My original article on Covid-19 has now been split into three parts:

Part 1: Covid-19 Facts, Analysis, and Advice
Part 2: Busting Covid-19 Myths
Part 3: Should My Game Be Canceled?

Each part will link to the other two, and they will all be extended and updated as necessary.

Part 1: Covid-19 Facts, Analysis, and Advice

• UPDATED March 15, 2020, in the section “Timeline”.
• UPDATED March 24, 2020, in the section “Infectiousness & Viral Persistence”.
• UPDATED March 26, 2020, in the section “Infectiousness & Viral Persistence”.
• UPDATED March 27, 2020, in the section “Timeline”.
• UPDATED April 5, 2020, in the sections “Symptoms”, “Treatment” and “Infectiousness & Viral Persistence”.
• UPDATED April 25, 2020, in the section “Infectiousness & Viral Persistence”.

Coronavirus. Specifically, Covid-19. What are the facts? What do they mean? And what should you be doing about them, to protect both yourself and others?

Douglas Adams said it best:

Don’t Panic! Beauty will still be there tomorrow.
Image by Gordon Johnson from Pixabay, text by Mike

Don’t Panic. There’s a lot of misinformation, speculation, and panic reaction floating around out there, and social media channels are more adept at spreading it than they are distributing reputable information.

Panic is an unthinking reaction to a situation in which there is a perceived emergency requiring clear thinking – and, as such, it is never helpful. Panic might lead to making the right choices by pure chance, but it probably won’t.

One reaction to panic is to try to calm people down – and the avoidance of measures that would be reasonable, but would promote further panic often implies an under-reaction to the current situation. Not that you can blame the authorities for that; they are walking a fine line between taking effective action and exacerbating any existing alarm, as well as triggering new public alarm.

The truth is that the situation is almost certainly both better than the doom-and-gloom merchants would have you believe, and worse than authorities can admit, unless they have been forced into drastic measures.

The absence of information is therefore a logical inevitability of managing a health crisis of this sort – but is also a breeding ground for misinformation. If you compare the information presented on the Australian Government’s Department Of Health on the subject, much of it has a vague or incomplete feel to it, at least in comparison to the public information page hosted by our national broadcaster.

With that in mind, this post will attempt to answer a serious question: should we suspend RPG gaming for a month or so?

To answer that question, I’ll be looking at the symptomology, the known clinical picture, the people believed to be at greatest risk and why, and so on.

This post will contain the most accurate information I can find, as of the 14 March 2020, and explain it as much as possible. Where I am including speculation, it will be specifically labeled as such and I will take extra care to explain the basis of that speculation, and will attempt to analyze how being wrong will impact on the analysis of the question.

At the same time, I want to make this post as short and digestible as possible. Nevertheless, along the way, I want to bust one or five of the myths that I’ve seen circulating. There’s a lot to get through, so this is likely to be one of those occasions when “short” is a relative term.

Pandemic

First, Coronaviruses are nothing new. At least one type of “Common Cold” is a Coronavirus. The human race has been living with them for a very long time. From time to time, a specific variety comes along that is notably worse than usual, that’s all. Covid-19 is one such case.

That has led to Covid-19 being declared a Global Pandemic.

What this declaration means is that the virus is now spreading in more than 100 countries, and that the illness itself is potentially serious.

In a practical sense: Each level of spread of an infection, when officially declared, triggers certain powers within and responses by, the government. What these are will vary from country to country. The most extreme responses to the current health emergency, by China and Italy, are empowered by such triggers.

Don’t Panic! Tranquility will still be there tomorrow, if we look for it.
Image by Diese lizenzfreien Fotos darfst du zwar verwenden from Pixabay, text by Mike

Contagion

Covid-19 is known to be highly contagious. Nevertheless, a runny nose or scratchy throat does not mean you have Covid-19. You almost certainly do not. It does mean that you should take precautions like self-isolation, and if symptoms get worse, make arrangements to get tested.

That’s not as easy as it should be. In countries with a single-payer health system like Australia, the cost of the test is paid by the government if a test is deemed necessary. Here, the number of cases not occurring as a result of travel from an area with a serious outbreak (China, Iran, South Korea, Italy) is a handful, and those who have not traveled overseas at all number only 1 or 2 cases, nationwide. This is because Australia has put strong containment measures in place quite early on – we were treating it as a potential pandemic at least a week before the World Health Organization confirmed the status.

There have been reports that the test can cost as much as US$3500 to conduct, and they do not have a single-payer health system. Those on lower incomes are thus much less likely to be tested and can thus act as carriers for the disease. They are also far less likely to be willing to self-isolate on the mere chance that they are infected and attend work anyway.

For a long time, the orientation promoted by the pharmaceutical industry, backed by the Medical profession, has been “soldier on” – take precautions not to infect others, but the priority is to get back on your feet and back to doing whatever you do, as quickly as possible. That is considered terrible advice where COVID-19 is concerned. Instead, the advice is to minimize your chance of infection in the first place, and self-isolate at the first sign of symptoms, just in case.

Transmission

The Virus is spread by small drops of moisture we release when we sneeze or cough. The moisture has to get into your body to make you sick, which means you can catch Coronavirus if those droplets get into your eyes, nose or mouth.

The skin is always covered by a layer of dead cells and the living cells beneath are relatively tough, designed to cope with wear and tear. The virus can’t get through. The greatest danger is that you get the virus on your skin and then rub your eyes or nose or bring your hand to your mouth for any of a dozen reasons – for example, I have the habit of stroking my beard and mustache when thinking. Washing your hands to remove the virus almost completely eliminates the danger – unless you’ve touched one of these “forbidden areas” in the interval.

