This is an overview of the current Coronavirus pandemic, affecting the United States and the rest of the world.
Upfront, I want to be very clear that this is not a situation that merits panic or extreme anxiety. I also want to be very clear that this is a serious situation, and needs to be taken seriously. The purpose of this post is to increase understanding of Coronavirus, what it is doing and going to do, separated from any rumor or agendas, and to use that to make suggestions about courses of action over the days and months ahead. From my background, I am concerned about this pandemic – Not strictly for the disease and its potential effects, but from the second and third order effects this will have on infrastructure, supply chains, the economy, and the healthcare systems of afflicted countries.

For background; I have been a frontline medical provider as an EMT and medical tech intermittently since 2004. I was on a Pre-Med track at New Mexico Tech from 2006-2009. I am a virology and epidemiology nerd, and have been reading about these topics for fun for over twenty years. I am well read, and have no-little education in relevant subjects – I am not an expert. What follows will not be my opinion on the Coronavirus, but facts and information with appropriate citation. This is an effort to break down the “need to know”, using my education and experience to cut through the heaps of misinformation, conjecture, falsehoods, and rumor that surround this pandemic.

My opinion will come in the later sections of this post – I will share my opinions on what we should all be doing about this situation, and what my experience leads me to expect from the coming weeks and months. Take what is useful, and discard the rest.

Much of this will be useful to international readers, but my focus in writing this was primarily on the United States. International friends, I hope you don’t ignore what’s useful here because of that, and that you can pull your own resources to examine your local situation with this as a starting point.

Two more notes before we began:
First, pay close attention to links in this article. This is heavily cited, and some sentences will contain multiple links. I have spent the past several days reading over 500 studies, papers, articles, dashboards, situation reports, twitter threads etc. etc., and condensing them down to the most important and relevant for this article (with many of the rest being diverted to the above Twitter feed). If you want to know more, or verify for yourself, then follow the links.

Second, this is not medical advice. Consult with a physician before taking any actions that could impact your health. TANSTAAFL, YMMV, and IANAD.

What is Corona Virus?
Corona Virus, COVID19, Wuhan Virus, the names by which this viral infection has become known are numerous, sometimes confusing, (and sometimes even racist). We will be using two names for accuracy: COVID19 (Coronavirus Disease 2019) is the disease caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) virus. In different sources you will hear others such as nCoV 2019, Novel Corona Virus 2019, CoV19, which are not inaccurate. For simplicity sake we’re going to stick to SARS-CoV2 to refer to the virus, and COVID19 to refer to the disease, in general.

SARS-CoV-2 is a member of a large group of viruses, named Coronaviruses for the crown or corona appearance of the virions (the individual virus particle). Coronaviruses are a common group of viruses, first identified in the 1960’s, that affect birds and mammals. Coronaviruses are not rare, being responsible for some types of common cold and existing worldwide in various forms both benign and severe in humans. Coronaviruses have caused global health scares before, including the 2003 SARS outbreak, and MERS.
SARS-CoV-2 is a novel (that means new) strain of Betacoronavirus, from group B. It is a positive-sense single-stranded RNA virus, which causes Coronavirus Disease 2019. COVID19 first emerged as an outbreak of viral pneumonia in Wuhan, China, in December of 2019. The outbreak was traced to a novel strain of coronavirus dubbed SARS-CoV-2. SARS-CoV-2 causes respiratory illness, which ranges from mild to severe-life-threatening.

Since emerging in China, COVID19 has spread globally, infecting (as of 18 March 2020) more than 214,894 people. There have been 8,732 deaths, and more than 83,000 recoveries. (From https://jsapi.dev/covid19-dashboard/ , accessed 18 March, 1530MDT). On 11 March 2020 the World Health Organization declared COVID19 to be a pandemic.

