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Coronavirus: Mar 3, 2020

We've had a lot of discussion this week on the PoG page--the Facebook page for Patrons of Greysteel--about the coronavirus outbreak. Some of it was a bit doom-and-gloom, some of it sounded prematurely post-apocalyptic, and most of it was common sense. We are all Masters Athletes, or Athletes of Aging, which means we are a population at risk. So let's take a quick look at what is known, what is not known, and what we should do to Keep Calm and Carry On.

The COronaVIrus Disease of 2019, or COVID-19, is caused by SARS-CoV-2, a member of the coronaviridae, a family of riboviriae, or viruses that use RNA instead of DNA in their genomes. The virus is closely related to the viruses that cause SARS and MERS, although it seems to be more infectious and yet have a lower mortality in serious infections. But coronaviruses are endemic in humans, and also cause minor respiratory illnesses ("colds") as well as asymptomatic infection. The current outbreak, as you know, started in China, almost certainly as a zoonosis, or species-hopping infection, and has spread all over the world, including to North America. Community infection, which has been documented in North America, is by respiratory droplet transmission--in other words, by people horking snot droplets filled with viral particles into the air. Once infected, symptoms take days to a couple of weeks to develop--if they develop at all, which is an issue we'll discuss further. Symptomatic infections range from mild cold- or flu-like illness to an overwhelming syndrome of respiratory failure caused by a pneumonia-like, ARDS (acute respiratory distress syndrome or "shock-lung")-like process, requiring intensive management. Death, in those cases when it occurs, is usually by respiratory failure or multi-organ system failure. As of 2 March 2020 there were more than 88,000 cases of infection, of which approximately 80,000 were in China. Total deaths are about 3000, mostly in China. Of those infected who are not fatalities, half have recovered and half are presumably still ill (>45,000 confirmed recoveries) As of this writing, there are 60 confirmed cases in the US, although that number is probably changing as I type this. The case fatality rate is very loosely estimated to be between 2-3% on the high end. Now: Compare all that with the far less newsworthy 2019-20 influenza season (you're soaking in it, right now). The CDC estimates that so far this season there have been at least 32 million flu illnesses, 310,000 hospitalizations and 18,000 deaths from flu. Moreover, the epidemiology of the coronavirus outbreak is a bit murky, because we don't really know how many people have been infected. In other words, we don't even know the denominator. This is because some COVID-19 infections--and for all we know, it could be a large percentage of them--are asymptomatic. So while the disease is clearly spreading, clearly infectious, and clearly has the potential to be serious, the actual virulence and lethality remain undetermined. Treatment is what we doctors call "supportive care," which is a fancy way of saying "try to keep the poor bastard alive until he fights it off himself." No specific antiviral therapy exists, although extant antivirals are being investigated for cross-activity. No vaccine is at hand, although people are working on it. (And presumably, the anti-vaxxers are already working on their objections to it.) The epidemiology of the virus is likely to become at least a little more benign, simply by virtue of evolutionary pressure--a virus that kills its host is like a guy who blows up the train he needs to get to work. Dumb. But time will tell. Clearly, there is cause for concern. And if you are the sort of person who enjoys worrying, and really gets off on a good clean panic....well, you're like a pig in poop right now. But for most of us, worry and panic aren't our Thang. So here are some tips for the more action-oriented and rational among you. 1. Sell all your stocks, hoard water, food and masks, stock up on ammo, fire on all intruders who cross the barricade, and burn everything. Whoops. Typo. Let's try again. 1. Wash your hands. All the time. Compulsively. Like, Lady Macbeth-compulsive.

2. Cough and sneeze into your elbow. If you have to cough and sneeze a lot, stay home.

3. Keep your constantly-washed hands off your face. Also, don't touch anybody else's face. And for heaven's sake, DON'T go sticking your face in people's elbows. It's a bad time for that. If elbow-diving is your Thang, you'll have to go cold turkey until this is all over.

4. Use the wipes and hand sanitizers that should be all over your workplace. They're all over our gym.

4. Yes, you probably want to avoid airports, malls, stadiums, ERs and the like if you can--but mostly because it's flu season.

5. Get a flu shot. If you were really worried about dying from a rapidly-spreading respiratory virus, you would have done this already. It has ZERO activity against COVID-19. But it has activity against flu, which is serious business. And I can't help but think that if you had symptomatic COVID-19 and then caught the flu, then that would be...bad.

6. Don't even bother with masks, unless you are sick and have to be around people. Masks won't block the viral particles from getting into you if they're in the air. But if you are a snotbag, they will reduce the amount of virions you can launch into the air in your snot-missiles. And besides: you can't wear a mask, because all the stupid people bought them all up already.

7. Get a thermometer. This is far more useful than a mask, because if you have symptoms of cough and shortness of breath and you have an objective fever (>100.4F or 38C), you could definitely have a viral infection--which is more likely to be the flu--and you should seek medical attention. Start with a call to your doctor or hospital, unless you are in real distress, in which case you should call 911 and relate that you have fever and respiratory symptoms.

8. Don't go to the ER for a cold. This is always good advice. Serious COVID-19 infections are characterized by "chest symptoms," such as cough, shortness of breath, and chest tightness, as well as fever. If you have a mild temp or a fever and only upper respiratory symptoms (sneezing, sniffling, watery eyes...your basic NyQuil commercial), you are not displaying the symptoms of COVID-19, and you probably do not need to go to the ER to further stress an already-overwhelmed healthcare system. Stay home and take the NyQuil. Or whatever.

9. If you don't have symptoms, live your life. Go to work. Eat. Sleep. Train. Repeat. Be reasonable, be alert, be aware, but don't freak out. There's a good chance this global health emergency will become a pandemic--like the flu is every year (although we don't call it that every year). There's also a good chance that, like SARS and MERS, it will end up Going Away. And it's also possible that COVID will become a regular seasonal illness, like the flu, which in many ways is the very worst outcome, even if we get a vaccine, because right now we have a far more lethal virus (in terms of total body count) that sweeps across our planet every year, and we can't get people to take it seriously or get vaccinated.

One thing is for sure: the situation will change. We may have to change with it, in a rational, educated way, and in an orderly damn fashion.

We can do that. We're athletes of aging.