That’s where face-masks come into the picture. They not only stop transmission of the virus if you cough or sneeze, but they stop you putting your hands to nose or mouth. If everyone had access to one, it could help slow the spread of Covid-19 significantly; but that’s not going to happen; there is a global shortage of masks right now. Ironically, Wuhan was the world’s #1 manufacturer of surgical masks. With that supply disrupted, countries all over the world have been scrambling to make up for the deficit.

Whenever a discussion on this subject arises, my mind instantly (and persistently) flashes back to an episode of Mythbusters, from, I think, the final season with everybody. The episode aired on June 9, 2010, entitled “Flu Fiction” and the segment in question asked, “Is it true that Nasal secretions from a person with a cold can spread so far and so quickly that anyone in the vicinity can become contaminated.?”

The Wikipedia write-up of the experiments reads:

Adam and Jamie consulted with an otolaryngologist and learned that a person with a cold may secrete up to 60 milliliters of mucus per hour. Jamie built a rig from a syringe and tubing to match that drip rate with fluorescent dye, and Adam wore it by his nose as he did model-building work. After one hour, he and everything he had touched were stained with the dye.

They then set up a party for Adam to host, with three ‘germaphobe’ guests (Kari, Grant, and Tory, who were briefed to try to avoid contact with Adam) and three unsuspecting ones. Thirty minutes later, Adam, the whole table, and every guest except Kari – who admitted that she actually was a germaphobe – were heavily contaminated. In a second experiment in which Adam consciously did his best to avoid physical contact (such as bumping elbows with his guests instead of shaking hands and asking the guests to pass certain things out to the other), all six guests came up clean.

Adam and Jamie declared the myth confirmed at this point, commenting that a healthy person would find it very difficult to avoid being contaminated by a sick one who did not attempt to keep from spreading his/her germs.

I was hoping to be able to present a screen shot of the table with the horror show of the fluorescent die everywhere, but couldn’t find one. But I was able to find a youTube video of the experiment up to this point which includes those unforgettable scenes of contamination. It’s ten years on, and those scenes remain firmly lodged in my memory, for good reason.

Don’t Panic! Sunsets will still be awaiting appreciation tomorrow.
Image by Free-Photos from Pixabay, text by Mike

Timeline

There’s a lot that is still not known about COVID-19. Statistical data is still being gathered, and is a secondary priority to actually treating those with the disease. As a result, the timeline of infection is a little vague, and this has shaped the advice being given.

A day or two, possibly three, after you become infected, you enter a stage of being infectious while showing no symptoms. Between one and three days later, you begin to experience the symptoms but remain infectious. Most people suffer only very mild symptoms and there is a strong temptation to go about your normal routine, enabling the virus to spread. You will typically experience symptoms for three-to-seven days, usually 5. Add all that up, and you get 13 days at most. There is a possibility that you will still be contagious for a day or so after that, but this is unconfirmed.

UPDATE 19 March 2020:

Over the last couple of days there has been some additional clarification on some of these subjects.

1. Most people become ill 2-4 days after becoming infected. Symptoms may be so mild, especially in younger people, that they do not realize that they are infected.
2. In the majority of cases, people have become contagious 24 hours before symptoms develop.
3. In a few cases, people have become contagious up to 48 hours before symptoms develop – but it’s entirely possible that the symptoms developed sooner and the victim simply didn’t notice them. For the sake of prudence, health authorities and the rest of this article will use two days as the infectious pre-symptomatic period.
4. It is therefore possible for one set of responses to an infection to occur while the commencement date and time of symptoms is unknown or only approximately known, and for those responses to be shown to be unnecessary when the patient is interviewed and an accurate determination of the onset of symptoms made. The current advice in Australia is that if you don’t have that accurate information, use the 48-hour rule; if you do, you can use the 24-hour rule. That’s to determine if you have potentially been exposed, whether or not you need to self-isolate, whether or not you may need to be tested, and so on.

UPDATE 27 March, 2020:

More information has emerged on the timeline of the illness. In general (and in a nutshell), the second week is more uncomfortable and symptoms are more serious; the first week, they may be comparatively mild, even in serious cases (i.e. those requiring hospital treatment). I don’t have further specifics.

Thus the advice that if you come down with possible symptoms, you should self-isolate for 14 days, and if they get worse, seek medical advice. In most people, it’s all over in a week or less, but in a few cases it may last longer – so the 14-days is long enough to not only cover the immediate victim’s experience with the disease, but any immediate family who are likely to have been exposed to the virus. If none of you are showing symptoms after 14 days, you’re clear – for now, at least. That’s not unlike any cold or flu.

There have been some reports of incubation periods of 14 or even 21 days. These are now regarded as extremely rare if they are even accurate at all.

Symptoms

Perhaps the most worrying aspect of Covid-19 is that you can be contagious and experience no symptoms at all. That doesn’t happen often but it is a known fact. In a sample group of 100 people with Coronavirus, about 80 will have only minor symptoms, if any at all. About 15 people will have more serious symptoms, and between one and three people out of 100 may die as a result of pneumonia and respiratory complications. The current mortality rate, globally, is 3.7%, but the trend is slowly downward. Compare that with influenza, which normally has a mortality rate of 0.1%; even a bad year, like 2019, only elevates that to about 0.5%.

By far the majority of people who contract Covid-19 infections report symptoms similar to those of the common cold. The “Fifteen in 100” mentioned above might report symptoms ranging from those of a mild influenza to a serious influenza.

The limited clinical reports available suggest that those under 18 are less susceptible to the virus. Those over 40, and especially over 65, are at a higher risk of developing more severe symptoms as are those with pre-existing conditions like heart disease or asthma. Those with any form of respiratory complaint are especially susceptible to the more virulent reaction. Below the age of 80, survival rates are quite high, but over that age, they suddenly ramp up considerably.

It should be remembered that diseases evolve to maximize their own spread and survival, and one of the mechanisms that they use is not killing the host.

