Written and Edited by Albert Chmielewski, MD
The novel coronavirus or COVID-19 has made an unquestionable impact on the world. Globally, countries are canceling schools, restricting the hours or closing bars, restaurants, and un-essential stores, while requiring social distancing and recommending that their residents stay home as much as possible. In this article both the terms coronavirus and COVID-19 will be used interchangeably however they are meant to indicate the same virus causing this unprecedented pandemic.
COVID-19 has had a severe impact on the world’s medical care system. The disease is highly infectious via close contact due to respiratory droplets and remains alive on many surfaces for up to 48-72 hours; which means that touching items like door knobs, car keys, household items, personal items like wallets or credit cards, even mail, can result in contagion.
Please see a very informative article from the National Institute of Health for more information in regards to the length of survival of the coronavirus on various surfaces. Below Dr. Albert Chmielewski explains the impact that COVID-19 has had on the global health care system and what the average person can do to help to slow the spread of this dangerous disease.
Origins of COVID-19
The disease was first detected in Wuhan, Hubei Province, China in December 2019. It is thought to be a zoonotic disease, spread initially from animals to humans. Since it is a new mutation of the coronavirus, people do not have any preexisting immunity to this disease.
The virus began to spread quickly in Wuhan. Hospitals were quickly overwhelmed by patients presenting with high fevers, cough, and difficulty breathing. The disease may lead to pneumonia, especially in the vulnerable population of elderly patients or patients with co-morbidities (other underlying medical conditions) which make them more susceptible to infectious disease, particularly viral lung disease. In the most severe cases severe respiratory distress occurs and patients need to be placed on a ventilator machine to assist with breathing.
The Chinese government began a system of containment that initially seemed controversial at the time. The government required that all residents stay home whenever possible, except for essential trips outside of their home; for example going to the doctor, a pharmacy, or to the grocer to shop for food and other personal necessities. They required that people who were experiencing symptoms (such as fever, cough, shortness of breath, chest pain) be tested, and if positive, quarantined and isolated either at home or the hospital.
Patients who tested positive for the COVID-19 virus immediately overwhelmed the health care system in Wuhan. The exponential rate of infection was an insurmountable burden initially. The Chinese government built new hospitals for patients afflicted with the coronavirus. Still, thousands of people who were affected succumbed to the virus; shopkeepers, bankers, grocers, and even farmers were affected, including many medical professionals directly involved with patient care.
At the time, most of the world believed that the undertaken measures were draconian and severe, but as the true scope and danger of the disease quickly became apparent, the Chinese containment methods were seen as reasonable and wise. In about two weeks after the measures were introduced, China started to see the results as the number of new cases started to drop. Ultimately, these methods were quickly, but in some cases only partially, emulated and instated by other countries affected by the virus to try to contain the insurmountable and inevitable pandemic.
The disease soon started to quickly spread to other counties like Iran, South Korea, and Italy. These three countries represented the largest mortality and infection rate from the disease early on. Other countries around the globe, such as France, Germany, Spain, Japan, the United States, Switzerland, the United Kingdom, Australia, Canada, among countless others, were at the time also starting to show cases of COVID-19 infection, albeit at a much lower rate. The WHO declared a public health emergency in late January of 2020 and characterized it as a pandemic in March of 2020. Many countries are now fighting uncontrollable outbreaks of their own. Below is a link to the most current CDC COVID-19 situation report.
Of note, another key factor which was elemental to the disease’s spread was cruise ships. People who had been to mainland China boarded cruise ships and, while traveling abroad, spread the disease worldwide. Several cruise ships were held in port or left at sea, being denied entry, as personnel on land struggled to deal with the influx of cases from all modes of travel; including boat, aircraft, train, and automobile. Many doctors were critical of the way these cruise ship cases were handled. Rather than taking people off the cruise ships and containing the virus, the disease spread among passengers who were confined to the ship. For example, The Diamond Princess, which was held in Yokohama, Japan for an extended period of time, was associated with 621 cases of the coronavirus, or approximately 20 percent of the 3,011 passengers and crew who were tested for the disease. Clearly, quarantining people with the disease in close proximity of each other was a grave failure in containing the spread of the coronavirus.
The estimated worldwide coronavirus infection rate was at 100,000 around March 7th, 2020, 10 days later it was doubled, and it only took 4 more days thereafter to double again, with most recent estimates ranging from 690,000 to 760,000 cases worldwide (this includes infected, recovered, and fatal cases). As of 3/30/2020, the CDC reported 693,224 total COVID-19 cases worldwide. The only continent at this time that has been spared from the coronavirus infection is Antarctica. Clearly this is a pandemic like we have not seen in decades and must: as a collective whole, make swift and responsible decisions to help plateau, and ultimately, decrease and stifle the rate of infection.
Overwhelming Health Care Systems
As the virus spread at an alarming rate, many health care systems were overburdened. One prime example is Italy, where COVID-19 cases quickly overwhelmed the health care system. There were not enough hospital beds, equipment, or enough medical personnel to treat the huge number of cases in the northern part of Italy known as Lombardy, and things only progresses from there. Regions in Italy like Piedmont, Emilia-Romagna, and Veneto, also quickly became under significant medical pressure to contain the virus, and like Lombardy, were ill-equipped to do so.
