Doctor and CEO Answers Questions About Coronavirus

Wei-Shin Lai, CEO of AcousticSheep LLC

Doctor and Business Owner Answers Questions About Coronavirus: What You Should Do to Prepare

February 28, 2020. Erie, PA. I wanted to write an article about how businesses should be preparing during this Coronavirus outbreak, so I asked business owners for their questions on Facebook. It turns out that there are far more basic questions unrelated to businesses. I have included some Q&A below. If you are looking for my Coronavirus predictions, this is the link. This was my question to a couple of Facebook groups:

Dr. Lai: Hi group! I am the CEO of AcousticSheep LLC, which makes SleepPhones. I used to be a family doctor. Prior to that, I was a scientist with a focus on epidemiology and was offered a job by the CDC. I was also a math prodigy. I'm writing an article for business owners about the Coronavirus epidemic. What questions would you like answered? Feel free to PM me. Thanks, and I'll share a link here when done.

Q: How much does an N95 mask really reduce the chances of contracting the virus if exposed?

A: Don't bother. You probably won't wear them correctly unless you are in the healthcare field. For healthcare workers, proper N95 fittings are recommended yearly and when you gain or lose weight. In one fit test, you have to count to 20 while a nurse sprays a scent. If you end up detecting the scent, then the seal is not good enough. It often takes several tries to find a good-fitting N95 mask. When properly fitted, they are uncomfortable to keep on for more than 10 minutes. You may feel claustrophobic because they restrict air movement so much. Talking without breaking the seal is hard, and exertion such as walking through an airport is exhausting.

Worn correctly, they definitely help reduce the chances. But it's just not practical. I suspect there will be a shortage even for healthcare workers, so leave them for people who really need it.

Q: What mask should we get?

A: If you get sick, wear a regular surgical mask (dust mask) to you reduce your chances of spreading to others.

Q: What are the chances it was leaked from the Wuhan bio research lab? It seems too much of a coincidence the epicenter is 8 miles from the lab.

A: Unlikely. The genome for the virus has been mapped out for weeks and in the hands of many scientists in many countries. If there was genetic manipulation, there would be markers, and someone other than conspiracy theorists would have raised a red flag already. It is entirely reasonable for this virus to have originated in bats and taken a ride via some other host at the market.

It's an RNA virus. RNA is single-stranded, so there is no redundancy for its code. DNA is double-stranded, which means built-in redundancy and harder to accidentally mutate. RNA viruses mutate faster. Like SARS and MERS, both recent Coronavirus outbreaks, this one just happened to make the leap from animal to human with its set of happenstance mutations.

Q: Even if they didn't manipulate it they may have just been studying it there, no? Seems pretty crazy China's only P4 lab (and only lab secure enough to have the virus) is a few miles away from the fish market where it was first found. It doesn't really matter at the end of the day but it just seems to much of a coincidence.

A: I agree that it is quite the coincidence. In fact, Dean Koontz's novel "The Eyes of Darkness" from 1981 "predicted" a virus outbreak from Wuhan's lab. It's also a coincidence that my lawyer happens to share a name with a Chinese character from that book. Which scenario is more likely in my opinion? That it was simply a coincidence.

Q: Why isn't America testing in mass like Italy and South Korea? Is it to slow play the numbers delay the impact on the US market?

A: I can't answer why without getting political. But I can tell you that the test kits sent out by the CDC last week had a faulty component in 47 states. Only 3 states had working kits. The criteria for qualifying for testing was not inclusive enough, so potential cases didn't qualify to be tested. Testing last week was a big deal, and most healthcare workers received no clear direction on how to approach cases in an efficient way. As of this writing, I've heard that California is out of coronavirus test kits.

Basically we had no cases of community spread until yesterday because we were not testing adequately. Now that the test kits are slightly more available, we'll see an explosion of confirmed cases as we catch up.

Q: How does one get tested for coronavirus if they want to be cautious?

A: Official from CDC: "If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel from China, you should call ahead to a healthcare professional and mention your recent travel or close contact. If you have had close contact with someone showing these symptoms who has recently traveled from this area, you should call ahead to a healthcare professional and mention your close contact and their recent travel. Your healthcare professional will work with your state's public health department and CDC to determine if you need to be tested for COVID-19."