UPDATE April 5, 2020:

Further reporting of cases has revealed some more subtle patterns to the symptomology. Most cases take two weeks to run their course; there have been outliers who have taken mere days and others who have experienced symptoms for three or more weeks. Symptoms in the first week are relatively mild for most people, becoming more intense in the second week. In a mild case, people might not even notice that they have it until that second week.

Last night I read a very moving first-hand account of what the experience is like for those who experience more severe symptoms They do not make for a pleasant experience, to put it mildly. You can read it for yourself at Quora (and if you click on the question after reading it, you will find at least 71 other stories, most nowhere near this severe), but it is worth remembering that at worst, this is the experience of a minority. Nevertheless, spare a thought for those suffering through the worst of this pandemic, the next time that restrictions and social distancing begin to bite.

One thing that several (but not all) mention is stomach pain and itchy or dry eyes as early symptoms. Others report the loss of their sense of taste and smell as the first symptoms. Intense lethargy is also a common symptom. In most cases, the fever predates the cough, but not always. It does seem at the moment like every case is just a little different and unique to that individual in terms of the sequence. However, there are definitely common themes in terms of what is experienced, and a lot of the treatments are aimed at controlling the symptoms. A number of complcations have arisen through dehydration – keep an eye on your weight and if it declines markedly, increase your fluid intake. One patient with a confirmed case lost 2kg in 2-3 days through dehydration and came close to needing hospitalization for that alone. Drinking hot liquids is reported as assisting in the breakup of the mucus that causes breathing difficulties, and gargling warm salt water helps clear the throat, which can become very painful during the coughing phase.

It is also now known that blood type makes a minor difference, though research is not clear on exactly why. Essentially, those with Type A blood are slightly more at risk of a serious case, while those with type O blood are slightly less at risk of a serious case. Types AB and B blood are about the same, and are therefore the standard against which the comparisons have been drawn. Understand that these are minor influences – perhaps plus-or-minus 5% to your risk of a serious case.

Infectiousness & Viral Persistence

Viruses are generally not the super-bugs that people like to imagine (there are specific exceptions). According to some reports, Covid-19 has very limited capacity to survive outside a host body; estimates that I have seen suggest a 24-48 hour period, and it might turn out to be considerably less. However, studies of other Coronaviruses suggest that the virus might be able to survive on a surface for as long as 9 days, though almost certainly most of it will be dead long before that, so the risk would decline even before that date.

UPDATE 24 March 2020, REVISED & UPDATED 25 April, 2020:

A study recently published in the New England Journal Of Medicine is the first serious investigation into the question of how well Covid-19 survives outside of an infected person. In air, it lasts at least 3 hours before settlng on a surface. Once there, it’s lifetime is variable, depending on the surface: Plastic and Stainless Steel, 72 hours; Cardboard, 24 hours; Copper, 4 hrs (note that no-one knows why copper is so much shorter than other materials – this research is simply too new).

There is also new evidence that the virus breaks down very quickly and completely in bright sunlight, but that hasn’t been confirmed.

From the moment that Covid-19 comes into contact with a surface, the danger that it poses is diminishing. On plastic, the amount of viable virus had halved after 6.8 hours; at 72 hours, none could be detected. It is not known from the summary of the research that I sighted whether or not this rate is consistent across all surfaces; logic suggests that it can’t be, because of the way the copper and cardboard results differ from plastic and stainless steel; it must be dying off more quickly.

The recommendation emerging from the study is to clean surfaces more regularly than you normally would, but that ordinary household cleaners are more than adequate to the task; Covid-19 seems to be extremely susceptible to soap, bleach, and alcohol-based hand sanitizer – much more so than many other viruses.

To those, I would add / reiterate: wash vegetables and fruit when you bring them home; you don’t know who had been at the bin before you. Wipe down cardboard packaging and plastic packaging with a rag moistened with a diluted bleach solution and dry it carefully. (Note added April 5: These are my personal recommendations; they are considered overcautious according to most health advice. Make sure not to use an antibacterial cleanser for these; not only could that attack useful bacteria if consumed, not only could it be inherently harmful in other ways if consumed, but we are already massively increasing the quantities of such materials being introduced into the environment, which risks long-term impacts. Wev’e already seen this with an older version of cleanser. Whatever we can do to reduce such threats is necessary to the long-term health of our societies. End note.) Continuing the advice: Try to get your hands on a box of disposable gloves (no pun intended) and wear a pair anytime you have to go out, so that you reduce the impact of other people having pressed the elevator call button, etc. Wash your hands before you make a meal, and do it again before you eat. Note that washing hands frequently can dry the skin, so a small amount of moisturizer afterwards may also be useful.

UPDATE 26 March 2020:

Bad news from the CDC – according to this report, “SARS-CoV-2 RNA” (aka Covid-19, aka Coronavirus) …”was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated on the Diamond Princess but before disinfection procedures had been conducted (Takuya Yamagishi, National Institute of Infectious Diseases, personal communication (to the CDC/report author) , 2020).”

This is hearsay, but from a credible source. Now, RNA alone doesn’t mean that there was still viable virus on those surfaces, but it does mean that there might have been. These were closed-up rooms, and there have been stories of flu strains preserved on surfaces by freezing in the past. The rooms had not been cleaned. There is a suspicion that something in the environment on board a cruise ship increases the susceptibility to the virus – it might be as simple as encountering the same infected people day after day, or it might be something more serious, relating (for example) to the way they distribute cool air to cabins.

All of which adds up to uncertainty as to whether or not this information is relevant to a domestic surface that is cleaned reasonably regularly. No-one knows what this means for you and me (assuming neither of us is on a cruise ship). We can’t simply assume the worst because that is contradicted by the actual lab-condition studies described in my March 24 update. At best, we can say that If you don’t follow the advice of health officials, as relayed above, your chances of infecting someone else if you have the bug are potentially much greater. We always knew this particular agent was extremely infectious; this might be the first hints as to the reasons for that.

