Ultraviolet Light Kills Viruses and Bacteria and it is “free”.

But we do not know whether exposing clothing and other articles to outdoor light will kill COVID-19. So washing machine + Dryer is the best advice unless you have a medically approved UV sanitizing device. Soap and hot/warm water works.

Viruses are not really “alive” in the sense that bacteria, parasites, algae are alive but they can cause great harm. For the rest of this discussion “alive” and “dead” in reference to harmful viruses will refer to “probably infectious/viable” and “not probably infectious/viable”.

A Stanford professor and viral researcher posted how he goes about grocery shopping and engaging in other tasks. His comments are worth considering.

You can find them here.

These are some of his salient points.

A recently published paper in the NEJM studied viable virus duration on various surfaces.

Copper – no viable COVID-19 after 4 hours
Cardboard – no viable COVID-19 after 24 hours
Stainless steel – no viable COVID-19 after 48 hours
Plastic – no viable COVID-19 after 72 hours
Not tested – glass, rubber, clothing, carpeting, tile, wood, stone, paper, and foods. No documented food transmission, cooked or uncooked, has been reported to my knowledge.

From Dr. Utz:

It is important to understand several things about these numbers:
–    The virus decay over time is “exponential”. 
o    This means that half of the virus on stainless steel is dead after 5.6 hours, and half of virus on plastic is dead after 6.8hours.
o    So for stainless steel at 24 hours, only about 5% is still alive. For plastic at 24 hours only about 10% is still alive. That’s not much. With hand washing and not touching eyes, ears or nose, my personal interpretation for typical exposure out in the community is that there is not much to worry about.
–    The studies were done under very controlled conditions – room temperature and 40% humidity.
–    There is no way to know what happens in fridges and freezers. 
–    It is thought that warmer weather and sunlight make it harder for viruses like this to survive.
–    The data on cardboard was “noisy”, that is was more variable, and should be interpreted with caution.

Here is Professor Utz’s practical tips.

–    Assume public surfaces could be contaminated. Wipe down surfaces, like door handles, gas pumps, and keyboards. Use Purell, wash hands frequently, and don’t touch your eyes, nose or mouth unless you have washed your hands. Gloves are really not needed in the community. Healthcare workers on the front lines need gloves way more than any of us. Our risks are extremely low if we follow the guidance.
–    Assume the virus can be aerosolized (the length of time in air is still being studied and is very hard to estimate given all of the variables in the community). Minimizing time in closed spaces with others in the public, and staying 6 feet apart is good practice and reduces this risk greatly. Personally, I only used an N95 mask once last week in a massively overcrowded grocery store. The mask I used was from my garage that I have used for years when sanding my decks. Again, healthcare workers on the front lines need masks way more than any of us. Moreover, unless properly trained, the masks don’t work and can even increase your risk if in a high-risk environment like a hospital ICU (but not uncrowded places like stores – these are low risk places). The same with gloves – most people don’t know how to properly put them on and take them off, potentially increasing the risk of getting the virus to aerosolize. MGH sent out an email this morning about this topic. They described how to use masks if on the front lines, and how to clean them in the event there is a shortage (a worrisome message). The take home point is that we don’t need masks, but our caregivers and first responders do. Donate unused masks if asked. The MGH video is here: https://www.youtube.com/watch?v=IfTVPCDami4&feature=emb_logo&mkt_tok=eyJpIjoiTVdabE1ERmhPVFV5TURFdyIsInQiOiJQQWNSZFJaTjBRNHYzWk01cUphbmEzRVNScXVtWG1FMmZsUEZQWUtJT25NTEs2RmdBVzEyS3ZHdTlVS1h5VFNETzFpalo1U0h3V1wvOWxRQjdNVElSVUpFNFMrZE1MdU5MdVhYYTFoemhydW9rK2FJb3ROWnlaaFdCUFpYOGJ0cFQifQ%3D%3D
–    There have not been any documented cases of food transmission. We should assume for now that we should be washing fresh food as usual, and preparing food hygienically.
–    Based on available data, I personally am doing the following (again, this is not a recommendation, just a description of my approach):
o    At grocery stores. I try to get in and out as quickly as I can. I used to go to our local store almost daily, but now go every 4-5 days to buy for several households. This means going in with a list of only what is needed. I keep my 6 foot distancing. I don’t wear gloves or mask. I go alone and if I had kids I’d not bring them in the store (yes, I still am seeing this happen – parents should STOP). If the store is crowded, I come back when it is not crowded. I pay with a credit card and not cash. After shopping I take the cart out to the car and then load into my own canvas bags myself. (Note some stores in our area are now banning customers bringing in their own bags). I bring the groceries home and unload them on the porch (that is, I don’t bring the bags in the house and I don’t place them on my kitchen floor like I used to do). I deliver to some at risk relatives and friends and just leave the bags on the front porch and text them to grab them. When I am done unpacking groceries, I leave the bags out in the sun and consider them OK to use again when I shop again 4-5 days later.
o    At restaurants. I am now starting to get take out again regularly. The restaurants clearly need the business. I distance myself, pay with a credit card, carry to my car, unload like I do for groceries, and I transfer food to plates (ie I don’t eat from containers). 
o    Delivery. Many people are using delivery services which is one way to cut exposure at grocery stores and restaurants completely, and to provide income to drivers. 
o    When returning home from work or these rare outings.
§    We have always had a “no shoe rule” in our home because we work in hospitals and have no idea what is on the floor. 
§    For those who do wear shoes in the house – based on the data in the NEJM paper, it sees unlikely that enough virus would land on the floor, then get transmitted to shoes, then somehow make it to the mouth, eyes or nose and cause an infection. Since carpeting has not been tested in studies yet, there is no way to know for sure. 
§    For days where we are in the clinics or in a crowded grocery store only, we change clothes and shower when we get home out of an abundance of caution. How long the virus can remain in clothing, and whether it is transmissible, is not known and is hard to study. Follow the CDC guidelines:  https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html.
§    We wash hands regularly, and particularly after unloading new purchases. And before, during and after preparing and eating food.
§    We wipe down cell phones, and we use speaker phone wherever possible so we don’t get the cell phone close to our face.
§    And to end with some levity, we don’t bite our nails, apply cosmetics while pumping gas (I observed this last week, I kid you not), pick our noses, or pick other people’s noses.

