Info on COVID 19 for my friends & family (and anyone else)

I've put this together because I'm finding I'm repeating the same info to many people. 
My headline is given the info we have at present we should assume this virus is an extremely infectious virus which is easily transmitted through the air in droplets from infected people’s sneezes, coughs AND breath and we should, therefore, reduce contact with people and keep away from places where may people have been.

Misinformation is also rife so I'm careful to draw out where I've made assumptions based on other viruses. The issue is that the scientific community doesn't like conjecture and like evidence and data. This is a problem when we aren't sure we have all the data and the stuff we do have may be misleading.

I'm relying most on the data coming out of Italy, Spain, France the UK and the USA are likely to be unadulterated. However, they too will only be as good as the testing the full picture in data is still missing.

Hopefully, the information below will help my friends & family understand why the authorities are taking such extreme measures. What I won’t attempt to do is comment on things like stockpiling and when it would be safe to start socialising again since these things really need to be managed by society and will need some of the questions I have answered.

I will add new blog posts and amend this one as more info comes to us.

Facts
1. We all know the disease is a Coronavirus - the same type as SARS & MERS. 
2. It is, therefore, a respiratory disease.
3. It has spread more rapidly than people expected globally and in the UK (I think the establishment & scientists were expecting it to behave like SARS & MERS initially but it is likely down to the period which it is infectious before noticeable symptoms develop)
4. It definitely is more dangerous to older people (especially 70+)
5. It definitely is more dangerous to people with underlying medical conditions or who are pregnant
6. It definitely is less dangerous to younger people (especially people under 20)
7. Washing/sanitising hands is useful to kill the virus
8. Surgical masks (i.e. ones that don’t create an airtight seal around the nose and mouth) are not that useful unless you are infected or treating an infected person  
9. People who die from the disease generally have the disease in the lungs (viral pneumonia – unlike bacterial type antibiotics have no effect)
10. People have a mild illness generally when the upper respiratory tract is infected
11. Secondary bacterial infections can complicate the disease but thankfully are mostly treatable with antibiotics
12. Some children have died from COVID-19
13. Some seemingly healthy people under 60 have died from the disease
14. Healthy people can often succumb because their immune system is overreacting (see cytokine storm mentioned later point iv) )

Pseudo Facts

These facts don't paint the full picture but are nevertheless bandied around a lot. They are mostly based on analysis of the data (which I've stated already is incomplete) and need much more investigation.

i) Other viruses (and almost certainly COVID-19) do not live long outside the body (minutes) UNLESS they are in droplets of water, saliva, mucus or other hydrating liquids. This means that cloths and absorbent material are VERY GOOD at destroying the thing. However hard surfaces can keep the virus alive for a long time (even several days) 
ii) The death rate (Case Fatality Rate or CFR) for people known to be infected is estimated to be between 1% and 8%. This is really difficult to assess but regardless the authorities are more concerned with the rate of people needing hospital treatment and intensive care/ventilation
iii) Herd immunity would result in the virus dying out after 60 to 70% of the population of the UK has got it (note the UK govt had had to move from this approach because it would overload our health system).  This is largely based on OTHER viruses but seems logical as long as there is little re-infection
iv) The disease can cause a cytokine storm where the body’s immune system produces far too many cytokines which trigger a massive response to the pathogen from the body’s defense cells. This can result in key bodily functions and organs being shut down and sometimes death and often lasting damage. (https://en.wikipedia.org/wiki/Cytokine_release_syndrome)
v) Surgical masks will not fully protect you in the presence of an infected person as air an droplets of liquid can be inhaled via the edges of the mask.
vi) Fully airtight masks (FFP3) are more effective but great care must be taken when removing them as they are likely to have viral particles on them 
vii) Dogs and cats can catch the virus but we don’t know if they are infectious
viii) 20% of cases require hospital admission (not necessarily 20% of infected people as we DON'T know how many that is). I haven't managed my own sums but this is based on BBC stating around 4 in 5 cases may not need admission.
xi) Younger people make up a large number of hospital admissions. Whilst they aren't so likely to die, probably due to their strong immune systems younger people seem to form a large number of admissions (https://www.washingtonpost.com/health/2020/03/19/younger-adults-are-large-percentage-coronavirus-hospitalizations-united-states-according-new-cdc-data/)

