Week 11.5 – coronavirus update – duration of illness, recurrences in China, new disease manifestations in those <18, variable contagion rates

Duration of recovery from COVID-19

Enough clinical experience has now been gathered to allow us to say that people with mild disease will recover in 2-3 weeks and moderate to severe disease 3-6 weeks. Those who required critical care and ventilator support can take months to recover due to prolonged bed rest, medication treatments, and the severity of multi-organ injury.

Recurrence in China

According to the state media from China new outbreaks have begun to recur within various Chinese cities. This is not unexpected and according to the reports have been on the order of 7-20 people in each identified cluster. Those reported clusters were one person bringing it home and having the disease spread within the family group. It is hard to know the true incidence and magnitude of the recurrences of COVID-19 after re-opening, since the Chinese state media has proven less than reliable about the true extent of this disease in that country.

COVID-19 in those <18

Some presumed new manifestations of COVID-19 have been reported in children. Although the numbers are small, the disease manifestations are very severe. There has been some degree of nonchalance in diligence protecting those under age 18, because “they just don’t get ill.” Although the chances of getting COVID-19 are less than adults, it is proving that it can cause very severe disease in the young.

Variable contagion rates

The degree of contagion seems to be unpredictably erratic. Sometimes the infectious rate is devastating and at other times surprisingly low. However one sure-fire way to get COVID-19 is to go to choir practice. The CDC reported that from exposure to one ill individual at one practice 89% of a 122 member choir became ill with COVID-19. Means of contagion included singing, sitting close to each other, personal contact, sharing a common snack area, and touching common surfaces like chairs and counters.

This event occurred in mid-March in Washington state before the social isolation policies came into force.

To contrast this with other experience, only 1/3 of people on the quarantined ship off Yokohama Japan tested positive. I would have thought 80-90% would be positive in such a contained space.

We have several experiences with peculiarly low transmission rates in settings where we would have expected the same high rate as the Washington choir group. We have observed one family of 5 where two members had the illness confirmed by testing but the other three did not get sick. AND the other three tested negative for antibodies several weeks after everyone was well. Another family had one member test positive after a high risk exposure, but never became ill and did not spread the virus to the other two family members, who tested negative for the antibody weeks later.

These experiences underscore how imprecise predicting contagion can be.

Dr. Gipson