Where Did It Come From?
Virologists have identified Horseshoe Bats as being the primary natural reservoir for related coronaviruses, and suspect that SARS-CoV-2 originated within bat populations. However, there is evidence that an intermediate reservoir, likely pangolins, was involved in the jump to humans.
Where that jump occurred is not known precisely, but early suspicions that it originated in the Wuhan Seafood Market have been disproved, as earlier cases with no association with the market have been identified. The earliest known case of COVID19 is from November 17th, 2019, but the origin of that infection has not yet been identified.

The information we have on the genetics and origins of SAR-CoV-2 tells us that it is not any kind of bioengineered virus. This is a naturally occurring virus, that came about most likely due to a “recombination event” between strains of Coronavirus in bat and pangolin hosts .

What Are the Symptoms:
SARS-CoV-2 causes COVID19. Symptoms of COVID19 can range from mild to extremely severe.
Common Symptoms are:
• Fever
• Tiredness
• Dry Cough

Some may have:
• Aches/Pains
• Nasal Congestion
• Runny Nose
• Sore Throat
Diarrhea

Severe Symptoms:
• The above, plus Difficulty Breathing

Mild cases present not unlike the common cold, with symptoms of mild fever, dry coughing, and tiredness, with sore throat, nasal congestion, headache, and muscle pain possible. No worse symptoms are typically present in mild cases.

Moderate cases present with a moderate pneumonia, respiratory symptoms including cough, shortness of breath (which can present as rapid, shallow, breathing in children), without any signs of more severe pneumonia.

More severe COVID19 cases display a worsened pneumonia, often with a fever associated with severe shortness of breath, worsening respiratory illness, rapid breathing, and decreased blood oxygen levels. Severe cases can progress to Acute Respiratory Distress Syndrome (ARDS), where inflammation in the lungs creates fluid buildup that severely impedes the transfer of oxygen between the lungs and blood. ARDS can lead to sepsis, respiratory failure, septic shock, multi-organ failure, and then death.


How Is It Transmitted:

SARS-CoV-2 is transmitted from human-to-human, meaning an infected person can pass the infection on to someone else. The basic reproduction number of SARS-CoV-2 has been estimated as between 2.2 and 3.9 , meaning that each infected person could transmit the virus to between two and four people.
The virus is spread primarily by respiratory droplets from coughing, but can also be transmitted as an aerosol (particularly in continued exposure or confined space). The virus can also potentially survive in aerosols for up to three hours.

In the primary transmission route, droplets containing the virus are expelled, and can land in the noses or mouths of people nearby, or be inhaled. Infectious particles can also land on or be transferred to surfaces where they are picked up by others, who then transmit the virus to themselves by touching their face or other bodily opening.

SARS-CoV-2 can survive for at least several days on surfaces, and can be spread by that route as well.

The incubation time of the virus, the time it takes for an infected person to show symptoms, is estimated to range between 5 and 14 days. There is some evidence to suggest that pre-symptomatic people can still spread the infection as well as some evidence that asymptomatic people can also spread it. Viral shedding, virus particles leaving the body to potentially infect others, lasts an average of 20 days, but has been documented to last up to 37 days.


Who Is At Risk:

Everyone is at risk of infection from SARS-CoV-2.
However, certain parts of the population are at greater risk of having severe symptoms than others. The highest risk factors for severe COVID19 are being older, or having preexisting health conditions such as high blood pressure, diabetes, heart disease, lung disease, cancer (or history of cancer), diabetes, or obesity. Children are at low risk of serious illness with COVID19, although they can be infected. Symptoms in children are typically mild, resembling the common cold. Pregnant women may be more susceptible to infection than others, due to physiological changes associated with pregnancy. The risk to the unborn child, however, appears low.


How Serious Is It:

COVID19 is not the black death, it is more severe than the flu. The global situation, due to the pandemic, is not great. Potentially, it could be very bad. It could also be not that bad. It depends on what people do, from here.

As of this writing, on the afternoon of 18 March 2020, there are 217,583 cases documented, with 8,936 deaths ,across 140+ countries. This is, obviously, not accounting for undocumented cases.

The case fatality rate (the percentage of cases that will result in death) is difficult to accurately predict during an active epidemic or pandemic, with lots of moving pieces and potential impacts and consequences if wrong. Current estimates for the CFR of COVID19 run as high as 3.9%, with the WHO saying 3.4%.

