[UPDATED 15TH MARCH 2020]
It feels like there has been nothing else in the news aside from Coronavirus in the last few weeks and, in all honesty, that’s really because there hasn’t. Each day we have seen more and more articles about rising numbers of confirmed cases and even news about entire travel bans and countries on lockdown.
There have been many questions about what to do during the outbreak and whether you should still travel during the outbreak and which countries you should avoid entirely. Some people are in the ‘don’t stop travelling’ boat while others say that everyone should stop travelling until the virus is contained. So, which is it? Should we still travel? Should we cancel all plans? How are we affected if we do?
We are here to try and answer some of the questions surrounding Coronavirus as well as travelling during the outbreak.
Disclaimer: I am not a medical professional myself. This article was written utilising many reputable sources including the WHO, CDC, NHS and studies in medical journals.
What to know about the Coronavirus outbreak
What is Coronavirus?
First things first, what is Coronavirus? How is it different from seasonal flu? What do we actually know about the virus so far?
Coronavirus, also known as COVID-19, novel Coronavirus and Wuhan Coronavirus, is actually part of a family of viruses called coronaviruses. Simply calling this strain ‘coronavirus’ is incorrect as a coronavirus (CoV) is a virus that causes illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.
Source: World Health Organization
Coronaviruses are zoonotic, meaning they are transmitted between animals and people (one of the differences between coronaviruses and the seasonal flu). SARS-CoV was transmitted from civet cats to humans and MERS-CoV was transmitted from dromedary camels to humans. It is likely that COVID-19 (or SARS-CoV-2) was transmitted from bats either directly to humans or via an animal like a pangolin, an animal that is particularly prized in Chinese medicine.
Additionally, the Coronavirus disease 2019 (also referred to as COVID-19 or CoVID-19) is the infectious disease caused by the virus strain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is the disease caused by the virus SARS-CoV-2, just like AIDS is the disease caused by HIV.
You may see this novel Coronavirus referred to by the following names in various news articles:
- Wuhan virus/coronavirus
- Chinese coronavirus
- Wuhan/China flu
- novel Coronavirus
- (the) Coronavirus
Is COVID-19 ‘just another flu’?
The simple answer to this is no. COVID-19 is not just like flu in the slightest. For many healthy individuals, being infected with the novel coronavirus may be similar to how getting flu feels but for many it can be significantly more serious. Other reasons, including the infectiousness of COVID-19 as well as the mortality rate, make COVID-19 much more serious than the seasonal flu.
However, this doesn’t mean we shouldn’t also be concerned about the flu. Make sure to get your flu shot anyway (it won’t protect you against COVID-19 but it WILL protect you against the flu – after all, your likelihood of getting flu is much higher and if you do get the flu you have a more compromised immune system when it comes to COVID-19).
The mortality rate of this novel coronavirus is around 2%, meaning that for every 100 people who are infected, 2 will die from it (usually due to complications thereof). The mortality rate is 20 times higher than that of seasonal flu.
Source: Science Alert
The biggest reason that this coronavirus could prove way more deadly than flu is the exponential nature of the virus spreading (for example, Spain went from 589 on the 9th March to 1,024 on the 10th and then 1,639 on the 11th – this is an increase of 278% of cases in only two days) combined with the limited nature of healthcare provisions. There is a finite amount of things like hospital beds and ventilators as well as doctors and nurses.
The most likely cause for COVID-19 to become more deadly is the overwhelm of medical systems and healthcare providers around the world. We will go into more detail below about this as to how you can help avoid this happening.
The fatality rate of COVID-19 is comparable with that of the 1918 Spanish flu pandemic, but luckily we have had significant medical advances in the last 102 years!
What countries are worst affected by COVID-19?
Certain countries around the world have been affected much worse than others. China, where the outbreak began, still has the highest numbers of cases and deaths than any other country but their stringent containment and quarantine measures have meant that their number of new cases is now lower than some other countries.
Worst Affected Countries by CoVID-19 (updated 15th March 2020)
|Country||Total cases||Total deaths||Current active cases||Cases per 1M (population)|
While cases in China have started to taper off slightly (only 14 new cases reported in the last day), other countries around the world still have thousands of active cases and as many as 3,500 new cases in one single day (Italy).
