranged between 8 and 37 days. The median duration of viral shedding was 20 days in survivors, but continued until death in fatal cases.  Researchers have found that the more severe the case — the more virus is shed from the victim.

A recent German study suggests that people who are only mildly sick, are not infectious about 10 days after they start to experience symptoms.  People that had mild symptoms still shed virus beyond the 10 days period, but it is not viable. Researchers were unable to grow the SARS-CoV-2 virus in a lab from collected samples after the 10 day period.

So how long should you isolate?  The latest research suggests for at least 10 days after your symptoms first appear — or two days after all of your symptoms are gone.  Whichever is longer.

Symptoms

Acute Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. Among those who survive, a decreased quality of life is relatively common.  There is often permanent damage to the lungs.

Hospitals Will Likely Be Overwhelmed

Initial data from Italy have shown that 9–11% of actively infected patients with COVID-19 required intensive care.

So the number of beds, ventilators, doctors and nurses are critical.

Canada which is still muddling its way through its pandemic response appears to be particularity vulnerable — based on this news article…

Canada has 1.95 acute care hospital beds per 1,000 people, fewer than any other OECD country but Mexico. (Italy, which has been overwhelmed by this coronavirus, has 34 percent more beds per capita than we do: 2.62 per 1,000 people.) Nationwide, the occupancy rate for Canada’s hospital beds is over 90 percent. (To put that number into perspective, the occupancy rate for US hospital beds is 64 percent.) Canada’s bed numbers and occupancy rates together imply that the “spare capacity” in our health care system is, at best, around 2 acute care beds per 10,000 people. If even a small fraction of Canadians contract COVID-19, and a non-trivial portion of those require hospitalization, our system will be overwhelmed.

Virus Persistence On Inanimate Objects

When talking about SARS-CoV-2 persistence on inanimate objects, it is important to remember just because virus can be detected on an object does not mean the virus is viable and is able to replicate in the human body.

A recent study completed by UCLA, Princeton University and the National Institutes of Health revealed how long SARS-CoV-2 was able to survive in the environment and on various surfaces…

  • aerosols up to 3 hours post aerosolization.
  • Copper surface 4 hours
  • Cardboard 24 hours
  • Plastic 2-3 days
  • Stainless Steel 2-3 days
  • Polypropylene plastic 3 days

Children

If there is one saving grace in this virus it is that it doesn’t seem to attack children.  There are a few cases but it is rare.

While there is no concrete evidence yet, it seems that ibuprofen may make COVID-19 worse for kids, so use Tylenol as a fever reducer instead.

Cleaning and Disinfection

If you can’t find the listed products here are two methods:

  1. HOUSEHOLD BLEACH (5.5% sodium hypochlorite): The CDC recommends using a 5% bleach solution (1/3 cup of bleach to 1 gallon of water) to clean surfaces. Canada Health recommends a 10% diluted bleach solution (1 part regular household bleach to 9 parts water). Why the difference between 5% and 10% solutions?  Canada just wants to eliminate the math and make it brain-dead easy for lumberjacks and mounties. 🙂
  2. DRY CALCIUM HYPOCHLORITE  ‘High Test Hypochlorite’ (HTH) also called ‘pool shock’ is used to disinfect swimming pools, and can be found in stores like Home Depot and Walmart.  It should say 65% calcium hypochlorite on the label.  A 5% HTH solution is used by the US military to decontaminate equipment. To make a 5% solution use 1/2 cup of HTH granules and 1 gallon of water. [SOURCE: SANITARY CONTROL AND SURVEILLANCE OF FIELD WATER SUPPLIES – Technical Bulletin Med 577 – Table 10–5; PAGE 70]

Testing For Covid-19

There are a lot of people dead-set on getting tested, even if they have mild symptoms.

Don’t waste time and limited resources.  There is a severe shortage of the chemical needed for testing.

Plain and simple: if you have symptoms quarantine yourself.  Treat any illness as if you do have COVID-19 and isolate yourself from others immediately.  Then contact your primary doctor over the phone for instructions.

Generally, there is no need to go to the hospital unless you have problems breathing or chest pains — in which case you call 9-1-1.

Going to a hospital for mild symptoms can do two things:

  1. Infect health care workers (HCWs) that are desperately needed right now.
  2. Make your mild illness worse!  The less virus (viral load) you take in, the more likely you are to survive.

As of right now, testing should be reserved for serious cases.  If you need to be admitted to the hospital for breathing problems, then testing is crucial because HCWs need to know when to put you on a ventilator.  The earlier they do it, the more likely you are to survive and the faster you will recover.

If the lab workers doing tests are overwhelmed by needless testing — then they won’t be able to help YOU when testing is critical.

Please be clear, that there should be widespread testing in order to suppress this pandemic.  However governments and the WHO failed, and we are beyond that now.  Now the goal is to protect the lives of our healthcare workers – so they can save the lives of people with serious complications.

So What About False Negatives In Testing?

There are a multitude of problems around COVID-19 testing.  There are reports around the world of false negatives – even a few reports of 5 to 6 false negatives.

According to this FDA fact sheet for health care workers…

When diagnostic testing is negative, the possibility of a false negative result should be considered in the context of a patient’s recent exposures and the presence of clinical signs and symptoms consistent with COVID-19. The possibility of a false negative result should especially be considered if the patient’s recent exposures or clinical presentation indicate that COVID-19 is likely, and diagnostic tests for other causes of illness (e.g., other respiratory illness) are negative. If COVID-19 is still suspected based on exposure history together with other clinical findings, re-testing should be considered by healthcare providers in consultation with public health authorities.

Re-Infection Might Be Possible

There are numerous reports in China, South Korea and Japan of recovered patients testing positive for SARS-CoV-2 in tests long after recovery.  It is unknown why.

Was the “re-infection” the result of false negative tests? Is the virus capable of laying dormant in the body like herpes?  Is a “re-infected” person contagious again?

The common cold virus reinfects people.  Maybe SARS-CoV-2 does too.  We just don’t know enough about the virus at this point.

Long-Term Lung Damage

Some patients who have recovered from the coronavirus have been left with a reduced lung capacity – and left gasping for air when walking briskly, according to many reports.  This is especially true of young people that are infected.  It is unknown if this damage is permanent — although it is suspected.

At Home Treatment of COVID-19

Known Risk Factors

If you have one of the risk factors below, I would not be going out into public without an N95 respirator. And even then it could be a dangerous endeavor.

  • Hypertension
  • Diabetes
  • Obesity

How To Protect Yourself

Wear A Mask!

The best way to stop the spread of the SARS-CoV-2 virus is to wear a respirator and eye-protection.  Just like a concealed carry pistol — you ALWAYS wear the mask.  It doesn’t matter how small of an errand you are doing outside of your house.  If you fail to wear protection and someone accidentally (or on purpose) coughs on you – it may be a death sentence.

I know that will sound dramatic to some people, and that is fine.

The CDC does not recommend you use a mask — because hospitals and the government failed to stockpile enough for healthcare workers. Their failure to prepare is not YOUR problem. If you have a mask wear it!

Social Distancing (23 to 27 feet!)

While the current advice for social distancing is 6 feet or 2 meters — that is wholly insufficient according to MIT researchers.  According to research the gas cloud and its payload of pathogen-bearing droplets of all sizes can travel 23 to 27 feet (7-8 m)!

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