It is important to remember that the fatality of COVID19 depends highly on your age, health, and geographic location, and that the percentage of people dying is largely clustered within the highest risk factors although there are severe cases occurring outside of the highest risk population.

The current percentage of deaths, among known cases, is around 4% globally (although this is not a perfectly accurate number, as unknown cases are a certainty. Certain countries are faring better, or worse, than this. Italy, for example, currently has an almost 8% fatality rate, while South Korea has a less than 1% fatality rate. Differences in these numbers are to be expected from region to region in an ongoing situation like this, where different response efforts are mounted in each region or nation.

Currently (1530 MDT 18 March) in the US we have just over 8990 identified cases of COVID19, with 150 deaths, for a current fatality rate of around 1.6%. However, these numbers can be safely assumed to be inaccurate, perhaps to a large degree, because the US is woefully behind on testing for COVID19 (As of 18 March 2020, the US has tested less than 60,000 people). When considering US infection rates, or trajectory, Italy may be a particularly pertinent example, as the US infection trajectory appears to be very similar to Italy, just running about a week behind, as charted by multiple sources.

Johns Hopkins Data Set

 Italy is in crisis, with hospitals overwhelmed by COVID19 cases, and although there are differences between Italy and the US in health system resources per capita, the Italian model provides concern for the outlook in the US.

The disease trajectory is very important to look at, because it gives us an entry to the concept of “flattening the curve”. To flatten the curve means to slow the spread of infection, thereby spreading the number of new infections out over a longer period of time. Experts have been saying that containment of COVID19 may be impossible, since late February. The disease is here, the SARS-CoV-2 virus is spreading, and we can’t stop the spread. How fast it spreads is what will make the final difference. If COVID19 spreads rapidly, the US healthcare system will quickly be overtaxed, as Italy’s has been, as cases exceed capacity. We are probably going to exceed capacity anyway, but the longer we can delay any infection, the less we’ll do that.

Estimates suggest that 5% of infected will need critical care in hospital , which means ICU beds and ventilators. There are an estimated 68,000 ventilators in the US healthcare system, with slightly less than 9,000 in the Strategic National Stockpile. There are around 68,000 ICU beds available in the US. Typical occupancy of ICU beds has been measured as between 57% and 82%, with between 20% and 38% of beds being patients requiring mechanical ventilation. That is the norm in the US, without a virulent disease outbreak. 

What does this mean for COVID2019? One report predicts the following “If the infection curve is not flattened and the pandemic is concentrated in a 6-month period, that would leave a capacity gap of 1,373,248 inpatient beds (274 percent potentially available capacity) and 295,350 ICU beds (508 percent potentially available capacity). If the curve of transmission is flattened to 12 months, then the needed inpatient and ICU beds would be reduced to 137 percent and 254 percent of current capacity. However, if hospitals can indeed reduce current bed occupancy by 50 percent and flatten the transmission curve to 18 months, then the capacity needed would be reduced to 89 percent of inpatient and 166 percent of ICU beds. If the infection rate is only 20 percent (low end of current estimates), we would largely be able to meet the needs for inpatient care if we flatten the curve to 12 months.” 

This is why what seems to many to be drastic measures are being taken to slow the spread of the SARS-CoV-2 virus. Epidemiologic controls such as social distancing, cancellation of events and gatherings, school closures , and encouraging self quarantine are enacted to flatten the disease trajectory, and spread the rate of infection out across a longer timeline in which resources can be better preserved and renewed. While many are screaming that it is unreasonable that they can’t go to concerts, or to see a movie, and that travel restrictions are in place, these measures could make the difference between life and death not just for COVID19 patients, but for those patients that occupy up to 82% of the ICU beds in the United States under normal conditions.

What To Do?
The first and most important thing to talk about, when we ask what should we do about all of this, is to encourage following the given guidelines for reduction of spreading SARS-CoV-2. National and global health agencies aren’t lying to you about the importance of hand washing, covering your cough, and in general not being a nasty bastard, or about the importance of maintaining social distance from other people.

