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Detailed information about Coronavirus can be found HERE.

CORONAVIRUS TRANSMISSION - WHAT WE KNOW AS OF 03/20/2020

3/20/2020

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As of 03/20/2020 we still don't know enough about Coronavirus transmission.

MY VIEW

From my personal extensive analysis of the available data (references are available on this page) it is clear to me that the virus can be transmitted in the following way:
  • Droplets (when someone with COVID-19 coughs or sneezes)
  • Surface transmission (when these droplets land on surfaces and someone touches them)

Additionally, it appears that SARS-CoV-2 (the Coronavirus responsible for this pandemic) 
  • may also present in the infected individual's gastrointestinal tract, stool, and urine
  • aerosol transmission (through the air) is a possibility.

EXPERT VIEW

Check out a litter from an expert on the subject of transmission. It is really eye-opening...

CLICK HERE to view the blog post with the letter.

Please take the time to read the letter. It is important. Please share it as well.

WHAT IT MEANS FOR YOU

Be conscientious about your own hygiene and take active measures to protect yourself and others:
  • self-isolate as much as you can even if you are not sick
  • cover your cough and sneeze
  • sanitize surfaces before and after you touch something
  • wash your hands for 20 seconds before and after you touch something
  • if soap and water are not available, use hand sanitizer with at least 60% alcohol
  • keep 6-foot distance with anyone who does not live in your home
  • if you have to be out of your home and are not able to maintain a 6-foot distance (like during pharmacy or grocery shopping) use a scarf to protect yourself from anyone's cough or sneeze (and to protect others in case you cough or sneeze); wash the scarf after each use
  • if you care for someone who is sick with respiratory symptoms, wear a mask and gloves
  • avoid coming in direct contact with anyone's bodily fluids (wear gloves, and wash your hands extensively, if you do)
  • if you have masks or any other personal protective equipment, consider donating it to healthcare workers in your area.

I know this is a lot to take in, but it will save lives.

​I am sorry if the information keeps changing all the time! I will do my best to continue keeping you updated. 

With love and care, 
Dr. Maria Danilychev, MD
www.danilychev.com

P.S.: Below are some images that may help makes sense of all the PPE (personal protective equipment)

PERSONAL PROTECTIVE EQUIPMENT

When around people outside of your home:

To protect yourself from droplets in case some coughs or sneezes on you (and to protect the others from your own accidental cough or sneeze), you can use a scarf if you are not sick and a mask if you are (PS: please don't go in public if you are sick):
IF YOU ARE NOT SICK
ONLY IF YOU ARE SICK

PPE for healthcare workers

ALL HEALTHCARE WORKERS SHOULD BE WEARING A MASK AT ALL TIMES!!!
Standard earloop mask is not enough in a healthcare setting - it does not offer as much protection from SARS-CoV-2 as N95 masks, which should be the masks of choice for healthcare providers (in addition to other PPE).

SIDE TIP: Since a face mask has to be discarded after EACH sick contact, to preserve the supply of N95 many doctors wear a standard earloop mask over the N95 and discard that standard mask after each patient, which allows them to use the N95 longer. This is not ideal, of course.
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Image from CDC website

OK

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BASIC DROPLET PRECAUTIONS PPE (regular face mask + face shield + gown + gloves)

BETTER

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PPE NEEDED BY MOST HEALTHCARE WORKERS NOW (N95 mask + face shield + gown + gloves)

BEST

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BEST PPE FOR HEALTHCARE WORKERS WORKING WITH SARS-CoV-2 PATIENTS (PAPR + suit + gloves)

If you are sick at the hospital with a respiratory infection, you want all your doctors and care providers to look like the BEST photo above in the ideal case scenario.

Which masks are currently provided to healthcare workers? Very few get PAPRs, many do not have access to N95s, some healthcare workers don't even have enough regular masks, any many are instructed by their hospital administrators to wear suboptimal protective equipment to avoid "scaring" the public. Honestly, I would be more scared of a doctor who is unprotected and may be passing germs around, then the one who is fully "suited up".