Currently, in Italy, doctors have been forced to triage patients and set guidelines for who does, and who does not, receive intensive care (such as ventilation), in essence, reserving the highest level of care only for patients that were the most likely to survive. This frightening situation caused the rest of the world to take notice of the severe impact COVID-19 would make on the global health care system. Several studies of the cases in Asia suggest that while the COVID-19 mortality rate seems to be about 1%, it can grow as much as to 4% or even 5% in areas were the healthcare systems gets overwhelmed.
Spread to the United States
On January 20th at 11pm, emerged the first officially diagnosed case of COVID-19 in Seattle, Washington. “Patient Zero,” as he is known, is a 35-year-old man who traveled to Wuhan to visit family. This patient spread the disease to the general population despite efforts to contain it. The quick spread to other people was likely due to the fact that many patients infected have mild disease like runny nose, malaise, sore throat, and headache. Others have different mild or moderate symptoms before they develop serious symptoms like fever, shortness of breath, chest pain/pressure, or confusion and do not go see the doctor until these more serious symptoms appear.
Some patient may never show symptoms at all despite carrying the coronavirus. Therefore it is hypothesized that an infected individual can potentially infect others without taking the necessary precautions due to believing they have the common cold or something similar, and not the coronavirus. Since then, COVID-19 has spread to every state in the US. To help portray the quick spread of this virus in the US, on 3/09/2020 there were only 2,234 cases reported, just 10 days later, the CDC reported 44,183 cases in the US and 544 deaths, that is a 20 fold increase in positive coronavirus cases in a very short period of time.
Below are some high quality sources of information to follow the world wide spread of the COVID-19 virus, as well as excellent general information about the virus itself:
Impact on the Health Care System in the US
COVID-19 has been making a serious impact on the nation’s health care system, and things are getting progressively worse, on 3/26/2020, it was estimated that there are anywhere from 64,000 to 82,000 cases of COVID-19 in the US, with states like New York, California, New Jersey, Washington, and Michigan being seriously affected. New York alone is believed to have almost half of the cases of coronavirus in the US. Multiple temporary hospitals are being erected in states with the highest rate of infection to help combat the spread of the virus.
Recently, the US has become a country with the largest number of diagnosed cases of coronavirus, passing Italy and China, as reported by the New York Times. Most states now require that patients do not to go into doctor’s offices unless they have serious suspicions that they may have the virus in order to prevent the unintentional spread to others, especially if they have mild symptoms which potentially might never develop into a critical condition. The incubation period of the COVID-19 virus is thought to be approximately 5 days, but the range is 2-14 days, and people affected by the virus can potentially spread it prior to showing symptoms, making containment even more difficult. Making matters worse, personal protective equipment (PPE) is in short supply, meaning medical masks, face shields, gowns, and gloves, as well as disinfectants which help mitigate transmission of the virus, are in short supply.
Therefore it is imperative that we practice social distancing, appropriate hand hygiene, and follow local government regulations instated in your area, if we do not, it is likely that cases will continue to quickly spread between members of the general public. Many states have ordered shutdowns of schools, bars and restaurants, which is intended to delay and contain the spread of the virus so that health care systems would not be completely overwhelmed like others have been in Wuhan and in countries such as Italy, Spain, or Iran, resulting in much higher fatality rates.
What can you do to help the spread of the COVID-19 Virus
Protect yourself and others by following everyday preventive measures:
- Avoid close contact with people whether they are sick or not (remember that in early stages people with no symptoms can be already infecting others) staying at least six feet away from other people.
- Stay at home as much as possible and practice social distancing. Cancel events and avoid groups, gatherings, and nonessential appointments. Most states in the US now have specific guidance on mass gatherings, whether public or social.
- Stay home when you are sick, except to get medical care if you think you are getting progressively more ill.
- Avoid touching your eyes, nose, and mouth. Wash your hands regularly for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
- Cover your mouth and nose with a tissue or article of clothing when you cough or sneeze or use the inside of your elbow.
- Clean surfaces and objects daily, especially those that are touched frequently. See the CDC’s recommendations for household cleaning and disinfection on their webpage.
Another good source of information about protecting yourself, your family, and others during this time of crisis can be found on the Wisconsin Department of Health Services website.
Stay Safe and Stay Healthy
In today’s coronavirus pandemic, health care workers like Dr. Albert Chmielewski are on the front lines. Many of these workers are exposed to the virus daily, many have gotten sick, and some have actually died. Dr. Chmielewski would like to remind members of the public that they should always follow the principles of social distancing and self-isolation, especially if they are told to do so by local authorities.
An excellent article that illustrates the importance of social distancing can be found here, Chart 7 in particular shows the positive impact of China’s isolation and lockdown of virus hot spots on decreasing the number of new cases of COVID-19.
I am providing a link for US residents which serves as an excellent source of local guidelines to follow, as well as news and recommendations state by state.
Written and Edited by Albert Chmielewski, MD
I am in no way affiliated or sponsored by the websites which are linked or cited above.