Some information on disinfectants from Michael Lin PhD-MD:

• Hand sanitizer is just 60-70% ethanol with moisturizers.
• The ethanol you want to use is 95% non-denatured ethanol
– 95% denatured ethanol has toxic additives to prevent drinking (will have a health hazard logo).
– 100%/dehydrated/absolute/anhydrous ethanol has benzene, also toxic, from the purification process.
• Isopropanol can be substituted for ethanol, but just takes longer to evaporate
– 60-70% isopropanol is just as effective as 60-70% ethanol as a disinfectant.
– 99-100% isopropanol (rubbing alcohol) can be purchased by the consumer as a cleaning and disinfecting agent.
• The moisturizer can be aloe vera gel (available in drugstores) or glycerol (a common lab reagent, and an ingredient in moisturizers and makeup).
Lin Lab recipe: Mix two parts 95% non-denatured ethanol or 99-100% isopropanol with 1 part aloe vera gel or 90-100% glycerol. That’s it!

Hygiene recommendations from Dr. Lin:

• Don’t shake hands and stay 6 ft away from people outside your household – these are easy.
• But ”wash your hands often” and “don’t touch your face” are confusing without context – how often is often? Why can’t I touch my face? Should I ask someone to scratch my itchy nose for me? Shouldn’t I also worry about what I’m touching, not just my hands? If so, what cleaning solutions should I use?
• I’ll provide some details. I treat hands and objects similarly, and I am pretty strict:
– To protect yourself, sanitize your hands right before eating and right after touching things touched by others.
– To protect others, use clean hands to touch others’ things or when handling things to others.
– Sanitize objects you get, and only give out sanitized objects. For example, I have hand sanitizer open and ready to clean my credit card right after I get them back from cashiers, before I put it back in my wallet.
– Outside your house, sanitize smooth surfaces you will touch directly with your hands (e.g. tables and chair edges, wherever you put your phone and computer).
– I keep track of whether hands/objects are clean. As long as they have not encountered unknown/dirty things after their last cleaning, they don’t need to be recleaned. This is why I suggest immediate sanitation of hands after touching unknown/dirty things, so you can resume using your clean things without worry.
– You can open doors with your body or foot, and use paper towels to handle faucets or knobs.
– Create clean zones – your house, your office (if you’re allowed to work), your car.
– Sanitization can be done by soap and water (hands) or hand sanitizer (hands or objects) or Windex (objects).
– “Disinfectants” like bleach or quaternary amines are for large areas for which soap (due to the need to rinse) or alcohol (due to fumes, expense) are not practical. If you can use soap or alcohol, you don’t need them.
– Finally, if your hands are clean, you can touch your face! But remember to sanitize them before you touch other people’s stuff.

Because this information is practical I have created a separate page on this website to include it’s contents.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

After posting the letter from an ER doc who eloquently expressed the danger, concerns, and most importantly, call for action I realized that some explanation for the lay person is necessary.

Intubation is the placement of a breathing tube into the windpipe for a person in respiratory failure. During the procedure the doctor and all providers in the immediate area are in a very high risk situation because the droplets filled with billions of virus can become aerosolized. I previously explained the difference between spread by droplet vs aerosol. Droplets fall to the floor and surfaces where virus can be infectious for hours. But when aerosolized, the virus remains suspended in the air for hours and anyone entering the area can become infected by simply breathing the air.

During intubation the doctor has his/her face inches from the patients mouth and nose. During this procedure droplets can become aerosolized. Even wearing a perfectly fitting N95 mask, goggles, gown, gloves the doctor (and those assisting) is/are not completely protected.

I received a warning letter from an ENT surgeon at Stanford, warning colleagues about cases of ENT and Neuro-surgery (endoscopic surgery through the nose) where despite FULL PPE, all practitioners in the operating room became infected and  surgeons have died. The ENT surgeon warned that PPE with N-95 mask was not fully protective and recommended PAPRs be used (Powered, Air Purifying Respirators.) Here is what the surgeon reported he received from his international colleagues:

“All 14 people who came in and out of the OR during that case became infected. He saw this repeat with other endoscopic cases

He has also shared that a significant number of doctors who died in China were ENTs and Ophthalmologists, possibly due to the high viral shedding from the nasal cavity. This has now been confirmed in the media as well.[i]

[i] https://www.bloomberg.com/news/articles/2020-03-17/europe-s-doctors-getting-sick-like-in-wuhan-chinese-doctors-say?fbclid=IwAR2ds9OWRxQuMHAuy5Gb7ltqUGMZNSojVNtFmq3zzcSLb_bO9aGYr7URxaI”

All 14 people who entered and left the operating room during the surgery became infected despite wearing PPE!!!!!!!!!!

“we have additionally heard from Iran that at least 20 ENTs are currently hospitalized with COVID-19, with 20 more in isolation at home.” 

Although SARs had a higher mortality rate, IT WAS NOT AS CONTAGIOUS.

This demonstrates how contagious this virus can be, and that was early on in China and Iran, before it mutated. Mutations can make the virus more contagious and more lethal. There has already been a SECOND STRAIN IDENTIFIED.

In my career I have performed more than 10,000 intubations. Many under emergency circumstances. Donning full PPE correctly takes time and when in a hurry the N95 mask may not be perfectly fitted. (WATCH THE VIDEO BELOW)

Although I have intubated people with sepsis and TB under emergency conditions, I have never been exposed to the level of danger that doctors and other providers around the world are now experiencing. The PPE (personal protection equipment) is already running short in hot zones. Many hospitals are a few days away from running out. MANY PROVDERS are reusing PPE that is not meant to be reused.

