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So… You’re Likely Going to Get the Coronavirus; COVID19. But… Just Maybe Not This YearI’m a retired anesthesiologist, father, husband, caretaker to an elderly parent and basically your average disabled American digesting what’s happening on Earth in 2020. About a month ago I wrote about COVID19, on Facebook, although, at the time, it was called 2019-nCoV – “The Wuhan Coronavirus” but has been now officially labelled as COVID19.This is a long answer and meant for those that have some minutes to read and some minutes to digest it. First a short answer for those without the time right now.Short Answer:The bad news is that COVID19 is not going to be contained globally. The decent news is that the United States (and many other countries) has/have done some things correctly to slow the spread of the disease for this 2019-20 Season. Hindsight will be 20/20 on this one and there will have been mistakes made, however, in my opinion, preventing COVID19 in the United States will eventually be found to have been impossible.Why? Basically, two reasons for such a fast spread:1) It appears there is a long period of time (more than 72 hours) when one has COVID19 and is infectious to others. Hence, the 14-day quarantine model being used.2) Initial data shows that 80% of people get a mild to moderate illness, about 15% of people experience a severe illness and 5% get labelled critical. Hence, there are a bunch of people sick but not sick enough to avoid others.Example: You are feeling not-great, but it’s Friday and you have these one or two things that need done at work before the weekend. You go into work, have a great day ‘work-wise’ even though by the end of the day you are exhausted and ready for the weekend. On Sunday, you have a fever of 100.8, cough a bit, and know you are sick. Later, you find out you got it from the gal who did this the last Friday at your workplace. She got it from her kid the week before who could not miss the three tests in school that he had the Thursday (because he studied so hard for them) and… because he was going on a high school sports team trip over the weekend… etc. Yep, the whole sports team has it now, too. And… the other team has it, too. And… the other team’s parents.This is how the virus will spread so fast throughout the world. There is no cure for human-to-human contact, although the Chinese have tried! This is not the whole story, though.Long Answer:My own four kids have all used ‘being sick’ as a way to attempt to get out of school. Yep. Some more than others. Just as often, they have lied in the other direction, stating they are fine, about being not-being-sick because of the pain of make-up work. Especially during their junior and senior years of high school. Just imagine, in your mind, a high school hallway, thick with teen spirit and pheromones, between classes and a virus that is transmitted by air, on all those voices, all those laughs, a few coughs, numerous high fives, fist bumps and playful slaps and all of that in very close proximity. Inevitable.The distribution of mild/moderate, to severe to critical cases of COVID19 makes global spread inevitable. Four out of five people with COVID19 have symptoms like the common cold or mild flu. I would guess, at least 50% of those people will go to work (when maybe they should not), go to school (when maybe they should not), congregate with friends (when maybe they should not), visit family (when maybe they should not), or ‘get through’ their normal days without so much as a thought that they are really ‘that sick’ and the pattern will repeat for families, for communities and for cities and countries. Human Nature.Well, that sucks. It does. It has happened before and will happen again, just like every novel human illness before this one. Think of your own city. I look at my own hometown of Columbus, OH. The “Arnold Sports Festival” is March 5-8, 2020 and was already the largest multi-sport event in the world by 2018. This is an amazing experience with people who train year-round to compete. It’s a people watchers dream. Last year, in 2019, Columbus saw over 22,000 athletes competing! The event – which ran from Thursday, Feb. 28, 2019 to Sunday, March 3, 2019 – had an economic impact of $54.1 million on Columbus last year! Even if 50% of the athletes choose not to come and 50% of the crowds stay home and everyone washes their hands all the time… even then, this airborne virus will spread here in my hometown. Then, back to where everyone was coming from.Life continues; my wife travelled this week to Colorado, domestically, but there’s a lot of people between here, in Ohio, all the way by airport to Colorado and then back next weekend. The following week, our Spring Break, I, my wife and my two youngest will travel domestically. This whole week, those younger ones are attending school. My two eldest are in graduate school, attending classes and my eldest son is travelling with his NCAA Volleyball team. Life goes on. We have not stopped our lives.I fielded a bunch of medical questions in late January and early February. Since then, here are the top three I’ve received from non-medical people across multiple platforms:Should I wear a mask? The only mask that would help is what they call an N95 