How quickly our lives have changed. In the span of just over 2 months, 113,000+ people have been infected by the coronavirus across 110 countries, resulting in 4,000+ deaths.[1] These numbers continue to grow, partly as testing becomes available, and a lot remains to be understood about the extent of the disease. As conferences, sporting events, and other large gatherings are being cancelled, companies are implementing work-from-home policies, schools are on the verge of closing, and Costco stores are selling out of home essentials, many of us are left with more questions than answers. While I am not a medical professional, I am a health advocate, mother, and daughter trying to wrap my head around these changing times.
One aspect of being prepared is avoiding getting sick by taking the obvious safety measures that I hope you are all doing by now: keeping hands clean, not touching faces, and avoiding public gatherings and sick people. There are more aspects to being prepared, however, as we face the possibilities of lockdowns and widespread exposure. I aim to strike the fine balance between preparedness and panic, with the goal being to be prepared for a quarantine that could last for weeks while also mitigating the impact on our healthcare system. Below are questions I’ve asked myself and I hope these thoughts help you prepare as well.
What does it mean when my state declares a “state of emergency”?
California declared a “state of emergency” this past week due to the coronavirus, as have multiple other states. While the declaration may help raise awareness of the virus, it doesn’t directly result in containment strategies or impact our daily lives. It does, however, mean the state is making handling the virus its primary focus, ease the region’s access to federal aid, and allow governors to sidestep certain federal and state laws.[3] Examples of the latter include how California Governor Gavin Newsom’s proclamation “includes provisions that protect consumers against price gouging, allow for health care workers to come from out of state to assist at health care facilities, and give health care facilities the flexibility to plan and adapt to accommodate incoming patients.”[4] Specific declarations are made at the state level, with further emergency responses (e.g., quarantines and school closures) occurring at the local level.
Why should I be worried about the virus if it’s only severe for some high-risk populations?
The symptoms of the coronavirus (more detail below) are mild in ~80% of cases.[5] In higher risk populations, such as the elderly and people with serious chronic medical conditions like heart disease, diabetes, and lung disease, or suppressed immune systems, however, symptoms can be severe and potentially fatal. The CDC has advised these high-risk groups to prepare for extended stays at home and avoid large groups and non-essential travel.[6] Children with underlying respiratory conditions such as asthma could be at higher risk of severe infections as well, and their parents should take similar precautions as when protecting them against the flu.[7]
At this time, it is not fully understood why children overall appear less symptomatic. For respiratory infections like the flu, generally the very young and the very old are most at-risk, with the former having under-developed immune systems and the latter having weakened immune systems. However, with this coronavirus and previous coronavirus outbreaks like SARS in 2002 and MERS in 2012, children have been consistently less symptomatic to date. According to the Washington Post, pediatric infectious disease specialist Frank Esper of Cleveland Clinic Children’s hypothesizes that, if children truly are less prone to this infection, “something about the receptors in children’s bodies or their lungs is interfering with the virus’ ability to attach itself.”[8]
The reason to be concerned about exposure for children is the dangerous combination of them being just as likely to be infected by the disease and able to transmit it, but possibly be asymptomatic or have such mild symptoms that the disease is undetected.[9]
Consequently, children play a critical role in containment and limiting the spread of infection to these higher risk groups (e.g., grandparents).
What happens in the case of a “lockdown”?
Today, Italy put the entire country on lockdown after initially phasing in specific regions. There, the lockdown means all sporting events, schools and universities are shut down, locations of public gatherings (e.g., cafes, theaters, cinemas, nightclubs, restaurants, and bars) are closed, and religious ceremonies (e.g., funerals, weddings) are postponed. Public transportation is available, but severely restricted to those with documentation proving necessity. Shopping malls and stores remain open with certain restrictions, but grocery stores are allowed to remain open.[10]
In the U.S., lockdowns have begun at a local level around certain containment zones[11] and more widespread lockdowns are very possible as communities continue to struggle with containment. While specific restrictions will vary by locality or state, we can expect to be largely home-bound in the case of a lockdown if Italy is any indication of what is yet to come.
How can I best prepare for a lockdown?
The possibility of being home-bound requires preparation on a number of fronts:
Food: Many of us already know to keep the home well-stocked with 2-4 weeks worth of food, particularly non-perishable foods (e.g., dry lentils, rice, pasta, canned foods) and foods that freeze well (e.g., bread, milk, frozen meals, etc.). In the case of a lockdown, restaurants may or may not be open as they were initially allowed to be open in Italy from 6am-6pm in the lockdown’s first phase, but have since been required to close entirely. Grocery stores may remain open, but it’s best to arrange for grocery delivery if possible, especially for elder family members. Delivery workers continued to work in China after the outbreak delivering groceries and medical supplies.[12]
Household supplies: We have all seen the viral photographs of empty aisles and long Costco lines as families stockpile household items (e.g., hand soap, toilet paper, paper towels, cleaning solutions, wipes). While important to keep on-hand, replenishment of supplies may still be available via delivery post lockdown.
