A regular person’s guide to outbreak preparedness

You’ve probably read or seen stories about a new virus in Wuhan, China. Scientists are callling it the “novel-Coronavirus” or nCOV, and as of Jan 27 it had been detected in more than 10 countries, with several thousand people infected, hundreds in serious condition, and dozens dead.

That sounds really scary, but right now we don’t know enough about the virus to say for sure what will happen over the next weeks and months. It could disappear nearly as quickly as it arrived. It could fizzle into something more like the Common Cold. There could be a world-wide epidemic of serious disease. Or it could be anything in between.

Much of what happens next will depend on how regular people, like you, react.

One of the main things that determines how big an outbreak gets is how many new people get infected from each person who’s already sick (called the reproductive number). For nCOV, inital guesses from scientists are that on average between 2 and 5 people are being infected by each existing case. (That’s a little bit more than the flu, but not as many as measles.)

But that reproductive number is not a fixed quantity! We can change it through our actions, and if we can, as a society, get that number below 1 the outbreak will disappear naturally!

As a regular person, the best thing you can do to keep yourself and your loved ones safe, feel in control, and contribute to a successful public health response, is to keep the reproductive number as low as possible! Try not to get sick, and if you do get sick, try not to spread it!

How? Scroll down for some simple tips!

IMPORTANT CAVEAT: First, a bit about me. I am a Harvard-educated epidemiologist and I’m faculty at Boston University. I mostly study how to do better research, for chronic disease and for infectious disease. I’ve had outbreak training, but I don’t work in outbreak response. The goal of this article is to provide public health advice but none of this is intended as medical advice (I don’t have medical training!).

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There are several simple things you can do to keep yourself healthy in an outbreak:

  • Wash your hands regularly — especially after touching very public surfaces like subway poles, or door handles, and after coughing, sneezing, or using the toilet.
  • Put your best (immune system) foot forward — there’s no magic trick to a good immune system, but eating healthful foods like fruits and vegetables, getting adequate sleep and exercise, and keeping control of your stress will all likely help make sure your immune system is in top-notch shape.
  • Try not to catch other infections — when you’re sick with a cold or the flu, your immune system is working at full capacity to help you recover and might not be able to handle the extra effort of protecting you from nCOV, so make sure to get your flu shot and stay up-to-date on all other vaccinations. (And if you do get sick, stay home!)
  • Don’t panic — Panic is one of the most dangerous things that can happen in an outbreak situation. When people panic, it can result in chaos and violence that can worsen an outbreak’s spread or do even more harm than the outbreak itself. Resist feelings of panic and help others stay calm. It is especially important to push back against people trying to scapegoat a group they think is “responsible” for the outbreak.

The symptoms of nCOV are a lot like the common cold or the flu, and so it can be hard to know what’s causing your coughs, sniffles, or sneezes. For now, it seems like the only people who are likely to have nCOV are those who’ve recently been to Wuhan China or those who live with someone who was recently there. Regardless, if you’re feeling unwell there are several important things you should do in an outbreak situation:

  • Stay home — even if you feel well enough to go to work, run errands, or hang out with friends, the best thing you can do for everyone is stay at home where you can’t spread whatever infection you might have. This is true whether it’s a cold, the flu, or nCOV.
  • Cover your mouth — if you’re sneezing or coughing, make sure to cover your mouth. Public health experts often recommend sneezing or coughing into your elbow rather than your hand, but if you prefer your hand just make sure to wash it afterwards! There’s also some evidence that when sick people wear face masks they can prevent spreading their illness, although it varies by infection. If you’re very concerned, an N95 mask (which you can get at any pharmacy) is probably the best, but even a simple cloth mask or handkerchief might help.
  • Call your doctor, if you or someone you live with was recently in Wuhan — if you think that there’s a good chance you might have nCOV because of recent travel to Wuhan China, then call your doctor and let them know your concerns. They will be able to tell you the best action to take so that you can be tested without spreading the infection to other patients.
  • Seek medical care if you feel very sick* — for many virus infections, there’s not much that medical doctors can do to speed your recovery. Typical advice for the flu or a cold is bed rest, fluids, and managing symptoms. But (just like with the flu), with nCOV there is a risk that you may develop serious complications like pneumonia. If you start to have a very high fever, have trouble breathing, or are sick for a surprisingly long time, then be sure to see a medical doctor. And if you have a recent travel history, always make sure to tell the doctor. *High risk individuals shouldn’t wait — see below for special recommendations.