Even if we are healthy, and do not fall into any of the higher risk factors (age, comorbidities, etc), we are at risk of spreading SARS-CoV-2 infection to those who are more vulnerable. That risk is only heightened if we ignore the guidelines being put out. Each of us has a role to play in flattening the curve, and trying to preserve the integrity of the healthcare system. In short, if you ignore these guidelines because you personally aren’t at risk, you’re putting others at increased risk, and that makes you an asshole. So, how can we do our part, and not be assholes, and minimize our own chances of infection along the way?

Hand Washing: Wash your hands! Hand washing with soap and water is the most effective way to not just remove, but kill, virus on your hands. Soap kills SARS-CoV-2 very effectively. Hands should be washed regularly, whenever you return home, before, during, and after meal prep, before eating, before and after caring for the sick or injured, after going to the bathroom (before as well, if in public facilities. You don’t want SARS-CoV-2 on your business, right?), after sneezing, coughing, or blowing your nose. This is kindergarten advice, but we teach it early because it’s fundamental and you need to be on board fully. 

  • Wet hands with clean running water
  • Lather with soap, rubbing your hands together, between your fingers and under your fingernails
  • Scrub for at least 20 seconds
  • Rinse well under clean running water
  • Dry using a clean towel.

Hand sanitizer should be used when soap and water aren’t available, but hand sanitizer will never be as effective as soap and water. Hand sanitizer must be at least 60% alcohol.

  • Apply gel to one palm
  • Rub gel over all surfaces of the hands and fingers, until it dries (at least 20 seconds)

Do NOT apply rubbing alcohol or household cleaners to your skin. These products can cause tissue damage, creating openings in the skin making you more susceptible to infection instead of less. DO use moisturizing lotion on your hands, to prevent them drying out from frequent washing. Dry skin can crack, and again create a pathway for infection. Keep your hands in good shape, and the skin well conditioned.

Avoid Touching Your Face: Your eyes, mouth, and nose are primary routes by which viruses can enter your body. Picking up pathogens on your hands, and then touching your face, is a known transmission route for almost every viral infection (and bacterial). People touch their face, without thinking about it, as much as 23 times an hour and every time you do, you’re potentially infecting yourself if your hands have picked up a pathogen. Work to break this habit.

Practice Respiratory Hygiene: Cover your mouth when you cough or sneeze, ideally with a tissue. You aren’t preschoolers, and shouldn’t need to be told this. If you are ill, wearing a face mask that blocks droplet spread from coughs and sneezes is more effective and hygienic than coughing into your elbow, and certainly more so than into your hand. Wash your hands after coughing or sneezing.

Clean and Disinfect Regularly Touched Surfaces: Those pathogens you can pick up on your hands? You redistribute them to anything you touch, and the more you touch it, the more likely it is. Others can also deposit nastiness on commonly touched surfaces for you to pick up. Regularly clean and disinfect surfaces and objects that get touched regularly, from tables and counters to computer keyboards and mice to doorknobs and steering wheels. You should also use disinfecting wipes or gel on public door and cart handles, prior to touching them, and then still wash your hands afterwards.

Wash Your Phone: That’s right, your phone. There are few objects we touch as often in our daily lives, in this modern world, as our phones. If anything in your possession is likely to be a literal hive of scum and villainy, it is your phone. Many modern phones are water resistant enough to wash, but if in doubt, give them a thorough wipe down with 70% alcohol wipes, or Clorox wipes. https://www.cnet.com/how-to/help-keep-coronavirus-off-your-phone-how-to-effectively-clean-and-disinfect-your-device/ Take the case off, and wash it with soap and water. This should be done about as often as you wash your hands.

Disinfect Items You Carry in Public: Your keys, every-day-carry gear, and the rest of the stuff you regularly take into public and touch also need the same treatment.