mask and that has to be fitted properly to work properly. Hospital employees will be using these when treating people with airborne illness, like COVID19. For the average person travelling or living their lives, masks will likely not prevent you from getting COVID19, but if you are sick with any cold or flu, wearing any mask may reduce the spread of your own infectious droplets (airborne or otherwise) to other people, surfaces, your own hands, etc. I say, may, because you have to be diligent not to spread your own germs.To be as safe as we can for all colds and flus, learn this, teach this to your kids:• WASH YOUR HANDS• TOUCH LESS THINGS AND PEOPLE• TOUCH YOUR FACE LESS• COUGH OR SNEEZE INTO ELBOWWhat’s the treatment? For the 80% of people that will have a mild to moderate illness when contracting COVID19, it’s fluids, rest and recover. Take your temperature every day and treat fevers, that means a temperature greater than 100.5 degrees, with Acetaminophen (Tylenol) or Ibuprofen (Advil).[ EDIT ADDED March 18, 2020 - There is a publication, that includes a warning by French Health Minister Veran that Advil (Ibuprofen) and other NSAIDs may make the course of COVID19 illness worse. The warning followed a recent study in The Lancet medical journal that hypothesised that an enzyme boosted by anti-inflammatory drugs such as ibuprofen could facilitate and worsen COVID-19 infections. Here is the paper: Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? END EDIT ADDITION ~Chris ]For the 20% that get severe or critically sick; They are going to need the best care they can get and if they develop further disease, perhaps hospitalization. If you are older, or have cardiac issues, or lung issues, or just have had a chronic illness, like diabetes for decades, you will be at greater risk of getting more sick than the average person BUT that’s true of every cold and flu you get!Can my kids get it? It would appear that they can but the CDC states, “there is no evidence that children are more susceptible [to COVID19]. In fact, most confirmed cases of COVID-19 reported from China have occurred in adults. Infections in children have been reported, including in very young children. From limited information published from past Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) outbreaks, infection among children was relatively uncommon.” *Coronavirus Disease 2019 (COVID-19)This past week, I think for obvious reasons, the questions I received turned more financial than medical in nature!Except one new medical question this week: If I get COVID19, can I get it again? The truthful answer is there is not enough good data to give a definitive answer, yet. It’s true, this is a new, or novel, form of coronavirus, but our human race has encountered many novel illnesses over time and ones much worse than COVID19. My medical suspicion will be that most people who get this year’s COVID19 virus, will not likely get it again. It is also my suspicion that most Americans will get COVID19 next year, not this year, if they are going to contract it.As for economic impacts, watching $3.6 Trillion dollars of value vanish for the S&P 500 was difficult for most Americans with an IRA to watch. As an individual, one thing I have learned about investing is that you, an individual, cannot ‘time’ the market, you can only time yourself. I’ve counselled many young new doctors and dentists just beginning their retirement accounts to “Bet on the USA” because they are all “individually” about 30 years old and have 35 years before they retire. Their ‘timing’ of the markets is to buy every month with their IRA contributions. Lori and I are 50 years old, our ‘individual’ timing is different, we retire in 15 years. Our elderly parent is near 85 years old, his ‘individual’ timing is different.I’ve been asked for advice (financially) a bunch this past week: (This is what I tell almost everyone) and I rarely answer anything about finances.GENERALLY SPEAKING: If you are under 45 years old and have less than $500k in retirement, you should by the least expensive (fee-wise) S&P500 Index Fund (I believe that’s Vanguard as of today) and you do not need to look or to care until you hit $500k in your retirement accounts. No individual will out-guess the thousands of business leaders running America’s 500 best companies! If you are over 45 years old and/or have more than $500k then go interview (3) financial advisors, yes, (3) of them, and pick the one that you and your spouse like the most. From 45 to 65 years old, meet at least annually and plan your retirement path. It is a marathon, not a sprint. Lastly, if you work with an advisor, do a 3rd party audit every 3 to 5 years (no matter whom you work with, double check their work every 3 to 5 years)… which is simple because most financial advisors are happy to review what you are doing in hopes of landing future business with you or your family.That’s it. Yep, that’s it. Really. It is simple, actually, we (humans) just make it complicated because of fear, mostly, perhaps, greed, intermittently over our lives. Speaking of fear and money, here is a quick glance at the past global illnesses and the effects or impact on the stock market the past 40 years:Green is a good color here. I hope seeing all that ‘green’ in the picture