2019-nCoV – The Wuhan Coronavirus Potential Pandemic Operations

Editor’s Note: I am posting this on here for others to use as a thinking tool. This was written by me, for me, though some of the content has been taken from other sources. I’ve included links for those sources where I felt it was needed. Please keep in mind that I make no warranty to the accuracy of this information.

At this time, finding N95 or N100 masks is futile, as all stock is gone. Stock seems to be gone even faster than previous high-tension periods. If you didn’t already have them, chances are you’re not going to get them. I would go ahead and put in an order and hope they’ll arrive relatively soon. We don’t know where this is going yet, and masks “on the way” may be better than no masks.

Currently, my thoughts are turning towards pandemic operations, as I’m pondering whether we are being told the facts on the number of infected and dead from this virus. Food, water, sanitation, and other things needed for a 4 month isolation.

From the CDC:

Much is unknown about how 2019-nCoV, a new coronavirus, spreads. Current knowledge is largely based on what is known about similar coronaviruses. 

However, there is scientific evidence this virus was genetically engineered (https://www.theepochtimes.com/scientific-puzzles-surrounding-the-wuhan-novel-coronavirus_3225405.html). If this is true, we may not know what to expect until we’re well into the pandemic. 

Another article that contains a good amount of information, including a number of things that will cause you to pause, is the one by Mercola: https://articles.mercola.com/sites/articles/archive/2020/02/04/novel-coronavirus.aspx

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Preventing Infection

  • This is a droplet transmitted illness
  • Wash hand frequently (sing the “Alphabet” or “Happy Birthday” song twice)
  • Use hand sanitizer in between hand washings (though this is not a substitute for washing)
  • Don’t go to school or office when sick
  • Social distancing – stay a minimum of 6 feet away from all persons, more if they’re coughing or sneezing
  • Understand objects around you may be infected (fomites)
  • Avoid restaurants and crowded areas
  • Don’t share food or drink
  • Don’t touch face unless your hands are clean (recently washed)

Infections don’t spread well outdoors, so this isn’t as much of a concern unless you’re in close proximity to others (like in a food line or protest).

Improper fitting of masks accomplishes nothing. Properly fitting masks can be uncomfortable, so people have a tendency to make then comfortable – which means the mask probably isn’t making a good seal. Nearly all of the Chinese you see wearing masks are either wearing them incorrectly or have the wrong mask. Thus, they have zero protection.

Masks

CDC does not recommend the use of facemasks for the general public to prevent the spread of 2019-nCoV.

This makes sense, as the virus is droplet transmitted and unless you’re in close proximity to sick people, you’re much more likely to get sick from unwashed hands.

When to wear a mask

  • Visiting hospitals or other places where they are sick people
  • When in crowded areas that cannot be avoided (planes, trains, markets, theaters)
  • When around people who are coughing or sneezing
  • When taking care of sick family members (who are isolated from the rest of the household)

Only use NIOSH-certified masks. There are 9 types of respirators (masks), using a combination of filtration efficiency (95, 99, 100) and whether they can protect from oils (N, R, P). 

The number represents the filter efficiency: 95%, 99%, 99.97%, and the letter designates its resistance to oily substances: N – Not resistance to oil; R – resistant to oil; P – oil Proof. This gives the following 9 combinations of mask filters:

  • N-95, N-99, and N-100
  • R-95, R-99, and R-100
  • P-95, P-99, and P-100

These masks are rated to filter out particles 0.3 micron or larger. Note that viruses are smaller than 0.3 microns, but they are nearly always attached to a larger particulate (bacteria, water vapor, dust). The N-95 will filter out 95% of non-oil based particulates down to 0.3 microns. A P-100 will filter out 99.97% of particles, whether their oil-based or not. Any mask or filter with any of these ratings will work for CoV.

Surgical masks provide no protection from inhaling the virus. They are meant to be used to limit the spread of droplets from coughs and sneezes of sick people.

The CDC has a procedure for doffing PPE (Personal Protective Equipment): https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf

As masks are contaminated, they need to be handled carefully after they’re removed, so they don’t contaminate yourself or other people or objects. Ideally, once you have removed a mask, it should be disposed, but the reality of a pandemic is there will be a shortage of masks, so careful reuse may be needed.

Keep in mind that institutions look at PPE as disposable and mostly as single-use items. That doesn’t translate well for personal use at home where budgets are limited. This means we need to find way to make our supplies last longer.

Reusing Disposable Masks

Reusing disposable masks is not recommended. Masks are contaminated and may contain concentrated amounts of the virus. They need to be removed correctly so you don’t contaminate yourself in the process. 

There are few studies on reusing disposable masks. Here are some guidelines I’ve found regarding the reuse of disposable respirators (masks).

If the mask is not torn or damaged, it’s likely it can be used again. You need to be careful about storing it, as the outside is likely highly contaminated. Some recommend placing the used mask in a paper bag, but I don’t see how this is possible without contaminating the inside of the bag, which is likely to cross-contaminate the inside of the mask or the part that touches your face.

You can (and should) use a face shield or a surgical mask as a protective covering to keep your main mask from getting splashed or dirty. If the covering is disposable, it should be thrown away after use. If the covering is reusable, it needs to be decontaminated.