Keep Your Distance: When you have to be out in public, keep your distance from other people. Droplets from coughs and sneezes can travel more than six feet https://www.sciencefocus.com/the-human-body/how-far-do-germs-travel-when-we-cough/ . Proximity to infected individuals is the primary source of SARS-CoV-2 transmission, and you don’t know who may or may not be infectious (or if you are, even). Keep your distance.

Don’t Shake Hands
: You may have impeccable hand washing habits, but not everyone else does. Politely decline to shake hands, and find other ways to greet people that require minimal-to-no contact.

Work From Home if Possible: Many of you reading this already have been given orders to work from home. Do it. It’s an adjustment if you’re not used to it, but you can do it (I transitioned to full-time work-at-home dad last fall, and it’s been a wild ride, but I did it). If you don’t want to get sick, avoid sick people. Since you don’t know who the sick people are, that means avoid people as much as possible. Text your most introverted friend, they’ve been doing this for years and will walk you through it.

If you absolutely have to go in to work, maintain health and hygiene practices in the workplace (your workplace should be doing this, but if it falls on you, it falls on you, do it). 

Avoid Crowds and Large Gatherings: Follow the advice given by the CDC, WHO, and other health-concerned alphabet soups, and don’t go where there are lots of people. The more people you are around, the more likely you are to be exposed to SARS-CoV-2. Now is not the time to go to large church services, or to gather all your friends, neighbors, and their brothers-in-law for a BBQ.

Avoid the Doctor, Urgent Care, and Emergency Room Unless Absolutely Necessary: This is a fine line. If you need medical care, you need it and should not avoid it. However, now is not the time to go to the ER because you’ve got a tummy ache, and if you have the skills, support, or network to avoid having to go in for minor or routine things, you should. Healthcare facilities will be where COVID19 patients are, both known and unknown. If you want an exposure, one of the best ways to do it will be to sit in an Urgent Care or Emergency Department for a few hours. Don’t be stupid and avoid getting treatment when you really need it, but make good decisions about when you can take care of issues at home, too.

These things are important for all of us. They are especially important for people who are at elevated risk, due to age or comorbidities. I have told my family members who are over 60, and in other risk categories, to take these steps seriously and extremely.

These steps are also critically important for any of us who have care providers roles in our networks and families, or have close contact with elderly or at risk friends and family.

When to Wear a Mask and Gloves:
Now, if you want. Especially if you’re at increased risk (or in contact with someone who is), and have to be out among other people.

Masks and gloves and other barrier precautions do not eliminate the need to wash your hands and maintain other hygiene and distancing protocols. Read that again. Your hands (and face) should be clean and disinfected prior to putting on mask and gloves. Your gloved hands should never touch your face. Your hands need to be washed as soon as you take the gloves off.

Not all masks are equal, and it is important to know the differences. The simple facemask, or surgical mask, does nothing to protect the wearer from inhalation of particles or virus-bearing droplets. These masks do, however, protect others from droplets the wearer expels. N95 respirators, when properly fitted, do protect the wearer from inhaled particles and can help prevent infection. If you are sick, wear a simple face mask. If you are worried about getting sick, trying to prevent infection, immune-compromised, or all of the above, wear an N95 respirator.

Wash your hands and face before putting on any kind of mask. Cover mouth and nose with the mask, making sure there are no gaps. Avoid touching the mask while using it, and if you do, wash your hands. Replace the mask with a new one as soon as it is damp, and do not re-use single use masks. When removing, do not touch the front of the mask, remove it from behind and throw it away immediately in a closed trashcan. Wash your hands immediately after removal. 

Avoid reuse of masks. This may be difficult, due to shortages. If reuse or multiple-uses of masks has to be performed, it is important to follow the guidelines closely


What If I’m Sick?