Unsubstantiated Information

This is information I've gleaned from sources (all mentioned) but which we do not have the data to confirm or deny. We should not ignore the risks that these points imply – I’ve only added ones I think are likely to be true and a high impact if they are true.

1. Re-infection by the virus is possible and indeed *may* cause a worse outcome as re-infection may have increased risk of causing a cytokine storm in the individual 
2. Ibuprofen can significantly worsen the disease and outcomes  (https://www.npr.org/sections/health-shots/2020/03/18/818026613/advice-from-france-to-avoid-ibuprofen-for-covid-19-leaves-experts-baffled?t=1584882911715)
3. Drinking plenty of liquid when you have a mild version of the virus (in the upper respiratory tract) can help wash the virus down to the stomach and stop running out of control and ending up in the lungs. This seems possible but a bit unlikely however staying hydrated is very important so do it anyway even if you don’t have the virus
4. Many more people currently have it than the government expects due to the long period people do not exhibit symptoms. This will be even worse if it turns out a substantial number of people never display symptoms.

Questions which we need answering ASAP 

and assumptions I suggest we make whilst they remain unanswered

A) Is the disease mainly spread through the Aerosol effect? [ASSUME:  this IS the case hence the UK govt encouraging people to stay meters apart – although this will not be enough in many cases as the aerosol effect means particles can hang in the air for a period of time]
B) We need evidence whether people can carry the virus and spread it whilst remaining largely asymptomatic without ever displaying significant symptoms. This especially applies to kids. If so what proportion of infections do we think this applies to? [ASSUME:  this IS the case and that people who are well maybe infectious so keep our distance]
C) What is the genuine length of time people are infectious whilst asymptomatic?
D) Can re-infection occur? [ASSSUME: Some level of re-infection is possible and so if you get COVID-19 put yourself in the AT RISK category afterwards until we have more information)
E) Does a re-infected person spread the disease? [ASSUME: they do until we hear otherwise]
F) Can re-infection cause worse outcomes due to the body overacting to the pathogen it recognised?  [ASSUME: it does do until we hear otherwise]
G) Can  Ibuprofen (eg Nurofen) make the disease worse? [ASSUME: Until we have more info if your doctor hasn’t prescribed Ibuprofen I would stick to paracetamol on the off-chance. To me it seems likely that there could be an issue here especially for diabetics or people with hypertension (as in UK govt advice: https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus)
H) Can animals catch the virus – especially dogs and cats? If this is the case then we need to find out very quickly if they can infect people and hence cause an animal reservoir of the disease ) https://www.afcd.gov.hk/english/publications/publications_press/pr2346.html?mod=article_inline).  [ASSUME: I think we are fairly safe to assume  reinfection from animals is not like to be a serious problem at the moment]


Useful Reading

Guardian Article on some Myths debunked (I agree with most):

https://www.theguardian.com/world/2020/mar/21/can-face-mask-protect-me-coronavirus-covid-19-myths-busted

Lancet letter which triggered concern over Ibuprofen

https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930116-8

Article on Aerosol Transmission vs Surface transmission

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682679/

NHS Guidance on When You need to use FFP3 masks (i.e. with coronavirus)

https://www.rdash.nhs.uk/wp-content/uploads/2017/08/Appendix-47-Surgical-Face-Mask-FFP3.pdf

National Geographic article from Feb 2020 about how the virus damages patients.

https://www.nationalgeographic.co.uk/science-and-technology/2020/02/heres-what-coronavirus-does-body