above makes some of that fear go away. Go ahead, look again, there is a lot of green!That’s money, but if you don't have your health, who cares.2019-nCoV – “The Wuhan Coronavirus” and now known or relabeled as officially COVID19 is going to propagate through the end of April 2020 in the northern hemisphere of Earth. By the middle of May 2020, the new case numbers will fall off and continue to decline for the end of the 2019-2020 Cold/Flu Season.However, it will come back next year in the 2020-2021 Cold/Flu Season.How do I know this? To answer: How is the Corona virus spreading all over the world so fast? Is there no cure for that? more completely let’s look at few things about colds and flus.What is a Flu Season or The Cold & Flu Season? Well, microbes, like those that cause the cold or the flu, do not do well in UV radiation… sunlight kills microbes surprisingly well. For the northern hemisphere of Earth, this means basically from the middle of May through the first week in October there is so much sunlight and UV radiation where people are and interact or congregate that colds and flus, and the microbes responsible for them, just can’t really spread effectively. Every time humans walk outside, their skin, their clothes, all get naturally radiated… while it can give your skin a tan or a sunburn, to a cold or flu microbe, the sunlight is deadly. The warmer ambient air temperatures also cause droplets to vanish much faster in the summer months. That means all the surface-to-surface or people-to-people transmissions are reduced dramatically. However, starting in October and continuing to the follow middle of May, the power of the sun fades in the northern hemisphere, people meet indoors more than outdoors, droplets in cooler air linger longer before evaporating and transmission rates for microbes’ surface-to-surface or people-to-people increases.For the Flu: (AS AN EXAMPLE ONLY)The 40th week of the year, in the northern hemisphere, where the USA and a lot of the world’s population lives, is usually the first full week in October. This is when cases of the Flu begin to show up, usually. The 46th week of the year, which is the middle of November, is when Flu cases double and then climb into the “Flu Season” each year. The 20th week of the year ends in the middle of May and concludes the “Flu Season”. We are in the 10th week of 2020.Let’s first look at last year, the 2018-29 Season:Adopted from: National, Regional, and State Level Outpatient Illness and Viral SurveillanceFirst, notice, the “Flu” is really a number of different types of Influenza with (2) major types for last year. The Flu Shot you may elect to get each year usually has the 3 or 4 most likely flu variants or types most likely to cause the flu illnesses that next season. While the ‘effectiveness’ of the flu shot bounces between 20% and 50% (2005-2018), millions of people likely do not get the flu or get a milder version of it because of the vaccine and transmission rates, overall, are slowed considerably. So, the above picture is a snapshot of the 2018-29 Flu Season.This year is the ongoing 2019-20 Season:Again, adopted from: National, Regional, and State Level Outpatient Illness and Viral SurveillanceYou see different colors in the bar graph for this year, a different curve and timing to the shape of the overall curve and basically, a different flu season compared to last year.We will all see how this cold and flu season ends but, in my opinion, even flu infections are going to fall off sooner and faster than last year because many people are being way safer (because of the COVID19 outbreak and the news cycles about it) and maybe Spring will get here earlier, too:• WASH YOUR HANDS• TOUCH LESS THINGS AND PEOPLE• TOUCH YOUR FACE LESS• COUGH OR SNEEZE INTO ELBOW• HOPE FOR AN EARLY SUMMERTIME!!!If COVID19 is at least similar in transmission to the Flu(s) we get in American Society and everything else being about the same for society, then you are very likely to get COVID19 next season if you do not get it this year. “But… there will be a vaccine!”Maybe, but it may also only be 50% effective. And… honestly, there may not be an effective vaccine, or not enough can be made and/or distributed and/or injected in time for next season, or a hundred other little issues with vaccines, rates of distributions, effectiveness and so, we just do not know what we do not know for next year.We do know this about coronaviruses in general:From: Coronavirus National Trends showing the seasonality of coronaviruses (matches the classic Flu Season) and notice that different coronaviruses (different color lines) peak differently each year AND repeat from one year to the next.My bet is that COVID19 will be a big part of next year’s colds around the world and in the United States, but COVID19 does not look much more deadly than the flu based on what’s been reported. This is a very good thing for the future outlook of the disease.After that, assuming COVID19 does not mutate in some manner and assuming most, 99.9%, of healthy humans, once they get COVID19, form proper antibodies to COVID19 and cannot get it again or there is a vaccine distributed, each new cold/flu season will see less and less beginning 2021-22. COVID19 will fade into history after that.There is no ‘cure’ for the Cold & Flu Seasons on Earth, not yet.I wrote this answer today for those of you who want to know what you can do, today, right now:WASH YOUR HANDS – with warm water, soap for 20-30 seconds, thoroughly dry. Antimicrobial gels (alcohol based) can be used when mobile or interacting but the tried and true method of washing your hands regularly is the habit you should work on for yourself and your family.TOUCH LESS THINGS AND PEOPLE – not saying you need to go Howie Mandel, who’s phobia of touching exists secondary to his extreme case of obsessive-compulsive disorder – he claims he went eight years without shaking hands with others! The point is that you do not need to touch as many things as you do in a given day… but when you touch a bunch of stuff that is not yours, outside of your home… WASH YOUR HANDS.TOUCH YOUR FACE LESS – and this is a very hard habit to break! My method was to write on the back of my dominant hand “DO NOT TOUCH FACE” in a sharpie. However, if you need to touch your nose, lips, face or eyes… form the habit of excusing yourself, go to the washroom, wash your hands… THEN touch your face all you want.COUGH OR SNEEZE INTO ELBOW – this should become a habit for all of us!I also wrote this today to mention what I have written for years and years online – we can all do a better job of self-care. Including me. I’ve written the following ‘prescription,’ first in 2003 for a pain patient who was at her wit’s end and nothing worked to solve her pain. Online, the following, or something close to it, has appeared in hundreds of posts from me:EAT RIGHT — vegetables and fruits, rice and beans, some nuts to make up for calories. Pay attention to get at least 40-50 grams of protein each day from vegetable and grain sources. Little to no meats, almost no dairy, little to no alcohol, little salt and use spices for taste, avoid processed foods, especially sugars – this reduces your body’s inflammation state dramatically. Drink mostly water, black coffee or plain tea.SLEEP RIGHT — this means 7.5–8.5 hours per night. Most people need to discontinue screen time 35–45 minutes before they want to be asleep. THE BIGGEST KEY to sleeping right is waking up at the same time every day… that’s 6:06am for me… I know, yikes, coffee helps make the transition each morning, for me.EXERCISE RIGHT — I used to promote “walk every other day 25–35 minutes” but new research shows moving and walking around 6-10 minutes each hour of the day is far more effective. Swimming is a great alternative. Be smart about physical activity but do it consistently.Like I began with, this is a long Quora answer and meant for those that have some minutes to read and some minutes to digest it. I’m going to cover one more piece of this unfolding COVID19 story and that is Fear, itself.I’d be lying to you if I said that in the past six weeks, I had not experienced fear. Fear of the unknown. Check. For sure, that’s part of this human journey. Fear of what I know about medicine, people, human nature and a host of really bad thoughts and possibilities… all of which brought me some level of fear for myself, distantly, and my family, mostly my family, mostly my kids.The worst fear I experienced was the fear of the Present State of Communication(s), social media(s), news(s), paper(s) – dating myself with that one, forum(s), blog(s), etc… made for profit’s sake, for the sake of getting eyeballs to tune in, or finger(s) to click something… and everyone is likely aware, for political sake(s) or stake(s) on both sides of the aisle in an election year.Instead of pontificating over how I wish all our leaders might conduct themselves and how information should be disseminated about things like COVID19 – because I am not going to impact either… I can only tell you how I will conduct myself to be part of the solution:Right now, today:• WASH YOUR HANDS• TOUCH LESS THINGS AND PEOPLE• TOUCH YOUR FACE LESS• COUGH OR SNEEZE INTO ELBOWThis year, this Spring and Summer, learn to do this 6 of 7 days for all the rest of your days:• EAT RIGHT• SLEEP RIGHT• EXERCISEIf you get sick with the cold/flu sniffles, fever above 100.5 degrees, body aches and pains:• WASH YOUR HANDS• TOUCH LESS THINGS AND PEOPLE• TOUCH YOUR FACE LESS• COUGH OR SNEEZE INTO ELBOW• AVOID OTHERS AS MUCH AS POSSIBLE UNTIL NO FEVER FOR THREE DAYSDespite many unfortunate events in my own life, many of which fuel my passion to write, I continue to believe in the optimistic outcome for the human species. We will get there, better in the future than we have been in the past, of that, I have no doubt.Peace. Love & Life to you All.~Chris

