Coronavirus COVID-19 and its trail running opponents

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The war with coronavirus in South Africa has begun

What can you do to protect yourself and fellow South Africans?

This post has one aim: to ask you to join in a worldwide effort to beat an invisible enemy that has potential to change our lives, for good or bad.

I believe we’ll learn many valuable things from the experience, and the top one will hopefully be that we can do much more together.

But sometimes, that means we need to be apart first. It sounds contradictory, but you probably know where I’m going with this.

War!

Both my parents experienced war.

My mother grew up in Tokai, Cape Town, and during the 1940s, as a teenager, she remembers the total blackouts that were enforced so that Nazi ships and submarines could not do offshore surveillance.

The Brauns
Parents en route from Swakopmund to Walvis Bay, 1964

My father, ironically, fought on the German side that my mother and others were so afraid would invade SA. His mistake was to be born Austrian in a time that a megalomaniac countryman decided to conquer the world.
While my mother remembers quiet dark night skies, he told me that his night skies were a time of terror. The enemy fired up flares to light up the landscape so their artillery could rain death on their positions.
These were crazy times. His brother died on the Russian front. He himself was wounded and captured by the Americans in Italy.
Starving in winter, an American guard taunted him and other prisoners with a chocolate bar, then fed it to his dog. War can make some people callous, and it brings out remarkable kindness in others. I was too young to ask him to say more about his experiences, and I regret that. Talking about it might have healed his pain. But people from that era were more stoic and more resilient than most of us today in our mod-con lives. When trail runners tease friends to take a teaspoon of cement and HTFU, I have to wonder. Perhaps you’re talking about feeling a little discomfort to get that Strava FKT?

I tell you this because we’re currently in a war of a different kind. But like then, it requires us to think of a better future, and not think of ourselves right now, of our immediate desires to socialise, to have coffee with friends, to live life. Our actions now could have a cascade of effects on people we don’t know, and tragedies for others that we might not be able to see.

This enemy is not American, Nazi, or any other kind of human. It’s invisible. There are no flares, no lights, no deafening explosions. The war is on a molecular level. We can be carriers, or we can refuse it passage on our ship.

Here are strategies from countries that have been affected before us, that have helped others before, and will help others here.

social distance isolation coronavirus Covid 191. Social distancing. The top strategy by far. People moving around can spread the virus far and wide. We can use these ideas to limit the spread.
Heloise is working remotely until further notice. (Hey there Heloise!)
My mother is 90 years old, and her well-being is my top priority. She lives with my sister 5km from me. We are both doing our utmost to not pass the virus on to her. I saw her this past weekend and kept a 3m distance. Hard to do when you are used to giving someone a hug. I won’t be visiting again for as long as the virus is still being detected anywhere in SA.
So please don’t be brave, fearless, unconcerned, or any of those chin-up positive attitude things. The reality is that anyone can be affected, whether we think we’re bullet-proof or not. You can believe that your diet, your faith, your good looks, your good luck, your genes, or your hospital plan will protect you, and that’s cool. But don’t think of you. Think of people you could infect by passing the virus on to them.
Stay home, just in case you or someone in your household is infected but is asymptomatic. Make trips to the food store or pharmacy only. Don’t let the current ‘less than 100 person meetings are OK’ guideline lull you into believing that small groups are okay. They’re not if people are still getting within infection range of each other. It just takes one.

2. Work distancing. Modern tech allows many of us to work from nearly anywhere. So let’s use that to keep us and our loved ones safe. Next, let any home helpers know they should also spend time at home until this passes. Don’t put them and their families at risk by using public transport. Pay your house help or gardener their regular salary so they are not out of pocket. Or if they get paid on a daily basis, let them know not to worry about a reduced income this month and that you’ll sponsor them – or employ them for extra days once things normalise to rebalance.

WHO hand washing infographic
World Health Organisation infographic for thorough handwashing technique.

3. Hygiene. You know the washing hands drill. And the “Stop touching your face, moron!” drill. Rinse and repeat.

4. Sunshine. UV seems to hurt many viruses, including the corona family. So get a healthy dose daily to keep your immune system strong. One of the lessons from the 1918 Spanish flu was that soldiers accommodated outside in tents, in the sunshine, had higher rates of survival. So get your morning sunshine, and some in the late afternoon too. Article via Medium.

5. Drugs. There seems to be a correlation between using NSAIDs and the young and fit being infected with coronavirus, when others are resilient. So get professional advice if you have been using these anti-inflammatories and need to continue using them. Read the comments in this tweet for other insights.

bananas
Three banana plants deliver the goods in Deon’s garden.

6. Dream of tomorrow. This challenge too shall pass. You’ve got to motivate yourself with a vision of a better tomorrow. I’m using my downtime in my work breaks to get outside, to get fresh air, and to get sunshine. In that time, I let go my worries, I meditate, I think about all the things I’m grateful for.
Very importantly, I’m also doing something powerfully constructive, by prepping my garden for plant crops in the next two months.

I am also reducing the strain on the food system by one less person. It’s not so much as I’m OK Jack, but rather that I am able to fend for myself.

