Know Your Enemy: Covid-19 Facts & Response

When dealing with any threat, a combat mindset approaches the battle in a structured fashion based on knowledge, training and experience. This process may take seconds, minutes or weeks, depending on the nature of the threat and the time available to generate a response (notably, COVID-19 facts were not freely available to the public in the early stages of this battle). 

Not all battles are ‘kinetic’ (the military term for active warfare with weapons and troops), and COVID-19 is a good example of such a battle. It could be compared with unconventional or asymmetric operations – those where the enemy’s power, strategy and tactics seem unpredictable and vastly different to our own.

We can apply the same type of battle strategy to this pandemic as we would in those other conflicts — starting by gaining some essential coronavirus knowledge.

COVID-19 Facts

Coronaviruses have crown-like spikes on their surface (the Latin corona means crown, halo or garland). There are four main sub-groupings of coronaviruses, known as alpha, beta, gamma and delta.

Human infections with coronaviruses were first identified in the mid-1960s, and there are seven known coronaviruses that can infect humans. The common human coronaviruses are generally benign, causing symptoms similar to the common cold:

  1. 229E (alpha coronavirus)
  2. NL63 (alpha coronavirus)
  3. OC43 (beta coronavirus)
  4. HKU1 (beta coronavirus)

There are three other human coronaviruses that are much more sinister, and may cause severe, life-threatening symptoms:

  1. MERS-CoV (beta coronavirus that causes Middle East respiratory syndrome, or MERS)
  2. SARS-CoV (beta coronavirus that causes severe acute respiratory syndrome, or SARS)
  3. SARS-CoV-2 (the new coronavirus that causes coronavirus disease 2019, or COVID-19)

The last three coronaviruses infect animals, but have evolved to be able to make people sick. They became new human coronaviruses, or ‘novel’ viruses. SARS and MERS caused outbreaks that were much smaller than COVID-19, but gave China and other Asian countries valuable experience in dealing with disease outbreaks.

The new COVID-19 is a strain of beta coronavirus from group 2B. It shares approximately 70% genetic similarity to the SARS-CoV, and approximately 96% similarity to a bat coronavirus. It is widely suspected to originate from bats, and be passed to humans through another intermediate animal host. Another example of this type of transmission is the Hendra virus, which was transmitted from Australian flying foxes (aka fruit bats) to humans and dogs via horses.

Weapon Delivery Systems

Knowing the enemy’s movements and attack mechanisms are key in fighting it.

The mean incubation period for COVID-19 is 5–6 days, but can vary between 1 and 14 days. This means that someone can have the virus for up to 14 days without symptoms appearing. A small number of people may be infective before symptoms develop, but at the moment that is not thought to be common.

COVID-19 is ‘droplet spread’, which means it is the contaminated droplets of fluid coughed or sneezed from an infected person that infect others. They enter the body through the eyes, nose and mouth by either inhalation or contact.

A recent study found viable COVID-19 virus three hours after it was aerosolised and suspended in the air. On copper surfaces it lasted four hours, on cardboard it lasted 24 hours, and on steel and plastic it survived 2–3 days. The median half-life for COVID-19 was 13 hours on steel and 16 hours on plastic — that is, its concentration was reduced by 50% over that time.

Comparison with other viruses that are spread in similar fashion is provided in the chart below. The ‘reproduction number’ indicates the approximate number of people infected by each case, so it can be seen that COVID-19 is 2–3 times more infective than influenza, etc. All of this means that there may be thousands more cases in the community than we are presently aware of.

Have I Been Hit?

The tricky thing in identifying — and therefore tracking — COVID-19 is that infection can have slow onset (i.e. a long incubation period) and mild or even no symptoms in some people.

Still, symptoms of COVID-19 generally differ from other common respiratory illnesses. Medical staff use this to determine screening, especially while availability of testing remains limited. However, if enough cases are allowed to develop in the community, it will become less relevant — anyone with respiratory symptoms will probably have COVID-19.

