Teepa’s Response to Coronavirus
by Teepa Snow
Annoying --> Risky --> Dangerous!
Panic equals blind, unreasoning fear
Let’s Hit the Pause Button for a Minute and Use Our Pre-Frontal Cortices to Figure out What to Do and What not to Do!
What kills more than 18,000 to 46,000 people a year in the US? Not a coronavirus, it’s the flu. It is actually much more likely to land you in a hospital or in a special care need situation than any coronavirus.
What seems clear to me is that this massive, disorganized reaction to COVID19 is not a reasoned or reasonable response to what we know about new viruses and what we know about the spread of communicable conditions, and what we know about vulnerable populations and how to minimize exposure to conditions while providing necessary supportive care.
What reduces risk: for any flu-like condition, including rhinoviruses and coronaviruses?
- Get a flu shot (although not an exact science it does help with many possible conditions)
- Use good hygiene practices during social contact and extra precautions during health-care or more intimate care related interactions.
- Cover your mouth and nose with the crook of your elbow to reduce risk for others
- Wipe shared and frequently used work surfaces and objects with wipes or spray and wipe with a disinfecting agent
- Get adequate amounts of rest, sleep, fluids, nourishment, enjoyment from living, and social and emotional support from people you like
- Limit your interactions with others if you do have any symptoms
- Avoid intimate contact with people who are symptomatic, without use of protective measures, and do not use the same protective gear from one care interaction into an interaction with another person or another setting.
- Avoid touching your face, or putting fingers or objects such as pens in your mouth.
So here are variations of a virus that has at least 100 forms:
It has been around a long, long time. It is very, very communicable! We have been unable to keep it from spreading each time it kicks up and we have no cure and no medication that can prevent it from happening. It is estimated that we typically experience it more in the spring and fall and that most people experience one variation or another at least 2-3 times each year. Each year some of our most vulnerable people across the US die from complications associated with it. We don’t even record it or typically notice it. We may well record it as a death due to pneumonia or complications of pneumonia or other chronic health condition. We do not know how many times it might have started with a rhinovirus. Like, falls, as a precipitating event, I suspect it is much higher than the vast majority of people would think, especially when it comes to select populations.
Who is vulnerable to rhinoviruses that trigger a more severe illness that needs medical support?
Frail elders, infants, people with respiratory or circulatory chronic health conditions, people who are weak and immobile, people in poor nutritional health, people who are immune-compromised, people who cannot clear their secretions, people with later state dementia, and several other categories comprise the groups of higher risk. In the world, countries with groups of people who have crowded living conditions with poor sanitation, and limited access to health care would be high risk as well.
What is this virus, called a rhinovirus?
In other words, it is the primary cause of the common cold.
How does this compare to the coronavirus? Well, the coronavirus has been around a long, long time as well. It has lots of variations. That is what is causing all the stir this time. We noticed and we realized we don’t have a prevention or cure for this one, either!!!!
Realistically, in the vast majority of cases it is a relatively mild form of something that acts like a flu! It is only, really problematic for a small portion of the population. It is only dangerous to an even smaller portion. Those individuals should be quickly noticed, vigorously supported, and limited to controlled areas of activity to reduce of sharing the condition with other vulnerable people.
So, what is the panic all about? Some of the people who are at higher risk aren’t the usual suspects. Current data indicates that children have low risk of serious illness and fewer symptoms, as long as they are healthy. That means they can be great carrier for virus, however, they are low risk for actually having problems, themselves. Some adults who have been low risk in other contagious diseases, may be at a higher risk in this one. Some chronic health conditions may be more risky. Adults without those risk factors are not likely to have significant illness and may not even realize they have had covi19, due to the mild nature of their case. It may feel more like an allergy or minor cold. In other words, it could be a case of we are worried and anxious because we are not sure of who to be afraid of or avoid. It seems we have gone to a cannon approach to the situation, and yet may have missed where we might have better aimed the cannon, known as resources!
So, is buying massive supplies of toilet paper, rice, bottled water, and beans in huge quantities indicated? Not for the vast majority of people. This condition Is not associated with diarrhea. It is not associated with vomiting which might be dehydrating. Rice and beans might be helpful, if you need a non-animal protein source, however, it has little to do in the way to offer for speeding recovery from a COVID-19 illness or preventing it.
What we should be putting our heads together and working out are four core things, in my mind, as someone who is committed to high quality care for people living with dementia, elders, health care providers, and human being in general:
- Creating reasonable plans of action for care situations where multiple people at risk share a space and healthcare staff and care must be delivered in intimate and personal spaces over and over each day.
- Creating a reasonable way to sustain social interaction within various human zones of awareness to limit the sense of stigmatization and isolation while supporting well-being.