The Foreign & Commonwealth Office (FCO) in the UK as well as other countries’ organisations that provide travel advisory and guidance have published information on which countries you should avoid travelling to. As of writing this article, the FCO currently advises against all travel to Hubei Province in China and all but essential travel to the rest of China. They also advise against all travel to the cities of Daegu, Cheongdo and Gyeongsan in South Korea and all but essential travel to all of Italy.
In the USA, the CDC has advised against all nonessential travel to China, Iran, South Korea and all of the Schengen area (26 countries in Europe, including Spain, Italy, France, Germany but excluding the UK and Ireland).
UPDATE: As of the 15th of March 2020, the CDC has advised against all nonessential travel to the UK and Ireland as well. The FCO in the UK has now also advised against all but essential travel to the USA, Spain, Iran and all the countries mentioned previously.
What are the symptoms of COVID-19?
The symptoms of this novel Coronavirus include:
- Dry cough (2/3 of cases)
- Sputum production (1/3 of cases)
- Shortness of breath
- Sore throat
According to the CDC, symptoms such as fever, cough and shortness of breath will appear around 2-14 days after exposure to the virus if you have been infected. According to a study published in the Annals of Internal Medicine journal on the 10th March 2020, the median incubation period of the virus is 5.1 days with 95% of people developing symptoms within 4.5 to 5.8 days.
The NHS (National Health Service in the United Kingdom) recommends staying at home for a minimum of 7 days if you develop a new continuous cough or a fever. This is, in effect, a self-quarantine in order to see whether the illness develops further. The NHS provides further information on what to do if your symptoms worsen during this time or do not improve after seven days.
How is the coronavirus transmitted?
Since COVID-19 is still a new virus, health agencies and scientists are still learning about the exact way it spreads. Currently, it is thought that the main ways the virus spreads are as follows:
- Person to person spread through respiratory droplets produced when an infected person coughs or sneezes
- the virus then spreads when these respiratory droplets land in or are inhaled through the mouth or nose
- usually, this is when you are within around 6 feet (1.8m) of the person
- people are likely most contagious when they are sickest (showing the most symptoms)
- it has also been reported that some people are contagious even when they don’t show symptoms (asymptomatic), but this does not appear to be the main way the virus spreads
- Person-object-person spread through contaminated objects or surfaces
- it is also possible that the virus spreads through a person touching a contaminated object or surface and then touching their mouth, nose or eyes
- however, this is considered to not be the main method of transmission
Latest research regarding coronavirus spread
The latest research published on the spread of the virus discusses aerosolization of the virus as well as how long the virus can live on surfaces. The study was published on March 9th 2020 by scientists at Princeton University, the University of California-Los Angeles and the National Institutes of Health in the USA and is currently awaiting peer review.
The study indicates that the COVID-19 virus could remain viable in the air “up to 3 hours post aerosolization,” while remaining alive on copper for up to 4 hours, on cardboard for up to 24 hours and for up to 2-3 days on plastic and stainless steel.
Note: You may also see this phrased as ‘viable in aerosols‘, which has nothing to do with the things you use to spray deodorant. Aerosols, in medical terminology, are a suspension of tiny particles or droplets in the air. Aerosol transmission is the person-to-person transmission of pathogens through the air by inhalation of infectious particles (the respiratory droplets mentioned above). Aerosolization is the production of airborne particles (i.e. respiratory droplets) containing the infectious virus. The infectious organism is said to be aerosolized.
However, it is worthwhile to note that the findings do not prove anyone has caught the virus in this way, only that it may be theoretically possible. “We’re not by any way saying there is aerosolized transmission of the virus,” stated Dr Neeltje van Doremalen at the National Institute of Allergy and Infectious Diseases.
Who is most at risk of catching coronavirus and having complications?
For those who are symptom-free but are over 60 or are otherwise at risk due to pre-existing conditions such as asthma, heart disease, diabetes, lung disease, cancer, or any other illness that compromises the immune system, you should make sure to take the most conservative measures of protecting yourself from the virus as you are one of the most at-risk groups.
The most at-risk group is those aged over 80 with an 18% case fatality ratio (CFR) based on data from cases in China.
