MTI COVID-199 > Prevention and Wellness
Prevention measures are similar to those utilized against the common cold and flu, which are currently circulating in high numbers.
By: BENJAMIN NEUMAN, THE CONVERSATION
COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses belong to a group of viruses that infect animals, from peacocks to whales. They're named for the bulb-tipped spikes that project from the virus's surface and give the appearance of a corona surrounding it.
A coronavirus infection usually plays out one of two ways: as an infection in the lungs that includes some cases of what people would call the common cold, or as an infection in the gut that causes diarrhea.
COVID-19 starts out in the lungs like the common cold coronaviruses, but then causes havoc with the immune system that can lead to long-term lung damage or death.
SARS-CoV-2 is genetically very similar to other human respiratory coronaviruses, including SARS-CoV and MERS-CoV. However, the subtle genetic differences translate to significant differences in how readily a coronavirus infects people and how it makes them sick.
SARS-CoV-2 has all the same genetic equipment as the original SARS-CoV, which caused a global outbreak in 2003, but with around 6,000 mutations sprinkled around in the usual places where coronaviruses change. Think whole milk versus skim milk.
Compared to other human coronaviruses like MERS-CoV, which emerged in the Middle East in 2012, the new virus has customized versions of the same general equipment for invading cells and copying itself.
However, SARS-CoV-2 has a totally different set of genes called accessories, which give this new virus a little advantage in specific situations. For example, MERS has a particular protein that shuts down a cell's ability to sound the alarm about a viral intruder.
SARS-CoV-2 has an unrelated gene with an as-yet unknown function in that position in its genome. Think cow milk versus almond milk.
How the virus infects
Every coronavirus infection starts with a virus particle, a spherical shell that protects a single long string of genetic material and inserts it into a human cell. The genetic material instructs the cell to make around 30 different parts of the virus, allowing the virus to reproduce.
The cells that SARS-CoV-2 prefers to infect have a protein called ACE2 on the outside that is important for regulating blood pressure.
The infection begins when the long spike proteins that protrude from the virus particle latch on to the cell's ACE2 protein. From that point, the spike transforms, unfolding and refolding itself using coiled spring-like parts that start out buried at the core of the spike.
The reconfigured spike hooks into the cell and crashes the virus particle and cell together. This forms a channel where the string of viral genetic material can snake its way into the unsuspecting cell.
SARS-CoV-2 spreads from person to person by close contact. The Shincheonji Church outbreak in South Korea in February provides a good demonstration of how and how quickly SARS-CoV-2 spreads.
It seems one or two people with the virus sat face to face very close to uninfected people for several minutes at a time in a crowded room. Within two weeks, several thousand people in the country were infected, and more than half of the infections at that point were attributable to the church.
The outbreak got to a fast start because public health authorities were unaware of the potential outbreak and were not testing widely at that stage. Since then, authorities have worked hard and the number of new cases in South Korea has been falling steadily.
How the virus makes people sick
SARS-CoV-2 grows in type II lung cells, which secrete a soap-like substance that helps air slip deep into the lungs, and in cells lining the throat. As with SARS, most of the damage in COVID-19, the illness caused by the new coronavirus, is caused by the immune system carrying out a scorched earth defense to stop the virus from spreading.
Millions of cells from the immune system invade the infected lung tissue and cause massive amounts of damage in the process of cleaning out the virus and any infected cells.
Each COVID-19 lesion ranges from the size of a grape to the size of a grapefruit. The challenge for health care workers treating patients is to support the body and keep the blood oxygenated while the lung is repairing itself.
SARS-CoV-2 has a sliding scale of severity. Patients under age 10 seem to clear the virus easily, most people under 40 seem to bounce back quickly, but older people suffer from increasingly severe COVID-19.
The ACE2 protein that SARS-CoV-2 uses as a door to enter cells is also important for regulating blood pressure, and it does not do its job when the virus gets there first. This is one reason COVID-19 is more severe in people with high blood pressure.
SARS-CoV-2 is more severe than seasonal influenza in part because it has many more ways to stop cells from calling out to the immune system for help. For example, one way that cells try to respond to infection is by making interferon, the alarm signaling protein.
