COVID-19 is a virus that affects the respiratory system. Many people who get COVID-19 will feel like they have a regular cold, but others could experience more severe illness or even death. People older than 60 or people living with an underlying illness are at greatest risk—e.g. heart disease, lung problems, or a compromised immune system. The virus emerged (seemingly out of nowhere) in December 2019 and over the intervening weeks has invaded our lives in nearly every way imaginable. This article explores the emergence of COVID-19 and provides practical information for New Orleans residents.
What the hell happened? A COVID-19 origin story:
COVID-19, then known as the 2019 novel coronavirus, crept into public consciousness when Chinese public health surveillance reported a disease cluster on December 31, 2019. Officials identified an association between the illness and the Hunan Seafood Market in Wuhan, China. The market was subsequently closed and thoroughly decontaminated by January 1, 2020.
COVID-19 belongs to a family of viruses called coronaviruses. These viruses share a thorny surface visible through a microscope that creates the crown-like effect (latin: corona) that earns them their name. Coronaviruses are examples of zoonotic infections, or infections that are spread by close contact between animals and people. Zoonoses can be caused by bacteria, parasites, or fungi (who hasn’t had ringworm?). Even the common flu, or influenza, began as a virus of waterfowl that eventually transferred to humans.
Scientists believed coronaviruses only infected animals for most of the 20th century, but that changed in 1964 when the first coronavirus known to jump the species barrier was discovered in the runny nose of someone with a common cold. Several other coronaviruses circulated in the intervening years that caused only mild illness, until SARS—a coronavirus that caused a more severe infirmity—topped the headlines in 2002. MERS followed a decade later in 2012. Unlike SARS and MERS, COVID-19 has proven to be more lethal and difficult to contain.
SARS, MERS, and COVID-19 are all believed to originate in bats. A recent study found the closest known relative to COVID-19 in a bat coronavirus with 96.2% identical DNA (Bat CoV RaTG13 for the biologists in the crowd). Coronaviruses are known to quickly mutate, and the genetic evolution from the bat coronavirus to COVID-19 likely resulted in the ability to jump the species barrier to infect humans.
But if the ability to infect humans was COVID-19’s only new power, the outbreak would have been limited to the Hunan Seafood Market. It wasn’t. Wuhan has a population of over 11 million and is a major transport hub in China. From December 18 to December 29, five patients associated with the market were hospitalized with acute respiratory distress syndrome, and one died. By January 22, 571 cases were reported in 25 provinces of China—many with no connection to the market in Wuhan. It became clear that COVID-19 had evolved another important trait: the ability to pass from person to person.
The startling emergence of these virulent coronaviruses (SARS, MERS, and COVID-19) can largely be attributed to natural evolution, though humans play a key role. In an article published by the New England Journal of Medicine (“Escaping Pandora’s Box — Another Novel Coronavirus”), Drs. Morens, Daszak, and Taubenberger explain, “We have created a global, human-dominated ecosystem that serves as a playground for the emergence and host-switching of animal viruses… [the human genome took] 8 million years to evolve by 1%. Many animal RNA viruses can evolve by more than 1% in a matter of days. It is not difficult to understand why we increasingly see the emergence of zoonotic viruses.”
What is the current state of the epidemic in New Orleans?
- Text COVIDNOLA to 888777
- Call 311 (New Orleans).
- Call 211 (statewide).
- Follow @nolaready on Instagram, Twitter, and Facebook.
- Johns Hopkins is also maintaining an interactive map: coronavirus.jhu.edu.
How do you protect yourself, loved ones, and the general public?
WASH YOUR HANDS
Always wash your hands before touching your eyes, nose, mouth, glasses, eating, or anything else that involves your face. Follow the Centers for Disease Control and Prevention (CDC) guidelines for handwashing:
- Wet hands, turn off the tap, and apply soap.
- Lather hands (front and back, between fingers, under nails).
- Keep scrubbing for at least 20 seconds.
- Rinse well under running water.
