I really want to blog about something other than existential threats and coronaviruses, but here I am again. This blog will be a weird one, because I know that one way or another it will appear absurd in 90 days. It will either appear absurd because it will strike future readers as a dramatic overreaction or a dramatic under reaction. That cannot be helped. When addressing the issue of pandemic in 2007, then HHS Secretary Mike Leavitt noted: "Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate." So it is.
Survival in General
In general, survival can be oversimplified with the Rule of Threes:
You can survive 3 minutes without air.
You can survive 3 hours without shelter in harsh weather.
You can survive 3 days without water.
You can survive 3 weeks without food.
You can survive 3 months without human contact.
While each of these is an imprecise approximation, should you exceed the parameters on any of these you are likely facing severe harm or death. Remember them; in a crisis situation, they will be a useful guide to your survival priorities.
Surviving an Outbreak in General
Practice social distancing. Social distancing is one of the oldest and most effective public health interventions. The short version of it is that you and others will want to curtail your in-person interactions with other people as much as possible. Sometimes this is accomplished by closures (school, work, daycare, etc.). Sometimes this accomplished by various levels of isolation ranging from one person staying home, to quarantine, to a full-blown cordon sanitaire. In the most extreme scenario, all travel might be shut down and all events canceled as a curfew is initiated. While the more extreme interventions will be the purview of governmental organizations, you can still opt to take sick days, work from home, or keep kids out of school when feasible.
Wash your hands frequently. Thanks to Dr. Ignaz Semmelweis we know that washing hands cuts down on infections and saves lives. Depending on the particulars, handwashing can cut viral transmission by 50% or more. When washing, make sure to get all of the skin on the hands and wrists, not just the palms.
Avoid touching your face. This one is hard, like really hard. Almost all humans touch our faces with extreme frequency. It typically takes dedication and attention to not do it. Start a mindfulness practice now of both becoming aware of how often you touch your face and seeing if you can interrupt the automatic habit.
When you have to sneeze, Dracula Sneeze. Dracula sneezing is sneezing into your elbow almost as if you were emulating Dracula with his cape. Never sneeze into your hands. Always either sneeze into your elbow or into a tissue.
Ebola handshake. In effect, you elbow bump instead of shaking hands, fist bumping, or high fiving. Start practicing it immediately. Every time you teach someone new, you are helping to spread a habit that might just save lives.
Avoid touching frequently-touched things. This is also really challenging, but doable. Instead of pressing buttons with your fingertips, use a middle knuckle. Instead of opening a door with your hand, try bumping it open with your hip. Instead of using cash, use a chip card or phone that allows you to avoid touching what others have touched. Avoid public touchscreens like the plague!
Have adequate supplies on hand. Assume that you will effectively be on your own for 4 weeks. If this seems unrealistic, just look at the fallout from hurricanes in New Orleans and Puerto Rico for some sense of what might be possible in a worst-case-scenario. A good list is here, but refer to the Rule of Threes above. You will need air. In an outbreak, this will mean that you will need to have some way of filtering the air you breathe. You need water. Assume 1-2 gallons (4-8 liters) per person per day. You will need shelter. If you are in any way housing unstable, fix that immediately or get with a close family member with a good location. You will also need food. Prioritize food that will not go bad easily and does not require refrigeration.
Know Our Enemy: SARS-CoV-2
The SARS-CoV-2 presents unique challenges. This outbreak is rapidly becoming the first true pandemic challenge that fits the WHO’s “disease X” category. It may be possible for asymptomatic transmission to occur. It can take up to 27 days to incubate. It replicates rapidly with an R0 value possibly as high as 4.7 to 6.6 when completely unchecked. It appears to have a case-fatality rate of 2.3% (though some estimates have put it anywhere between 0.5% and 10%). There is also now a reasonable chance that this may break containment and that as many as 40% to 70% of the world’s population could get this infection as there is currently no vaccine on the immediate horizon and humans generally lose their immunity to coronaviruses.
It is almost incomprehensible to me that I just wrote the previous paragraph, and yet there it is. In order to survive this situation should containment be broken, we will all need to wrap our minds around the implications of this. A worst-case scenario is probably something that exceeds anything in living memory. If you are reading this, I invite you to make a commitment to survive and see that those within your immediate circle of care do so as well.
In many ways, surviving SARS-CoV-2 will be much like how our ancestors survived outbreaks and pandemics of the past. Their best weapon then, is still one of our best weapons now: social distancing. Avoid any unnecessary in-person contact with others. The next best weapon is handwashing. Get really good at scrubbing like a surgeon. Given the particulars of this virus, these alone are not enough. Find some quality masks (rated N-95) and learn how to use them properly. Acquire 70% or better alcohol sanitizer. Use the sanitizing hand wash every time you enter your home. Acquire these things now as they may be inaccessible in the days and weeks ahead. If a pandemic genuinely emerges, seriously consider a complete bunker mentality and shelter in place. If going out is required, change in a garage or on a porch before coming into the home. Bleach shoes in a pan outside and leave them there. It will take 2 incubation periods of no virus to be reasonably assured that it is no longer in the environment. For SARS-CoV-2 this will be 28 to 54 days. Set yourself tasks or games to pass the time and avoid cabin fever. Read a book. Use video chat to check in on relatives.
That’s the basics. Best of luck to you and yours.