My personal opinion is that doctors offices would not want to be fielding this question over and over. There should be a hotline set up to help someone make the determination. The worst thing to do is to show up unannounced at the ER. If things are working correctly, you should call the hotline who can then contact public health officials if you meet the criteria for a swab. And then ideally, someone would show up at your door to swab you and tell you to quarantine yourself until the test results the next day. But I'll warn you - no one seems to know what to do yet. My cousin is an ER doctor at Kaiser in California, and we are seriously unimpressed with how things are being managed there. This is an instance where the government really should have firm guidelines on procedures, but...yeah, politics.

If you don't have a good reason, don't get tested "just to be safe." You would contribute to overwhelming the medical system and prevent people who actually need to be tested from being able to do so.

Q: What are the real numbers in China? Obviously they are lying but by how much?

A: Any scientist will tell you that there are many ways to spin numbers. It's all about the denominator.

  • If you don't test, you have no cases.
  • If you test only people who show up at the hospital, you'll detect few cases but a high mortality rate.
  • If you test everyone with cold symptoms going to the doctor, you'll detect a ton more cases but now have a lower mortality rate.
  • If you stand at the entrance of every building and test everyone going in and out with a fever, you will find even more cases, lower mortality still.

The last one is what China is doing. Part of our supply chain is in China, so I speak with our factories weekly. I speak Mandarin and have a great relationship with our people there. I think I'm getting reliable intel from them. What the Chinese have done with their quarantines is absolutely astounding and as comprehensive as one can hope. Only an authoritarian government top heavy with agents can pull it off. It's truly amazing.

But it was too late. The lower level government officials who initially covered it up allowed it to leak out of China. The reason why the number of cases are going down in China is because they are now really trying and doing a great job identifying cases and immediately quarantining the heck out of everything.

There is no way that could happen here, and we will be identifying far fewer cases than them because we won't be monitoring literally everyone for a fever. So our denominator will be skewed and actually less reliable.

In case you are wondering, I have no incentive to support the Chinese government as my loyalties are with Taiwan. I have to say that China is to be commended on what they are doing now. They will have better stats on infection rate than any "free" country. They are now transitioning to keep travelers out of China for fear of bringing the virus back.

That said, I don't think they are testing people without a fever, like kids who may never exhibit symptoms. So that's where they are off with their numbers. I don't believe that they are deliberately lying with the numbers since the start of February when they began to take it seriously.

Q: If (when?) this turns into a pandemic in the US what will our government response be compared to China's? Will we have a worse outbreak because our government can't force the same quarantines as the socialist regime?

A: Don't confuse communism with socialism or authoritarianism.

If you need someone to tell you it's a pandemic to see it for what it is, then I am telling you now that it's a pandemic.

I can't tell you how our government will respond.

I can tell you that there are two extremes for response. One is to do nothing, and many many people will get sick all at the same time and overwhelm the medical system. More people will die this way because we will run out of hospital beds for people needing oxygen and run out of equipment and medications.

The other extreme is what China is doing, and we will suffer greatly from economic losses and over-reaction. Some people died in China because they couldn't get their routine heart medications due to quarantines. The chemical sprays they are using for decontamination of spaces and waterways may have long-lasting health effects as well. Economic damages are real, and have long-lasting quality of life consequences.

Which way is correct? Depends on your perspective, but probably somewhere in the middle. We need to quarantine enough to reduce the rate of infection so that we can adequately treat the cases that require medical care.

Because the transmissibility is so high, to minimize lives lost would require closing schools, non-essential businesses, eliminating social gatherings, and restricting travel.

Q: Do you think people should continue flying domestically right now or is that a bad idea?

A: I recommend driving over flying, if possible. The next few days are the last few days to fly relatively safely — but it does depend on where. Major cities are of course higher risk. By the middle of March, I would not fly anywhere. By the end of March, no one will want to fly anywhere. Note that travel insurance often excludes epidemics. Read the terms carefully if you buy ticket insurance.

Q: Why will people not want to fly anywhere by the end of March?