- Dry hands using a clean towel. Air drying works too if you’re not sure about that hand towel.
Hand sanitizer can be used if soap and water are not available. Use hand sanitizer that contains at least 60% alcohol (read the label). Note that hand sanitizers are not a replacement for soap and water: they do not get rid of all germs and toxins, and your hands must be relatively clean for hand sanitizers to work.
Why all this talk of hand washing? What is the science behind hand washing? Why does it work so well for COVID-19?
Yes, proper hand washing with plain old soap can help protect you from getting or spreading COVID-19. Rinsing your hands for a short time with plain water will send some COVID-19 viruses down the drain, but it won’t kill the virus like soap can.
For thousands of years, we have relied on the shape of soap molecules to drive this phenomenon. Soap molecules have one end that loves water and another end that loves fats and oils. When you wash a greasy pan, for example, the soap molecules’ fat-loving end surround globs of grease to create millions of tiny soap-enclosed packets. The water-loving ends are now pointing outward, and they interact with the water to get rinsed away. Similarly, viruses are coated in a fatty outer layer that is stripped away when the fat-loving end of the soap molecule comes in contact with it. This effectively kills COVID-19 without fancy ingredients (like antibacterials).
PRACTICE SOCIAL DISTANCING
Social distancing describes a set of behaviors that increase the physical space between people to prevent the spread of disease, e.g.:
Maintain a minimum of at least 6 feet between you and others.
Minimize contact with others: work from home, switch to online classes, and visit loved ones by electronic devices instead of in person. Avoid touching things others have touched.
WEAR A MASK
We firmly believe that the supply line of medical grade masks must go directly to frontline providers. Still, there is a growing consensus among international disease control experts that mask-wearing—even among the well—is critical for slowing the spread of the virus. A hidden benefit could be that people sick with COVID-19 will be more likely to wear a mask if it is less stigmatized. A fun craft idea to help cabin fever: sew a homemade mask, which is better than no mask at all!
TAKE CARE OF YOURSELF
Keep your immune system up: get sleep, eat well, stay hydrated, and exercise (either at home or in open air, at a safe distance from others, of course).
Focus on what you can control: your health. The news can leave us feeling bereft and hopeless. Most of us are out of work and it is torture. You are maybe having a panic attack at the idea of self-isolation because you are a social person, or because your FOMO is real, or maybe you simply live alone. There is plenty of stress to go around, and that stress can hurt your immune system. Do your best to take time to breathe.
How is COVID-19 transmitted?
COVID-19 is generally passed from person to person like the common cold. Very little of the virus is required for infection to take hold, and infected people are contagious even before they show symptoms. Many viruses rely on coughing and sneezing for reproduction. The droplets released by a cough or sneeze provide a vehicle for viruses like COVID-19 to enter a new host’s body. Close contact with people who are infected (but not yet sick) with COVID-19 puts family members and friends at risk for infection. You can be exposed to COVID-19 by breathing it in or by touching your mouth, nose, or eyes after:
- Someone with COVID-19 coughs or sneezes.
- Any close personal contact (e.g. kissing, holding hands, sharing a drink) or contact within six feet (e.g. sharing an elevator).
- Touching an object or surface with the virus on it.
A recent study noted the virus was also found in blood and fecal matter in a few cases, suggesting that other routes of transmission might be possible. WASH YOUR HANDS.
Surfaces in the home, office, or grocery store (for example) can collect viruses and other germs when people touch, breathe, cough, or sneeze on them. Different surfaces have varying survival times. A recent study found that COVID-19 can live:
- Up to 3 hours in the air.
- Up to 4 hours on copper.
- Up to 24 hours on cardboard.
- Up to 2 to 3 days on steel and stainless steel.
I’ve probably been exposed but I feel OK. Can I really get others sick with COVID-19 even if I don’t have symptoms?
Yes. A person infected with COVID-19 can transmit the disease for 2 to 14 days before they show signs they are sick, and there is a growing body of evidence that asymptomatic people are driving the rapid spread of the disease. Practice self-quarantine if you think you may have been exposed.
