Infectious Disease Researcher’s Thoughts about COVID-19 Go Viral; Land on ANC

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Social epidemiologist Malia Jones’ Facebook post went viral, and has been shared more than 500,000 times.

I authored a version of the following document on Thursday, March 5, 2020. I didn’t write it in my professional capacity as an infectious disease researcher, but rather as a personal note to my friends and family about the emerging outbreak of the newly discovered coronavirus, SARS-CoV-2. I posted it publicly on Facebook, and it went viral—no pun intended. As of this writing it has over 50,000 shares. Please take my advice in that context: it expresses my personal opinions as an educated person working in an adjacent field of study.

I’ve lightly edited the original document, mostly to remove the swearing, for this publication.

What I think about COVID-19 this morning

March 5, 2020

Maybe I’m the closest thing you personally know to an infectious disease epidemiologist. Maybe not—I’m not an expert on this virus by any stretch, but I study epidemics, and I have general knowledge and training that is applicable, so here are my thoughts, for what they are worth.

First and foremost: we are going to see a tremendous increase in the number of U.S. cases of COVID-19 in the next week. This is not entirely because of some new pattern in the spread of the disease, but rather due to a major change in the requirements to be tested. Until yesterday, if you had flu-like illness but had not recently traveled to China, Italy, South Korea, or Iran, you could not be tested. This is just the way healthcare works, you get tested if you meet the case definition and the case definition included travel.

As of yesterday, you can be tested if you are sick and have a doctor’s order to be tested. So expect things to feel a lot more panicky all of a sudden. We will see hundreds or thousands of new cases as a result of testing increases.

Second: is that panic legitimate? Sort of. This is not the zombie apocalypse. The death rate of 30 deaths per 1000 cases is probably a wild overestimate. (The denominator is almost certainly wrong because it is confirmed cases–and we only confirm cases when we test for them). That said, even at 3 per 1000 cases, this would be a big deal. A very big deal. By way of comparison, the death rate for seasonal influenza is between 1 and 2 in 1000 cases. So, yeah. Roughly 0x to 30x worse than a bad flu year? That’s a problem.

Unlike flu, COVID-19 is not particularly dangerous for children, so that’s some happy news. It is dangerous for older adults and those with lung conditions, so we need to be extra careful to protect those populations from exposure.

Also, for millions of Americans, getting any serious illness requiring a hospitalization is a major problem because they can’t pay for it. And our health care system is probably going to struggle to keep up with it all. And with China basically closed, our global economy is going to take a huge hit and we’ll feel the shock waves for years. Those are real concerns.

What can we do? Our focus should be on *slowing down the spread* of this disease. We have a limited healthcare system and this disease is spreading very quickly right now. We need to slow it down so that we have time to deal with new cases within the capacity of our healthcare system. Here is my advice:

1. Wash. Your. Hands. Wash them so much.

The current best guess is that the new coronavirus is transmitted via close contact and surface contamination. COVID-19 can be transmitted by contact with contaminated surfaces.

I have started washing my hands each time I enter a new building and after being in shared spaces (classrooms especially), in addition to the standard practice of washing after using the bathroom and before eating. Soap and water. Hand sanitizer also kills this virus, as does rubbing alcohol (the main ingredient in hand sanitizer).

There is no need to be obsessive about this. Just wash your hands. A little bit more effort here goes a long way.

2. Don’t pick your nose. Or put your fingers in your mouth, on your lips, or in your eyes. Surface contact works like this: you touch something dirty. Maybe it’s an elevator button. Virus sticks to your hands. Then you rub your eye. Then you touch your sandwich, and put the sandwich in your mouth. Now there is virus in your eyes and mouth. See?

You may be thinking, but I don’t pick my nose because I am an adult! An observational study found that people sitting at a desk working touched their eyes, nose, or lips between 3 and 50 times per hour. Perfectly normal grown-ups, not lowlifes like my friends.