The early AIDS crisis. Patient after patient, lovely young men who should have been in the prime of their lives with wasted bodies, having coughing spasms from pneumonia, night sweats and so much more. And there was nothing I could do as a nurse to help them.In the hospital, total confusion on the level of protection needed by the staff - changing weekly. First - everyone should wear gloves. This was back on the early 80's, when nurses did not wear gloves unless it was to clean up a mess. Certainly not as a barrier between you and the patient.Next week, gloves and gowns. Oh, maybe not, maybe gloves are enough. Never mind, now you need gloves, gowns masks and caps. All the patient could see, sometimes the last thing he would ever see, would be the eyes of the person caring for him.Blood drawing and IV insertions became a trial for the staff and the patient, due to lack of veins and the uncertainty of how this was transmitted. If you got poked by a used needle, you were sent to employee health for AIDS testing, repeated a few more times before you were told you were not infected, a process that took months.Staffing was another nightmare. Caring for a patient with all these needs in isolation gear, and 6 or 8 more, was impossible. Staffing was never increased to reflect the increased needs of these patients. Never. We were expected to “make do" and “do the best we could". Every day I went home knowing I had not done everything I needed to do.Staff would refuse to care for AIDS patients, either for medical or moral reasons. Can they do that? I was outraged at this. I became a nurse to care for the sick, what do you mean you object to their lifestyle or you are worried about catching it? I am still outraged.Every day there was a new memo from administration. Every week a new report in TV with the latest theory on how it was spread. Theories, but no treatment, no cure.Friends died, with the reason masked in the obituaries as “a sudden illness".Still no treatment. The president (Reagan) refused to address this health crisis that felt like the plague in the middle ages. Night after night, nurses went into work to care as best they could for these (mostly) young men.This was a terrible time. There are treatments today, but as of this date, no one has been cured of AIDS.

For the same reason that men grow beards, to look older and more manly.Okay, bear with me here for a bit, because in recent times the entire goal has been to look perpetually like a teenager. The body type the media encourages these days (clean-shaven, six-pack, skinny, etc.), is actually the body type of a young teenager, especially the clean-shaven bit. Generally speaking most men won’t be able to cultivate a full and bushy beard until they’re in their mid-20’s or even early 30’s, and for some it will never happen.There’s a reason that some professions encourage beard growing, and why you see many doctors, psychologists, etc. sporting beards, because it makes them look older, and therefore more experienced and trustworthy. If you walk in to your doctor’s office and they look more like they should be in high school, with a bare chin and skinny physique many patients turn turn right around and head out to find someone “more experienced”. Now this isn’t universal, some medical professionals, such as surgeons, avoid beards because they make scrubbing up difficult, make masks less comfortable to wear, and because surgeons have less face-to-face time with patients. But you’ll notice that a lot of younger doctors cultivate a beard to give the appearance of maturity. Even if someone doesn’t like beards that isn’t the point - you’re not looking to date your doctor, you want someone you feel is experienced enough to trust, and this really does help.Except Asians generally don’t grow facial hair very well, so instead they found another way to look older and more experienced, and therefore to be taken seriously in their leadership positions, namely by immitating male-pattern baldness:Notice the similarity? That’s deliberate. The idea is to make even the baby-faced guy in the photograph look older and like he shouldn’t be in kindergarten.There are some who speculate that it was to help prevent their helmets from falling off, but that’s pure bull. The Japanese helmet was designed to accomodate the hairstyle (which dates back to the Nara era, approximately 710CE to 794CE), not the other way around. Plus anyone who’s had their hair pulled will tell you that the idea that your helmet is being held on largely by your hairstyle is utterly ridiculous as well as the wost idea in history.Nope. The entire point was to look older.Now this may seem counterintuitive to people today, where there is widespread distrust of the older generation and the response “Ok boomer” is the ultimate put-down.In the past though (when this hairstyle was popular) the older generation were viewed as wise, experienced, and far more dangerous. To the modern tech generation this seems weird, but the old kung fu movie trope of the insanely dangerous old grandfather figure is completely true in the martial arts context. Practice and muscle memory are incredibly important.Looking older suggests that you’re dangerous and experienced.And that’s why the hairstyle became popular and remained popular for so long, right up until guns came on the scene. The Japanese military initially had some problems with guns because they had a hard time comprehending how simple they were, and that it really was just “point and click” (yes, yes, I know there’s more to using a gun properly than that, but compared to the complexities of, for example, traditional Japanese archery, a gun really is an amazingly simple device).You can see the modern shift towards youth in the “new style” faux-samurai hairstlyes:Note how the hair isn’t shaved or pulled back to create the appearance of male-pattern baldness?That’s because there isn’t a serious need to deter other samurai who might see a young fresh-faced samurai as an easy kill.