Now, back to the original post…

This vagueness is partially responsible for the conflicting information in this area; I have seen suggestions in the past that virus survival should be given in half-lives, like radioactivity: “wait this long, and half the virus population on an isolated surface will no longer be dangerous”. But that is not the way things are done at the moment. The bottom line is that just being exposed to it doesn’t mean that you will catch it – the most reliable estimates that I can find suggest a 10-30% infection rate.

That’s still scarily high. Let’s do some math:

One person becomes infected.

If they come into contact with 10 people a day (a low number), and are infectious for 2 days before noticing symptoms, that’s 20 people exposed. If 20% of those 20 people then catch the virus, that’s 4 people, even assuming that the original victim does his best to self-isolate. Two days later, 4 people become 16, 16 then become 64, 64 become 256, 256 becomes 1024, 1024 becomes 4096, 4096 becomes 16384, and 16384 becomes 65,536 by the time the original carrier’s two-week isolation period is up.

If the average is contact with 20 people a day, those two days infect 20% of 40 people, or 8. Then 64, 512, 4096, 32768, 262144, 2097152. That’s 2.1 million.

But these numbers are unnecessarily pessimistic. For one thing, the contagion rate outside the worst-affected areas appears to be closer to the 10% mark, or less, than to the 20% used above, or the 30% originally reported from China. For another, taking reasonable steps to minimize infection like coughing or sneezing into your elbow (far more effective than covering your mouth with your hand) and washing your hands regularly can drop the risks 100-fold or more.

A more realistic number of contacts, daily, is 100. Let’s try a more realistic set of calculations, with precautions: One person, two days, 200 people contacted. 10% of 200 is 20, divided by 100 is 0.2 people. One fifth of a person. That means that to get even one more victim, we need to start with five people infected, spreading the disease.

The real danger is of people not taking enough care. You only have to miss once – touch an elevator call button or a door handle or whatever and fail to wash your hands afterwards – and that 0.2% can leapfrog back up to 20%. Do so five times and the chance of being infected climbs markedly to 67%.

On top of that, the calculations shown assume that there are none of these potential 200-per-day encounters in common between the sufferers, and that’s improbable beyond description (but the math is a lot easier that way). The reality is that there would be overlaps, people exposed to the virus multiple times, and hence far more likely to catch it, and this results in clusters of people becoming ill.

You may have wondered why “Pandemic” is such a big deal, based on what I wrote earlier. The answer is that when a disease is “Epidemic”, it’s confined to these clusters, but when it becomes “Pandemic”, the size of the clusters and the number of clusters are such that the risk becomes general to the whole population. The “Pandemic” declaration means that the World Health Authority think that there is a very good chance that this will happen. That’s the reason for governments having greater powers in such events, and what they are trying to stop.

It’s statistics like these that led German Chancellor Angela Merkel to forecast that she expects as many as 70% of the German population to contract the disease – eventually. She may be correct – but for the immediate future, that prediction is alarmist. It may take years for that to occur – or it might be a lot more rapid; we just don’t know, yet.

National social habits will undoubtedly play a big part in determining the rate of infection. In France, for example, it is normal to kiss people on the cheeks in greeting; while I have no doubt that the current advice is not to do so, this would have increased transmission of the disease markedly before the restriction was put in place. That’s why there is now a surge in French cases taking place.

Don’t Panic! Nature will still be waiting for us tomorrow.
Image by Patty Jansen from Pixabay, text by Mike

Detection

There is a test for Covid-19. Currently, it takes 24 hours to process a test kit. Various labs are working on faster-response kits – South Korea reportedly now has one that is 99% accurate and gives results in just three hours.

Early kits were even slower and – in the case of the first kits released by the CDC, flawed. I’ve mentioned the impact of those flaws and the consequences elsewhere.

When developing such test kits, there are four goals that are almost contradictory – affordability, speed of manufacture, speed of results, and reliability. Often, one or more needs to be compromised. Sometimes, a two-tier approach is needed – a cheap and somewhat unreliable test that never gives a false negative for an initial screening, and a more expensive test with high reliability for those possible cases flagged by the first test.

Testing regimens for Covid-19 are not yet that advanced. The US test kit is particularly expensive – I can’t speak to the cost of the tests of other nations. I can simply state that for the same price as getting tested in the US, I could have a double hip replacement here in Australia (not that I need one, thank heavens).

Kits will get cheaper, and faster to manufacture (which will also make them cheaper). They will get faster at giving results – hopefully without compromising reliability. But they aren’t there yet. And that means that unnecessary testing becomes a significant problem, eating into the limited supplies of the kits that are available. It’s in addressing this problem that the Australian government has made its’ most serious misstep in its management of the emergency to date.

We know that eventually, inevitably, there will be cases of people becoming infected as a result of exposure to someone who caught the virus overseas, rather than catching it overseas themselves. This is secondary transmission. Until now, the policy has been to test anyone presenting symptoms – but demand has outstripped supply and analysis resources. That tends to happen in a panic. In response, the government has decided to develop a protocol for assessing whether or not someone needs to be tested for Covid-19. So far, so good. The problem is that in the meantime, the advice is that unless you have recently been overseas, you don’t need to be tested. With at least two reported cases of secondary transmission, it’s too late for that restriction; it will only be counterproductive, enabling the broader spread of the disease here. It’s a white flag, an act of surrender to the circumstances. It’s an acceptance that the virus has escaped containment, and an unwillingness to be told how bad it really is out there in the real world.

If this policy goes ahead, what will happen is that the government will buy itself some room for complacency until the protocol is developed; they will then find that far more people are meeting the standards for testing than they were expecting (return of the problem), and that an unexpectedly high number of those tests will result in confirmed cases (the consequences of the misstep). Thus, the number of confirmed cases will skyrocket even faster than they would otherwise have done, and if anything is likely to induce panic, that’s what will do it. Of course, if that’s the only mistake they make, they will be doing an exemplary job of handling the crisis; but it signposts the possibility of other failures of the decision-making process, and that’s the real problem.