2a. There was one note that came out suggesting that face masks actually promote surface contamination because you’re always adjusting them–i.e., touching your face. I don’t know if that’s true. But face masks should not be worn by the healthy public right now, unless you are the person who is sick and you’re on your way to or actually at the doctor’s office. The mask’s function is to prevent spit from flying out of your mouth and landing on things when you cough or sneeze. It flies out of your mouth and is caught in the mask instead. If you are the person who is sick and not on the way to the doctor, go home. Let the people who really need them have the masks. Like doctors, nurses, and people who are sick.

[Edited to add on 3/6/2020: honestly people I am getting so much push back on the mask recommendation!! The world is running low on masks. If everyone wants a mask so they can feel OK about keeping their Daytona Beach Spring Break plans and then hospitals in India can’t buy them anymore, shame on us.]

Coronavirus does not appear to be airborne in the sense that it doesn’t remain floating around freely in the air for a long time, like measles does. You are probably not going to breathe it in, unless someone is coughing in front of you. If someone is coughing in your face, feel free to tell them to go home and immediately move 6 feet away from them. (Yeah I know, if you have a toddler, this is hard advice to follow.)

3. Sanitize the objects you and lots of other people touch, especially people outside your family–like door handles, shared keyboards at schools (brrr), salad bar tongs, etc. Best guesses are that the virus can live on surfaces for 2-48 hours, maybe even longer, depending on the surface, temperature, and humidity.

Many common household cleaning products will kill this virus. However, white vinegar solution does not. You can make your own inexpensive antimicrobial spray by mixing 1 part household bleach to 50 parts cold tap water. Spray this on surfaces and leave for 10-30 minutes. Note: this is bleach. It will ruin your sofa.

4. “Social distancing.” You’re going to get so sick of this phrase. This means keeping people apart from one another (preferably 6 feet apart, and sanitizing shared objects). This public health strategy is our next line of defense, and its implementation is what will lead to flights and events cancelled, borders closed, and schools closed.

For now, you could limit face-to-face meetings, especially large ones. Zoom is an excellent videoconferencing option. If you spend time in shared spaces, see #1. Ask your child’s school about their hygiene plan, if they haven’t already told you what it is. Keep your child home if they are sick. I am planning to email our school nurse right after this to ask if they need my volunteer help cleaning surfaces.

If you can telecommute, do that a little more. If you are someone’s boss and they could do their job remotely, encourage them to do that.

Avoid large gatherings of people if at all possible, especially if they are in an area with cases OR places that lots of people travel to. If you attend group events and start to feel even a little bit sick within 2 to 14 days, you need to self isolate immediately. Like for a tiny tickle in your throat.

5. All your travel plans are about to be disrupted. If you are considering booking flights right now, get refundable tickets. ETA: most trip insurance will not cover cancellations due to a pandemic. Look for “cancel for any reason” trip insurance.

Considerations for risks related to that trip you’re planning: how bad would it be if you got stuck where you are going for 3 to 6 weeks? How bad would it be to be isolated at home for 2-3 weeks upon your return? Do you have direct contact with people who are over 70 and/or have lung conditions? Are there cases in your area that you might be carrying to new places and groups of people?

6. If you are sick, stay home. Please! For the love of all that is holy. Stay at home. Your contributions to the world are really just not that important.

7. There is a good chance some communities will see school cancelled and asked to limit non-essential movement. If someone in your family gets sick your family will almost certainly be isolated for 2-3 weeks (asked to stay at home). You could start stocking up with essentials for that scenario, but don’t run out and buy a year’s worth of toilet paper. Again, not the apocalypse. 2 weeks’ worth of essential items. Refill any prescriptions, check your supply of coffee, kitty litter, and jigsaw puzzles.

8. I do want to remind everyone that when public health works, the result is the least newsworthy thing ever: nothing happens. If this all fizzles out and you start feeling like ‘Wah, all that fuss for nothing??’ Then send a thank-you note to your local department of public health for a job well done. They are working very, very hard right now. Fingers crossed for that outcome.

9. Look, I think there are some positives here. All this handwashing could stop flu season in its tracks! We have an opportunity to reduce our global carbon footprint by telecommuting more, flying less, and understanding where our stuff comes from. We can use this to think about the problems with our healthcare system. We can use this to reflect on our positions of privilege and implicit biases. We can start greeting each other using jazz hands. I’m genuinely excited about those opportunities.