AS more doctors, nurses, and techs become infected (which is inevitable) there will be less personnel to care for patients so MORTALITY RATES WILL INCREASE.

This has not been factored into the epidemiologic models and projections.

Temporary emergency hospital tents are great, but useless without personnel. There is a limited # of ICU and ER doctors, nurses and techs. And they all need PPE.

That is why flattening the curve is so important.

That is why folks who ignore the behavioral guidelines are reckless and endangering others in the community and in hospitals.

We need to hear this every day from Doctors like FAUCI.

Misinformation from uninformed and anti-science politicians is tragically harmful.

EASTER WILL NOT BE MAGICAL.

Ventilators are useless without doctors, nurses and respiratory therapists to manage them. So production of ventilators is futile unless PPE are prioritized, WHICH HAS NOT YET HAPPENED. Shortages abound and the executive branch has not coordinated the private sector in addressing production and distribution. Instead leaving it up to the MARKET!

This has been described as a WAR, but we are not mobilizing the way we did during WW2. Mobilization requires central coordination, not bidding wars between states and hospitals for PPE, bleach and other sanitizers.

Here is the link to AN instructional video on donning PPE. Watch how long it takes and the steps required to achieve proper fit and seal for the N95 mask. Now imagine doing that while a patient is blue/hypoxic, or in cardiac and/OR respiratory arrest.

Later I will post practical precautions for groceries, mail, gas stations etc. A separate page on this website will document that.

I will also create a COVID 19 page with cut and pasted excerpts from documents as well as links to informative documents, videos and websites.

STAY SAFE.

I do not wish to create or contribute to panic, if you follow the recommendations of shelter in place and social distancing and follow good hygiene you and everyone around you will be MUCH SAFER. I merely want to emphasize why flattening the curve and following recommendations are so important. The more people comply, the shorter will be the time when we can prudently start to return incrementally to normal activity.

Testing still remains inadequate with backlogs of 10 days in hot zones. So the information we are getting on # of cases is almost 2 weeks behind what is out there and even if we had 45 minute turn around, the testing kits are being rationed. So we are just seeing the tip of the iceberg. And that will be the UNFORTUNATE situation for a while.

Although we have seen TOO LITTLE TOO LATE, we can still flatten the curve by following recommended practices. We can still save lives, prevent disability and suffering, and get to a point where we can return to a more “normal” life. The longer we wait for every state to institute necessary measures (Florida is an example of inadequate measures) the longer will be our restrictions.

Remember, you can boost your immune system by getting adequate restorative sleep, rest, exercise, sunshine, stress reduction and eating an anti-inflammatory diet. Avoid alcohol (which impairs your immune system) and quit smoking. You can help prepare your body to mitigate a cytokine storm by increasing in your cell membranes, the omega 3 marine fats (EPA and DHA) which are the precursors for RESOLVINS that help regulate the inflammatory response. The inflammatory response is protective but when out of control it can be lethal in the ICU or on your way to the hospital. Your body’s defense systems can be optimized by eating an anti-inflammatory diet rich in nutrients that support immunity and regulate inflammation. A healthy diet can only be beneficial. All of these measures can be practiced while sheltering in place and practicing social distancing.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

PLEASE READ THIS AND SHARE AS WIDELY AS POSSIBLE:

CDC recommending hospital staff use bandanas when masks run out. Hospitals are asking the public to sew masks. Here is a physician responding:

Please don’t tell me that in the richest country in the world in the 21st century, I’m supposed to work in a fictionalized Soviet-era disaster zone and fashion my own face mask out of cloth because other Americans hoard supplies for personal use and so-called leaders sit around in meetings hearing themselves talk. I ran to a bedside the other day to intubate a crashing, likely COVID, patient. Two respiratory therapists and two nurses were already at the bedside. That’s 5 N95s masks, 5 gowns, 5 face shields and 10 gloves for one patient at one time. I saw probably 15-20 patients that shift, if we are going to start rationing supplies, what percentage should I wear precautions for?

Make no mistake, the CDC is loosening these guidelines because our country is not prepared. Loosening guidelines increases healthcare workers’ risk but the decision is done to allow us to keep working, not to keep us safe. It is done for the public benefit – so I can continue to work no matter the personal cost to me or my family (and my healthcare family). Sending healthcare workers to the front line asking them to cover their face with a bandana is akin to sending a soldier to the front line in a t-shirt and flip flops.

I don’t want talk. I don’t want assurances. I want action. I want boxes of N95s piling up, donated from the people who hoarded them. I want non-clinical administrators in the hospital lining up in the ER asking if they can stock shelves to make sure that when I need to rush into a room, the drawer of PPE equipment I open isn’t empty. I want them showing up in the ER asking “how can I help” instead of offering shallow “plans” conceived by someone who has spent far too long in an ivory tower and not long enough in the trenches. Maybe they should actually step foot in the trenches.

I want billion-dollar companies like 3M halting all production of any product that isn’t PPE to focus on PPE manufacturing. I want a company like Amazon, with its logistics mastery (it can drop a package to your door less than 24 hours after ordering it), halting its 2-day delivery of 12 reams of toilet paper to whoever is willing to pay the most in order to help get the available PPE supply distributed fast and efficiently in a manner that gets the necessary materials to my brothers and sisters in arms who need them.

I want Proctor and Gamble, and the makers of other soaps and detergents, stepping up too. We need detergent to clean scrubs, hospital linens and gowns. We need disinfecting wipes to clean desk and computer surfaces. What about plastics manufacturers? Plastic gowns aren’t some high-tech device, they are long shirts/smocks…made out of plastic. Get on it. Face shields are just clear plastic. Nitrile gloves? Yeah, they are pretty much just gloves…made from something that isn’t apparently Latex. Let’s go. Money talks in this country. Executive millionaires, why don’t you spend a few bucks to buy back some of these masks from the hoarders, and drop them off at the nearest hospital.

I love biotechnology and research but we need to divert viral culture media for COVID testing and research. We need biotechnology manufacturing ready and able to ramp up if and when treatments or vaccines are developed. Our Botox supply isn’t critical, but our antibiotic supply is. We need to be able to make more plastic ET tubes, not more silicon breast implants.

