Covid-19 ‘Stealth’ Spread. Some Implications

“Stealth”spread is one of today’s headlines. It means that most who become ill are contaminated by carriers of the virus who manifest minimal or no symptoms. This is hardly an unknown medical circumstance. It has been long known about tuberculosis. As to TB, the carrier state is fairly easily recognized using routine chest X-ray and/or Tine test; not so easy for coronavirus, so far.  This state of affairs is thus hardly surprising and it is important to know. It ought to inform some particular behaviors going forward. Several epidemiologists are saying what I have been suggesting to my family for some time now – that for every confirmed case, there are at least six others. I have been saying there are ten carriers for every confirmed case of illness. I still suspect my guess is closer to reality.

Be that as it may, I will share with you what I am doing to protect my family in light of these facts. Today, Amazon announced it was prioritizing deliveries. It will, prudently, first deliver medical products and staples. As with mail, it is important to remember that coronavirus, it is believed, persists on fomites for anywhere from minutes to hours to days. Now, mail and packages are not sterile – far from it. Thus if any individual who handles the product is a carrier, your deliveries may be contaminated with virus and you may become infected by merely handling them!

I now assume everything coming into my home is contaminated. So, as a good NRA member, as I know to never point my gun at anything I am unwilling to destroy, in analogous fashion, I handle every incoming item as though it is contaminated. What do I do? I wear disposable gloves (I reuse them as long as they stay intact, by washing them with soap & water then sanitizing them with alcohol or sanitizer – I don’t have an infinite supply of gloves and they are likely to remain scarce for some time) when getting the mail and when opening packages. I do both things outside on the front porch with the trash can beside me. I do not open any junk mail. It goes straight to the trash. I open all real mail and discard the envelope. At minimum, I set the contents aside for at least a few hours or even a day to ‘age’. When possible, I leave them to sit in the sun.

I open packages on the porch as well, wearing gloves. Containers or shipping envelopes go straight to the trash once I remove the contents. Depending on the contents, I spray them with Lysol or wipe them with disinfectant wipes. Although I have not yet done it, an option for something I deem to be high-risk for some reason, is to put it in the oven at say 175 – 200 degrees F for an hour or so. Obviously, the wisdom of doing this depends on the nature of the item and its tolerance to heat. I don’t know the effect of low temperature on viruses, so I haven’t considered that option. It is probably ineffective.

There are likely other implications of the so-called “stealth” infection mechanism. I am thinking it implies the need for our current isolation to continue for many weeks or months. Otherwise, the moment we stop isolating, the spread of infection will resume its exponential rate of growth from whatever point to which it has (hopefully) decreased.

Do you think me paranoid? Prudent? The coronavirus, after all, is out to get me.

In passing, I want to share an upcoming quandary and solicit your thoughts. I work at an inpatient drug/alcohol detox unit every Saturday. I always work with another doc or PA, so I am not there alone. With a normal census, it takes two people to see all the patients in a 5 – 8 hour workday. The census is low and will likely stay that way, so a single provider can do the job. I am considering asking to not be required to come to work as long as the others can cary the reduced load without me. If I ask to not have to work under present conditions, I would explicitly say that, should any of the other provider(s) become sick and unable to work, I would be willing to fulfill my duty and come to work.

I am at much higher risk than any of the other providers (I hate that word, but it does include several categories of professionals), who are far younger and generally healthy. This is because I am 75 and have heart, lung, and immunologic conditions. In addition to the risk to me personally, it adds risk to my co-habiting family (wife and son). Reducing the risk of my outside contact to them would be quite onerous. In addition to covering myself and disinfecting at work (which I would do anyway), I would have to isolate myself at home. On the assumption I would be infected and lacking symptoms, I would have to sleep in another bedroom, use a separate bathroom reserved only for me, wear a face mask at all times, not prepare or touch any food, plates or utensils… you get the picture. For a week or so, I contemplate this to be manageable. For a month or more, I can’t imagine I could be scrupulous enough for the efforts to remain effective. After all, the chain of separation is only as strong as the weakest link and bugs will be bugs.

I would value any thoughts, especially on the work issue.

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Author: civil westman

Driven to achieve outward and visible things, I became a pilot, a doctor and a lawyer. Eventually, I noticed the world had still not beat a path to my door with raves. Now, as a septuagenarian I still work anesthesia part-time, fly my flight simulator to keep my brain sparking and try to elude that nagging, intrusive reminder that my clock is running out. Before it does, I am trying, earnestly, to find a theory of everything - to have even a brief "God's-eye" view of it all before the "peace which passeth all understanding."

15 thoughts on “Covid-19 ‘Stealth’ Spread. Some Implications”

  1. I am communicating with a young man (US Army –> California Guard —> Governor Newsom’s special biohazard response team) who is sending me all kinds of information. If you want me to keep you in that email loop let me know by email jacksarfatti@icloud.com

    I think John has them and he can forward them to you as well.

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  2. civil westman:
    Several epidemiologists are saying what I have been suggesting to my family for some time now – that for every confirmed case, there are at least six others. I have been saying there are ten carriers for every confirmed case of illness. I still suspect my guess is closer to reality.

    If you are correct, the gross death rate is 1/10 the reported value since the case fatality rate (CFR) is the quotient of deaths to diagnosed cases. Hence, your estimate would put it in the seasonal flu zone. That would be great news. Of course, the number is also age- and comorbidity-dependent. As you’ve mentioned, you have special circumstances. Others can adjust to their particular situation.

    The Diamond Princess data, which included testing everyone in the population, says there’s about 1.5 asymptomatic cases for every symptomatic case. I don’t know how many mildly symptomatic cases were among the positive cases nor how the line was drawn for asymptomatic. The sample was not huge but 700 positive individuals is enough to narrow the error bars so the 10:1 looks unlikely. A more substantial complaint is that the population was not representative of the general population. It’s also worth bearing in mind that asymptomatic people in China and elsewhere were also tested if they had the right contact or travel history.

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  3. drlorentz:

    10 Cents:
    Thank you! I was wondering about the mail.

    One infected sorter or letter carrier could be a real Typhoid Mary or Typhoid Gerry😉, as the case may be.

    “I decided to send your check later since I was afraid it would be infected so the check won’t be in the mail. You can thank me later.”

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  4. I thought of the mail right away! Have you read Kalki, Gore Vidal’s  novel where the deadly virus is spread by leaflets?

    Oh and what about money?  In Frank Herbert’s The White Plague, the virus is put  into circulation by contaminating bills and coins!

    Finally CW: what are you doing, or recommending your wife do, about the supermarket?  Everybody touches everything in there!

    And for that matter, clothing stores?  Everybody handles the goods on the racks…

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  5. MJBubba:
    Bleach them as soon as they arrive.

    Oh, MJB, that’s so perfect!  Lo, we must all be clothéd in white, bereft of all we have, to await the great epiphanies of the socialists.

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  6. I just heard that the virus can live for hours or days on surfaces.  So what is the point in having restaurants go to delivery and takeout?

    This is also being used as an excuse to get rid of cash.  So forget the Frank Herbert  scenario.  Coins and bills will be illegal.

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  7. John Walker:

    Hypatia:
    Coins and bills will be illegal.

    Replaced, of course, with touchscreens and keypads, which as we all know, could never transfer germs among the multitudes who use them.

    See, this is perfect from the employer’s point of view.   There is a touchscreen and keypad that is used by the clerk, and a different touchscreen and keypad that is used by the customers.  The clerk avoids risky exposure to cash that has been handled by the customers, and the employer does not care that all the customers pass the bug around among themselves.

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