Some people are particularly susceptible to infectious diseases, especially respiratory diseases like nCOV. These include the very young and very old, those with compromised immune systems because of other diseases or medical treatments (such as chemotherapy), and those with sensitive airways, such as people with asthma. If you’re in this group of people, you may want to take these extra precautions:

  • Avoid crowded public places — very busy or tightly crowded places may make you more likely to come in contact with nCOV if it’s in your area, and this is also true of other infectious diseases, such as the flu, so if you’re at high risk you might consider minimizing your time in busy public spaces.
  • Avoid shaking hands — you might remember that during previous infectious disease outbreaks, public health agencies suggested we all switch to a fist-bumps or elbow-taps instead of shaking hands. That may be too over-the-top for most people, but if you’re at high risk it can sometimes be a good idea to avoid shaking hands.
  • Speak up — tell the people you spend your time with that you’re at high risk, and encourage them to stay home/ away whenever they have any symptoms of an infectious disease (whether nCOV or anything else!), and remind them to cough or sneeze into an elbow instead of into their open hand, and to stay up-to-date on all their vaccines.
  • EDITED TO ADD: Dont wait to see a doctor if you get symptoms — A reader suggested an addition to the list above. If you are a person at high risk and you start to feel like you have the flu, it’s better to call your doctor right away than to wait until you get very sick. Even if it’s “just” the flu, there are medications that can help, like Tamiflu, and these work better the sooner you start after symptoms.

If you have a friend or family member who is at high risk, but you yourself aren’t, then you may want to consider checking in on them and offering to help out in some of the following ways:

  • Run errands that require going to crowded public places — your friend or family member will likely want to avoid these areas, so offer to help out with errands that require being in crowds or taking public transit at busy times of the day.
  • Stay away when you feel sniffly — or have a scratchy throat, a sniffle, or a cough. Tell friends & family you’re not feeling 100% and that you need some distance. If the high-risk person is someone you live with, wear a face mask, take extra care washing your hands, and remember to sneeze or cough into your elbow instead of your palm.

Health care workers and emergency responders, like ambulance workers, public health field agents, and volunteers can have special needs in an outbreak. In particular, they may be asked to work extra hours and can be at higher risk of infection than the general public. If a friend or family member is in this group, some things you could do to help include:

  • Offer childcare, elder care, or pet care — while your friend or family member is working hard to keep others healthy, they may have to disrupt their regular routine. This can mean they have unmet childcare, elder care, pet care, plant care, etc needs suddenly. Help them fill these gaps if you can.
  • Run errands and help them with their ‘second shift’ — after work, we all have many other obligations. If your friend or family member is working extra hours to deal with an outbreak, offer to bring them food, get their groceries, take in their mail, or help with other chores & errands.
  • Listen — in a very serious outbreak situation, health care workers and emergency responders may have to deal with emotionally difficult situations. Provide a shoulder to lean on or an ear to listen and let them diffuse some of their tension.

On TV and in movies, outbreaks are very frightening things, but in reality your community likely deals with multiple infectious disease outbreaks a year and you probably don’t even notice. An outbreak just means “an unexpected number of cases of an infectious disease”. When a disease is new to science, then even 1 case is unexpected and counts as an outbreak. Other outbreaks that happen regularly include stomach viruses like E.coli or norovirus, and childhood infections like hand foot and mouth disease or (increasingly commonly these days) measles.

Outbreaks are inherently a community problem, and so we need to solve them as a community too. Luckily, most of the solutions are simple, no matter the outbreak cause: wash your hands, stay home if you feel sick, eat healthily & get some exercise, keep up-to-date on vaccines, follow advice from your local health department, and check in on family, friends, and neighbors to offer a helping hand!

Remember, the number one way to control an outbreak is to make sure that each person who’s sick infects on average less than one other person. If you’re healthy, try to stay healthy, and if you get sick, do your very best not to infect others. We’re all in this together!

Assistant Professor of Epidemiology at Boston University School of Public Health. Follow for causal inference, epidemiology, & data science. Twitter: @epiellie

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