There is a lot we don’t yet know about this virus. It didn’t even exist 90 days ago. So stay tuned, it is an evolving situation. The WHO website has a decent FAQ. Free to email or text with questions, and you can forward this to others if you think it’s useful.

May the force be with you.

Malia Jones, PhD, MPH

I’m a social epidemiologist and demographer by training. I have a master of public health and a doctorate in public health from UCLA Fielding School of Public Health. I work as an Assistant Scientist in Health Geography at the Applied Population Laboratory at the University of Wisconsin-Madison. I study spatial patterns of infectious disease and spatial patterns in other human activities.

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32 Responses

  1. Avatar bruce vojtecky says:

    Thank you for this informative article. I am seeing my primary care doctor on Thursday, monthly check up, and will be asking him about COVI as we have had cases here in Phoenix going on almost a month.

  2. Steve Towers Steve Towers says:

    My daughter—a midwife/nurse practitioner at the Kaiser hospital where California’s first positive test popped up—posted this on Facebook the other day. Being me, I immediately wanted to quibble with the mortality rates, but I held back. Truth is, we don’t know at this point—not enough test kits available to know. A nurse at that hospital got sick after being a front-line caregiver to the patient who tested positive for COVID-19. They quarantined the nurse for 14 days, but didn’t test her—not enough test kits. Thanks, Obama.

    She also posted an advice column from a UC San Francisco Medical School (her alma mater) mental health expert about coping with anxiety. It’s worth a read. It would suggest that I trust that there are still enough smart, well-meaning scientist-bureaucrats at the CDC that we’ll make the right decisions, and to not worry so much that a demented vulgarian orangutan put an anti-science Bible-thumping lickspittle in charge.

    https://www.ucsf.edu/news/2020/03/416836/feeling-anxiety-about-coronavirus-psychologist-offers-tips-stay-clearheaded

  3. Frank Treadway Frank Treadway says:

    Yes, it’s time for meditation to take over our frantic thoughts. Hold your breath for 5 seconds, do this 3 times, good for the mind, lungs & heart. Take walks out into the daylight, an evening walk, just keep yourself active, cardio, whatever. Watching the continuous news every single moment will drive you to live in a bubble. Of course take precautions, but stop the frantic insanity of…OMG ! Whatever will I do if I die ?! We’re dying from the moment we’re born, we have to accept this.
    Now, it’s also time for a Manhattan-Like Project for this current earth born virus, bringing together all the key scientists to get this virus under control. If we can make an Atom Bomb in a flash, then we better get on this or we’re gonna succumb to an economic downfall, while the virus fades into history.

    • Steve Towers Steve Towers says:

      “Meat’s just meat and it’s all born dying, some is tender and some is tough
      Somebody’s got to mop up the A.1., somebody’s got to mop up the blood.”
      —”Shit Shots Count” Drive-By Truckers

      We were supposed to attend the BNP Paribas Open tennis tournament in the Palm Springs area later this week, but they cancelled the tournament a couple days back. We still have our Airbnb rental down there, and maybe hiking in Joshua Tree National Park is a better option, for both maintaining social distance and keeping chill.

  4. Avatar Marilyn says:

    Best comment of the week, Frank. “Whatever will I do if I die” Wouldn’t it be great if we knew.

  5. Avatar Patrecia Barrett says:

    Everyone needs to read the Sacramento Bee article below about the dangerous practices of Redding’s Bethel Church. They have supposedly suspended their practice of invading hospital emergency rooms to engage in faith healing in response to the coronavirus threat, but please be aware of being approached by its followers on the street, who often target the elderly and infirm to “lay hands on”.

    Per this article Bethel has not decided to suspend its jam-packed services (with thousands of attendees from all over the world), which seems like an extremely fertile breeding ground for this disease.

    https://www.sacbee.com/entertainment/living/religion/article241044316.html

    • Steve Towers Steve Towers says:

      In Bethel’s defense, their actions to avoid COVID-19 are in many ways more rational than those of Chairman Phonychrister and his band of soulless flunkies in the White House.