- Age group 70-79 years: 9.8% CFR
- Age group 60-69 years: 4.6% CFR
- Age group 50-59 years: 1.3% CFR
- Age group 0-49 years: 0.14% CFR
Note: The CFR in this study has been adjusted for underreporting of cases and the time delay to death, as well as asymptomatic cases.
For those with chronic illnesses, the likelihood of this novel coronavirus being more severe is significant. While the overall global fatality rate is 3.4%, it is estimated that the fatality rate increases to 13% for those with cardiovascular disease, 9% for those with diabetes, 8% for those with high blood pressure (hypertension), chronic respiratory disease or cancer. Patients with no comorbid conditions (i.e. one or more pre-existing conditions) had a CFR of only 1.4%.
These numbers are probably slightly skewed by age as well, considering diseases like cardiovascular disease, diabetes and high blood pressure are more prevalent in the older population. However, this demonstrates that if you do have a pre-existing condition such as the ones mentioned or any immunocompromising or suppressing conditions (HIV or AIDS, rheumatoid arthritis, lupus, etc), you are a higher-risk individual and should practice the most conservative measures to avoid catching the virus.
Source: WHO Covid-19 Report
The lowest-risk population is those aged 0-9 years old with no pre-existing conditions, followed by those aged 10-19 years with no pre-existing conditions. The disease seems to appear very mild or asymptomatic in these populations with a very low fatality rate (none in the 0-9 age group and 0.2% in the 10-19 age group). However, children might still carry the virus around, and pass it between each other and then to their parents and caregivers, so those aged 19 and below still need to make sure to wash their hands, cough and sneeze into a clean tissue and then promptly throw it away and so on.
How can I avoid catching the coronavirus?
There are a few different ways for minimising your likelihood of catching this coronavirus. The main ways to minimise the likelihood are:
- Social distancing
- Washing your hands
- Using hand sanitiser
- Sanitising surfaces that the virus could live on
- Avoiding touching your face, particularly your mouth, nose, and eyes
You should also aim to be as healthy as possible, which includes the following:
- Staying hydrated
- Eating healthy
- Managing stress
- Getting adequate sleep
These measures mean that your immune system will be as prepared as can be if you were to contract the virus.
The most common way that the virus seems to be spreading is via airborne respiratory droplets. This means that the virus spreads most easily by people who have the virus coughing or sneezing and then these respiratory droplets landing in or being inhaled through the mouth and/or nose.
Social distancing is the most effective way of avoiding this method of transmission. So, what exactly is social distancing? The New York Times has published an excellent ‘Coronavirus glossary’ that explains many of the terms that you will read in various articles. They explain social distancing as:
“measures that are taken to increase the physical space between people to slow the spread of the virus. Examples include working from home, school closures and the postponement or cancellation of mass gatherings, such as [festivals and] conferences. By maintaining a distance of six feet from others when possible, people may limit the spread of the virus.”
Here are ways to follow social distancing measures:
- Avoid large-scale events, such as conferences, festivals, networking events and even religious services. Many are being cancelled anyway but, even if they are going on, it’s best to avoid them if you want to ensure you don’t get the virus
- Avoid crowded places such as crowded bars and clubs
- If you go to the gym, disinfect items that are constantly touched by people (and also make sure to use hand sanitiser yourself)
- Work at home if this is an option for you, particularly if you work in a large open-plan office usually
- Avoid crowded public transport such as peak hours on buses, trains and subways
- Limit visitations to places like care homes or assisted living facilities – this is predominantly for the benefit of the elderly who live in places like this. If you do visit, ensure you wear a face mask (more on these below) to prevent spreading the virus if you are unknowingly infected.
- Aim to avoid communal spaces or use them at non-peak times to reduce the number of people you interact with
- Postpone non-essential travel
Washing your hands
Well, I really do hope that you were washing your hands before this coronavirus outbreak but now really is the time to make sure you’re doing it often and effectively.
Washing your hands with soap and water is one of the most effective ways to kill the virus. But why IS soap so effective against this virus that we haven’t yet found a treatment or vaccine for? Is soap some magical item?!