Reusable Masks

There are reusable respirators that have replaceable filters. These are more expensive, but generally provide a better seal and are easier to use. These respirators are easy to clean and sanitize, as the filters can be easily disposed and replaced when needed. The nature of these filters also makes it easier to reuse the filters, as the mask makes it easier to touch the filters as little as possible. Follow the manufacturers directions for cleaning and sanitizing the reusable parts of the mask (especially before putting on new filters). 3M has a PDF on cleaning these masks: https://multimedia.3m.com/mws/media/473937O/3mtm-cleaning-reusable-respirators.pdf.

There have been several studies on sanitizing disposable masks for use during pandemics, but there are no official methods as of yet. Also, those studies looked at methods available to hospitals, not homes. As such, the best use of a disposable mask is to not use it more than once.

That said, the following is something to consider, realizing you are taking your health and welfare into your own hands – And realize the following has not been clinically tested and you assume all risks for your actions. You should also read through this CDC document on Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings (https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html).

Per CDC (https://www.cdc.gov/h1n1flu/guidelines_infection_control_qa.htm):

…in general, extended use (i.e. wearing over multiple encounters while minimizing touching, removing, or re-donning between encounters) would be favored over re-use because it is expected to involve less touching of the respirator and face.

An OSHA directive indicates that a respirator can be reused as long as it “maintains its structural and functional integrity and the filter material is not physically damaged or soiled.” 

It’s clear that keeping the mask on for extended use is better than donning and doffing. The clear case for repeated use, I think, is when you’re taking care of a sick loved one in your home, where you’ve set up an isolated area in your house and are tending to them. When taking off the mask, be very careful and place it in a location that prevents it from cross-contaminating other objects. 

Be careful not to touch inside the mask or the parts that touch your face, and avoiding touching the mask as much as possible (using the straps to put on and take off when possible). Wear gloves when putting on the mask and realize that these gloves are now contaminated. If you’re going to be entering the isolation area, you can probably keep them on. If not – like if you’re going to the store – you need to take them off once the mask is on.

Using a Mask

Timing and planning need to be considered when you’re going to be wearing a mask. If you feel that it’s important enough to wear a mask to protect yourself, don’t forget to eat and drink if you’ll be wearing it for long periods of time. Because the mask is potentially contaminated, you can’t simply drop the mask to your neck or push it to the top of your head to eat or drink. You always need to doff the mask properly to avoid exposure to the virus. This is in stark contrast to what you are likely seeing in nearly all videos showing people wearing masks.

Fomites

Objects or items that have become infected are called fomites. Shoes, countertops, doorknobs, keyboards, steering wheels, gas pumps, etc. – all are likely to be contaminated and can transfer the virus to you. It’s important to remember not to touch your face and wash your hands immediately after handling infected or potentially-infected items. It’s better to wear a pair of gloves and immediately remove them once the task is complete (such as refueling your vehicle).

Other Concerns

One way the authorities are checking for infection is by checking if you have a fever. If you have one, even if it’s not from the virus, you’re likely to find yourself stuck in quarantine, along with other people who likely do have the infection.

Ignorance Abounds

There is far more falsehoods being spread or acted on during pandemics than legitimate information. You need to be careful where you get your information from and you need to vet that information. Legitimate information should coincide from authoritative sources, so be sure to verify.

Symptoms of 2019-nCoV

For confirmed 2019-nCoV infections, reported illnesses have ranged from people with little to no symptoms to people being severely ill and dying. Symptoms can include:

  • Fever
  • Cough
  • Shortness of breath
  • Some evidence suggests diarrhea may be the first indicator of infection

The CDC believes, at this time, symptoms of 2019-nCoV may appear in as few as 2 days or as long as 14 days after exposure. You are infectious during this incubation time!

Home Isolation and Care of Infected

CDC: “In general, people should adhere to appropriate transmission-based isolation precautions until the risk of secondary transmission is thought to be low. Current information on 2019-nCoV is limited, thus home precautions should be conservative based on general recommendations for other coronaviruses, like Middle Eastern Respiratory Syndrome (MERS), and may last up to 14 days.

Per the CDC (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html):

“You should follow the prevention steps below until a healthcare provider or local or state health department says you can return to your normal activities.

Stay home except to get medical care

You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Do not use public transportation, ride-sharing, or taxis.

Separate yourself from other people in your home

As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.

Call ahead before visiting your doctor

If you have a medical appointment, call the healthcare provider and tell them that you have or may have 2019-nCoV infection. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.

Wear a facemask

You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not stay in the same room with you, or they should wear a facemask if they enter your room.

Cover your coughs and sneezes

Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can and wash your hands with soap and water for at least 20 seconds. If soap and water are not available, immediately clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.

Clean your hands

Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing personal household items

You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people in your home. After using these items, they should be washed thoroughly with soap and water.

Monitor your symptoms

Seek prompt medical attention if your illness is worsening (e.g., shortness of breath or difficulty breathing). Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, 2019-nCoV infection. Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people from getting infected or exposed. Ask your healthcare provider to call the local or state health department. Persons who are placed under active monitoring or facilitated self-monitoring should follow instructions provided by their local health department or occupational health professionals, as appropriate.

Discontinuing home isolation

Patients with confirmed 2019-nCoV infection should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low. The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments. Current information on 2019-nCoV is limited; thus, home precautions are conservative and based on general recommendations for other coronaviruses, like Middle Eastern Respiratory Syndrome (MERS).”

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