For fellow plant nerds, my garden is an established food forest, and is bursting with life and vitality. The recent good rains and Durban humidity have made some plants grow to double their size in the past two weeks. Now I’m focusing on establishing leaf species that will provide a varied daily supply of fresh green leaves, especially sweet potato, Malabar spinach, and herbs. I already have giant amaranth, cassava, and lambsquarter for cooked greens, and there are four chaya plants growing up to harvest from soon.
There is an abundance of tropical fruits with nearly 120kg in bananas, either harvested, or still on plants and maturing in the next few weeks. Five papaya plants provide a daily pawpaw or two. Kumquat and mandarin oranges are growing fast and already their branches are showing the weight of fruit they’re carrying. There’s stacks of taro, turmeric, ginger, sweet potato, and tania tubers/rhizomes in the ground ready to harvest whenever I need.
If you don’t have a garden or have brown fingers, you can grow your own super-nutritious sprouts from shelled sunflowers, lentils, chickpeas, or mung beans.

7. Other. Read these runner-specific ideas at Trail Runner magazine.


Spanish Lessons

If you’re still thinking about taking your chances with coronavirus and beating it at its own game, here is an account from Spain, passed on by a friend (Warren K) who is cautious of hoaxes and not one to fan the flames of hype. I hope it will convince you of the seriousness.
I think in situations like this, it’s better to be over-cautious and have a laugh afterwards that maybe we overreacted, rather than sit on our hands, and then watch the Titanic slip below the waves, then suck us under too.

Here it the account from Spain, unedited:

Hello all, I am writing to you from my fourth day in coronavirus quarantine, here in Barcelona, Spain.
This is a message to everyone- family, friends, former colleagues, peers and teammates back home (or wherever you are in the world).
Please take this virus seriously. I want to share with you what is happening here now, what the consequences are of a delayed response. I hope this will help you to understand that all jokes and toilet paper memes aside, your action needs to be taken now.
A week ago here in Spain, we only talked about coronavirus. We already had some cases, but it just didn’t seem that bad. We saw the suffering in Italy and said “That won’t happen here.” Changes were not made. People still went out on the weekend, went to the gym, went to work, to school, etc. Preventing the spread of the virus was not a priority. Fast forward just 1 WEEK: Spain is now in a state of emergency. The virus is here and it is tearing through this country. I have coronavirus. My friends have coronavirus. Parents of children have coronavirus. Teachers, students, business people, researchers, politicians, bus drivers, etc. have coronavirus.

Read the full original post here.


Advice from a South African doctor

Dr Ant Allwood from Vergeleegen mediclinic

We face the COVID-19 pandemic. Earlier in March, we heard an excellent speech from our president. His decisions are sound, and there are many good decisions and actions that are being made by our authorities. I have confidence in plans that I know about. There are some brilliant people around, and we need to listen to what they are saying and advising.

But there is also a deluge of information coming from all directions and people are struggling to make sense of it. I have had many requests for insights and what to do.

The exponential speed of what is happening is difficult to comprehend. First world countries who thought they were prepared are finding that the speed and numbers of sick people are rapidly overwhelming their health care systems.

The statistics that are being reported are frightening. What we are seeing is a global pandemic of a highly infectious new virus to which we have no immunity. We know that the virus is very easily transmitted. We know that once infected, the virus attacks the respiratory tract and causes a cough and sustained fever and later may progress to severe pneumonia. We know that the incubation period before you show symptoms is about 5-14 days. We know you can make a complete recovery and will probably gain immunity unless it mutates into another type. Like influenza. We don’t know when a treatment or vaccine is likely. We know of many false rumours about the virus going around.

What makes this virus tricky is that even before you feel unwell you can start infecting others. This can happen as soon as 24 hours after becoming exposed. The other difference is that we now know that the virus can survive outside the body on some surfaces up to 72 hours. This is making it very difficult to control. We believe that transmission is via droplet spread, but there is a lot we don’t know about the transmission, infection, and effects. Research papers and reports are coming out on our medical airwaves thick and fast. They are all showing similar data: that about 80% of infections will be mild, and you will make a complete and rapid recovery at home; 15% of infections are more severe and will require medical help at a hospital or clinic; 5% will be so severely hit with pneumonia that they require critical care and possibly ventilation. At present we see the current mortality at around 2%. Older patients, and those with underlying chronic health issues will have a higher incidence of severe infection and poor outcome, but this virus is not restricted to the elderly. It is a misconception that younger healthy people are hardly affected. Certainly children seem to be spared bad infections, but as a younger healthy adult you can still get severely ill.

Why the virus causes severe illness in some and not in others is not yet known. This virus is going to go around the world possibly more than once until such time that there is an natural immunity or a vaccine. 60% of us must get it before we benefit from what’s called herd immunity – which is where enough people in a population are immune that the virus fails to transmit effectively. Like influenza.

This past week we have had discussions and meetings to try to strategise our preparations. The hospital management has been working for weeks on preparation. As doctors we are part of the machine. I am monitoring the figures and stats very closely. We know what to expect from our colleagues in European hospitals. Sadly, no amount of preparation is going to be enough. We do not have enough resources to offer every critical patient the same care. Neither does Italy, the USA, or the UK.