SARS-CoV-2 blocks this by a combination of camouflage, snipping off protein markers from the cell that serve as distress beacons and finally shredding any anti-viral instructions that the cell makes before they can be used. As a result, COVID-19 can fester for a month, causing a little damage each day, while most people get over a case of the flu in less than a week.
At present, the transmission rate of SARS-CoV-2 is a little higher than that of the pandemic 2009 H1N1 influenza virus, but SARS-CoV-2 is at least 10 times as deadly.
From the data that is available now, COVID-19 seems a lot like severe acute respiratory syndrome (SARS), though it's less likely than SARS to be severe.
What isn't known
There are still many mysteries about this virus and coronaviruses in general – the nuances of how they cause disease, the way they interact with proteins inside the cell, the structure of the proteins that form new viruses and how some of the basic virus-copying machinery works.
Another unknown is how COVID-19 will respond to changes in the seasons. The flu tends to follow cold weather, both in the northern and southern hemispheres. Some other human coronaviruses spread at a low level year-round, but then seem to peak in the spring. But nobody really knows for sure why these viruses vary with the seasons.
What is amazing so far in this outbreak is all the good science that has come out so quickly. The research community learned about structures of the virus spike protein and the ACE2 protein with part of the spike protein attached just a little over a month after the genetic sequence became available.
I spent my first 20 or so years working on coronaviruses without the benefit of either. This bodes well for better understanding, preventing and treating COVID-19.
By Scottie Andrew, CNN
Life under coronavirus means staying at home as much as possible — but you’ll likely need to make a trip to the grocery store or pharmacy at some point. Download or print this tip sheet to make sure you don’t bring the virus back home with you.
Note: Recommendations for Covid-19 may change as oﬃcials learn more, so monitor your local health department and the Centers for Disease Control and Preventionforupdates.
Make a game plan
- Designate one person to be your errand-runner to limit your outside exposures
- Set up a disinfecting station — an area outside your home or in a room with low foot traffic where you can disinfect packaged food
When you’re out
- Avoid coming within less than six feet of others Wipe handles on carts or baskets while shopping
- You don’t have to have gloves or a mask — just wash your hands frequently while you’re out and avoid touching your face
When you get back
- Wash your hands with soap and water for 20 seconds
- Disinfect takeout boxes and packaged foods at your disinfecting station
- Thoroughly wash produce before putting it in your kitchen
- Disinfect everything you touch — doorknobs, light switches, keys, phone, keyboards, remotes, etc.
- Use EPA-approved disinfectants (these include Clorox Disinfecting Wipes and certain Lysol sprays) and leave surfaces wet for 3-5 minutes
- Ask workers to drop deliveries off on your doorstep or an area of your complex If they need you to come to the door, keep six feet of distance
- Pay and tip online when possible
- After you pick up mail from your mailbox, wash your hands
- Wash clothes, towels and linens regularly on the warmest setting
- Disinfect your laundry hamper, too, or place a removable liner inside it
- Don’t shake dirty laundry to avoid dispersing the virus in the air
- You shouldn’t allow guests over right now
- If you need to house a family member or friend, avoid shared living spaces as much as you can
- If they need to enter shared living spaces, ask them to keep six feet of distance
If someone in your home gets sick
- First, consult your doctor
- Isolate them in another room and ask them to use a separate restroom Disinfect frequently touched surfaces every day
- Avoid sharing items with them
- Wear gloves when washing their laundry Continue to wash your hands frequently
- Ask them to wear a face mask if they have one
Supplies you’ll need
- EPA-approved disinfectants
- If you don’t have disinfectants, make a bleach solution:
- Mix four teaspoons bleach per quart of water; or
- Use a 70% alcohol solution
- Laundry detergent Trash bags
- Prescription medicines (you can mail order these) Canned foods — fruits, veggies, beans
- Dry goods — breads, pastas, nut butters Frozen foods — meats, veggies, fruits
- Supervise your pet in your backyard
It's OK to play with them outside — just keep your distance from other humans
- If you’re sick, ask someone you live with to take care of them while you recover If you must care for them while you’re sick, wash your hands frequently
Dr. Leana Wen, former Baltimore City Health Commissioner and an emergency physician and public health professor at George Washington University in Washington.