- Visual/public zones - greater than 6 ft away from one another - in a larger shared space with common surfaces and without physical contact with one another
- Verbal/Personal zone - from arm’s reach to double arm’s reach and within a sneeze/cough zone - typically used for conversations, talking, and verbally interacting, however, touching is not expected or required – except for a handshake (special cases)
- Physical Touch/Intimate Zone – within arm’s length, this is a zone where touch is offered and given during care routines and personal needs meeting. In some cases no bodily fluids would be present, in others they might. There is certainly a higher risk of one person’s secretions coming in contact with another person.
- Creating a plan of support and care for workers and staff who are now in a high-risk situation. Providing their family with additional support and care as needed, if they are not able to transition from home to work and work to home without someone at either location with a higher risk profile becoming more at risk by their presence and care in the alternate location.
- Creating a plan of re-entry into normal life for those who had tested positive but have had no symptoms or have recovered from their symptoms. How and when. The plan should provide a recovery period plan. Not simply, leave them isolating until…..
In China, so far there have been approximately 80,757 cases reported, of those 66,908 recovered with self-monitored and delivered treatment (rest, hydrate, take over-the-counter medications to help with symptom management, and avoid intimate contact with others, so as to limit further transmission).
In China, the starting point for the COVID-19 spread, 3,024 people have died. In other words 3% of the population that reported symptoms had progression of the condition from a simple cold or flu-like experience to a much more severe situation with high fever, acute respiratory distress, pneumonia and respiratory failure that caused them to not be able to survive. We have little in the way of details about the length of time that passed between initial cold/flu symptoms and the conversion. Most information indicates that like rhinoviruses many vulnerable groups are similar, however, some are different. Unlike rhinoviruses, the Coronaviruses seem to create greater risk for elders and people with chronic conditions. Additional risks seem to exist conditions like diabetes and heart conditions with this version of the virus.
In an article posted on March 11th on the World Socialist Web Site there was an indication that different areas in China fared differently. This is what was stated, “The case fatality index for Wuhan city was highest, at 4.5 percent, while in Hubei province it was less, at 3.2 percent. For the rest of the regions that abided by the social distancing and contact quarantine measures instituted in the early phase of the epidemic, the study found that the fatality index was an exceptional low of 0.8 percent. These regions were able to keep their health care infrastructure operating at full capacity.”
In Italy, where the average age is 46.5, and there are many more elders living in small communities with limited health resources, the current number of cases of COVID-19 has hit 10,000 and the death rate is around 631. This indicates a higher mortality rate. About 6.3%. This is also the case with many countries throughout Europe. In the states, the situation is both similar and different.
Here is the major problem with US stats. We have only been testing for the virus as it relates to probable exposure for a few days, so we do not have any good quality numbers for comparison. All we have to date, is the CDC official report which put the national number of confirmed COVID-19 cases at 1629 and number of confirmed deaths related to severe complications at 41, as of March 13th. That puts the risk rate at approximately 2%. That is 1% less than the Chinese data indicated for their outbreak, and much less than Italy’s numbers. Washington state, New York, and California are hot spots so far.
What we are doing here at PAC:
We are monitoring ourselves for symptoms and limiting risks for ourselves by following all reasonable recommendations coming from the WHO and CDC.
- PAC personnel will not be attending any large gatherings of more than 100 people, if that is what an individual state or province has required.
- PAC personnel will continue to follow recommended guidelines for hygiene and social contact in public settings.
- PAC will continue to offer Certification programs, for those who are able to attend and are symptoms-free. These trainings will take place in small group learning situations and will follow hygiene protocols that have been established. We have also added a virtual participation option with an offer to come to a real-time program later in the year, after this situation has resolved.
- PAC is creating and will post a variety of PAC supported care routines and strategies that are designed to help provide high quality care while addressing newer and more challenging environmental constraints and limits in protective gear.
- At PAC we are working hard to try to come up with suggestions, supports, and some guidelines that adhere to PAC Principles, recognize the continued need to provide intimate and timely care for people at risk while limiting risk for those providing that care and for spreading the virus, to provide care for those who have active and significant symptoms of the virus, and for comfort care, when all reasonable measures have not resulted in a positive recovery pattern.
Finally, if you have questions, concerns, or challenges – please connect, we will do what we can to try to help!
Articles or Postings of possible interest:
2002 article about coronavirus and rhinovirus as being more problematic for frail and vulnerable elderly populations. In this review article, no one died, all recovered with the proper treatment for severity of symptoms.
Report done by WRAL on February 24th and updated on March 11th. This article provides practical and reasonable information.
Report from the Economic Times about the effects of emotional side effects of isolations, quarantine, and stigma if you are identified as having the virus compared to the actual risks of significant illness and possible death.