Let’s see all that. Then we can all talk about how we played our part in this fight. Netflix and chill is not enough while my family, friends and colleagues are out there fighting. Our country won two world wars because the entire country mobilized. We out-produced and we out-manufactured while our soldiers out-fought the enemy. We need to do that again because make no mistake, we are at war, healthcare workers are your soldiers, and the war has just begun.

Thank you my fellow healthcare workers for working on the front line.
I pray for you and your safety.
Copy & Paste!

PLEASE SHARE THIS WITH YOUR ENTIRE NETWORK OF FRIENDS, FAMILY, COLLEAGUES.

DR. BOB

I highly recommend this webinar from Israel. The medical leaders there really have their act together. Possible treatments on horizon discussed around 20 minute mark.

WEBINAR FROM ISRAEL MARCH 17

The early part discusses some basics everyone can/should understand.

Some key points.

COVID 19 is an RNA virus. After entering the cell it must use it’s own enzymes to replicate and this is one place an anti-viral might work. (Block replication). DNA viruses can use the host cell’s own DNA replication enzymes/machinery.

Blocking entry into the cell is also a possibility (Chloroquine and Hydroxychloroquine) These drugs (that treat malaria) may be useful in that regard based on small studies in-vitro and in-vivo. I have several papers in my files on both relative to COVID-19 if anyone is interested.

Because RNA viruses mutate quickly, vaccine production is more difficult as compared to DNA viruses (darn!)

Singapore got things under control very quickly because they had a plan ready to go (after experiencing previous virus outbreaks). For example, they had already built a 400 bed hospital with 250 negative pressure rooms just to be used for a SARs type situation. (Large facility for a very small country). They had travel restrictions, stay at home, rapid testing, etc., all immediately in place. Public health teams were immediately dispatched to investigate all contacts and institute isolation and quarantine. Japan seems to have done very similar quick containment. The Japanese culture is also conducive to social distancing and compliance with public health recommendations (they follow rules/recommendations, including the teenagers and young adults,  unlike Americans).

Back to the Israeli Webinar.

So blocking viral entry into the cell and blocking viral replication seem to be the best targets for potential drugs. The Protease Inhibitors used to treat HIV are much less likely to be useful according to the virologist (Susan Weiss) on the webinar. I have already read a paper and editorial in NEJM demonstrating no benefit.

The fatality rate in Germany is about 1/4 that of Italy. These societies are very different. Italian households often include multiple generations, Germany less so.

The virus has hit Northern Italy (colder) much harder than Southern Italy (warmer) and we know that many viruses are temperature sensitive relative to replication/survival/epidemiology.

Also observed has been less viral activity in the Southern as compared to Northern hemispheres.

Israel has been tracking data from multiple perspectives. # cases went from 30 to 300 in one week (double every 2 days approximately, which I have discussed appears to be the case in US). They project 600 cases in 4-5 days (as of the Webinar), 4,000 cases in 2 weeks, and as many as 20,000 cases at peak which they anticipate will be late April or early May.

Israel is working on technologies for remote monitoring of isolated positive patients who are mildly symptomatic and has already converted a building into that kind of facility (US take a hint)

The webinar is an hour long and well worth the time.

I applaud the governor of California for taking decisive action for state wide stay-at-home and essential services open only. This should prevent the degree of crisis seen in the Lombardi region of Italy.

Finally, another note on improving and maintaining your immune status.

Immunity and Morality in COVID-10

There are two general aspects. We must do everything we can to support our immune system and at the same time follow an anti-inflammatory lifestyle so our immune system does not over-react to an infection producing a cytokine storm.

People who develop COVID-19 related pneumonia and progress to multi-organ failure and death follow a path led by excessive inflammation. The immune system produces various inflammatory chemicals and cascading events that are not resolved in time to save the host. The host’s own immune system response causes friendly fire damage and death. What keeps the immune system in check?

Resolvins are produced by humans to contain excessive inflammation. They are produced from the marine omega 3 fats (EPA and DHA) which are widely deficient in modern diets. That is one advantage of the anti-inflammatory diet.

The dietary approach on this website provides for a more healthy intake of  anti-inflammatory omega 3 fats relative to pro-inflammatory omega 6 fats. The latter are consumed in great quantities in the standard American diet.

But that is just one aspect of the diet that can contribute to your body being more able to handle an infection.

With regards to maintaining a properly functioning immune system a few simple lifestyle habits are essential,

1.  Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
2.  Get plenty of sleep (without adequate sleep your immune system does not work well )
3.  You must follow good sleep habits
4.  Exercise, especially out of doors in a green space, supports the immune system
5.  Get some sunshine and make sure you have adequate Vitamin D levels.
6.  Eat an anti-inflammatory diet rich in micronutrients.
7.  Practice stress reduction like meditation and yoga which improves the immune system

Now would be a good time to address all of these areas to enable your body to withstand the stress of social isolation and COVID-19.

Hopefully, with warmer weather coming and most states taking the lead in stay-at-home policy (federal leadership still lacking tremendously) if independent-minded American culture can overcome our innate distaste for following rules we may see a rapid turn-around and ability to resume modest amounts of economic and social activity. But this will take very aggressive behavior changes (especially among the young) and a united-we-stand approach.

More to come so stay tuned. I will stay on top of this crisis and provide filtered and up to date information.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

This is an excerpt from a MEDSCAPE article. MEDSCAPE is a clinical on-line source of information.

“Clinicians across the United States are petitioning the federal government to follow the lead of South Korea, China, and other nations by imposing an immediate nationwide quarantine to slow the inevitable spread of COVID-19. Without federal action, the creators say, their lives and the lives of their colleagues, patients, and families are being put at increased risk.

In addition to the quarantine, the petition, posted on the website Change.org, calls on US leaders to institute emergency production and distribution of personal protective equipment for healthcare workers and to rapidly increase access to testing.