The answer can be found in this excellent article in The Guardian, which I have summarised briefly below:
- The virus is a self-assembled nanoparticle in which the weakest link is the lipid (fatty) bilayer
- Soap dissolves the fat membrane and the virus falls apart like a house of cards and dies (becomes ‘inactive’)
- Human skin is an ideal surface for a virus – it’s “organic” and the proteins and fatty acids in the dead cells on the surface of your skin interact with the virus. If you touch a surface with the virus on it, the virus creates strong, glue-like interactions with your skin (and then the virus can be transferred to your nose/mouth/eyes)
- Water alone doesn’t compete as well with these strong interactions between the virus and your skin
- The soap contains fat-like substances known as amphiphiles, some of which are structurally very similar to the lipids in the virus membrane.
- The soap molecules “compete” with the lipids in the virus membrane (which is more or less how soap also removes normal dirt from the skin). The soap not only loosens the “glue” between the virus and the skin but also loosens the interactions that hold the proteins, lipids and RNA in the virus together.
Source: Pall Thordarson, professor of chemistry at the University of New South Wales, Sydney via The Guardian
Recommendations for hand washing
- Wash your hands for at least 20 seconds (which is the time it takes to sing Happy Birthday twice – for better song choices, check out Wash Your Lyrics)
- Use soap
- Turn off the tap with a paper towel or your elbow (i.e. not your now clean hands)
You can also use a hand cream once your hands are completely dry, which will prevent getting dry skin as chapped or bleeding skin can be a way for viruses to enter the bloodstream.
How should you dry your hands?
A study by Mayo Clinic in 2012 concluded that (from a hygiene standpoint): “Paper towels are superior to air dryers.” Paper towels dry your hands more quickly and more thoroughly than dryers do, and contamination happens more through wet hands than dry.
Using hand sanitiser
Firstly, washing your hands with soap and water is actually considered more effective than using hand sanitiser. However, you obviously don’t have a basin with soap and water on you at all times so for when you need to clean your hands, hand sanitiser is an excellent way of doing so.
Pall Thordarson, from The Guardian article above, writes the following about hand sanitiser versus soap:
Alcohol-based products… contain a high-percentage alcohol solution (typically 60-80% ethanol) and kill viruses in a similar fashion [to soap]. But soap is better because you only need a fairly small amount of soapy water, which, with rubbing, covers your entire hand easily. Whereas you need to literally soak the virus in ethanol for a brief moment, and wipes or rubbing a gel on the hands does not guarantee that you soak every corner of the skin on your hands effectively enough.
So, soap is the best, but do please use alcohol-based sanitiser when soap is not handy or practical.
The NHS and Public Health England all agree that to kill most viruses, a hand sanitizer requires at least 60% alcohol content (most contain 60-95%). Anything with a lower than 60% alcohol content is not strong enough to kill the virus.
Coronavirus is an envelope virus, meaning it has a coating around it which the alcohol can attack, thereby eliminating the threat. Sally Bloomfield, a professor at the London School of Hygiene and Tropical Medicine, recommends against trying to make your own hand sanitiser at home: “It’s very unwise… Shop-bought products also contain emollients to make them softer on the skin, without which you run the risk of hurting your hands. Getting the mix right at home would very tricky – so it is a big no-no.”
Sanitising surfaces the virus could live on
It’s also important to note the study mentioned previously that reported findings of the virus being able to live on surfaces (including steel and plastic) for up to three days. It does appear that the virus is much less likely to be spread via person to surface/object to person transmission, but it’s worthwhile paying attention to disinfecting items that are often and regularly used, particularly when they are used by multiple people (and especially if anyone has a pre-existing condition or is elderly).
Disinfectant wipes (or disinfectant spray on clean paper towels) can be used to clean the following surfaces once or twice a day:
- Cabinet handles
- Refrigerator doors
- Remote controls
It is also worthwhile disinfecting the following:
- Your car (e.g. steering wheel, gear stick, keys, anything touchscreen, etc)
- Computer keyboard and mouse
- Home phone/mobile phone
- Debit and credit cards
How can I avoid spreading the coronavirus?
Even if you have not been diagnosed with coronavirus, if you start to feel ill with a cough or fever then you should most definitely stay home. If you suspect you may have COVID-19, the CDC recommends you follow these steps:
- Stay home! If you are mildly ill, you should self-isolate/self-quarantine during your illness.