A: There will be so many cases by late March, and the death numbers will start rolling in by then. Everyone (okay, not literally everyone) will be too afraid to talk to their neighbor let alone consider traveling.

As for your mother flying through smaller East Coast airports next week, it's your risk tolerance. The chances of catching it are still low but not zero. And mortality is unlikely unless she is 80+ with health issues. Here is the mortality breakdown by age.

Q: I'm signed up for a cruise at the end of May. Ports out of Miami. My thinking is that the bulk of the danger will have passed by then. If I want to cancel it, I would have to do it now.

A: The CDC is recommending no cruises in Asia, but that will likely expand to here too eventually. Looks like it's thousands of dollars. I don't know how much they would refund if they can't launch. You might ask them. Depends on how important that amount of money is to you to risk. I can't say what the government will do, but late May is an awfully bad time if my projections are right.

Q: I'm going to a conference in Vegas in late March. Should I go?

A: I think it's not a matter of IF you will catch it but WHEN. The more exposures, the earlier one might catch it. If you are under 50, you'll just catch the "bad cold" version, with a very low risk of death. So I wouldn't worry about catching it and dying. The things to consider for whether or not to travel would be as follows:

  1. Would you be greatly inconvenienced if plans had to change last minute due to quarantine recommendations? (No refunds on air, hotel, conference, child care)
  2. Do you have serious chronic illnesses that make you really worry about this potential exposure?
  3. Do you have frequent contact with elderly people or care for them?
  4. How badly would you feel if you ended up bringing it back to your community? (This is not a rhetorical question.)
  5. Do you expect that the conference will be well-attended given the global spread and various travel inconveniences worldwide?
  6. How important is it? Are you a speaker or an attendee?
  7. Would you risk having to be placed in a self-quarantine? I believe the US will continue to implement the "stay at home for 2 weeks" recommendation with no actual enforcement. (We don't have enough workers in public health to begin with- definitely none to police anything.)

I hate to say cancel all plans prematurely. We just don't have good numbers for cases in the country. We only just started widely testing in a few states last week. We really have no idea what the disease burden is out there. My article makes a lot of guesses for how many have it now and how many will have it by late March. It's the best intelligence I have at this time.

Personally, I wouldn't do it, but it's because I couldn't deal with the guilt and uncertainty if I gave it to someone who ended up really sick or dead. I'm not afraid to catching it personally.

Q: I don't think most people here are prepared at all. Most think it is fear mongering by the media and that only a few cases will be reported here and there. What you describe is very difficult and quite scary. Hm. Do you think people should be stocking up on food and water?

A: I have advised my family to stock up not because I expect them to not catch it by social isolation but because a soft quarantine (school closing, non-essential businesses closing, travel restrictions) is possible and would be wise. Water is not necessary, but keeping your refrigerator and pantry topped off would be helpful when a quarantine is imminent.

Q: Do you think the media is fear mongering or do you think actually people have no idea what could come and will be unprepared?

A: It depends on which media you follow. I think that there is a lot confusion which causes fear. But at risk of being Chicken Little, most people are underestimating this epidemic if they aren't paying attention like you.

Q: I'd be curious to know if the virus can exist (or more accurately, how long it can exist) outside of a human host. For example, if someone that was 'sick' touched a product that was then shipped to the US... could the virus remain viable until it arrived here (2 weeks?) and then be transferred in to someone when they touched the product?

A: 2 weeks, close to impossible. (I'm a scientist, so nothing's actually impossible.) A few days, unlikely but possible. Hours, yes. I have absolutely no concerns about our latest ocean shipment that recently arrived. According to this research article, other human coronaviruses have been found to survive up to 9 days. For SARS, survival on hard surfaces averaged up to 5 days. If you have an air shipment that arrives from China, look into how long it's been in transit and if it was during the summer or winter. Viruses tend to survive better in colder temperatures, and this is no exception. Even though viable viruses could be extracted from the test surfaces, there weren't many left after the few few days. The risks are really quite low in the summer. In the winter, consider letting air shipments air out a few days if they arrive in less than 5 days. Ocean shipments are completely outside of the potential window of viability.