Medications: Maintain a 2-3 month supply of prescription medications and vitamins on-hand. Discuss with your healthcare provider if you should be taking Vitamin D supplements given its potential role in lowering your risk for respiratory illness,[13] and risk of potential deficiency if less time is being spent outside during a lockdown. Also ensure you have a thermometer, fever reducer and cough medications, tissues, and nasal sprays at home for adults and children (as needed).
School closures: While my children’s school district has not announced an official closure, we are likely to begin keeping our daughters home from school beginning next week regardless to minimize exposure. If you are considering this or simply want to be prepared for a closure: (1) ensure you have appropriate back-up childcare in place, (2) discuss with your child’s teacher what schoolwork they can complete from home, and (3) have an internet-enabled device at home available to your child for virtual classrooms.
Home activities: Ensuring we have plenty of sources of entertainment at home for the kids (and us!) will help in maintaining sanity during a lockdown. Ideas that come to mind include board games, card games, activity books, puzzles, arts/crafts, dance parties, baking, starting a micro-garden, and setting up in-home "classes" to teach other family members fun skills. Also, consider renting a small stockpile of books/movies from your local library in advance. For those of you with younger kids, when in doubt, make slime. You should still aim to get some natural vitamin D for your family by taking walks around the neighborhood, playing in your backyard, or heading to low-populated beaches or parks if you have access, while taking other necessary precautions.
What symptoms do I watch out for?
We’ve all heard that a fever and dry cough or respiratory issues are potential indicators of the coronavirus, but some are also common symptoms for the flu. Below is the most useful table I’ve seen summarizing various symptoms and whether they are indicative of the cold, flu, or coronavirus.
What if I’m experiencing coronavirus symptoms?
Based on this great chart,[14] here’s what to do if you begin experiencing symptoms:
Stay at home and follow the CDC's recommendations for how to minimize spread
Wear a face mask and practice good hygiene
Monitor your symptoms
It is important to remember that a big risk to containment is hospital capacity and limited medical resources.[15] According to STAT News, a 10% hospitalization rate would result in all hospital beds in the U.S. being filled by May 10. Note that China had a 15% hospitalization rate.[16] So, if you are experiencing mild symptoms and are not in a high-risk group, it is best to try and manage your symptoms at home.
If your symptoms become more severe (i.e., you have trouble breathing) or you’re in a high-risk group, call your healthcare provider and follow instructions. If you must go to the ER or urgent care, especially if you believe you’ve been exposed to COVID-19, be sure to call in advance to give notice that you are coming so hospital personnel can prepare accordingly. Given current protocols, we are at risk of a shortage of healthcare workers as self-quarantines increase.[17]
U.S. insurance companies announced today that they will cover the cost of coronavirus testing and treatment, with no surprise billing, however test availability remains very limited.[18]
There is currently no vaccine, and other than anecdotal stories, limited information about how exactly to treat coronavirus symptoms beyond fever reducers, cough medicines, and possibly inhalers, to minimize escalation to the lungs. If you’ve seen any medical articles speaking to how to slow the progression of COVID-19 symptoms, please send them my way!
How can I stay informed?
As more information continues to be learned and released, I’m avoiding false claims and misinformation by referring to reputable sources, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) - including their “myth busters” page.[19]
There is a lot to be learned as we navigate the coming weeks, and possibly months. Being prepared is a way to find moments of empowerment in these times of uncertainty as we seek to take the best care of ourselves and our families.
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Parul Somani
Mother. Warrior. Storyteller.
Parul is a healthcare executive and cancer survivor turned professional speaker championing health, resilience, and a positive mindset. As the Founder & CEO of Silver Linings, Parul combines her experiences as a young working mother diagnosed with breast cancer in her early 30s, a caregiver who transformed her parents' lives with her patient advocacy, and a businesswoman with 15+ years of experience in management consulting and executive roles in consumer, technology, and healthcare companies. Parul's mission is to help improve the state of healthcare by sharing her experiences, and inspiring others to live a healthy, thankful, and fulfilling life. She has shared her personal story through her cancer blog that's been read in ~80 countries, films on survivorship and mindset, TV and radio segments, podcast interviews, and public speaking engagements. More information about her story, speaking topics, and portfolio of work can be found at parulsomani.com.
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Instagram: @pdsomani
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Sources:
World Health Organization, “Coronavirus disease 2019 (COVID-19) Situation Report - 50.” 10 Mar. 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200310-sitrep-50-covid-19.pdf?sfvrsn=55e904fb_2. Accessed 10 Mar 2020.
Centers for Disease Control and Prevention, “Locations with Confirmed COVID-19 Cases Global Map.” 10 Mar. 2020, https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html. Accessed 10 Mar 2020.