  6. Avatar Candace says:

    I don’t know Patrecia, I’m no fan of Bethel Church but I find the fact that they have been and are continuing to be in close contact with the Public Health Dept. and are taking steps to curb some practices and cancel missionary trips to be reasonable. There of course is a concern with any large group of people being packed into one building but to be fair other churches here (albeit smaller congregations) have also not canceled their services. I think we need to be reasonable (have they traveled to their country of origin lately and which country and how did they travel? ) and careful about the “people from all over the world” thing as we’re already hearing about racist attacks happening on public transport, etc. in larger cities. Bethel is concerning regarding the potential spread of the virus due to it’s sheer size and it may turn out to be that it and other churches may have to rethink public services. I’m not religious but many are and church is a comfort so I’m sure stopping public services is concerning to them. Still…Covid-19. As far as the laying on of hands thing, as a rule I personally wouldn’t let any stranger lay their hands on me. The social distancing health experts are recommending makes sense. Take good care of yourself, Patrecia.

    • Avatar Patrecia Barrett says:

      Candace,

      Attacks on subways haven’t been happening to people from the predominantly white countries that make up much of Bethel’s following. They’ve been happening to people of color and non-Christians, in good part because of the violence-inciting politicians and politics that Bethel leaders scream in support of from their various pulpits on an almost daily basis.

      And perhaps you missed the part in the article above in which Bethel adherents have been laying hands on children and others without permission.

      Hopefully Bethel is more serious about efforts to contain this illness than their teachings that their followers can magically cure all kinds of diseases – and even raise the dead – would imply.

      • Avatar Candace says:

        Patrecia, As I previously mentioned, I’m no fan of Bethel and any racist attacks are concerning. I take no issue with you on that point and the cause thereof. I also don’t think anyone should be touching anyone without permission. My point was that I think Bethel’s being in contact with our Public Health Dept. while scaling back on missions, etc is a step in the right direction. Whether or not they have to/need to close their doors remains to be seen.

  7. Avatar Denise says:

    Last week I visited my doctor for a different reason and he spent most of his time telling me CoVID19 is being underplayed by the government. His message was very much the same as Malia’s. He also said there’s no running from it, soon it will be everywhere. At least half of us will get it; symptoms will vary from mild to severe.

    I am predisposed to anxiety so per my usual pattern, I’m fine all day as I go about my business. But at night certain aspects creep in. Of course, that my loved ones will be in some compromised situation and not get proper care, and so on.

    But what calms me is remembering the ER workers and others who are expected to show up to treat CoVID19 patients. How brave they may have to be every day.

    At this point I’d like to get my mild case going, over with toot sweet, then in my immune state, help those who will be compromised.

    Maybe sign up as a Candy Striper.

    • Steve Towers Steve Towers says:

      Learn how to do diaphragmatic breathing and thought-stopping. It works. It’s how I fall asleep at night when the voices of negativity in my head are fighting for attention.

      • Avatar Candace says:

        Steve, I do the count from 1 to 10 thing to use a different part of my brain to try and switch off the hamster wheel thought process. I started using that method after my mom died in order to shut out some truly awful visuals I experienced by her side towards the end of her life. Works most of the time. That and as you said, concentrating on breathing. Sadly I had to make the heart- breaking decision to put my pal of 12 years to sleep (Benny – Scottie – bone cancer) last week so I’ve been counting away, taking walks in my neighborhood and keeping in touch with frequent phone calls and texts with friends, family ( kids in Chicago and NY) on a daily basis. In fact we’re setting up a group “chat” so that all of us (more family in Redding, Seattle, Portland, Santa Cruz and Carmel-By-The-Sea) to help keep us all grounded by staying connected. I say, whatever works is whatever works.

  8. Avatar Richard Christoph says:

    Doni,

    Thank you for sharing this informative and timely post by Dr. Jones.

    • My pleasure. I was completely blown away when not only did Dr. Jones reply to my request for publication, but she asked if she could revise it a bit (mostly to remove swear words, which, imo, only made her article more delightful). She sent the new piece with her head shot, just for ANC readers, and here we are. I’m honored!