Q: Since the virus has been known for so many years, what is causing its resurgence now?

A: There are 5 routinely circulating Coronaviruses that cause common colds. You've likely had some of them. It's not a resurgence of those.

It's a mutated one- a variant- that likely originated in a bat, hopped to another animal, and spread to humans visiting the animal market in Wuhan, China.

This is the 3rd Coronavirus that has caused an epidemic. There was SARS in 2003 and MERS in 2012. Both of those were even more deadly than COVID-19 (the technical name for this variant).

Q: While COVID-19 is not as deadly as other coronaviruses, I've read that it is more easily transmittable. Is this accurate?

A: It's true that COVID-19 is not as deadly as SARS or MERS. It is more transmittable than those two. There are 5 routinely circulating Coronaviruses that cause the common cold (along with many other cold viruses).

Q: Does the 83 year old Pope Francis fall victim to the Coronavirus? If so, does he make it?

A: Seems like we might lose a few federal lawmakers if the stats pan out.

Q: What are the implications of this virus in Sub-Saharan Africa? I heard there were cases in the most populated country of Nigeria.

A: I've never been to Africa and really don't know much about it. My cousin is in Rwanda currently and I worry about her coming back next weekend. She had a Taiwanese passport and was pulled aside after deplaning at the airport for a cheek swab test even though she lives in NYC. They weren't wearing protective gear and did not make any attempt to isolate anyone including on the bus ride to and from the hospital. Everyone signed the paperwork with the same pen (except her - she's as paranoid as I am!). If they don't have access to medical oxygen or respirators, the overall death rate may be higher. But I believe that the entire population skews younger, so maybe they won't have as many deaths per infection.

Q: How accurate is the John Hopkins map?

A: Only as accurate as the data input, which is sketchy for the US, for example. We have not been testing adequately. It's quite reliable for China, which has learned to track this and has enough cases for real statistical analysis with good confidence levels. I only worry about the kids being adequately represented. They may have such mild disease that they are going undetected.

Q: What are the top three food items households should buy?

A: No adults will suffer greatly from a few weeks of malnutrition. I'd recommend good old comfort food from your culture! Something you eat regularly anyway so you don't end up wasting it if the emergency never materializes.

Q: While COVID-19 is not as deadly as other coronaviruses, I've read that it is more easily transmittable. Is this accurate?

A: It's true that COVID-19 is not as deadly as SARS or MERS. It is more transmittable than those two. There are 5 routinely circulating Coronaviruses that cause the common cold (along with many other cold viruses).

Q: From a business continuity and school focus. It seems like every other country's play book is to shut down offices and schools. Is the US prepared to do that and what would be your estimate for a timeline? When will things get to that point and what's your estimate for how long those shutdowns would last?

A: According to the CDC, a soft quarantine like what you describe is anticipated as of yesterday, when they updated their guidance based on the fact that a case in CA was found with no ties to international travel. Also, that person was in contact with numerous healthcare workers, ending up in intensive care prior to the diagnosis of COVID-19. Community spread is definitely happening, and there will be a 7-10 day lag (average 5-6 day incubation, 1-2 days of illness, 1-2 days to see the doctor, 1 more day to actually confirm diagnosis) before we know about cases. During that time, they are spreading it to others. It's all guesstimates. I think most officials and even doctors hate to be pinned down for timelines because they will for sure be wrong. But I'm retired from being a doc now, and I don't mind going out on a limb. I'm putting all of my assumptions and wild speculations together in a (hopefully cogent) post by the end of today. I'll share.

Q: Vice President Pence is in charge of approving all media appearances of all government officials and isn't approving many appearances. So where do we turn for accurate, scientific information?

A: The CDC site is the best we have. I worry that some information may not be fully transparent, and the advise may be too reductive or out of date. For example, the site still recommends testing only people with known exposure to international travelers. As we know, there is a confirmed case of no known exposure. Still, it does have accurate information, and it's the playbook medical professionals rely on.

Here is the link to my Coronavirus predictions and how to prepare as a business and as an individual.

Here are a few other good links: CDC website

JAMA article from Feb 24, 2020

Numbers from around the world

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