As frontline doctors, we are fearful. We are fearful for our own safety, that of our families, and that of our future patients. All of us at the hospital will be exposed to many critically ill COVID-19 patients over the next few months. The hospitals are all trying desperately to re-organise and plan resources and how best we can cope. This is happening at speed at local, regional and national level. SA is lagging a few weeks behind the rest of the world in time-line, but the trajectory of expected caseload will be roughly the same. We are fortunate to be able to learn from the rest of the world and prepare better. We have a few weeks to do it.

The only thing we as a population can do is try to slow down the spread in order to try and not overwhelm our hospitals. Forced quarantine at home of entire populations is one option, but disciplined social distancing and contact precautions are more effective. (See link below). This spreads out the number of very sick patients over time and allows us to offer our expert resources to more people.

In the Western Cape we have less than 800 ICU beds available, but based on European data we expect that out of every 10,000 infections, 500 patients will need intensive care. You can see that there is a big problem there. It will reach a time that the ICU doctors will have to decide which patients are going to be helped and which not. A terrible situation to be in.

So my advice to you all is the following – and this is what we are doing in our home:

1) Explain to your kids what is going on in the world. They will pick up your anxiety if you don’t.
2) Strict social distancing: Prepare and plan to stay at home as much as possible. We are not allowing our family to go to any more social or public gatherings. No parties or braais.
3) No close physical contact within 2-3 metres outside the home. We’ll go for walks in the open or the beach. Then we’ll go home. Period.
4) We will consider every surface and object outside the home a potential source of virus.
5) We will all wash our hands thoroughly with soap and water many times a day at home.
6) We will not touch our eyes, mouth and nose. The only time we’ll use alcohol hand rub is when we cannot wash our hands. Like in the car, or after touching anything foreign, like trolleys, lift buttons, banisters, tea cups, etc outside the home. We’ll wipe down anything bought off the shelves, or delivered, with an alcohol cloth/soap and water.
7) We want to minimise trips into crowded shops, and so are slowly building a supply of basic essentials to cater for two weeks at home in the case of forced home quarantine. Stockpiling masses of stuff will only put others at risk. These might be friends or those less fortunate. There is time enough not to panic. When there are cases reported in our hospital then we will avoid the shops as much as possible.
8) We want to make sure our friends and neighbours and domestic workers are also taken care of. We plan to tell our maid to stay at her home and pay her something as usual. Their community is going to be hardest hit, and I want to support her and advise her.
9) If you have a person in your home that is at risk, that has a chronic illness, or is elderly, then you need to prevent them from getting the virus. Take extra care. Make sure that you have enough medication for them.
10) We are expecting this to go on for months. I would think 4-6 before we see the infection rates start to go down. But I’m not an epidemiologist. I may be wrong. This does not mean you need to stock up for that whole time. It simply means that we are in for a very rough time over winter.
11) There are a lot of people going to die. Some healthy people too, and possibly someone we know. But let’s not forget that if you get the virus there is an excellent chance you will just get better. We will most likely all be exposed to it at some point in the future. Like influenza.
12) We really need to be there for each other and the poor. Especially the poor. The burden is on us as an affluent society to limit the spread as much as possible and try flatten the curve. We need to step up to the plate, take responsibility, be brave, do not panic, and to religiously follow the advice given to us by our NICD, WHO, our government and local leaders. There are no exceptions.
13) Please don’t panic. It will make it all worse. We have time to prepare.
14) If you are worried please phone your doctor. Or the NICD hotline 0800 029 999. Or go to the Mediclinic portal (link below). Do not rush out to the GP or the local casualty. You will only put them under more pressure. If a state of emergency is declared all health facilities will be forced to treat all patients presenting for treatment. Private or not. Resources are so precious. We cannot waste them unnecessarily early on.
15) If you have a sustained high temperature, with a continuous hacking dry cough, with or without a positive contact or recent travel, then you need to get tested and advised. Go to the Mediclinic casualty first where they will advise or admit you if necessary, and arrange for testing. Test kits are limited and unnecessary negative tests will mean someone else won’t get one.
16) Please take time to browse the following websites and arm yourself with correct information. Try not to google or YouTube randomly.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

http://www.nicd.ac.za/media/videos/

https://www.nhs.uk/conditions/coronavirus-covid-19/

https://www.worldometers.info/coronavirus/

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

https://www.mediclinic.co.za/en/corporate/corona-virus.html

https://www.epi-win.com/advice-and-information/myth-busters

So, arm yourself with the correct information and stay safe.

Stay safe, stay apart, wash your hands, work as a team, and help your neighbours.

Much love,

Dr Anthony Allwood – Anaesthesia and ICU, Blaine and Associates, Vergelegen Mediclinic, Somerset West


There you have it.

You might figuratively be dying to see friends or going on that local trip. But think about someone else – nameless, faceless – who might die or suffer long-term lung damage because of that decision.

Be safe out there, trail friends!

Deon Braun, TRAIL founder

PS: Thanks to Spurg F for sending the Time meme. And Warren K for forwarding the message from Spain.

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