Please do whatever you can to help! You don't want people in the front lines to start getting sick and dying. Who is going to help the rest of the people?

Physicians are notorious for being really bad at advocating for themselves. I've been asking everyone how is not adequately protected by their healthcare organization to speak up, but very few people are doing it. It will take a public outcry to for this horrible situation to change. 

I am doing everything I can to increase public awareness of this issue which is largely hidden from the public eye and which is not being adequately addressed.

Please spread the word! Please find ways to contribute PPE to healthcare workers near you!
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COVID-19 FOR HEALTHCARE PROFESSIONALS

3/15/2020

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Updated daily. Last updated on 03/15/2020 at 20:10 PM PST.

Let's help each other flatten the curve!

COVID-19 GRAPHS


ADDRESSING VENTILATOR SHORTAGES

Off-label use of one ventilator to save multiple lives.

USEFUL LINKS FOR HEALTHCARE PROFESSIONALS

THIS SECTION IS CURRENTLY UNDER CONSTRUCTION - ADDITIONAL LINKS TO BE ADDED
MAP - Coronavirus interactive map
WHO - online training
CDC - for healthcare professionals
Stanford coronavirus study - please share

CORONAVIRUS RESEARCH

THIS SECTION IS CURRENTLY UNDER CONSTRUCTION - ADDITIONAL LINKS TO BE ADDED
  1. Symptoms of Novel Coronavirus (2019-nCoV) - United States Centers for Disease Control and Prevention (CDC)
  2. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China - JAMA, Wang et al., February 7, 2020
  3. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China - Huang et al., The Lancet. January 24, 2020
  4. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study - Chen et al, The Lancet, January 30, 2020
  5. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Pdf] - World Health Organization, Feb. 28, 2020
  6. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) - China CCDC, February 17 2020
  7. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Pdf] - World Health Organization, Feb. 28, 2020
  8. Novel Coronavirus (2019-nCoV) Situation Report-7 - World Health Organization (WHO), January 27, 2020
  9. China's National Health Commission news conference on coronavirus - Al Jazeera. January 26, 2020
  10. Symptoms of Novel Coronavirus (2019-nCoV) - CDC
  11. Novel coronavirus (2019-nCoV) - Australian Government Department of Health
  12. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany - The New England Journal of Medicine, Jan. 30, 2020
  13. 'There's no doubt': Top US infectious disease doctor says Wuhan coronavirus can spread even when people have no symptoms - CNN, Jan. 31, 2020
  14. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia - Qun Li et al., New England Journal of Medicine, Jan. 29, 2020
  15. Asymptomatic #2019nCoV infection - WHO Tweet, Feb. 1, 2020
  16. Philippines reports coronavirus death, as China toll reaches 304 - Al Jazeera, Feb. 2, 2020
  17. Backer Jantien A, Klinkenberg Don, Wallinga Jacco. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Euro Surveill. 2020;25(5):pii=2000062. https://doi.org/10.2807/1560-7917.ES.2020.25.5.2000062
  18. Clinical characteristics of 2019 novel coronavirus infection in China, Guan WJ, Ni ZY, Hu Y, et al., February 9, 2020.
  19. Coronavirus incubation could be as long as 27 days, Chinese provincial government says - Reuters, Feb. 22, 2020
  20. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. Bai Y, Yao L, Wei T, et al., February 21, 2020.
  21. Novel Coronavirus (2019-nCoV) situation reports - World Health Organization (WHO)
  22. 2019 Novel Coronavirus (2019-nCoV) in the U.S. -. U.S. Centers for Disease Control and Prevention (CDC)
  23. Outbreak Notification - National Health Commission (NHC) of the People’s Republic of China
  24. Novel coronavirus (2019-nCoV) - Australian Government Department of Health
  25. Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic prediction - Jonathan M. Read et al, Jan. 23,2020.
