I am writing this for my friends and for the several communities I belong to. When I first decided to do the research and contemplation for this paper, my concern was chiefly to raise awareness and heighten a sense of urgency. And indeed as of March 23, 2020 the coronavirus is widespread, with 332,935 confirmed cases, and the rate of infection is accelerating. (And the acceleration continues; as of March 30 there are over 735,000 confirmed cases):
- 67 days to reach 100,000 cases
- 11 days to reach 200,000 cases
- 4 days to reach 300,000 cases
The world can change the trajectory, but it requires solidarity. It is the need for this solidarity and social cohesion that I would like to most emphasize.
We may stock up on supplies for ourselves, but in so doing bring about empty shelves in stores causing hardship for others. On the other hand we may continue social interaction when we feel healthy, thinking “social distancing” is for others but does not apply to us right now. However, we may be infected and not know it yet, since the average incubation period of the virus is 5 days and may be as long as 14 days. If we do not cover our mouth on a cough, the very first cough when we begin to be symptomatic may expel droplets that may infect somebody standing close to us.
Measures like washing hands and social distancing are important, helping to contain the spread of the virus and buy time. But to win against the coronavirus, the development of effective therapeutics is essential. Small, non-randomized studies and anecdotal results are not useful. They can give false hope and take medicines away from where they are needed. What is needed are large, randomized clinical trials on a scale not done before.
There is an urgency both to our individual actions and to our advocacy of proper measures by government at every level. Because of the exponential rate of spread of the virus, every day of delay results in more infections, more deaths, and greater stress on our healthcare system.
By responding promptly and cooperatively at both the community and global level, we lay the groundwork for a deeper shift in consciousness that can begin a transformation of our community and our world.
A Note on Sources of Information
There is a welter of information in the news and on the Internet about COVID-19. The most definitive and reliable information is that available from the Center for Disease Control (CDC), the National Institutes of Health (NIH), and the World Health Organization (WHO). Most of the information in this paper is derived from these sources.
Information is continuously been updated from research. Over 1000 scientific papers have been published to date. So detailed information is subject to change. However, the current preventive measures (i.e., hygiene and social distancing) are valid and may even become more stringent.
Coronaviruses are named for the crown-like spikes on their surface. Human coronaviruses were first identified in the mid-1960s. There are seven coronaviruses that can infect people. Four are common and typically cause mild illness, such as the common cold. Prior to 2019 there were two serious coronaviruses:
- MERS-CoV (that causes Middle East Respiratory Syndrome, or MERS)
- SARS-CoV (that causes severe acute respiratory syndrome, or SARS)
A novel coronavirus is a new coronavirus that has not been previously identified. The seventh coronavirus, originating in Wuhan, China, is a novel coronavirus:
- SARS-CoV-2 (that causes Coronavirus Disease 2019, or COVID-19)
COVID-19 is a respiratory disease. It can manifest in several forms:
- Some people may become sick and be dying within 48 hours
- For about 80% of people it is like a cold
- Other are asymptomatic but are carriers of the disease
Vulnerable groups include older people as well as those who have: diabetes, hypertension, cardiovascular diseases, cancer, especially under chemotherapy (e.g. leukemia, lymphoma and others), lung diseases, asthma, any chronic diseases especially involving the immune system – and this includes children.
The concern is not the proportion of death, it is the number of people who become severely ill and need ICU and respirators (ventilators) all at the same time surpassing the number of equipment and hospital beds available. That contributes to the number of deaths. The other contributor is that once the virus compromises the immune system, bacterial infection spreads and the person develops a disseminated bacterial infection (sepsis) which evolves to multiple organ failure and death.
Currently there is no vaccine to prevent the disease. Since the virus is novel, it will take time to develop one and to do clinical trials to assess benefit and risk. It is not expected a vaccine will become available until early 2021. The best protection is to avoid being exposed to the virus and to consistently follow CDC protection guidelines.
The virus is thought to spread mainly from one person to another, who is in close contact (within about 6 feet). It spreads through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
Clean Your Hands
Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. It is important to do it thoroughly, as demonstrated in this video. (If you wash incompletely, it easy to miss some areas of your hands, as graphically shown in this video.)
Avoid touching your face particularly your eyes, nose or mouth.
Hands touch too many surfaces and can quickly pick up viruses. Once contaminated, hands can transfer the virus to your face, from where the virus can move inside your body, making you sick.
Avoid close contact
Avoid close contact with people who are sick Put distance between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick.
