We have delayed posting about the new corona virus until more facts were known and wanting to avoid too much speculation. Now at least we know a lot more about what we don’t know.

WHO may be close to calling a “pandemic”. China has effectively managed the epidemic, there are now more new cases every day outside China than inside. No cases have been “imported” from China to other countries for 3 days yet numbers imported from Iran, Italy and Korea are increasing. The number of deaths in Iran is far more than expected from the number of cases announced.

So what do we know or not know?

How many cases and what is the fatality rate.  We don’t know the number of cases, so can’t say what the death rate is. China tests only people who are sick, very sensible otherwise they would be testing about 5 million people. Most of the rest of the world tests anyone who is considered a contact. Some countries may be giving inaccurate data. So some countries have a lot of positive cases who are not sick at all, China has a lot of people who are sick enough to be tested and have tested positive. So we don’t know how many have actually been infected by the virus but are not sick enough to be tested. Looking at countries who have tested contacts and found many cases, it might be as many as 80% of those infected are hardly sick or have no symptoms at all.

So if China has 80,000 cases tested positive and 2,700 have died that is 3% of sick people died. Other countries might have 10 or 20 or 500 cases but they have tested anyone who might have been in contact and many of the ones testing positive have no symptoms. Most will recover without even being sick and don’t die. So it is possible that fatality is 3% of sick people but only 0.5% of the total infected. Compare that to flu: real seasonal flu such as H1N1 kills hundreds of thousands some years. Average is about 8% of the population each season are infected, about 10% of those are seriously unwell and admitted, and of those about 5% die. So fatality of Covid19 might be 10 times worse than flu but flu every year affects hundreds of millions of people, so right now flu is still a far bigger risk than Covid19 

Something we do know: Very few children have died. Most deaths have been in those over 70 years old, some deaths in 50 to 70, a few under 50 but hardly any children. Furthermore most deaths have other problems: heart disease and diabetes in particular.

Symptoms: We know that most cases start with a fever and then a dry cough. They do not sneeze or have running noses. After a week most get better but a few get pneumonia, are very unwell, and may need to be admitted for oxygen and general life support.

Prevention: We know it is spread by droplets from those coughing on to surfaces, hands, tissues etc, but it is caught through the eyes. So face masks might stop you spreading it to other people but do not protect you from others. We don’t know if those with no symptoms are infectious and can silently spread the virus. We do know that those with mild symptoms who are coughing can spread it. The best prevention is wash your hands and don’t rub your eyes. Avoid crowded indoor places where droplets can spread. Bars, discos, conferences anywhere within 1.5 metres of someone coughing. Unfortunately this includes Matatus, so at least open all the windows. 

Good news: Uganda is not an easy place for infections to spread outdoors, too windy, too hot.

If you have high fever, and difficulty breathing then you should go to hospital. Sadly many waiting rooms are as bad as cruise lines for spreading viruses! Good news: The Surgery’s waiting room has no windows it is open all the way round and spreading flu or coronavirus here is most unlikely.

The best way to avoid getting pneumonia is to be as physically fit as possible! Given time, diabetes and heart disease can be much improved with serious weight loss. I suggest start now:  if this does become a pandemic and starts to affect millions in the next 6 months than obese people with diabetes and heart disease still have a few months to lose a lot of weight. Walking every day and losing 2kg every month for 6 months might just save your life.

Treatment: There isn’t any. No really: there isn’t. Antibiotics are a waste of time and possibly harmful, as if you kill off all the harmless bacteria that live on us, then bacteria we do not have immunity to are more likely to colonize us. So those keeping antibiotics at home to treat every cough are doing more harm than good. Drinking a lot helps, so does steam, it helps to keep airways open. Once someone has pneumonia then rest, oxygen and eventually possibly a ventilator is the only treatment.

Summary: Most people, about 80% of those actually infected don’t even know they have it: they may have no symptoms or just a small fever and cough that gets quickly better. A few mostly elderly people, often with other diseases, get pneumonia. Overall about 3% of sick people die. You can help by being as fit as possible. If you are overweight lose a lot of weight by a strict diet and a lot of exercise. If Uganda starts to get cases then avoid crowded indoor places and if you get a cough drink a lot, steam helps, stay home and stay away from family members until you stop coughing. If you have a high fever difficulty breathing and obviously unwell then go to hospital.