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Dr. Sarah E. Archer specializes in public health and infectious diseases and has provided humanitarian medical assistance in some of the world’s most underdeveloped countries over her sixty-year career. Currently with the Richard M. Fairbanks School of Public Health at Indiana University, Dr. Archer is also a subject matter expert providing the U.S. Army with guidance in understanding how disease affects populations in conflict and war zones. This week, she talked with the Chronic Disease Coalition about how those with chronic health issues should prepare for COVID-19, or Coronavirus. __ Dr. Archer, thanks for speaking to the Chronic Disease Coalition. We’ve received a lot of interest from patients about how COVID-19 might impact them. Would you mind reviewing the most prevalent symptoms of this virus? What we are seeing in terms of symptoms is very close to the influenza that all of us are familiar with in recent years. Patients identified with COVID-19 show symptoms that include mild to severe respiratory illness with fever, cough, and difficulty breathing. As the conditions worse, the symptoms progress unfortunately into pneumonia. Here are some current statistics that I have tracked:

- - 80 percent of people infected have a mild form of the disease
  - 14 percent have severe disease with pneumonia and shortness of breath
  - 5 percent have critical disease with respiratory failure, septic shock, and multi-organ failure
  - An estimated up to 2 percent die, most of whom are elderly with pre-existing medical conditions

You have spoken about the lack of baselines and “denominators” about this virus. What do you mean? I have been working with infectious disease and the chronically ill for many years. This is a significant new set of data to assess and analyze. The coronavirus, or COVID-19, is a novel virus which means we have no experience with it prior to December 2019. The 2 percent case fatality rate that is being used at this time is based on confirmed cases. As with many infectious diseases, there are many cases that are subclinical—no symptoms—or at least very mild symptoms. These may never be brought to medical attention. As such, the denominator of number of actual cases is likely much larger than the reported number of cases being used now. This is possibly good news, since that means the real case fatality rate is actually lower than 2 percent. How does this virus spread? Simply put, this virus is highly contagious and appears that it can be spread from people infected with COVID-19 who are asymptomatic, before they even know they have the disease. Originally, it appears to have passed from animals to humans in the live animal markets in Wuhan, China were the outbreak was first recognized. Currently, we know that it is spread person-to-person by respiratory droplets that happen when someone coughs or sneezes from people up to six feet away. We also know that the virus can live on objects such as doorknobs, steering wheels, cell phones, etc., for as long as 9 days. Many of our ambassadors want to ask you specific questions. The first is preventive measures. What specific precautions should those with compromised immune systems take as this virus continues to spread?

- - Because people with compromised immune systems are at high risk of infections, including COVID-19, they must stay at least 6 feet away from people who appear to be sick or are sick themselves.
  - Avoid touching your eyes, nose, and mouth; wash your hands very frequently and for at least 20 seconds. Remember, it’s the friction and rinsing that remove germs.
  - Carry at least 60 percent alcohol hand sanitizer and use it often.
  - Disinfect cell phones, door knobs, and anything that other people touch or breath on with bleach or hand sanitizer. COVID-19 can live on objects for as long as 9 days.
  - Ask your doctor about wearing “N95” face masks.
  - Discuss your personal risk factors based on your medical conditions with your physicians and ask what specific things you can do. Follow their instructions.

How do you assess the impact on chronic disease involving respiratory deficiencies? As with the common flu and other viruses, those patients -- especially the elderly -- with COPD, asthma, chronic bronchitis and similar illnesses are at greater risk since severe COVID-19 results in pneumonia. The numbers are changing quickly. Are we likely to see a sudden, significant increase? Yes, since we are now looking for COVID-19. The case in Davis, California is particularly concerning since no specific source of exposure has been found. What is the predictive analysis of the projected spread of the disease? COVID-19 is passed by person-to-person contact through droplets from sneezing and coughing. Infected people who do not yet show symptoms or have subclinical cases and are also infectious. This increases the possible rate of transmission. What types of chronic disease are most at risk to this virus? Immunocompromised and respiratory illnesses increase the risks of developing severe COVID-19, if you become infected. Travel is always a concern for those with a chronic health issue. What should we be considering as spring and summer approaches when families may have trips planned not only in the U.S. but overseas. I suggest that you read the U.S Centers for Disease Control (CDC) website every day for advice. Call your local or State Health Department, and your personal health care providers for advice on travel, particularly internationally. Finally, what can caregivers do to help those with a chronic disease prepare, or assist those who contract the virus? First, thank you to all of our caregivers. To them, please protect yourself and those you are caring for with some of the same precautions we’ve discussed. These include all the steps of constant hand-washing and vigilance that are a part of good health care. They should for instance wear the N95 masks, to not only protect themselves, but to further decrease the patient’s exposures to contaminants. Provide patients with factual information from CDC. Encourage them to talk with their medical provider. You may want to get an extra supply of existing prescription medications in case there are supply chain issues or other shortages.