Code Veronica Two Zero Wun Niner: a practical primer

from a Western European household perspective

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Site compiled by a non-expert, occasionaly and partially reviewed by experts. Best read as a whole. If any contradiction, more recent information is presumed to be more correct. If contradiction remains, please ignore contradictory information, or find better source through your favorite search engine.

Version 0.18 : Monday 9th of March 2020, 0930 CET, 0830 UTC

Changes from last version: 0.17 : Sunday 8th of March 2020, 2350 UTC

• FNI: How to boost your immune system (the guardian)

• Moved previous FNI to YESTERDAY'S KEY INSIGHT

To-dos/ideas for next version:

• Prepare for quarantaine lockdown

• Practical aspects of avoiding intra-household transmission

• Ensure all sources and bits of info are date-stamped, in light of rule: more recent = presumed to be more correct or at least less wrong

• Point to other relevant curated lists

TABLE OF CONTENTS

• 1. WHY THIS DOCUMENT?

• 2. CURRENT US CDC ANALYSIS AND RECOMMENDATIONS + HARVARD MED SCHOOL

• 3. TODAY'S KEY INSIGHT

• 4. YESTERDAY'S KEY INSIGHT

• 5. STICKY: CHINESE STUDY RE HOUSEHOLDS WITH CHILDREN (INTRA-HOUSEHOLD TRANSMISSION)

• 6. BEST UP-TO-DATE PRACTICAL SUMMARY + MISC PRACTICAL INFO

• 7. EXTRA PREVENTION TIPS

• 8. DAILY ACTIVITIES IN A CODE VERONICA ZONE (BEFORE / AFTER LOCKDOWN)

• 9. INFO FOR PATIENTS AND CAREGIVERS

1. WHY THIS DOCUMENT?

• eurointelligence report, Thursday 5th of March 2019:

  We believe that the economic impact of Code Veronica is going to be on a similar scale to the global financial crisis. [The disruption at German ports] is only now starting to show its full effect, given that the sailing time from China to Germany is 4 to 6 weeks. The big lock-down measures have yet to occur. The EU's biggest mistake so far has been its reluctance to close borders, as a result of which the entire Schengen area is now a single Code Veronica zone, with decentralised and largely uncoordinated health policies.

• Check article "YESTERDAY'S KEY INSIGHT" below, final paragraph, "The big unknown".

• Though elder patients are more at risk, 15% of identified cases require ICU intervention including, in most cases, assisted breathing (ventilators). Hospitals and ICU units can quickly become overwhelmed. The long-term effects of the virus are unknown. It is therefore still in the individual's interest to avoid being infected.

• At the time of writing, and based on the latest propagation data at our disposal, it cannot be excluded that similar events as currently taking place in Italy, will also happen in other places in Europe (including Western Europe).

• On panic vs denial, and best practices re crisis communication and preparedness, see On Human Reactions to Risk and Why Denial is a Bigger Problem than Panic.

2. CURRENT US CDC ANALYSIS AND RECOMMENDATIONS + HARVARD MED SCHOOL

• People at Higher Risk for COVID-19 Complications https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

• How COVID-19 Spreads

• Note: danger zone for close contact is 2m (6 feet); however, some sources even recommend 3m distance

• Most transmissions happen by touching a contaminated surface (fomites), followed by touching face (which people subconsciously do, all the time)

• Prevention & Treatment , https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html

• Effective Handwashing, https://www.cdc.gov/handwashing/

• Harvard Med: As coronavirus spreads, many questions and some answers https://www.health.harvard.edu/blog/as-coronavirus-spreads-many-questions-and-some-answers-2020022719004

3. TODAY'S KEY INSIGHT

How to boost your immune system to avoid colds and coronavirus - the guardian, 9th of March 2020

• Vitamin D confirmed (see below)

• Exercise

• Other/misc (to be summarised on this page)

4. YESTERDAY'S KEY INSIGHT

https://beamtest.com/resources/Inside_Chinas_All-Out_War_on_the_Coronavirus.pdf : WHO official discusses China's effort, contains a lot of practical insights.

• difference between "mild", "severe" and "critical" categories of cases.