Sorry, letting myself drift off-topic there. Getting back on-track: since the initial announcement of the three-hour kits, I have heard nothing more on the subject. Results continue to be overnight, here in Australia, some weeks after the report. That says to me that the Korean test kit has a significant failure in one of the four criteria; taking their reliability and speed of results at face value, that means that it either takes too long to mass-manufacture, or costs too much, or both. At best, if that’s the case, it demonstrates that a faster test is at least possible. But we don’t have it yet.

Treatment

Currently, there is no effective treatment other than general respiratory support in the event of a serious form of the illness. A human vaccine is probably a year away, and it will still need testing and mass-manufacture, a process that the most generous of fast-tracking cannot reduce to less than about six months. The clock on this is already running; it started the moment a lab outside China succeeded in culturing the virus, three or four weeks ago. In effect, they learned how to manufacture more of the virus so that it could be studied in multiple locations under laboratory conditions. But don’t expect it to be announced before December 2020 or widely available sooner than mid-July 2021.

The current expectation is that Covid-19 will be like the flu – it will mutate relatively rapidly from one strain to another. Immunity to one will confer a limited immunity to other strains that will probably further mitigate symptoms upon reinfection, except in those who have become more vulnerable in between due to other medical problems or advancing age. I speculate that It will take years before the vaccine achieves full effectiveness.

To understand this last, it’s worth briefly recounting how the flu vaccine works because the Covid-19 vaccine is likely to work in a similar manner.

There are four major strains of influenza. Each year, labs select the two that appear most likely to be widespread in the coming winter and prepare a vaccine against those strains. This confers immunity to those strains for two or three years, slowly reducing in effectiveness. Some of this protection goes away more slowly than the rest; a vaccination may help mitigate symptoms from a strain as much as five or ten years afterwards. But that will vary from individual to individual, so one of the pillars of the vaccination programs is not to rely on that residual benefit. It is also widely believed that the benefits of a fresh immunization before the last one targeting that strain will have minimal benefit. That’s why they don’t target all four strains every year. So, this year they might target the A and B strains, next year the A and C strain, the year after, the B and D strains, and so on. That’s why, if you are considered vulnerable to the flu, you should get the shot every year.

The A strain, twice in a row? Yes, because the vaccine-makers can’t assume that you got vaccinated last year. For those who did, the A-strain vaccination a second year in a row has virtually no benefit, but for anyone else, it confers protection against one of the two strains most likely to be circulating.

There are times when the predictions are wrong, or when a particularly nasty sub-variety emerges, and the vaccines have to be re-made with different priorities.

So, let’s apply this knowledge to the likely form of a Covid-19 vaccine. How many strains will it have? No-one knows; we’re busy dealing with the one that’s circulating at the moment. But it’s likely that it will be more than one. The vaccine, as first developed, will probably only protect against one of these strains – the one that’s currently running rampant.

Diseases don’t come out of nowhere; they are simply a more virulent strain of something that’s been around for a while. Quite often, they will culture and evolve in animal hosts until getting a toe-hold on the human population. That’s true of flu, of the common cold, of Ebola – and almost certainly true of Covid-19. What that means is that from time to time there will be an outbreak, but in the meantime, there will be little or no risk from the virus. It’s entirely possible that by the time we have a vaccine, we’ll no longer need one – for this outbreak.

The US Center for Disease Control knew all this years ago, and established a program to specifically look for the next pandemic and prepare for it in advance as much as possible. President Trump and his republican allies gutted that program when he came to office, deeming it a waste of money. I can only speculate on how much better-prepared we might have been if this short-sighted decision had not been taken. You can’t blame Covid-19 completely on them, but they bear more of the blame than others for the social and economic harm that is now occurring.

What a vaccine will do is put a full stop to this strain, for at least the time being. And it is exceptionally unlikely that the next strain will be anywhere near as serious – if that were likely, there would have been an outbreak before this, and we would have known about it before now. The mere fact that Covid-19 seems to have come out of nowhere shows that it’s usually pretty harmless. What we are now learning – the very hard way – is that it can assume a more malevolent form, and that we need to actively monitor it. It might be fifty years, or seventy-five years, or a hundred years, before the next life-threatening outbreak – of this strain of this disease. But, when it does, we’ll be ready for it.

That doesn’t mean that we shouldn’t be looking now for the next bird-flu, or SARS, or swine-flu. It’s out there, waiting. The CDC program described was an insurance policy; most years, you pay it and don’t need it, making no claims against it. But every now and then, something catastrophic will happen and you will be desperately glad that you have that insurance – unless you’ve let it lapse in the meantime.

UPDATE 5 April 2020:

Some sites have been reporting that there have been 8 strains of Covid-19 currently circulating globally, all extremely similar genetically. I have not seen this confirmed by a compelling source but it fits information that has come from such sources.

The virus has been genetically sequenced in at least 32 different countries. Contrary to the expectations raised above, it appears to be extremely slow to mutate significantly. This means that a vaccine is likely to be much longer-lasting, conferring immunity for years or even decades. It also means that it’s slow to become a threat and slow to stop being a threat once that transition is made.

That says to me that Covid-19 will become another of the childhood immunizations that everyone needs to get, and that there may need to be booster shots at regular intervals. More like measles than the flu, in other words.

Recovery

Eighty percent of victims recover with no special treatment whatsoever. Most people with minor symptoms will be told to quarantine themselves at home, keep up fluids and take paracetamol to control their temperature. Australian patients have generally recovered in about four weeks according to some reports, and that’s the long extreme; most are reported to recover within a week to fortnight.