The most common COVID19 symptoms, and the mildest form of the disease, are fairly indistinguishable from the common cold by observation. For many infected, that’s all that will happen to them as the virus runs its course. But, what do we do if it gets worse, or we’re at risk?
The difference between mild or moderate and severe symptoms is respiratory function. As symptoms worsen, respiratory function decreases. This decreased respiratory function, as discussed in the symptoms section, is what leads to severe complications or death as it worsens. The condition of anyone who is sick with COVID19-like symptoms needs to be closely monitored, particularly their breathing.
The CDC has the following advice for those who are sick:

  1. Stay Home except to get medical care. Don’t leave, don’t visit public areas. Stay in touch with your doctor, without visiting their office unnecessarily. Avoid public transportation, ride sharing, or taxis.
  2. Practice home isolation: Separate yourself from others in your home as much as possible. Dedicate a specific sick room, away from others, and use a separate bathroom if possible. Limit contact with pets and animals, as well as other people, as it’s possible they could spread infection to other household members.
  3. Call before visiting your doctor. If you have routine appointments, notify your doctor that you are sick before coming in, and follow their directions.
  4. Wear a facemask if you are sick. If you are experiencing difficulty breathing, or otherwise unable to wear a facemask, everyone in contact with you should wear an N95 mask.
  5. Practice respiratory and personal hygiene. Cover your cough, wash your hands, throw your tissues and other trash in a dedicated lined trashcan. Wash your hands often, not just after coughing, sneezing, or touching your face.
  6. Avoid sharing personal or household items. Do not share dishes, utensils, towels, or bedding with others. Wash these items thoroughly with soap and water after use.
  7. Clean all regularly touched surfaces every day (multiple times a day would be better) in your “sick room”, and anything you touch if you have to go out of that room. Phones, remote controls, counters, tables, doorknobs, bathroom fixtures, toilets, tablets, bedside tables, etc. are all candidates for regular cleaning and disinfecting. Caregivers should wear masks, gloves, and wait as long as possible after the infected person has used the bathroom, when cleaning for them.
  8. Monitor your symptoms. If your symptoms worsen, particularly if shortness of breath or difficulty breathing develops, seek medical attention. Call before going in to your doctors, the emergency room, or urgent care, and follow their directions. Wear a facemask if you have to visit medical facilities, and maintain at least 6-feet of social distance from others.
  9. Do not discontinue home isolation (except to seek medical attention) until the following conditions are met: You have had no fever for 72 hours without the use of medicine, other symptoms have improved, AND at least 7 days have passed since your first symptoms. All three conditions must be met. Alternatively, you can leave home isolation after meeting the first two conditions if you have received testing for COVID19 and been tested negative twice, 24 hours apart.

If you are a family member, roommate, intimate partner, or caregiver to someone who is sick, you need to monitor yourself for symptoms as well, while taking precautions to prevent infection. Help the patient to maintain their isolation, and do not share items, bedding, dishes, etc. with them. Stay out of their “sick room” as much as possible (no, it’s not weird to skype in the same house, do it) and wear personal protective equipment (gloves, N95, goggles) when you have to enter.

If you are responsible for monitoring their health for them, as in the case of an elderly family member, keep a close eye on their symptoms and be prepared to call their doctor if symptoms worsen, particularly their breathing. We need to observe them for increased/increasing respiratory effort: An increase in the number of breaths per minute; cyanosis (turning blue in the nail beds, lips, etc), grunting or other sounds of effort when breathing, nose flaring, retracting (when the area between the ribs and in the neck sinks in when a person attempts to inhale), and other signs of increased effort like wheezing, sweating, etc. These symptoms should be your trigger point for contacting their doctor.


What to Prepare?

A lot of people have been caught behind the power curve on this. Not everyone has the financial ability to lay in multiple layers of preparations for unexpected events. Not everyone anticipated this emergency, and their preparations are weak in key areas. Some people are just now realizing the need for emergency and disaster preparedness and are playing catch up. None of this is helped by the panic run on stores and the national supply chain for items both ludicrous and essential, like toilet paper and meat.

If you are already well prepared for this event, good for you. You’ve done well. Give yourself a pat on the back, and then get back to taking care of yourself and your family, keeping them out of the doctors office unless necessary. Use your security as an opportunity to be a good ambassador for your lifestyle, be it prepping, gun owning, whatever it is that may be essential in this emergency.