  9. Avatar Common Sense says:

    Excellent Article! I see where As of this week, the World Health Organization reported that the death rate for COVID-19 increased from roughly 2% to 3.4% and say it is more lethal than the flu, which kills tens of thousands of Americans each year?

  10. AJacoby AJacoby says:

    THANK YOU!! It was a rude, RUDE I tell you, awakening a couple of days ago when I finally realized (translate: admitted) that I am a member of that bullseye group! Old with a compromised health issues !!! YIIIKES!!!
    Maybe I’ll face that the way I used to face scary math tests. I’ll just go to sleep and then I won’t have to worry about it!!! But I’ll wash my hands first.

  11. Avatar Candace says:

    On a different (but related) note I just renewed my subscription to ANC along with a modest booster gift. If one is in a position to do so perhaps it will help support those such as R.V. having to make these hard decisions which affect their livelihoods. No one asked me to do so and if you aren’t in a position to do so then you aren’t; no judgement intended on my part whatsoever.

    • Awww, Candace, thank you. A “booster gift” is brilliant.

      You are smart to follow the dots and figure that R.V. will be stepping up his writing to help compensate for his job loss, and that means ANC will be paying him more.

      Much, much appreciated!

  12. Avatar Gracious Palmer says:

    Thank you, Malia Jones. May the force be with YOU!

  13. Avatar bruce vojtecky says:

    AZ Family news reports that there have been six cases of COVI in Arizona and they are waiting on results of 27 other tests. The people infected had come into contact, or have traveled, from infected areas mostly China. No deaths, so far, have been reported in Arizona.
    We faced the reality of COVI a month ago and there was a lot of immediate apprehension due to the lack of little information coming from officials, plenty of negative reaction on social media. Now that the state has been more forthcoming and the news media is actually getting answers to their questions the apprehension has changed to cautious watchfulness.
    Paying attention to the news should be, it is mine, first should be on everyone’s list.

  14. Avatar Candace says:

    Doni, happy to help when I can. That said I realize it can be a big ask for a lot of folks facing these uncertain times. I certainly appreciate you and the ANC contributors.

    • Candace, everyone at ANC is so grateful for the readers like who are able to help support this site with subscriptions, but we understand that many of our regulars would like to help, but times are tough, so they can’t. Readers like you who give extra are doubly appreciated. Thank you. 🙂 xod

  15. Avatar meredith says:

    I liked the original post with swear words!

  16. Avatar Candace says:

    Meredith, LOL. There are some pretty good multi-faceted one’s, eh?

  17. Avatar bruce vojtecky says:

    The first casualty of the COVI here in Phoenix. Sanders and Biden both requested that there be no live audience at their debate. That prompted the state DNC to ask then why have a debate.
    As far as other events they are all still going on but the promoters are saying that if you don’t feel good stay home.
    The schools K-12 and College will be going on spring break and the colleges are talking about doing online courses after. With all the precautions in effect the next two weeks could tell if the COVI has been held in check or if not, then there will be massive closure of the state.

  18. Avatar bruce vojtecky says:

    I find it difficult to not touch my face so every time I wash my hands I also wash my face.
    In addition I have 1 inch by 1 inch alcohol swabs, for my insulin, that I now keep a couple near my computer and they are perfect for wiping down the mouse and keyboard. They come in packages of 500.
    I also have for years used ceramic coffee cups, no plastic cups to the landfill, but now where I might use the same cup all day I change frequently, I have lots of cups I got at auctions but Goodwill is a good source for cheap cups.
    Anyone else have tips not related to politics to pass on?

    • Avatar Candace says:

      Bruce, I’ve taken to sitting on my hands if I’m idly watching tv. Crazy how much we touch our faces. Tonight, I’ll be laundering my reusable grocery bags as well. I’ve also taken to sanitizing my cell phone ( wiping it down) and putting it in my purse and leaving it there (emergency use only) until I get home from any errand running. I think our massive cell phone use is going to be/is one of the biggest transmitters of this virus.

  19. Avatar Patricia Bay says:

    Excellent information! Thank you!

  20. Avatar Bob says:

    Can it live in water ?

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