People suffering from more severe symptoms may need to go to hospital, where they will be cared for in a negative pressure ward (to keep the virus from spreading) and might be given intravenous fluids and possibly oxygen in more serious cases.

A few may develop an infection which could lead to pneumonia. These patients would be treated in an intensive care unit where more aggressive life-support is available. Severe pneumonia can lead to respiratory failure, which is the leading cause of death from Covid-19.

Don’t Panic! Flowers will still bloom tomorrow!
Image by Edda Klepp from Pixabay, text by Mike

Health-care Capabilities

One of the primary goals of containment is not to eradicate a virus, but to buy enough time for the health-care system to prepare by slowing the spread of the virus. Until there is a vaccine, the spread of a really infectious agent like Covid-19 can only be slowed, not stopped, unless there is really low levels of exposure.

This pandemic will almost certainly be a lot worse in the US than in someplace like Australia, for a number of reasons. First, the health-care system, as mentioned previously, is not set up for mass testing and mass-immunization; it operates on the premise that all medical treatment is optional, to be paid for by the person opting for treatment. Health insurance may or may not relieve them of part of the burden. But a LOT of people can’t access health-care, promoting the spread of the virus. Second, the emphasis of the Trump Administration was on keeping the number of confirmed cases low at all costs – not on locating and identifying those with the illness. This gave the virus still more opportunity to spread. Third, the test kits that were initially released were defective. If they merely gave the occasional false positive, that would be bad enough; but they actually permitted a false negative, telling infected people that they were not infected, enabling them to further spread the virus. There have been some estimates that for every confirmed case in the US, as a result of these circumstances, there may be as many as 10,000 undiagnosed cases. And the math I presented earlier shows in graphic (if exaggerated) terms just how quickly 10,000 can become a hundred thousand, and how quickly 100,000 can become a million.

If 1,000,000 people become ill with the virus, 800,000 will be fine – but 200,000 may require medical treatment in hospital conditions. The US Hospital system is not set up to cope with that level of demand, but they can hardly be faulted for that – few national health systems are. The Chinese managed this problem by building three temporary hospitals in the heart of the outbreak at astonishing speed. While it seems unlikely that this can be matched everywhere in the world, the success that has resulted suggests that the temporary re-purposing of existing structures and the erection of temporary structures might be enough.

The current population of the US is almost 309 million. If 10% of them become infected, that’s 30.9 million. That’s 6.18 million requiring hospitalization. Those are the sort of numbers that the alarmists are offering. The reality is not that bad, because those cases won’t all occur at the same time. But the long-term picture is still gloomy; the current expectation is that even with all possible precautions, 25% of any given population will catch the virus over the next six months.

Six months is 26 fortnights. 25% divided by 26 is roughly 1% – certainly within the margin of error. But the cases won’t be evenly distributed; they will increase for a while, and then peak, and then die down. The peak might be as high as 5%. For the more heavily-populated northern hemisphere, that six months includes some spring, a whole summer, and some autumn – which is also good news. For those living in the Southern Hemisphere, though, we are entering our cold and flu season. Inevitably, both the number of confirmed cases and the number of people presenting as possible cases is going to explode here.

The other troubling number is that the number of confirmed cases in Australia is roughly doubling every five days. In six months, there are roughly 182 days – which is 36.5 lots of 5 days. Two to the power of 36.5 is 97,184,015,999 and a fraction. That’s only 3790 times our total estimated population – if we had only one confirmed case. We don’t; we have 160, of whom 26 have recovered and three have died, leaving 131 current cases.

You can see why the authorities here are pushing measures to contain the spread. Even reducing the rate of doubling to every six days or seven days has a massive impact due to the exponential growth involved. Six day doublings is only 30-and-a-fraction doublings, which still produces a monstrous number – but not as big a number as before. Seven days gives, as you might expect, 26 doublings, and two to the power of 26 is only 6,7108,864. Every increase from that point only lowers the total number of cases – both overall and that have to be coped with at any given moment.

It follows that even if your local authorities are not implementing emergency measures to achieve containment, you shouldn’t wait; you should prepare now and implement a considered stay-safe plan without waiting.

There’s a secondary consideration: Covid-19 is happening on top of all the usual things. There will be no fewer heart attacks or accidents or cancers because it is happening. That becomes a problem when the hospital bed, or hospital equipment, that would normally be available to treat your condition has been appropriated to care for someone suffering from acute Covid-19. Inevitably, the mortality rates from other conditions will rise because some of the health-care capacity of the existing system will have been diverted to the Coronavirus.

Once again, the reality is slightly better than this grim picture; there is always some slack built into the system for moments of peak demand. But part of the process of making private hospitals profitable and public hospitals affordable is to cut that slack to the bare minimum; so this is a very limited balm to spread on this problem.

Many forms of emergency are localized, and when that happens, additional capacity can be brought in from outside, or patients transferred elsewhere. This has enabled the slack in the system to be further reduced. Because of its international scope, that’s not a viable approach to Covid-19. That’s the grim reality being experienced in Italy at the moment., where patients have overflowed from the available capacity into field hospitals, and the mortality rate is skyrocketing from lack of equipment that could have saved some.

Rate of Serious Responses

There has been some suggestion today that the risk of serious health complications for the under-80s – that’s the vast majority of people – is 3%. I’ve also seen figures of 5% and 8% reported. The trend in reporting lately has been downward. Above the age of 80, the rates rise to 15% or more, and there is at least three times as much risk that death will result from such serious health conditions as there would be in a younger person.

Do whatever you can to avoid exposing the elderly to Covid-19, therefore.