  26. Early Transmissibility Assessment of a Novel Coronavirus in Wuhan, China - Maimuna Majumder and Kenneth D. Mandl, Harvard University - Computational Health Informatics Program - Posted: 24 Jan 2020 Last revised: 27 Jan 2020
  27. Report 3: Transmissibility of 2019-nCoV - 25 January 2020 - Imperial College London‌
  28. Case fatality risk of influenza A(H1N1pdm09): a systematic review - Epidemiology. Nov. 24, 2013
  29. A novel coronavirus outbreak of global health concern - Chen Want et al. The Lancet. January 24, 2020
  30. Symptoms of Novel Coronavirus (2019-nCoV) - CDC
  31. China's National Health Commission news conference on coronavirus - Al Jazeera. January 26, 2020
  32. Wuhan lockdown 'unprecedented', shows commitment to contain virus: WHO representative in China - Reuters. January 23, 2020
  33. Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) - WHO, January 23, 2020
  34. International Health Regulations Emergency Committee on novel coronavirus in China - WHO, January 30, 2020
  35. Human-to-human transmission of Wuhan virus outside of China, confirmed in Germany, Japan and Vietnam - The Online Citizen, Jan. 29, 2020
  36. Who: "Live from Geneva on the new #coronavirus outbreak"
  37. CDC Confirms Person-to-Person Spread of New Coronavirus in the United States - CDC Press Release, Jan. 30, 2020
  38. CMO confirms cases of coronavirus in England - CMO, UK, Jan. 31, 2020
  39. Coronavirus in France: what you need to know - The Local France, Jan. 31, 2020
  40. First two persons infected with coronavirus identified in Russia - Tass, Jan. 31, 2020
  41. Updated understanding of the outbreak of 2019 novel coronavirus (2019nCoV) in Wuhan, China - Journal of Medical Virology, Jan. 29, 2020
  42. Estimating the effective reproduction number of the 2019-nCoV in China - Zhidong Cao et al., Jan. 29, 2020
  43. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak - Jan. 30, 2020
  44. Coronavirus: Window of opportunity to act, World Health Organization says - BBC, Feb,\. 4, 2020
  45. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China - Wang et. al, JAMA, Feb. 7, 2020
  46. Update on the situation regarding the new coronavirus [transcript] - World Health Organization (WHO), January 29, 2020
  47. WHO: "Live from Geneva on the new #coronavirus outbreak" [video] [audio]
  48. A novel coronavirus outbreak of global health concern - Chen Wang et al., The Lancet. January 24, 2020
  49. Case fatality risk of influenza A(H1N1pdm09): a systematic review - Epidemiology. Nov. 24, 2013
  50. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China - Huang et al., The Lancet. January 24, 2020
  51. Updated understanding of the outbreak of 2019 novel coronavirus (2019nCoV) in Wuhan, China - Journal of Medical Virology, Jan. 29, 2020
  52. NHS Press Conference, Feb. 4 2020 - National Health Commission (NHC) of the People’s Republic of China
  53. Methods for Estimating the Case Fatality Ratio for a Novel, Emerging Infectious Disease - Ghani et al, American Journal of Epidemiology
  54. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China - Wang et. al, JAMA, Feb. 7, 2020
  55. Virus-hit Wuhan speeds up diagnosis, treatment of patients - Xinhua Net, Feb. 2, 2020
  56. Coronavirus: 100,000 may already be infected, experts warn - The Guardian, Jan. 26, 2020
  57. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Pdf] - World Health Organization, Feb. 28, 2020
  58. WHO Director-General's opening remarks at the media briefing on COVID-19 - 3 March 2020 - World Health Organization, March 3, 2020
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    Author

    Dr. Maria Danilychev, M.D., is a San Diego based medical doctor with 20 years of experience and board-certified in Internal Medicine, Geriatrics, Hospice/Palliative Medicine, and as a Hospice Medical Director. Dr. Danilychev also conducts clinical trials and was one of the first responders during 9/11.

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