William W. Forgey, M.D.
The Covid-19 Survival Guide
Excerpt from The Prepper's Guide to Surviving Pandemics, Bio-terrorism and Infectious Disease. Page reference numbers point to additional information available within the book.
To make decisions, more importantly, so you can understand comments and decisions provided you by governmental authorities, this book explains the basics about SARS-CoV-2 and the disease it causes covid-19, provides links to daily updated data, and describes past pandemics whose management we forget at our peril. This includes what these terrible natural disasters could become if they are turned into either purposeful or accidental bioterrorist weapons.
Early in this pandemic there was a significant setback when the disease became a political issue. This is not unusual with severe pandemics. They always result in tremendous political upheaval, lockdowns, resistance to lockdowns, even the collapse of society and empires. In London during the Black Death, quarantine was strictly enforced by watchmen posted out in front of any house with an infected individual inside. People were so desperate to escape from their homes they would carve through the walls, only to be beaten back by the ever-careful watchmen. And when the watchmen were not careful, they could fall prey to the noose. Confined home-dwellers were known to wait until the watchman nodded off asleep in front of their house, then lower a noose from the second floor around his neck, hanging him and thus making their break from confinement. There are reports of friends or family sneaking poison into the watchman’s food or drink so the confined could escape. So, the occasional scuffles between people wearing or not wearing masks seems tame in comparison to the upheaval disease outbreaks have caused within a society. Much more on this in the section on pandemics.
How do I know if I have covid-19 or some other condition?
COVID-19 affects different people in different ways. Perhaps 40% will never develop symptoms, but unfortunately can pass the disease to others. Most infected people will develop mild to moderate illness and recover without hospitalization.
These are the most common symptoms at onset by severity of disease in those who are unlucky enough to progress to worse disease.
What is the difference between isolation and quarantine?
Isolation is placing an ill person into a period of confinement, while quarantine is placing an exposed person into confinement. Oddly enough, a quarantine of an exposed person can last longer than the isolation of an ill person. Once ill, a person can get over a disease and no longer be contagious, while an exposed person may have a much longer period of time that they are incubating the illness and being contagious.
What is a quarantine period and how long should it last?
The ideal quarantine period should match the full incubation period so that nobody exposed to the disease, even those who are asymptomatic, can pass the disease on to others. Obviously, some people incubate the disease longer than others. It has been shown that some persons exposed to a covid-19 patient have not developed the illness for 28 days, but this is an outlier. Initially, the median incubation period was estimated to be 5.1 days (the period when half of those infected was 4.5 to 5.8 days), and that 97.5% of those who develop symptoms did so within 11.5 days (95% confidence interval was 8.2 to 15.6 days) of exposure. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile) will develop symptoms after 14 days of active monitoring or quarantine. So initially, the quarantine period of persons exposed to SARS-CoV-2 was 14 days.
The term “quarantine” comes from the late medieval period when the plague resulted in the first official isolation of incoming ships, cargo and people for forty days, or in Italian quaranta giorni.” Thankfully, quarantine periods for covid-19 have been much less.
One year into the pandemic (in February 2021) the U.S. CCD released the following quarantine instructions:
“ For most adults with COVID-19 illness, isolation and precautions can be discontinued 10 days after symptom onset and after resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.
Some adults with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; severely immunocompromised patients may produce replication-competent virus beyond 20 days and require additional testing and consultation with infectious diseases specialists and infection control experts.
For adults who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test result for SARS-CoV-2 RNA or 7 days depending upon symptoms. If individuals do not develop symptoms, they need only quarantine for 10 days; if they test negative, that period can be reduced to just one week.”
Public health decisions are made based on general safety and economic impacts on the community as a whole. It is understood that a shortened isolation period would allow some infection to spread. The shortened isolation period would also allow more persons to work and continue activities. If there is a mutation that makes this germ more dangerous, the length of time would again be changed toa longer period for the greater good,
What is the lag time from start of illness to potential death in a seriously ill individual?
Mean time from start of symptoms to death is 12.9 to 19.2 days amongst those who die. The infection fatality rate is highly variable amongst age groups particularly and this is discussed further in the book. In fact, the purpose of this book is to explain how to minimize your finding yourself amongst this unenviable group.
What is the most important concept to learn about taking an appropriate (not over, not under) precautions against SARS-CoV-2?
Understanding the concept of ID50 and MID, discussed further in Chapter 2, is important to being able to understand why immunizations, masks and other social engineering can make a difference in controlling the disease. The ID50 stand for the infectious dose of a germ that will infect 50% of the people exposed to that dose and MID is the minimal infectious dose that will give an individual an infection. This is the most important concept there is in developing a plan to minimize becoming infected and at the same time maximizing normal daily life. The minimal infectious dose of SARS-CoV-2 that will get you ill depends on your age and multiple other conditions. Understanding those conditions will help you understand what chances you can “safely” take, or at least how to minimize your risk greatly.
Can you trust the results of a covid-19 test?
Only if it is taken at the correct time from exposure, from the correct location of your body, and if it is the right type of test. This is discussed in detail in Chapter 5. Beware of why there could be false negative and prolonged meaningless positive PCRs. This is the test taken by nasal or buccal swabs and processed by a technique called polymerase chain reaction. Understand that the sensitivity and specificity of a test varies with the percentage positivity of the test in the population. This is a rather difficult concept to understand, so you had better see the full discussion in Chapter 5.
How many people are asymptomatic?
Estimates have ranged that between 40 to 80% of people are either asymptomatic or pre-symptomatic when they have the disease. The asymptomatic person never has any symptoms. The pre-symptomatic person has no idea that they are infected, does not feel ill – until suddenly they do feel ill. The lack of availability of testing is complicated by over-testing or inappropriate testing complicating results. For example, if only symptomatic people are authorized to get tested, the positivity rate will be quite elevated. But if persons are tested too early after contact to show results or needed for administrative reasons such as travel, these large numbers of negative results indicate a lower positivity rate. If a certain positivity rate in an area is the benchmark against when schools or other activities may open, the data source is skewed one way or the other.
Are people contagious when they are asymptomatic or pre-symptomatic?
The game changing answer is: yes and yes. With most disease, including influenza (and SARS and MERS, the other two deadly coronaviruses in the same species as SARS-Cov-2), people were not contagious prior to becoming ill. It allowed you to rapidly isolate them from others, without even the need for testing. A disease will spread rapidly and widely through a community particularly when those infected do not even know they have it.
How contagious is SARS-CoV-2 virus and how will the variants change this?
The infectiousness of a disease is called the “R naught” expressed as R(o). In theory this number gives you an idea of how infectious a disease is. This book goes into more detail in Chapter 3. The infectiousness of a disease is better expressed by the term “relative infectiousness” or R(e) as described in that Chapter. The population changes and can become less likely to catch the disease (from either surviving infection and gaining natural immunity or receiving vaccine immunity) or becoming more susceptible (perhaps to the disease developing a new variant that is more infectious). The issue of how the variants of SARS-CoV-2 might change their infectiousness is discussed in Chapter 6. The R naught becomes a critical point of discussion in helping compute the level of immunity required to reach herd immunity. The more contagious a disease, the higher the herd immunity must be.
Can variants cause the vaccines to fail to protect me?
Can variants fool tests?
Will variants change treatments and how?
Yes, yes, and yes. That is the bad news. It is also possible that variants will develop a weakness that we can exploit, that we can better treat, and which will eventually replace multiple variants with just a few “winners” that can be more easily targeted with vaccines or preventative medication. The main trick is to prevent them from forming in the first place. Variants – their challenges and solutions – are discussed in Chapter 6.