If you haven’t prepared well, and are scrambling, please know you have my sympathy and understanding, and don’t give up. There is still time to get things you need, and to take advantage of resupply of essentials. As I am writing this, I am hearing reports from my personal network (which spans all of the US, and several other countries) of store shelves being replenished with items that went out of stock last week, and I am still finding many essentials online with careful searching.

As you try to stock up on, or improve your stocks, of various items consider unconventional sources. The great toilet paper debacle provides an excellent example: Big box stores and grocers quickly ran out of toilet paper as people panic bought, while office supply, home and hardware stores, restaurant supply, and medical supply business continued to hold stock. Many still do. Similarly, many people have been having trouble finding their regular groceries at the usual stores, while ethnic markets and smaller community grocers have things still in stock. Many of us do not shop at ethnic markets or “funny” grocery stores, because we’ve bought into the monoculture ideology of brand-recognition and not eating “strange” food. This situation presents a really good opportunity for you to get over that kind of nonsense.

As we evaluate our preparedness, we need to consider what the future holds. We are not tasked just with being prepared for the COVID19 outbreak and its health effects, but also with preparing for the second and third order effects of the pandemic.

The economy is taking a massive hit already from the COVID19 pandemic. As more people stay home, either to maintain social distancing or because they’ve fallen ill, this will only get worse. Fewer consumers will be spending money, and staffing will be a problem for businesses. Once again, the toilet paper stupidity provides us with a perfect example as manufacturers, normally running 24/7 to meet regular demand, are hit by the double hammer of a spike in demand and a reduced production capacity. This is happening with almost everything. It is reasonable to expect ongoing shortages of good, and increased disruption to our supply chains. If you are not currently prepared to weather these events, it is not to late to begin, but you need to begin now. A reasonable goal would be to have, and maintain, at least a months worth of supplies on hand. Everything you need, from groceries to household products to medications. If you can bring your stocks up even higher, do so. Talk to your provider about changing any prescriptions that aren’t to a 90-days supply. Begin adding additional supplies now, and building a stockpile of the things you need most. Doing this while you can, to any extent, will soften the impacts of quarantines, lockdowns, illness, job loss, and the rest of what we can look forward to.

Preparedness is not just stuff, however, but behavior. Your behavior, actions and lifestyle, are going to have more to do with whether or not you become infected with SARS-CoV-2 (and when you do) and with your success or failure in the other aspects of this crisis.

Personally speaking, I have largely isolated my immediate family. We are staying home, and continuing life largely as normal. We are obeying all handwashing and hygiene protocols discussed in this article, and doing so strictly (this has meant making a game out of it for the kids as we do it more often and more strictly enforced, while also explaining to them why it’s important especially right now). We are doing everything we can to maintain our health, and keep our immune systems robust, including good amounts of sleep, eating well, exercising, and continuing use of both Vitamin D, and Elderberrywhile also avoiding snakeoil.

Ourhousehold posture is good, with preexisting habits of cleanliness and doubling down on keeping things clean, and neat. We have identified a “sick room” for isolation of anyone symptomatic, and talked over the fundamentals of a care plan. We have made an effort to get to know our neighbors (pre-dating this crisis) and have reaffirmed those connections in recent days. Most of our closest family, friends, and neighbors have gotten some version of this article, as a conversation, in recent days.
We have discussed within the household, and those closest to us, various plans for further isolation and pulling back to a more remote location if the situation devolves more aggressively, and gone through checks on equipment and contacts necessary for this.

I pulled a large number of medical supplies from my caches, to organize and stage them so that I can run my home as a clinic for my family and closest friends to keep them from having to risk COVID19 exposure over minor issues (or even major ones, if they are within my scope).

Even though we came into this better prepared than many, we have begun adding a few things to our supplies, as possible, to ensure our ability to do two things: Stay at home for 2-weeks per infected individual, without having to go anywhere for anything and risk spread; and to weather the coming supply chain shortages as they happen without insufficiency.