Wolf, Zachar B, “What ‘state of emergency’ means for coronavirus’.” CNN, 10 Mar. 2020, https://www.cnn.com/2020/03/10/politics/state-of-emergency-meaning-explained/index.html. Accessed 10 Mar. 2020.
Office of Governor Gavin Newsom, “Governor Newsom Declares State of Emergency to Help State Prepare for Broader Spread of COVID-19.” 4 Mar. 2020, https://www.gov.ca.gov/2020/03/04/governor-newsom-declares-state-of-emergency-to-help-state-prepare-for-broader-spread-of-covid-19/. Accessed 10 Mar. 2020.
World Health Organization, “Coronavirus disease 2019 (COVID-19) Situation Report - 46.” 6 Mar. 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4. Accessed 10 Mar 2020.
Centers for Disease Control and Prevention, “People at Risk for Serious Illness from COVID-19.” https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html. Accessed 10 Mar. 2020.
Hernandez, Salvador. “This Is What You Need To Know About Coronavirus If Your Kid Has Asthma.” BuzzFeed. 6 Mar. 2020, https://www.buzzfeednews.com/article/salvadorhernandez/coronavirus-children-asthma-tips. Accessed 10 Mar. 2020.
Wan, William. Achenbach, Joel. “Coronavirus is mysteriously sparing kids and killing the elderly. Understanding why may help defeat the virus.“ The Washington Post. 10 Mar. 2020, https://www.washingtonpost.com/health/2020/03/10/coronavirus-is-mysteriously-sparing-kids-killing-elderly-understanding-why-may-help-defeat-virus/. Accessed 10 Mar. 2020.
Newman, Tim, “Coronavirus myths explored.” 6 Mar. 2020, https://www.medicalnewstoday.com/articles/coronavirus-myths-explored. Accessed 10 Mar. 2020.
Aljazeera, “Italy coronavirus lockdown: What are the restrictions?” 10 Mar. 2020, https://www.aljazeera.com/news/2020/03/italy-coronavirus-lockdown-restrictions-200310050125680.html. Accessed 10 Mar. 2020.
Brice-Saddler, Michael. Kornfield, M. et al. “Live updates: NY creates coronavirus containment zone; new deaths reported in S.D. and Washington State.” 10 Mar. 2020, https://www.washingtonpost.com/world/2020/03/10/coronavirus-live-updates/. Accessed 10 Mar. 2020.
Xu, Yuhan. Gharib, Malaka. “PHOTOS: In a Coronavirus Crisis, Delivery Workers Can Be A Lifeline.” 8 Mar. 2020. https://www.npr.org/sections/goatsandsoda/2020/03/08/812925775/photos-in-a-coronavirus-crisis-delivery-workers-can-be-a-lifeline. Accessed 10 Mar. 2020.
The New York Times. “Can I Boost My Immune System?” 10 Mar. 2020, https://www.nytimes.com/2020/03/10/well/live/can-i-boost-my-immune-system.html. Accessed 10 Mar. 2020.
Hall, Ellie. “What Should You Do If You Think You’ve Caught the Coronavirus? Follow This Chart.” BuzzFeed. 6 Mar. 2020. https://www.buzzfeednews.com/article/ellievhall/coronavirus-news-us-symptoms-cdc-covid19-chart-faq. Accessed 10 Mar. 2020.
Cohn, Jonathan. “The Coronavirus Outbreak Is About To Put Hospital Capacity To A Severe Test.” HuffPost. 8 Mar. 2020. https://www.huffpost.com/entry/coronavirus-outbreak-hospital-icu-masks-shortages_n_5e6521f9c5b6670e72f9b902. Accessed 10 Mar. 2020.
Specht, Liz. “What does the coronavirus mean for the U.S. health care system? Some simple math offers alarming answers.” 10 Mar. 2020, https://www.statnews.com/2020/03/10/simple-math-alarming-answers-covid-19/. Accessed 10 Mar. 2020.
Gold, Jenny. “Scarcity of Health Workers A New Concern As Self-Quarantining Spreads with Virus.” NPR. 9 Mar. 2020. https://www.npr.org/sections/health-shots/2020/03/09/813557328/scarcity-of-health-workers-a-new-concern-as-self-quarantining-spreads-with-virus. Accessed 10 Mar. 2020.
Wetsman, Nicole. “US insurance companies will cover costs of COVID-19 testing and treatment.” The Verge. 10 Mar. 2020. https://www.theverge.com/2020/3/10/21173970/insurance-coronavirus-treatment-testing-coverage-cigna-aetna-humana-pence. Accessed 10 Mar. 2020.
Shmerling, Robert H. “Be Careful Whre You Get Your News About Coronavirus.” Harvard Health Publishing. 1 Feb. 2020. https://www.health.harvard.edu/blog/be-careful-where-you-get-your-news-about-coronavirus-2020020118801. Accessed 10 Mar. 2020.