To better understand the likelihood of experiencing specific symptoms when infected by the virus, see the two tables below. The first, ‘What to Watch For’, helps train our focus on the main and most severe symptoms of COVID-19, with comparison to other illnesses that have well-documented characteristics. Note, its authors have not listed all the possible lesser symptoms for COVID-19 due to the lack of concrete data on their frequency, even very recently. As we know, the virus moves quickly, but data collection takes time — another reason COVID-19 facts are still limited in some respects.

However, the second table below documents research conducted on confirmed infected populations by the World Health Organisation–China Joint Mission on Coronavirus Disease 2019. It helps provide a clearer picture of the symptoms we’re most likely to experience if infected.

How Bad is the Wound?

Based on the confirmed cases in China, the WHO reports “the median time from onset to clinical recovery for mild cases is approximately 2 weeks”. For more severe and critical cases it is 3–6 weeks, according to the same study. For those who eventually died, the time from symptom onset to death ranged from 2 to 8 weeks.

The degree of illness in patients can be classed as mild, severe or critical:

Mild cases: Approximately 80% of patients testing positive have mild disease. They have symptoms that are more irritating than debilitating. It’s estimated that only about 5% of the total cases in China were detected, so it is likely that many more people have mild illness than the 80% quoted.

Severe cases: Approximately 15% of patients get significant pneumonia, with shortness of breath the dominant symptom (≥ 30 breaths per minute, with oxygen saturation ≤93%). These patients probably need hospitalisation and supplemental oxygen therapy.

Critical cases: About 5% of patients suffer respiratory failure, which may lead to septic shock, and/or multiple organ failure. They will probably not survive even with ventilator support (i.e. in ICU).

The degree of illness and eventual mortality is strongly related to the age of the patient, as shown in the table below. The overall death rate is probably around 3%, but differs by country due to big differences in quality and availability of health care, as we’re seeing play out worldwide.

The case fatality rate for COVID-19 can be compared to previous disease outbreaks, as shown in the graph below. This virus appears to be less deadly than some of the earlier outbreaks, but it is more contagious and will spread further. We’re seeing this play out globally right now, with containment of the spread being dependent on the measures authorities put in place, as well as how individuals behave. Thus, it’s impossible to predict how many people will die from COVID-19, but it’s likely to be in the tens-to-hundreds of thousands. At the beginning of April 2020, there were already more than 50,000 deaths from the virus worldwide. It was fewer than 5000 just a month before.

To stop this, we must combat the enemy’s key strength.

The Enemy’s Strengths

Having considered the COVID-19 facts, we can analyse the strengths of this particular enemy:

  1. It is easily transmitted, and moderately infective.
  2. It only kills a small number of its hosts, allowing it to spread further through less-sick patients.
  3. It is relatively hardy outside the host, enabling some transmission for a time even when an infected person is not nearby.
  4. It produces a large number of moderate-to-severe patients, which if unchecked can rapidly overwhelm national medical resources. This may lead to a higher death rate in some countries (such as Italy).

The enemy’s ‘Centre of Gravity’ is transmissibility – its ability to pass from host to host. All of the power of COVID-19 is dependant on this strength.

The Enemy’s Weaknesses

On the same note, COVID-19 has a number of vulnerabilities that must be considered:

  1. Droplets are heavier than air, and thus fall to the ground through gravity. It is estimated the risk of infection is much less outside about 1.5m away from an infected person.
  2. COVID-19 can only enter the host through the eyes, nose and mouth.
  3. It has no inherent mobility, i.e. it must be carried by a host from place to place.
  4. It cannot reproduce without a host.

Our Defence Strategy

To defeat an enemy, its centre of gravity must be disrupted — for COVID-19, that is its transmissibility. There a number of steps that we must take, individually and collectively, to accomplish this:

  1. Avoid infected people. This is harder than it sounds, given the number of people likely to have minor infection and minimal symptoms (but still be infective). A personal strategy of avoidance, which is now being recommended or mandated by governments across the world, includes:
    1. Staying 1.5m from EVERYONE during the endemic phase of the illness.
    2. Avoiding public gatherings where exposures are more likely.
    3. Deferring non-essential travel. Work from home if possible.
  1. Protect your eyes, nose and mouth. Everyone can do this, but it takes some will power!
    1. Don’t touch your face. COVID-19 on your hands will not harm you, unless you pass it to its desired points of body-entry.
    2. Wash your hands. A lot. Soap is very good at killing COVID-19 by dissolving some of its components. Hands should be washed with soap and water frequently, and vigorously, and for a minimum of 20 seconds. Hand gels with alcohol content greater than 60% may also kill the virus, but are less effective than soap and water. Wash your hands especially before and after eating, after coughing, sneezing, using the bathroom, contact with others or recently handled goods, etc.
    3. Surgical masks do not protect you from COVID-19. (See below for more information.)
  1. Clean surfaces around home, at work, etc. Most household cleaners that are bleach-based, or have 70% alcohol, are considered adequate for cleaning at home. Consider the surfaces that are frequently touched; for example tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, etc. Some brands of disposable wipes are acceptable for this as well.
  1. Frequently launder your clothes, towels, etc. Do not shake them out, which may release viral particles into the air, and always wash your hands afterwards.
  1. Isolate sick members of your family. Feed them in a separate room. Make them wear a mask when outside their room. Make them wash their hands frequently. Clean their room as above regularly.
  1. Do your bit if you get sick:
    1. Isolate yourself. Do not be the cause of other’s misfortune.
    2. Protect those around you from infection by wearing a mask. A normal surgical mask will not protect you from COVID-19 exposure. Only specialised, custom-fitted masks will protect you, and they can only be worn for short periods at a time. Wearing a surgical mask is most effective for those already sick. It can protect those around them from droplets, thus reducing the risk of infecting others.
    3. Avoid the elderly. They are at the highest risk of death from COVID-19.
    4. Do not share household items.
    5. Cover your coughs and sneezes, and dispose of tissues responsibly and immediately.

The Mission Ahead

It is possible to treat COVID-19 as an unconventional enemy. The facts provided allow us to better understand that enemy, to protect ourselves from its strengths and to target its weakness in order to defeat it.

The coronavirus situation is still unfolding worldwide, and it is fluid, changing on a daily basis. Although there is now consistent communication on the crisis from our reputable health organisations and government channels, there is still a massive amount of misleading information floating around. This article has been prepared using reputable resources, with the aim of providing the essential knowledge required to tackle this current enemy effectively — with resolve rather than panic.

So, for the time being, stay at home, stay healthy and keep up to date on COVID-19 facts.

 

About the author: Professor David Ward is Kinetic Fighting’s Chief Medical Officer. The Army Colonel, Senior Medical Officer and former combat medic has served in the Australian Army for almost 30 years. He has been deployed 8 times to disaster and combat zones worldwide, including Afghanistan, and is currently a specialist emergency physician at Brisbane Northside Emergency Centre. Ward shares his extensive medical knowledge as Adjunct Professor in the School of Public Health at Queensland University of Technology (QUT), and as Adjunct Lecturer at University of Queensland’s Centre for Military and Veterans’ Health. He is also president of the Australian Defence Force Martial Arts Association (ADFMAA), holding a Brown-belt in Brazilian jiu-jitsu and a Green-belt in KEF–IC

References:

‘How Covid is Spread’, The Scientist, Feb 21 2020 – https://www.the-scientist.com/news-opinion/how-covid-19-is-spread-67143

‘Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1’, medrxiv.org, Mar 13 2020 – https://doi.org/10.1101/2020.03.09.20033217.

‘Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)’, World Health Organization, 16 Feb 2020 – https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

‘Human Coronavirus Types’, Centers for Disease Control and Prevention, 15 Feb 2020 – https://www.cdc.gov/coronavirus/types.html

‘Coronavirus Disease (COVID-19) – Statistics and Research’, Max Roser, Hannah Ritchie and Esteban Ortiz-Ospina, 2020 – https://ourworldindata.org/coronavirus

‘Wuhan seafood market may not be source of novel virus spreading globally’, Cohen, J., ScienceMag – American Association for the Advancement of Science (AAAS), 26 January 2020

‘We’re still not sure where the COVID-19 really came from’, Eschner, K., Popular Science, 28 January 2020 

Australian Government Department of Health, 2020 – https://www.health.gov.au/resources/publications

Coronavirus (COVID-19): Centers for Disease Control and Prevention, 2020 – https://www.cdc.gov/coronavirus/2019-ncov

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