The petition, which garnered more than 40,000 signatures in just 12 hours and as of this writing was approaching 94,000, was started by an apolitical Facebook group to focus attention on what members see as the most critical issues for clinicians: slowing the spread of the virus through a coast-to-coast quarantine; protection of medical personnel with adequate supplies of essential equipment; and widespread testing.”

Meanwhile, growth curves for various countries show US is on the same path as ITALY. The doubling time of cases in the US appears to be about 2 days! See the slope for the US on the chart below. Compare it to the double-every-2-day line.

You can see the direct source of this curve here. But on the curve below the US has been superimposed. (added) Please note that # cases is on a logarithmic scale.

Doctors at the front line are trying to protect everyone, including their own families who are at risk from their daily exposure while at work.

“The COVID-19 US Physicians/APP Facebook group includes 20 volunteer moderators who handle hundreds of posts per hour from persons seeking information on the novel coronavirus, what to tell patients, and how to protect themselves.”

While initially denying the problem, CHINA subsequently took drastic measures and the results are evident in the curve above. Almost complete cessation of growth has occurred in China (but this could rebound as restrictions are removed).

China is not an open society and personal freedom, that we cherish so dearly and appropriately defend, in combination with ineffective leadership, has produced the deadly and alarming situation in the US.

The response in the US has been TOO LITTLE, TOO LATE.

Finger pointing at this critical time will distract from our country uniting to fight this. But we need thoughtful and effective leadership at the highest level, which has been tragically lacking.

At the same time we must learn from our mistakes and the mistakes of others.

“When health authorities in Wuhan, China ― widely cited as the epicenter of the global pandemic ― cordoned off the city, the infection rate dropped from one person infecting 3.8 others to one infecting 1.25, thereby significantly slowing the rate of transmission.”

Early on, WHO-approved test kits (made in Germany) were available but the US did not use them and instead waited for kits to be produced in the US. (Whitehouse mandate) Our testing is still FAR behind other countries, delaying a full scale response.

Doctors from around the country have reported shortages of test kits and PPE (sources: personal phone calls to my colleagues across the country, various press reports, and The COVID-19 US Physicians/APP Facebook group)

The present administration eliminated, soon after taking office, the Pandemic Emergency Response Team that would have coordinated multiple Federal Agencies responding to a PANDEMIC.

Why? “Unnecessary duplication”.

If a centralized coordinating TEAM  was not necessary why are we seeing such an ineffective response to the crisis (rapid growth rate of cases)?

Hospitals in hot zones will soon be running short on masks, gloves, gowns (PPE, personal protection equipment) that protect health workers from contracting the disease. Previous OSHA rules would have required (before COVID-19 existed) that hospitals  stockpile these supplies in adequate amounts to meet the demands of a PANDEMIC. This measure was tragically removed from OSHA requirements by the present administration. (too expensive)

We must stop making mistakes and respond forcefully, quickly, more intensely and learn from these and other mistakes to avoid this in the future.

So think about  the petition signed by 94,000 (and growing) US doctors and other providers which asks for an immediate coast to coast quarantine and immediate emergency-funded production/distribution of PPE and test kits.

White House press conferences have promised allot but produced very little. Germany has ordered 10,000 new ventilators and asked a manufacturer to immediately increase production. The Whitehouse, after stating that “many, many ventilators” would be available later told governors to fend for themselves in getting ventilators. (no instructions for where/how were provided)

Because we have, as a nation, done too little too late, we must now take EVEN MORE drastic measures. We must unite, cooperate,  and listen to the doctors and nurses on the front lines (as described in the petition).

Last week FOX NEWS was still describing COVID-19 as less serious than the flu! Apparently they have thankfully started to change their tune.

BEWARE OF FAKE NEWS.

Here is a comparative chart by country. Please note that # cases is on a logarithmic scale..

This shows how South Korea quickly flattened the curve with fast and effective action while the US continued to demonstrate rapid rates of growth. South Korea instituted major closures, shelter-in-place,  and widescale rapid testing. South Korea responded appropriately with strong and effective leadership. South Korea is much closer to the original source and has as much international travel as the US.

US citizens must think and act responsibly and listen to the petition of >94,000 doctors and other providers.

Yesterday’s Bay Area testing was 1700 total tests, 55 positives.  About 3%.  This ties with the Wuhan rate before drastic measures were instituted.

STAY AT HOME except for essential items and urgent medical care. Do not travel. If you have any symptoms self-quarantine. Follow home hygiene recommendations. Go to the CDC website for details on protection..

Here are some other CDC links

Are You at Higher Risk for Severe Illness? 

Caring for Someone at Home

All A-Z TopicsCoronavirus Disease 2019 (COVID-19)

In my rural county there has only been one case reported (a traveler who returned home) but this is the tip of the iceberg here and testing has not been widespread. Although compared to other areas our Department of Public Health states we are still low risk it is only a matter of days or weeks before that changes. The risks increase on a daily basis EVERYWHERE. Rural areas are just a week or two behind major cities.

We must all do our part to flatten the curve.

Please share this discussion widely with friends, family and colleagues.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Read  the words of this Italian journalist and take heed!

“So here’s my warning for the United States: It didn’t have to come to this.

We of course couldn’t stop the emergence of a previously unknown and deadly virus. But we could have mitigated the situation we are now in, in which people who could have been saved are dying. I, and too many others, could have taken a simple yet morally loaded action: We could have stayed home.”

“According to several data scientists, Italy is about 10 days ahead of Spain, Germany, and France in the epidemic progression, and 13 to 16 days ahead of the United Kingdom and the United States. That means those countries have the opportunity to take measures that today may look excessive and disproportionate, yet from the future, where I am now, are perfectly rational in order to avoid a health care system collapse. “

Now some facts about US hospital beds and ventilators.

Although Europe has TWICE AS MANY HOSPITAL BEDS PER 1000 PEOPLE compared to the US, THE US HAS MORE ICU BEDS. (Our hospitals have disproportionately more ICU beds)

But COVID-19 patients in respiratory failure will need more than an ICU bed, they will need a ventilator (and healthcare personnel to manage the ventilator and other aspects of care.)