We are keeping an eye on restocking for masks, ammunition, and medical supplies to let others know, or to secure additional numbers for distribution to friends and family. At the same time, we are not adding unnecessarily just because it’s available, and thus denying others the ability to prepare.

My instructions to my elderly father and his wife are to stay home (they have 18+ months worth of supplies, and live remotely), avoid the doctors office, and pretend they’re young again without the risk of contributing to the upcoming baby-boom, and if they get sick to contact their doctor as soon as either of them displays any increased shortness of breath/difficulty breathing.

What Comes Next?
The epidemic continues to evolve. Most of what we have currently are models, predictions, of what might happen, and what could make things better or worse. Everyone is feeling the stress of these large unknowns, and the more tangible effects of shortages and beginning disruptions. More affecting than the COVID19 illness itself, and already evident, may be this strain on society at large as services, venues, businesses, and normal routines are disrupted by this epidemic. As noted above, the economy is already suffering , and supply chains are disrupted. Services we all rely on are also disrupted, as various governmental offices close and police departments begin scaling back response to all but the most dire calls

Modeling potentials tells us that, no matter how successful various measures are, COVID19 and its impacts are going to last, at the very least, months. COVID19 will continue to spread. The situation will get worse, from what it is today. Models suggest that saturation of healthcare resources will begin within the next couple of weeks. If people continue to violate social distancing and quarantine orders, it will get much worse much faster.

Spread mitigation efforts (social distancing, event cancellation, etc) are likely to turn to more severe suppression efforts, such as lockdowns, local travel restrictions (even street closures), and forced distancing with people restricted to their homes. Many places are already discussing these measures, and it would be reasonable to expect them in the coming days to weeks. The downside to this is that the more successful severe measures are at suppressing infection, the less herd immunity is developed in communities. With decreased herd immunity, lifting any restrictions without a vaccine available will mean a renewed spike in infection rates. This may cycle going forward until vaccine production is successful and stockpiles exist to inoculate the population.

Predictions for how long this epidemic will go on vary from weeks to months or longer, with many predictions extending past a year, and the earlier l linked paper on modeling predicting this continuing through 2021.

Testing for COVID19 is improving in the US, with various efforts underway to provide new tests , increase access, and speed up processing, but it is still not at the capacity it needs to be. We will get there, but until we do, the only safe assumption is that anyone is infected, and to act accordingly (while simultaneously acting as if we are not infected, and want to prevent it).

Work is underway to develop a COVID19 vaccine, but it remains at least 12-18 months away. This is the nature of vaccine production, and there isn’t much that can be done to change it. What we can do is everything detailed above, to ensure that more people make it to that point and that the pressure on health infrastructure isn’t increased to the breaking point (which will slow vaccine research and production even more). Even as the situation improves, the strain on the healthcare system will remain increased as people recovering from COVID19 suffer lasting effects, and from minor issues that couldn’t be treated and blossomed into larger issues. Individuals who put in the work (either ongoing, or starting now) to improve and maintain their own health will fare better in this new paradigm, than those who do not. We are learning more every day about how to successfully treat COVID19. The world health community is racing to meet the challenges of this epidemic, and finding success. But we aren’t there yet, and we have a long way to go.

We’re going to stop here for now. I will probably follow this post up with a second post entirely focused on COVID19 mythbusting. Although this post contains most of the necessary information to disprove all the common nonsense going around, it will probably be helpful to put together a “listicle” that goes over them one at a time and debunks them. That’s coming, but I am going to take a break. This post has taken almost a week of work, regularly staying up till 3AM to research and write.

This is a serious epidemic, and needs to be taken seriously. The Las Vegas casinos don’t close for nothing,  and their choices are entirely built on extremely solid math. They chose to forgo billions of dollars of business and close, due to COVID19. If that doesn’t shape your concern about this, then nothing will.

I have established a Twitter feed solely focused on sharing information on COVID19/SARS-CoV-2 at Twitter.com/ControlMeasures – This is a rapidly changing situation, with new information almost constantly being generated, if you want to take a deeper dive, look at that feed over the coming days.