Stay at Home
A strong case can be made for a 5-week national lockdown.
Closing schools, bars and movie theaters are good measures, but not enough. Our relaxed approach to social distancing is insufficient to stop the exponential growth of COVID-19. Until Americans consistently adopt strong social distancing recommendations — a lockdown — the disease will continue to spread exponentially.
During a five-week national lockdown, federal, state and local authorities would ensure that all Americans stay home except to obtain food and other essentials, access medical care or do work essential to the functioning of society. Travel would cease: We would close our borders and airports and prohibit all unnecessary travel across state and county (or town) lines within the United States. The U.S. government would have to provide aid to citizens separated from their sources of income and ensure care for vulnerable members of society.
NOTE: As I write, “shelter in place” orders are becoming widespread, including in Mecklenburg County, North Carolina, where I live. If such an order is in effect in your community, please comply with it completely. If not, please do it on your own and urge all your friends to do likewise.
Winning Against COVID-19
These remarks are from the WHO Director-General Dr. Tedos Ghebreyesus made at the WHO media briefing on March 23, 2020.
You can’t win a football game only by defending. You have to attack as well. Asking people to stay at home and other physical distancing measures are an important way of slowing down the spread of the virus and buying time – but they are defensive measures.
To win, we need to attack the virus with aggressive and targeted tactics – testing every suspected case, isolating and caring for every confirmed case, and tracing and quarantining every close contact.
We recognize that some countries are struggling with the capacity to carry out these offensive measures. Several countries have shown that mobilizing resources internally from less-affected regions is one way to increase capacity.
We’re also grateful that several countries have sent Emergency Medical Teams to care for patients and train health workers in other countries that need support. This is an incredible example of international solidarity. But it’s not an accident. WHO has been working with countries for years to build a network of Emergency Medical Teams for exactly this eventuality, to provide surge capacity of high-quality health professionals who can be deployed to care for patients and save lives.
But health workers can only do their jobs effectively when they can do their jobs safely. We continue to hear alarming reports from around the world of large numbers of infections among health workers. Even if we do everything else right, if we don’t prioritize protecting health workers, many people will die because the health worker who could have saved their life is sick.
As you know, WHO has been working hard with many partners to rationalize and prioritize the use of personal protective equipment. Addressing the global shortage of these life-saving tools means addressing every part of the supply chain, from raw materials to finished product. Measures put in place to slow the spread of the virus may have unintended consequences by exacerbating shortages of essential protective gear, and the materials needed to make them.
Solving this problem requires political commitment and political coordination at the global level. This week, I will be addressing heads of state and government from the G20 countries. Among other issues, I will be asking them to work together to increase production, avoid export bans and ensure equity of distribution, on the basis of need.
We need unity in the G20 countries, who have more than 80% of global GDP. Political commitment at the G20 means strong solidarity that can help us to move forward and fight this pandemic in the strongest way possible. The most important ask to G20 leaders is solidarity, to act as one, because they have the biggest stake in the world, in all respects.
We also recognize that there is a desperate need for effective therapeutics. There is currently no treatment that has been proven to be effective against COVID-19.It’s great to see the level of energy now being directed to research against COVID-19. Small, observational and non-randomized studies will not give us the answers we need. Using untested medicines without the right evidence could raise false hope, and even do more harm than good and cause a shortage of essential medicines that are needed to treat other diseases.
That’s why WHO has launched the SOLIDARITY trial, to generate robust, high-quality evidence as fast as possible. I’m glad that many countries have joined the SOLIDARITY trial, that will help us to move with speed and volume. The more countries that sign up to the SOLIDARITY trial and other large studies, the faster we will get results on which drugs work, and the more lives we will be able to save.
I have been frustrated about the slowness of individuals and governments to take effective action in a timely manner. And when action is taken, it seems too little. But I have been slow myself. I became concerned about COVID-19 several weeks ago and began canceling plans to attend several conferences. But I did not do any more than that, and only in the last few days started work on this paper. I recognize my own complicity in inaction.
We are all human beings in a process of spiritual evolution. Judging ourselves and others is not helpful. When there is confusion at high levels we have all the more need to act responsibly ourselves and to take wise action at the local level. By our communities responding promptly and cooperatively to the COVID-19 challenge, we may lay the groundwork for a deeper shift in consciousness that can begin a transformation of our communities and our world. For the spur of the coronavirus we can actually be grateful, as beautifully expressed in the this video.