From the AMERICAN SOCIETY OF CRITICAL CARE MEDICINE

“Supply of mechanical ventilators in U.S. acute care hospitals: Based on a 2009 survey of AHA hospitals, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators.⁷ Approximately 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply.⁷ The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8,567 continuous positive airway pressure (CPAP) units.”

The later mentioned “older devices” are not useful for treating Acute Respiratory Distress Syndrome associated with COVID-10. The use of these devices is contra-indicated for COVID-19 because they create an aerosol which is highly contagious. A patient with COVID-19 in respiratory failure needs intubation and mechanical ventilation with a “full-featured” ventilator. Other “non-invasive” measures for respiratory support cannot/should not be used.

There are already many patients in ICUs on ventilators for other problems like Flu, pneumonia, trauma, burns, COPD exacerbations, sepsis, asthma, post operative care after emergency surgery, etc. We cannot just take those patients off of ventilators to care for COVID-19 cases.

So the 62,000 fully featured ventilators in the US will not all be available for COVID-19 patients (which could easily cause 200,000 cases of respiratory failure in the US).

And if all the remaining unoccupied ventilators are used for COVID-19 then what happens to other critically ill patients with other problems that require mechanical ventilation? (Like your son, daughter, spouse, parent who is in a car wreck, develops bacterial or viral pneumonia, asthma attack, complicated pregnancy, premature baby, or has emergency surgery for any reason and requires ventilator support)

That is why flattening the curve is so necessary.

The protective measures needed to adequately flatten the curve HAVE NOT BEEN TAKEN.

Take heed of the Italian journalist’s warnings. They did not act quickly enough, they did not act intensively enough. What seems like “excessive measures” ARE NOT EXCESSIVE.

1.  STAY HOME EXCEPT FOR FOOD AND URGENT MEDICAL CARE AND OTHER NECESSITIES (BUT WALK OUTSIDE FOR EXERCISE IF YOU ARE NOT SYMPTOMATIC, MAINTAINING 6  FEET BETWEEN YOU AND OTHERS)
2.  ANYONE WITH SYMPTOMS OF AN UPPER RESPIRATORY ILLNESS MUST SELF QUARANTINE AT HOME (FEVER, CHILLS, COUGH, SORE THROAT, FUNNY NOSE, ETC.) WHICH MEANS SOMEONE ELSE MUST GET FOOD INTO THE HOME.
3.  FOLLOW THE CDC PUBLISHED GUIDANCE REGARDING how to clean and disinfect your home,
4.  AVOID PUBLIC TRANSPORTATION
5.  NO SOCIALIZING EXCEPT WITH FAMILY THAT LIVES WITH YOU
6.  WASH HANDS WITH WARM WATER AND SOAP FOR AT LEAST 20 SECONDS EVERY TIME YOU ENTER YOUR HOME FROM OUTSIDE.
7.  IF SOMEONE IS SICK IN YOUR HOME THE SICK PERSON SHOULD BE WEARING A MASK TO PROTECT OTHERS IN THE HOME, NOT THE OTHER WAY AROUND.
8. WASH CLOTHING AND SHEETS FREQUENTLY.
9. WIPE SHOPPING CART HANDLES WITH DISINFECTANT BEFORE YOU USE THEM AND WEAR GLOVES WHEN SHOPPING.
10.  NO KISSING, HUGGING, SHAKING HANDS. (Physical contact with infants, children of course is necessary)

The US still has not instituted adequate measures. “Shelter In Place” along with proper social distancing (when you must absolutely leave home) and hygiene precautions are all necessary to prevent a repeat of the Italian disaster in the US. Some services are essential such as first responders, grocery stores, urgent medical/dental care, mail, pharmacies, utilities etc. These must continue.

Do not eat in a restaurant. Be cautious with take out food. Every time you touch a door handle to a store or shop, your hands are potentially contaminated. So wash hands as soon as you get home, wear gloves whenever possible outside the home. You can use work gloves and disinfect them/leave them in a bag etc.

In my community people are still going for manicures, pedicures, etc. That is NUTS AND IRRESPONSIBLE.

Again the Italian journalist says:

“I heard from a manager in the Lombardy health care system, among the most advanced and well-funded in Europe, that he saw anesthesiologists weeping in the hospital hallways because of the choices they are going to have to make.”

“Until last week, the Italian public health care system had the capacity to care for everyone. Our country has universal health care, so patients aren’t turned away from hospitals here. But in a matter of days, the system was being felled by a virus that I, and many other Italians, had failed to take seriously.”

“The way to avoid or mitigate all this in the United States and elsewhere is to do something similar to what Italy, Denmark, and Finland are doing now, but without wasting the few, messy weeks in which we thought a few local lockdowns, canceling public gatherings, and warmly encouraging working from home would be enough to stop the spread of the virus. We now know that wasn’t nearly enough.”

Please share this as widely as possible with your network of friends, family, colleagues.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a green space, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love (but shelter at home), AND sleep well tonight.

Doctor Bob

This video, produced by a colleague, is very informative.

Sleep well, exercise outdoors, laugh, love, engage in meaningful work, drink filtered water, eat clean, eat whole foods, get plenty of sunshine, spend time with those you love.

Doctor Bob

A report from the Imperial College in UK summarizes the results of a model utilizing the most up to date data available. Very sobering!!

Some key points.

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half.

However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over.

For countries able to achieve it, this leaves suppression as the preferred policy option.

We show that in the UK and US context, suppression will minimally require

• a combination of social distancing of the entire population,
• home isolation of cases and household quarantine of their family members.
• This may need to be supplemented by school and university closures

The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.

We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound

Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

Certainly this is very sobering. We are in this for the long haul. Reports of some beneficial effects of drugs presently used for other purposes are providing hope for the critically ill.

Various cities and counties have instituted curfews and local ordinances, closing non-essential business under penalty of criminal charges. These measures are necessary for immediate mitigation and suppression.