Dr. Koushik Kasanago ttu, an internal medicine resident physician at John Hopkins Bayview Medical Center in Baltimore, Maryland, and who is among the thousands of health care professionals treating patients with coronavirus.
Dr. Richard Kuhn, a virologist, director of the Purdue Institute of Inﬂammation, Immunology and Infectious Disease and editor-in-chief of the journal "Virology."
The COVID-19 virus primarily spreads when one person breathes in droplets that are produced when an infected person coughs or sneezes. In addition, any infected person, with or without symptoms, could spread the virus by touching a surface. The Coronavirus could remain on that surface and someone else could touch it and then touch their mouth, nose or eyes. That's why it's so important to try to avoid touching public surfaces or at least try to wipe them with a disinfectant.
Social distancing refers to actions taken to stop or slow down the spread of a contagious disease. For an individual, it refers to maintaining enough distance (6 feet or more) between yourself and another person to avoid getting infected or infecting someone else. School closures, directives to work from home, library closings, and canceling meetings and larger events help enforce social distancing at a community level.
Slowing down the rate and number of new Coronavirus infections is critical to not overwhelming hospitals, which could lead to large numbers of critically ill patients not receiving life-saving care. Highly realistic projections show that unless we begin extreme social distancing now — every day matters — our hospitals and other healthcare facilities will not be able to handle the likely influx of patients.
What should and shouldn't I do during this time to avoid exposure to and spread of this Coronavirus? For example, what steps should I take if I need to go shopping for food and staples? What about eating at restaurants, ordering takeout, going to the gym or swimming in a public pool?
The answer to all of the above is that it is critical that everyone begin intensive social distancing immediately. As much as possible, limit contact with people outside your family.
If you need to get food, staples, medications or healthcare, try to stay at least six feet away from others, and wash your hands thoroughly after the trip, avoiding contact with your face and mouth throughout. Prepare your own food rather than going to a restaurant or even getting takeout. It's best to avoid the gym; but if you do go, be sure to wipe down anything you are about to touch, and once more after you use the equipment. Again try to keep a distance of 6 feet or more from others. Since the virus won't survive in properly treated pool water, swimming should be okay as long as you avoid close contact with other people.
Here are some other things to avoid: playdates, parties, sleepovers, having friends or family over for meals or visits, and going to coffee shops — essentially any nonessential activity that involves close contact with others.
What can I do when social distancing?
Try to look at this period of social distancing as an opportunity to get to things you've been meaning to do.
Though you shouldn't go to the gym right now, that doesn't mean you can't exercise. Take long walks or run outside (do your best to maintain at least six feet between you and non-family members when you're outside). Do some yoga or other indoor exercise routines when the weather isn't cooperating.
Kids need exercise too, so try to get them outside every day for walks or a backyard family soccer game (remember, this isn't the time to invite the neighborhood kids over to play). Avoid public playground structures, which aren't cleaned regularly and can spread the virus.
Pull out board games that are gathering dust on your shelves. Have family movie nights. Catch up on books you've been meaning to read, or do a family read-a-loud every evening.
It's important to stay connected even though we should not do so in person. Keep in touch virtually through phone calls, Skype, video and other social media. Enjoy a leisurely chat with an old friend you've been meaning to call.
If all else fails, go to bed early and get some extra sleep!
The best way to prevent infection is to avoid being exposed to the virus. The CDC recommends everyday preventive actions to help limit the spread of respiratory viruses:
- Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people who are sick.
- Stay home when you are sick.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
- Clean and disinfect frequently touched objects and surfaces.
Patients with confirmed COVID-19 infection have reportedly had mild to severe respiratory illness with symptoms of:
- Shortness of breath
The CDC believes at this time that symptoms of COVID-19 may appear in as few as two days or as many as 14 days after exposure. Current estimates are that it takes about five days for COVID-19 symptoms to show after contracting the virus.