• practical aspects of patient treatment in different hospitals

• large number of ventilators

• actual events during a lockdown

• how not to get infected:

• hand-sanitizer

• face masks

• social distance (air gap, shout from afar)

• good summary with action points on pages 7 and 8 of the pdf

5. STICKY: CHINESE STUDY RE HOUSEHOLDS WITH CHILDREN (INTRA-HOUSEHOLD TRANSMISSION)

Warning - disclaimer : limited study of cases in Chinese households living in Shenzhen. May or may not contain lessons relevant to Western-European households. Preprint, not peer reviewed. Chinese data is not very reliable in general, see "the big unknown" mentioned above.

Major difference, e.g.: separate homes (often) vs apartments shared with multiple family members, 3 generations.

Time will show if relevant, but at least: interesting.

https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1

6. BEST UP-TO-DATE PRACTICAL SUMMARY + MISC PRACTICAL INFO

https://threadreaderapp.com/thread/1235127363341553667.html publication date 4th of March 2020

• Risk factors : Number one, by far: age, then smoking, followed by obesity.

• How can I prepare for a possible outbreak?

Keep a 30-day supply of essential medicines. Get a flu shot. Have essential household items on hand. Have a support system in place for elderly family members.

7. EXTRA PREVENTION TIPS

Useful supplements (EXERCISE JUDGMENT - only added to the list when confirmed by metastudy, RCTs or similar - this list should at all times be short)

Vitamin D (source: metastudy on pubmed)

Disinfectants & prophylactics - things to use and things to do

• Avoid close contact with people who are sick.

• Avoid touching your eyes, nose, and mouth.

• Stay home when you are sick.

• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

• If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

• Each time a risk area has been touched, but also at the end of social gatherings (work meetings, etc)

• Aside from washing your hands frequently, you can gargle with Betadine Sore Throat Gargle ( alcohol-based mouth wash ) to eliminate or minimize the germs while they are still in your throat (before dripping down to your lungs).

• Sanitizing gel with >60% alcohol is very effective against Code Veronica type invaders, but in short supply at time of writing. To safeguard stockpiles for first responders, local governments may temporarily downplay or misrepresent the effectiveness of alcohol-based sanitizing gel. Making your own DIY alcohol-based sanitizing gel is a very simple process. Multiple recipes available through your favorite search engine.

• Practically: soap + water where possible, sanitizing gel if no other solution (e.g. on the road)

• Face masks are an effective barrier (to avoid being infected as well as to avoid infecting other people). The minimum standard is N95 (medical market) or FFP2 (DIY / construction market). In all global regions except South-East-Asia, face masks are currently in short supply. To safeguard stockpiles for first responders, local governments may temporarily downplay or misrepresent the effectiveness of facemasks, which in reality however are effective, even without a perfect fit. (as proven by metastudy, see pubmed).

8. DAILY ACTIVITIES IN A CODE VERONICA ZONE (BEFORE / AFTER LOCKDOWN)

• Article on daily life during the SARS outbreak of 2002-2003 (a more lethal, but less contagious virus), with many valuable practical points: http://archive.ph/pdkNj

• Safe activities (list to be completed):

• indoor communal swimming pool (source: https://www.todayonline.com/8days/liveandlearn/vanityandhealth/it-still-safe-go-swimming-novel-coronavirus-outbreak-how-about )

• Risky activities:

• filling up the gas tank (a lot of potentially contaminated surfaces, always wear gloves, apply sanitizer liberally)

• paying with a bank card (PIN code terminal): potentially contaminated keypad, other.

9. INFO FOR PATIENTS AND CAREGIVERS

• For the moment, there is not much practical information available for patients that do not require ICU intervention and who can recover at home (i.e. the presumed majority of patients).

• Based on our information, mild to medium cases are, as a general rule quarantined during two weeks, during which they are expected to recover as one would recover from the flu.

• To avoid secondary transmissions within one household, it is recommended that a single patient only interacts with one designated caregiver, both wearing facemasks when interacting (as limited as possible). Furthermore, the patient should be isolated in a separate place or room, to be cleaned twice per day with bleach, alcohol-containing disinfectants, etc.

• There is an extremely high presumed rate of transmission through stool, diarrhea etc.!!! Toilets should be either separate or cleaned thoroughly so the infection cannot spread.