- Avoid public areas
- Avoid public transportation
- Stay away from others – if you live with other people, try to minimise your contact with them as much as possible. If this is impossible, they may have to also self-quarantine to avoid passing the virus on.
- Call ahead before visiting your doctor – call your healthcare provider and tell them that you have or may have COVID-19. Don’t simply visit a hospital or the doctor as this could expose others to the virus.
- Wear a face mask if you are sick when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office
- Cover your mouth and nose when you cough or sneeze. Dispose of the used tissues in a lined bin as soon as possible.
- After coughing or sneezing, immediately wash your hands with soap and water for at least 20 seconds or, if soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.
- Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other members of your household if you are sick or suspect you are sick. After using items like dishes or cups, make sure to wash them thoroughly with soap and water.
How to keep yourself safe if you think you might be sick:
- Seek prompt medical attention if your illness seems to be getting worse (e.g., difficulty breathing).
- This can either be by calling your healthcare provider, the non-emergency healthcare number or, if it is very severe, by calling the emergency services
Self-quarantine and self-isolation
What is the difference between self-quarantine and self-isolation?
Self-isolating: People who have already been infected with the virus and are ill
Self-quarantining: People who may be ill and need to keep themselves separate from others in case they become sick during the incubation period
If you have travelled to certain locations in the past 14 days, your country or state may require you to self-quarantine for a certain number of days (usually 14 days). This is also applicable if you have been in close contact with someone who has been to these places in the last fourteen days (currently the destinations listed include China, South Korea, Iran, Italy, Hong Kong and Japan but some countries have increased this list to include all Schengen countries).
If you experience any of the COVID-19 symptoms (mentioned above in the symptoms section) during your self-quarantine, call your doctor or healthcare provider for advice on what to do next. Do not turn up at a hospital or medical centre without first calling to be told what you ought to do.
If you are looking for more information on self-quarantine, this article in The Verge by a woman who had to self-quarantine is an excellent guide on how to deal with it and how to get around things like buying groceries.
Travel and coronavirus
Starting at 11:59PM EDT on Friday 13th March 2020, a travel ban will be enacted from the entire Schengen area to the USA. Announced by Trump on Wednesday 11th, this travel ban was met with a lot of confusion and frustration. Foreign nationals (people who are not U.S. citizens) who in European countries that are part of the Schengen Area within the last two weeks will be unable to travel to the United States.
The Schengen Area includes 26 countries that generally allow free and open movement across their borders, which are: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden and Switzerland.
Notably, countries such as the UK, Cyprus, Turkey, Ireland and Ukraine were not included in these restrictions. However, on March 14th it was announced that the UK and Ireland were also now included in the travel ban. This means that foreign nationals who are flying from one of these countries (or another not in the Schengen Area) and who haven’t been in any of the Schengen countries in the last 14 days will still be able to enter the United States.
Who is exempt from this travel ban? All US nationals, Green Card holders and the spouses, parents or siblings of American citizens or permanent residents, will be exempt, as will members of the U.S. military and their spouses and children.
During the announcement of this travel ban it was stated that Americans returning from Europe in the next 30 days would be “funnelled through 13 airports”, screened, and asked to self-quarantine for 14 days. The 13 airports are the following:
- Atlanta: Hartsfield–Jackson Atlanta International Airport (ATL)
- Dallas-Fort Worth: Dallas Fort Worth International Airport (DFW)
- Detroit: Detroit Metropolitan Airport (DTW)
- Newark, New Jersey: Newark Liberty International Airport (EWR)
- Honolulu: Daniel K. Inouye International Airport (HNL)
- New York City: John F. Kennedy International Airport (JFK)
- Los Angeles: Los Angeles International Airport (LAX)
- Chicago: Chicago O’Hare International Airport (ORD)
- Seattle: Seattle-Tacoma International Airport (SEA)
- San Francisco: San Francisco International Airport (SFO)
- Washington, D.C.: Washington-Dulles International Airport (IAD)
This article will be updated with further information on any updates regarding the pandemic, as well as more information in regards to travel during the outbreak.
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