San Francisco  instituted a “shelter in place” starting at 12:01am this morning in order to enforce enhanced social distancing measures. Again, a wise measure in a hot zone.

Anthony Fauci MD, Director of Infectious Disease and Allergy at NIH has sated “if someone tells you that you are over-reacting then you are doing it right”.

“Younger people should be concerned for two reasons. You are not immune or safe from getting seriously ill. Even though when you look at the total numbers, it’s overwhelmingly weighted toward the elderly and those with underlying conditions. But the virus isn’t a mathematical formula. There are going to be people who are young who are going to wind up getting seriously ill.

So protect yourself, but remember that you can also be a vector or a carrier. And even though you don’t get seriously ill, you could bring it to a person, who could bring it to a person, that would bring it to your grandfather, your grandmother or your elderly relative. That’s why everybody has to take this seriously, even the young.”

Too many in our community are under-estimating the gravity of this situation and the measures necessary to save lives. Those who ignore these recommendations increase risk for their families, friends, and society at large.

Stay at home except for necessities which include food, medicines, urgent medical care.

Immediately wash your hands with soap and water for at least 20 seconds when you come home or come in contact with anything from the outside. Soap and water more effective than hand sanitizer.

Wipe down hard surfaces with Clorox type disinfectants in kitchen, bathroom, phone, door knobs, car door handles, steering wheels, etc.

When out in public for necessities wear gloves, eye protection. Disinfect shopping cart handles before touching them AND wear gloves.

Any item brought into the home handled by other folks should be wiped with disinfectants.

Wash clothing and sheets frequently. Droplets from asymptomatic carriers of COVID-19 can remain on clothing and hard surfaces for a few days and remain infectious. If a retail worker touches their face then touches the item you purchase (or coughs or sneezes on an item) it could transmit disease.

Keep your immune system optimal:

1.  No alcohol. Alcohol suppresses the immune system for several days
2.  Get plenty of sleep, at least 8 hours.
3. Follow good sleep habits.
4.  Eat an anti-inflammatory diet.

Stay safe.

Sleep well, exercise outdoors, laugh, love, engage in meaningful work, drink filtered water, eat clean, eat whole foods, get plenty of sunshine, spend time with those you love.

Doctor Bob

Here is the link to a great interactive tool that shows the risk reduction or increase with early/aggressive vs. late/mild intervention with respect to social distancing etc. I highly recommend visiting this site. You can move the time line through various scenarios. The site also provides very useful information. Hat tip to my friend Joe Andresen MD for sending me the link.

Be Safe.

Doctor Bob

Here it is, you can subscribe to receive daily email update.

Stay safe.

Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security. The Center for Health Security will be analyzing and providing updates on the emerging novel coronavirus. If you would like to receive these daily updates, please sign up here and select COVID-19. Additional resources are also available on our website. March 13, 2020 Note: although we include case counts to help provide situational awareness to our readers, the numbers are constantly changing. Please refer to the WHO or the public health agencies of affected countries for the latest information. EPI UPDATES The WHO COVID-19 Situation Report shows a total of 125,048 confirmed cases (4,613 deaths) worldwide. There have been 6,729 new cases in the past 24 hours. French Polynesia, Turkey, Honduras, and Cote d’Ivoire have all reported their first COVID-19 cases in the last day. The Johns Hopkins Center for Systems Science and Engineering (CSSE) dashboard is reporting 137,066 cases and 3,337 total deaths as of noon today. Iran’s Ministry of Health reported 1,289 new cases of COVID-19 and 85 new deaths, bringing the total there to 11,364 cases and 514 deaths. The Italian Ministry of Health reported a total of 12,839 cases and 1,016 deaths. The Singapore Ministry of Health reported200 total cases, of which 103 are currently hospitalized and 11 are in critical condition. Spain reported a total of 4,209 cases and 120 deaths. The US CDC reported a total of 1,215 cases and 36 deaths across 42 states and Washington, DC. Of those cases, 125 are travel-related, 102 are close contacts of known cases, and 988 are still under investigation. The South Korean CDC reported a total of 7,979 confirmed COVID-19 cases, including 67 deaths. Epidemiological links have been identified for 79.8% of cases. The most recent report provides an updated breakdown of cases by region, sex, and age group, providing additional insight into the ongoing epidemic. Females represent 61.9% of cases but only 41.8% of deaths. The unadjusted case fatality ratio for individuals aged 80 years and older is 8.30% (21 deaths out of 253 cases), and it is 4.74% for those 70-79 years old and 1.42% for those 60-69 years old. For cases under the age of 60, the case fatality ratio is only 0.12%. Notably, there have been only 2 deaths below the age of 50, despite 4,712 confirmed cases. The epidemic in South Korea has been driven largely by the community around the Shincheonji religious group (4,780 cases; 59.9% of all cases). REPORTS OF HEALTH SYSTEM BURDEN IN ITALY The New York Times reported that Italy’s health system has become rapidly overwhelmed in just 3 weeks, leading to severely limited availability for ventilators and necessitating difficult decisions regarding how ration medical care among patients. The rapid spread and increase in the number of severe cases prompted Italy to enforce radical social distancing measures and to strongly encourage other countries to rapidly implement these measures as well. As reported yesterday, Italy implemented strict quarantine measures nationwide, including closing many businesses. People will still be able to access public areas under certain conditions, but they are encouraged to remain at home and avoid non-essential gatherings. A pre-print recent report from faculty here at the Johns Hopkins Center for Health Security and collaborators also addresses the need for rapid implementation of social distancing measures to slow the spread of epidemic and mitigate health system burden. SINGAPORE ANNOUNCES NEW RESTRICTIONS Singaporerecently expanded its travel restrictions to include visitors with travel history to Italy, France, Spain, and Germany in the last 14 days. These individuals will not be allowed entry or transit through the country, and those already in the country with travel history from those countries will receive stay-at-home notices. Singapore already had travel restrictions in place for China, Iran, and South Korea. US RESPONSE The US Senate will cancel the recess scheduled to begin today in order to remain in session to draft and debate legislation related to the US COVID-19 response. Senate Majority Leader Mitch McConnell was under pressure, including from fellow Republican Senators, to keep the Senate in session in order to finalize coronavirus legislation. The US House of Representativesand the White House are still negotiating a legislative package that aims to address economic and other effects of the COVID-19 epidemic in the United States. Reportedly, the bill is close to being finalized, with hopes that the House of Representatives could vote on it today. Key issues include free coronavirus testing, paid sick leave for COVID-19 patients, and increased support for states to address funding for unemployment and food assistance programs. According to NPR, the Office of Personnel Management now requires agencies to incorporate telework into their continuity of operations plans, reversing a trend of scaling back telework infrastructure among government employees in recent years. ECONOMIC DECLINES CONTINUE TO BEAR MARKET NPRreported that recent wide-scale stock sell-offs have now led to the start of a “bear market,” which could potentially forecast an impending recession. The Dow Jones Industrial Average has dropped 28% since its high point on February 12. The South China Morning Post also reported similar declines in Asian financial markets. US SCHOOL CLOSURES AND SOCIAL DISTANCING MEASURES Note: for the most up to date information about individual communities, please visit the relevant jurisdiction’s website directly. Ohio Governor Mike Dewine announced that all K-12 schools will be closed through April 3, and the state banned all mass gatherings of more than 100 people. Michigan Governor Gretchen Whitmer also announced that all K-12 schools will be closed through April 5. Notably, Governor Whitmer also expanded access to telemedicine statewide, and she called for President Trump to initiate a special enrollment period for the ACA to ensure access to healthcare during the COVID-19 pandemic. Maryland Governor Larry Hogan announced closure of all schools through March 27 as well as a series of other response measures, including a ban on gatherings larger than 250 people, the closure of cruise ship terminal in Baltimore, and the activation of the Maryland National Guard to support the response. The announcement comes on the heels of Maryland detecting its first reported instance of community SARS-CoV-2 transmission. Washington, DC, public schools will be closed from March 16 – March 31. Spring Break for these schools has been rescheduled for March 17-23 (formerly scheduled for April), and students will participate in distance learning from March 24-31. Meals will be made available for all students during that period at designated schools throughout the District. In addition to Ohio, Michigan, Maryland, and Washington, DC, several other states have closed schools in certain higher-risk areas. Washington Governor Jay Inslee ordered K-12 schools closed in King, Pierce, and Snohomish counties through April 24, affecting 600,000 students in high-risk areas. Schools in San Francisco and part of nearby Contra Costa County in California are also closed, but the state has not mandated closures statewide. Pennsylvania Governor Tom Wolfe announced that schools in Montgomery County (13 reported cases) will be closed for 2 weeks. Pennsylvania is also mandating remote work for state employees, and the state is implementing a 10-day paid leave policy for individuals who cannot work remotely. The governors in Georgia and Kentucky both recommended that schools consider closing, but they did not mandate closures. Many government agencies are recommending or mandating that people avoid crowded spaces and large gatherings, particularly if they are exhibiting COVID-19 symptoms, but this may be more difficult (or impossible) for individuals experiencing homelessness. In Washington, DC, the Department of Health Services (DHS) is coordinating with homeless shelters and local healthcare systems to provide support for these individuals who may need to undergo quarantine. DHS Director Laura Zeilinger said that individuals who seek care for symptoms would not be returned to shelters or other congregate settings. DHS is also providing additional assistance to increase access to hand sanitizer and improve hygiene and sanitation at shelters and locations where food is served. Considering the elevated risk to older individuals, some adult long-term care facilities (e.g., nursing homes) are taking additional measures to protect their residents and patients. As seen in Seattle, nursing homes can be high-risk environments for spreading SARS-CoV-2 among a particularly vulnerable population. Nursing homes are beginning to screen and limit visitors in order to reduce their residents’ risk of exposure, and efforts are ongoing to increase the quality and effectiveness of disinfection and hygiene efforts to reduce the risk of transmitting within facilities. Concerns remain, however, about the toll of prolonged isolation from friends and family for residents of these facilities. The NCAA announced yesterday that all remaining winter and spring sports championships, including the Men’s and Women’s basketball national championships (also known as March Madness), are cancelled due to concerns about coronavirus. The NHL announced yesterday that it is suspending the 2019-20 seasonindefinitely. Major League Baseball, Minor League Baseball, and Major League Soccer all announced a range of cancelations, restrictions, or suspensions in response to COVID-19 as well. Additionally, officials from the Boston Athletic Association and Boston Mayor Martin Walsh announced that the Boston Marathon will be postponed until September 14. CLINICAL COURSE OF COVID-19 A study published on March 11 in The Lancet provides analysis of the progression of the COVID-19 disease in survivors and non-survivors. The study involved 191 hospitalized COVID-19 patients (54 deaths, 137 discharged) in Wuhan, China. Notably, the study describes the timing of various aspects of disease progression in hospitalized patients, including the time from first symptom onset to the onset of various symptoms/conditions, including dyspnoea, sepsis, and ARDS as well as their duration. The article also reports the time to and duration of ICU admission. The study found an increase in the odds of death with increased age, and the mean duration of viral shedding was 20 days from symptom onset in survivors and continuously until death in non-survivors (maximum duration: 37 days). The study found no evidence that antiviral treatment reduces the duration of viral shedding. SPOUSE OF THE PM OF CANADA TESTED POSITIVE Prime Minister Justin Trudeau’s wife, Sophie Grégoire Trudeau, tested positive for SARS-CoV-2, according to a statement by the Prime Minister’s Office. At this time, her symptoms do not appear to be serious, and she will be self-isolating for at least 14 days. Prime Minister Trudeau will not be tested at this time because he is not exhibiting symptoms, but he will self-quarantine for 14 days as well. He does not expect this to affect his duties as Prime Minister. There are growing reports of political leaders from various countries becoming infected or exposed to COVID-19. Subscribe to our newsletter