Don’t Panic! Butterflies will still fly tomorrow.
Background by Lisa McLean, Butterfly image by OpenClipart-Vectors from Pixabay; Text, additional sky, and arrangement by Mike

Child Exposure

Initially, it was suggested that children were also at elevated risk. Their immune responses are still forming, after all, and they are well-known to be germ factories; if there’s anything going around, kids seem sure to catch it and pass it on. In part, that’s because they have no judgment – while a slight unease can feel like the end of the world, at least as often, enthusiasm makes them willing to forget and ignore feelings of ill-health. They are also less likely to wash their hands often enough, and more likely to touch hands to mouth or nose. In other words, to do all the things that you don’t want people to do under the current conditions.

To some extent, the urgency has gone out of this advice. Children are still a special problem, but not quite for the same reasons as were initially assumed. The indications are that they are less prone than adults to get seriously ill from Covid-19, but no more- or less-likely to catch it. And schools are natural mass-gatherings. Effectively, so are park and playground equipment. Consider both to be petri-dishes incubating whatever is going around; normally, that’s just a cold or flu. Right now, it’s more serious.

Therefore, the concern is not about the kids being at direct risk, but about them passing the disease on to someone of lower resilience.

Here in Australia, it had become a regular thing for preschools to visit nursing homes. Normally a brilliant idea, under current conditions, it’s one of the worst, and was the first activity curtailed here in response to the outbreak. The resumption of the practice will almost certainly be one of the last signals that the crisis is past. (That’s not meant to say that our government has gotten it right 100%, just that we’re batting above average when it comes to this crisis. It doesn’t forgive or make up for past lapses nor any current/future idiocy on the part of our elected officials).

Some people don’t understand these facts, and call for schools to be closed. That’s part of the playbook for dealing with an influenza pandemic, and it works because when it comes to influenza, children are super-spreaders. They’ll not only catch it, they’ll pass it on to someone else. Wherever schools have been closed in the current crisis, it’s because people have been treating Covid-19 like the flu – when it isn’t. There is presently no evidence that closing schools does anything whatsoever to contain the spread of the disease.

An exception has to be made for schools where a student or staff member have actually tested positive for Covid-19, and if the virus spreads far enough through a population, that will eventually be all or most of them. And Universities are not the same thing.

Of course, the other reason why most governments will be reluctant to close schools is that this automatically removes almost half the workforce, who then have to be home to care for the children. Child-care facilities, even if they were affordable, are no better than a school would be; they kind of defeat the purpose. Given that Covid-19 will already have economies under extreme pressure, dealing yet another body-blow is something that most governments will consider only reluctantly.

Mass gatherings

The most recent emergency measure here is a banning of unnecessary mass gatherings, which have been defined as more than 500 people. That’s a problematic number because our mass transit systems can carry that many aboard a single train at rush hour, and there can be thousands of people waiting on the train platform for their ride home at the end of the day. It’s not a problem of the same scale going the other way, because the numbers are dispersed over a much greater number of railroad stations and therefore platforms.

Our government has deliberately excluded train travel, for this reason. They are referring to sporting events and social events and cultural events. There are still some problems to be surmounted; the question of movie theaters, for example, where a premiere can pack in hundreds at a time and far more than 500 in a day – without time to disinfect the seats in between. Big businesses with more than 500 staff are also an uncertain proposition – which includes the Australian Government itself; there are about 5,000 staff in parliament house, and while they don’t routinely gather, the number of contacts is still significant.

Fortunately, these have been described as preemptive and preventative measures. They aren’t actually necessary here, yet – so there’s time to work out any bugs before they do become critical.

Sporting codes across the world are either suspending their 2020 competitions or competing behind locked gates. Conventions are being canceled. Broadway has closed. Everywhere you look, society is making it easier for you to do so. But these measures will do no good if patrons who would normally attend such activities simply gather to mourn the absence of their preferred pastime.

This is an area where there is no one-size-fits-all advice; it depends on the number of cases and the rate of spread and the estimated number of undiagnosed cases, all of which combine to determine the potential exposure of a group of size X. The one rule of thumb should be that if you don’t have to go somewhere where there are such crowds, you should not do so.

Don’t Panic! Waterfalls will still flow tomorrow.
Image by Barbara Jackson from Pixabay, text by Mike

Smaller Gatherings & Events

These are currently unrestricted here. They are drastically restricted in Italy. The US is currently somewhere in between the two of us – but it’s probably closer to Italy in terms of the number of undiagnosed cases.

A Keep-yourself-safe plan

The advice being offered at the moment is very simple and sensible stuff.

Washing Hands

Wash with soap and water. You don’t need an anti-bacterial hand sanitizer, Covid-19 is a virus and won’t be affected. Wash frequently and thoroughly.

Zone of separation

Stand at least three feet away from a person who is sick to avoid being sprayed with liquid droplets from their bodies.

Self-isolate

Be prepared for the need to self-isolate without further warning. That means having 14 days worth of food and medication and other essentials on hand at all times. In particular, if you feel unwell, do not visit the elderly.

Face masks

If you are a member of a vulnerable group, or if it is confirmed that you have Covid-19, wear a surgical mask. If your job involves contact with a lot of other people, e.g. cashier, wear a surgical mask. Otherwise, don’t wear a mask; doing so only takes one away from someone who may need it more.

Consciously avoid touching your face.

Put a reminder on your hands – a fluorescent label or tag or something. Write the word “STOP!” on it in big black letters. Whenever it comes into view, you should glance at the label and be reminded – because it’s all too easy to get distracted and forget.

Save.

Especially if you’re a casual or part-time worker, or a recent hire, cut your spending to the bone until you have enough set aside that you can live on it for about three weeks, paying any bills that will be due in that time. Your income might disappear tomorrow, either directly (you or your boss gets sick) or indirectly through economic impact.

Spend

The effects of the Coronavirus outbreak on the global economy are only guesswork at the moment, but current expectations put the magnitude as roughly double that of the Global Financial Crisis. Yes, that bad. And that’s without fools making the problem worse.