Should I stay home if I know I’m healthy?
Yes. Social distancing protects unexposed people and slows the transmission of the virus by keeping them away from the general population (where the illness is circulated). Recent evidence suggests the lethality of COVID-19 is determined both by genetics and general health, so practice caution regardless of your current health status.
I’m sick or I’ve been exposed. What should I be doing right now? Should I get tested?
If you do have symptoms: Call your doctor or the Louisiana Department of Health hotline at 1-855-523-2652. If you are severely ill and you think you need hospitalization, call 911 or go to an emergency room.
If you do not have symptoms: STAY HOME ANYWAY! There is a growing body of evidence that asymptomatic people are driving the rapid spread of the disease. Quarantine is the practice of keeping sick people physically separate from healthy people to slow the spread of the illness. Self-imposed quarantine is key to controlling the spread of COVID-19 because it is so infectious. Self-quarantine involves:
- You and others that live in your home staying in for 14 days without visitors, long enough to determine if you will become sick.
- Following handwashing and hygiene advice.
- Not sharing objects where the virus can survive on the surface, like towels and utensils.
- Maintaining a 6 foot distance from others.
How is it treated?
As of this writing, there are no approved treatments or vaccinations for COVID-19. Treatment plans currently are focused on alleviating symptoms of the illness.
It is hard to predict how the virus could affect you because it is so new. As of this writing, the CDC has not stated conclusively what effect COVID-19 could have on pregnancies. A few small studies have revealed encouraging data, though. Babies born during a COVID-19 infection are more likely to be healthy than in other coronavirus infections (e.g. SARS), and a study of nine pregnant women found no virus in amniotic fluid, cord blood, breastmilk, or neonatal throat swabs. In other words, the virus is unlikely to pass from mother to child during birth.
What about my kid?
Again, it is hard to predict how the virus could affect kids because it is so new. As of this writing, the American Academy of Pediatrics reports most children will experience a mild case of COVID-19, though kids with heart disease, diabetes, lung disease, or suppressed immune systems are at greatest risk for serious illness. AAP recommends the same protocols for cold and flu season. If your child begins showing symptoms of COVID-19, call your pediatrician or call the Louisiana Department of Health hotline at 1-855-523-2652. Visit healthychildren.org for more information.
What about my pet?
Yet again, it is hard to predict how the virus will affect pets because it is so new. It is important to remember that domestic animals can collect COVID-19 on their coats if infected people handle them and, moreover, we do not yet know if domestic animals can contract the virus. Have another person care for your pet while you are ill, if possible. According to the American Veterinary Medical Association, “If you have a service animal or you must care for your pet, then wear a facemask; don’t share food, kiss, or hug them; and wash your hands before and after any contact with them.”
I rely on NA/AA and I’m not sure what I’ll do without meetings.
Virtual AA meetings can be accessed here: aa-intergroup.org/directory.
Virtual NA meetings can be accessed here: virtual-na.org.
More guidance for people who use drugs can be accessed here: harmreduction.org.
Why is COVID-19 called COVID-19?
Historically, viral diseases have two names: one among scientists who study viruses and another among health care professionals who treat the diseases they cause. Viruses’ scientific names communicate information like genetic origin. COVID-19’s scientific name is SARS-CoV-2 because of its genetic similarity to the virus involved in the 2002 SARS outbreak. Health care professionals generally prefer to use a common name (e.g. “the flu”) that is more helpful in treatment and prevention. COVID-19 comes from CO (corona) + VI (virus) + D (disease) that emerged in 2019, and is named that way to avoid confusion with the 2002 SARS outbreak.
But I had PLANS! Doesn’t COVID-19 understand I had PLANS?!
This is serious. Life or death serious. You might have a mild illness and stay home most of the time, but any contact that results in infection could make someone very sick or worse. New Orleanians, in particular, are proud that we stick together in order to survive and prosper. Be a New Orleanian and stay home to stop the spread of COVID-19 to protect both our culture and the arbiters of that culture. It is impossible to have a complete medical history on everyone you meet, and Louisiana is known for its high rates of preexisting conditions. Our community is just more vulnerable.
