Updated: Mar 30, 2020
This updated addendum to our COVID-19 overview provides risk assessment and recommended actions for organizations to consider in response to the current outbreak. Please use this in conjunction with the overview for individuals.
This is an updated overview of the information that provides a general risk assessment and recommended actions for consideration in response to the current outbreak.
Bottom Line:
In the United States, the actual medical risk to individuals is still exceedingly low. The risk of social/economic disruption at some level, however, is increasing. The most important action now is keeping abreast of the situation through sources focused on facts rather than hype. Members planning international travel need to pay special attention to developments and recognize that the international situation and implications for freedom of movement will change daily.
Could this become a major international crisis?: Yes
Is it likely?: Originally, the assessment was “No”, but at this point, it has become a major international crisis. This exceeds the impact of the 2004 SARS outbreak and bares many similarities. For the reasons outline below, it should not be ignored.
At this stage, widespread infection is still limited to one region of China. What has changed since January, is that there are a number of regions of the world including very developed nations such as South Korea and Italy, with large-scale evidence of community transmission. Up until last week, there was no sustained community transmission in the United States, but on the basis of three cases in the Western U.S. without any links to known cases, an assumption has to be made that there is some degree of uncontrolled community spread of the virus. This is not a reason for panic, as will be outlined, but members should consider prudent preparatory planning in the event that this does become widespread.
Why is this virus so concerning?
This is a newly recognized type of virus. This novel virus, while still early in the characterization process:
- Does effectively infect humans
- Can cause significant disease. For most, the disease is no worse than a bad cold or flu. But, those at risk appear to be the elderly, especially males, with other major medical issues, such as chronic heart disease, chronic pulmonary disease (as well as those that smoke), and diabetes.
- Does pass relatively easily between humans. So far, it appears to be transmitted in a manner similar to influenza, that is, primarily in large droplets mainly via eyes or nose, either directly (airborne) or from hands touching contaminated surfaces. The investigation is still ongoing, but disinfection of hands/surfaces and maintaining a 6-foot distance from infected people significantly reduces transmission.
What will determine if the coronavirus becomes a problem I need to worry about?
The impact of the virus must be considered on 2 levels:
- Actual disease risk: For most this will remain low. While it now appears inevitable that this will become more widespread, public health measures will slow the spread, and for MOST people, even if they become infected, the risk of severe illness or death is low. Influenza remains a higher risk because of the number of people infected every year.
- Social Disruption risk: This is of greater concern. Despite the actual disease risk remaining low, because this is a novel disease with some unknowns, expect individuals and governments to react at levels that will disrupt normal commerce. Recall the 30- 60 days after 9/11 with the global commerce slow-down and fear of terrorists everywhere. This has the potential to have similar effects until people and governments understand the prevention, management, and impacts of the disease.
The degree of social disruption will depend on the ability of public health systems to:
- Identify and quarantine or isolate affected people. The degree to which people are infectious, but still able to carry out their daily activities, is critical and not yet known. Because of this, China took a relatively extreme step in limiting internal movement in the country to mitigate spread which has blunted the growth of disease at huge costs to commerce. Until the virus is better characterized, quarantine of potentially infected people and isolation of those with a suspected or known infection will remain a key control strategy.
- Develop a better understanding of the population risks of the disease. There will be deaths even with advanced care measures, but this is the case today with influenza. We do not yet know how effective advanced care techniques/drugs can be in minimizing severe illness and death.
- Apply infection control measures to protect non-infected people. This depends on understanding where and how long the virus survives in the environment and will be one of the first important characterizations that the public health community will develop. If the infection characteristics are similar to influenza (as is likely), then fairly straightforward methods such as hand-washing/disinfection, frequent surface cleanings, keeping sick people out of public places, etc., will be effective in limiting the breadth of the epidemic.
- Develop countermeasures (vaccines and/or anti-viral drugs). This takes months to years unless an existing anti-viral is found to be effective. Coronaviruses are typically not well controlled by existing antivirals, although there are existing and investigational agents that appear to have reasonable efficacy. Vaccines are likely 9-12 months away.
Why aren’t all viruses this concerning?
Viruses are constantly evolving. These evolved viruses rarely cause us concern because they do not affect humans. Even if they do, they most often do not easily pass from person to person in general commerce, are controllable by a drug or vaccine, or only cause minimal illness. Often, we know what carries the disease (an animal or insect) and can control that carrier, or the disease is only transmissible when the affected person is obviously ill, making isolation easier to carry out.
So, what do I need to do now?
As noted earlier, unless you are traveling internationally, no specific actions are needed. This is flu season, however, so the things you can do to reduce your risk of catching the flu would also reduce your risk of becoming infected with coronavirus:
- Wash your hands frequently and use hand-sanitizers routinely when touching public/semi-public surfaces
- Maintain your personal space in public areas (ideally 6 feet from others). Airborne droplets that can carry viruses typically only travel a few feet before falling to the ground.
- Masks are generally NOT needed. They are more helpful in preventing infected people from transmitting disease rather than keeping healthy people from being infected. If you, your family members, or household staff have any signs of an upper respiratory infection, wearing a mask can greatly decrease viral transmission. The most common route of viral infection is not breathing in viral particles, but inoculating yourself (touching eyes, nose, mouth) after touching a contaminated surface. Masks may help you remember not to touch your face without washing or disinfecting your hands, first, so they do have limited value, especially if you are directly caring for someone who is ill.
- Clean and disinfect public and semi-public surfaces in your home and office regularly. Minimize sharing of items such as phones, computers, office equipment without disinfection.
- Various vitamins and other home remedies have not been shown to effectively limit infection although they may help your body minimize disease if you are infected. A balanced diet will help ensure your body is optimally situated to deal with infections, but no supplements have been shown to minimize infection. Studies on Vitamin C and E have found theoretical benefits but no actual real-life effects on preventing infections.
- Airflow on modern airplanes is designed to knock down and filter all airborne particles relatively efficiently. Applying the above guidelines (including wiping down your personal space on the plane, such as seat-back trays, armrests, and public reading material) when flying will help minimize your infection risk.
Aside from the medical risk, some people may wish to consider social- disruption risk. Remember that even within the epicenter in Wuhan, food supplies and utilities have continued in operation. The availability of certain medical supplies, however, has been limited. Some considerations that will make people more comfortable include:
- Maintain an adequate supply of over-the-counter medications for addressing cold and flu symptoms for at least one illness cycle per person in the household. For most people, even if infected with either coronavirus or influenza (this is still one of the most widespread flu seasons on record), these typical medications are all that is needed.
- Maintain a one-month supply of prescription medications in case pharmacy supply chains are impacted.
- Ensure your “work-from-home” environment is optimized with adequate equipment and bandwidth in case authorities do recommend decreasing personnel density in office settings and public transport.
We will pass along additional updates as they become available.