To combat these economic impacts, governments are putting various stimulus packages in place to support their economies. The specifics vary from country to country, government to government, economy to economy; just as every country is different, so their exposure to the consequences will be different.

There is also an inherent inertia to stimulus packages. They take time to prepare and implement, and by the time you find out whether or not it has been enough, it may be too late for another.

In large part, these stimulus packages are designed to do two things: sustain the businesses that are impacted so that people have jobs to go back to when the crisis is over; and keep an economy ticking over, even if at a reduced level of activity, until a recovery can begin.

Part of protecting yourself from Covid-19 has to be doing your best to prevent damage to the essential economic infrastructure around you. And that means keeping the economy moving by spending what you can afford, taking into account the realities of freight and delivery. So as soon as you have the savings minimum in place (a moving target), spend every cent in excess of it that you can, and spend on local products as much as possible.

Casual workers are a problem that will be faced by a great many countries, and are one of many reasons why this economic emergency is not the same as the GFC. In Australia, 25% of the workforce are now casual labor, accruing no sick leave or other benefits; if they are required to self-isolate, there’s a huge economic problem. Because they can’t afford not to do so, they would probably work on – spreading Covid-19. There’s a great deal of uncertainty as to whether or not the current plans adequately address this problem. It’s a situation that will be replicated the world over; most countries have this problem to some extent. In the US, the percentage of casual labor is even higher at 30%, for example.

Right now, the world has a high fever, and it’s rising. Adding a recession to that won’t do anyone any good.

Avoid Panic Shopping

I said at the start, Don’t Panic.

Panic Shopping is a form of panic in which the victim assuages their jangled nerves by performing an unreasonable act of shopping. In Australia, we’ve seen shelves emptied of toilet paper (even though few victims of Covid-19 experience symptoms that would require unusual quantities), shelves emptied of hand sanitizer (more reasonable, but ordinary soap will work just as well), and mass buying of staples like rice and flour (month’s worth). You need to keep enough food for a fortnight’s isolation – that’s it.

Support others

If you suspect that someone around you – a friend, co-worker, or neighbor – is self-isolating, contemplate what you might be able to do to help them. Supplies of perishables – milk, bread, sugar, eggs – can go further than you think. Even simply inquiring as to their health through a closed door can have a tremendous positive impact on the psychological problems that result from self-isolation. Call people on the telephone. Interact with them over the internet. Do all the things that you would hope someone would do for you if you were the one isolating yourself.

Self-isolation in the modern age does not mean that you have to become a hermit.

Avoid perpetuating myths

…at least, myths about Covid-19. Squash misinformation whenever you come across it – but be aware that the information sources you are relying on may have dated; the impact that Covid-19 is having is constantly evolving, and the responses to it are also evolving in response. The content of this article was best advice on Saturday the 14th – it might be out of date by Monday March 16th, when it’s actually to be published.

Be friendly, supportive, and polite

Have you ever had to do two people’s jobs because someone was out sick? How about three people’s jobs? With unreasonable customers screaming at you because you were slow in wiping their nose and rolling out the red carpet? While you were worried about making ends meet because there weren’t enough customers?

Assume that everyone still on-the-job is operating under maximum stress and difficult circumstances as best they can, cut them as much slack as you can, and don’t be the unreasonable a**-hole in the picture. Do what you can to relieve some of that stress. It’s a good habit to get into, regardless of the circumstances.

And, should bad news come, don’t shoot the messenger and don’t shoot bystanders. There’s always someone whose life is worse than yours.

Minimize exposure

Avoid large crowds as much as you can. If you can’t avoid a crowd, take appropriate precautions while in that environment, like washing your hands before and after. Don’t shake hands with others. Avoid unnecessary contact. Don’t kiss strangers. Contain sneezes and coughs. If unwell, stay home – and avoid contact with the vulnerable, especially. If you need it, don’t be afraid to ask for help.

Wash Everything You Buy (or cook it)

With the uncertainty over how effective the virus is at surviving on a surface, assume the worst. When you buy something, it will have been touched by at least one person (the stockist who put it on the shelf) and may have been handled by many. So wash the fruit and veg (DON’T use soap!), wipe the packets and plastic containers with a moist cloth and dry well, cook the meat well, and so on.

A Covid-19 Myth Or Two (or three, or four…) Jabbed

This section of the article has been excerpted into it’s own post – it was simply growing too quickly, and had reached the point where it needed to be out there on its own.

The Central Question: Should My Game Be Canceled?

Answering this question was the original motivation for publishing the article, and the advice within remains: three different ways of getting to the right answer to the question. Those techniques have been placed in their own standalone article.

PRINCIPAL SOURCES (in no particular order):

1. ABC-TV (Australia): Coronavirus symptoms explained – what happens when you get COVID-19 and how likely is a full recovery?
2. ABC-TV (Australia): Coronavirus FAQ: Frequently asked questions about COVID-19
3. Australian Government Dept Of Health: Coronavirus (COVID-19) web-page as retrieved 14th March 2020
4. KVIA.com: Coronavirus Outbreak Timeline Fast Facts
5. Facebook: Coronavirus Q&A with Dr Norman Swan
6. ABC 7 (New York): Busting COVID-19 Coronavirus myths: Facts from the Centers for Disease Control
7. ABC News (Channel 24, Australia): “The Virus”, broadcast March 8th, 2020
8. ABC 7 (New York): How is Coronavirus spread? Symptoms, prevention, and how to prepare for a COVID-19 outbreak in the US
9. Worldometer: Coronavirus Web-page
10. ABC News (Channel 24, Australia): Covid-19 Stimulus Package Review & Analysis with David Spears, broadcast March 12th, 2020
11. World Health Organization via New York State Senator Alessandra Biaggi (Twitter Account)
12. Dr Faheem Younus, MD, Chief of Infectious Diseases, University of Maryland UCH (Twitter Account)
13. ABC-TV (Australia): Fact Check Website