Will going to the woods save me?
The short answer is probably not, but the decision to evacuate is always totally up to you. If you are unexposed (and stay away from others while you’re away) you are simply going camping. That sounds nice. Is it more effective at preventing COVID-19 infection than staying home? Probably not. There are other considerations, too. If you are exposed and not yet sick, you run the risk of spreading the virus geographically. And should you get sick while you are away, are you sure you want to be sick at your destination?
What’s the worst case scenario in terms of my health?
Most of us won’t experience a worst case scenario. Severe complications of COVID-19 are generally only seen among those who are over 60, immunocompromised, or have an underlying illness. Those at high-risk are more likely to experience hospitalization or death from COVID-19 infection. Many Louisianans might not know they have an underlying health concern as Louisiana lags behind the nation in important health metrics. As an example, Louisiana is home to the fifth highest heart disease rate in the US.
Separately, the healthcare system is buckling, both internationally and domestically, under the burden of increased caseload. If we do not slow the spread of the disease, the death toll will further rise because medical staff do not have available beds or basic medical supplies to care for the sick.
Does ibuprofen or other NSAIDs aggravate COVID-19? Do I need to take Tylenol instead?
As of this writing, the medical community does not have a consensus on the use of Tylenol over ibuprofen. At issue are the side-effects associated with ibuprofen under normal circumstances, which appears to be the source of this debate, not with any special interaction between ibuprofen and COVID-19.
Was my Mardi Gras Crud™ actually COVID-19?
Could be! Many experts, including Dr. Rebekah Gee, former Secretary of the Louisiana Department of Health and current CEO of LSU Health Services Division, said the recent explosion of cases is likely associated with carnival crowds. And what an explosion it was: A University of Louisiana Lafayette study found that the case counts grew faster in New Orleans than anywhere else in the world, outpacing New York and mimicking hard-hit areas like Spain and Italy.
Here’s the logic: Mardi Gras was February 25. The incubation period for COVID-19 is 2 to 14 days. Counting forward 14 days from Mardi Gras (to allow for incubation), we arrive on March 10. The first positive test result arrived in Louisiana on March 9 in the greater New Orleans area. Within two weeks, the case count skyrocketed to 837 cases. It is unlikely that you had (and recovered from) COVID-19 before Feb 25 without having travelled to an affected area. There is no evidence to suggest the origin of COVID-19 was outside China or that there was a single case before December 12, 2019. The first documented U.S. case was recorded on January 19, 2020 in Washington State in a man who had recently returned from Wuhan. No matter how nasty your post Mardi Gras yuck was, the only proven way to prevent COVID-19 infection is social distancing (as of this writing). Newer models of the body’s response to COVID-19 suggest the virus sometimes evades tripping the alarm in the immune system that clears out the virus and protects us from future infection, making it possible to recover and then either test positive again or, worse, relapse.
Why didn’t Mayor Cantrell do more to protect us?
Allow us to remind you of the national climate at the time. Here is the president on Lundi Gras (February 24):
And here’s the CDC on Mardi Gras day (February 25):
I heard COVID-19 was developed as a plot to (insert conspiracy here).
We have heard a few claims that COVID-19 is man-made, or that it is a plot by the ruling class. We love a good theory too, but we fail to see the utility in such speculation in confronting the crisis at hand. We must face what is in front of us. It may also be helpful to know that there is ample international scientific evidence to support a natural origin of COVID-19.
Robin Gruenfeld is Director of Southeast Louisiana Area Health Education Center’s AHEC Scholars Program. She made a career of moving data to action by leading state and community-level projects during her tenure as State Maternal and Child Health Coordinator for the Louisiana Department of Health and Best Babies Zone Program Lead at the City of New Orleans.
Graphics inked by Kallie Tiffau