Three University of Oregon professors in Italy who warned the university to shut down online classes sent an open letter to ordinary Oregonians, offering a range of advice.

That advice boils down to stay home—particularly if you're sick but also if you're not—and wash your hands.

By one estimate, the United States is 11 days behind Italy, a country that is the second hardest hit by the coronavirus outbreak and where some hospitals no longer have enough ventilators for all the patients:

Here's the full letter:

March 12, 2020

We are three University of Oregon professors currently based in Northern Italy where the COVID-19 outbreak is raging. We are writing to alert residents of our home state to the public health emergency that is unfolding here in Italy and to raise the alarm about the limited window of time Oregonians have to prepare. We have 4 suggestions for how Oregonians should be preparing and responding–primarily through practicing rigorous social distancing and widespread closures of schools and activities–and call on all citizens to demand more widespread testing of suspected coronavirus cases.

We have experienced first hand how quickly coronavirus jumps from being a problem "over there" (China, South Korea, Iran) to "here." In the past three weeks, the virus—and the Italian government's response—have moved at what feels like light speed. A few dozen cases grew to a few hundred, into a few thousand, into more than 15,000. Quarantines of 11 towns, affecting 50,000 people turned into quarantines of entire regions containing more than 10 million people, which turned into a closing off of the entire country of 60 million people three days ago, which turned into a full stay in your home quarantine 24 hours ago. If you asked Italians three weeks ago about the risk of coronavirus, they would have laughed and mentioned China. If you asked Italians two weeks ago about coronavirus, they would have sent you a dark joke on WhatsApp. And if you ask someone about coronavirus now, they are scared.

The risk of coronavirus is not just that any single individual may get sick, but that the disease is contagious enough that the entire health systems can get overwhelmed in a matter of weeks. Here in Italy, hospitals in the northern Lombardy and Veneto regions are reporting that beds in intensive care units where the required care can be administered are near capacity and staff are working at their limits even after 20,000 additional medical and health workers were hired to augment services at hospitals and clinics across the country. The government has warned that if cases continue to increase in particularly hard hit areas they do not know how everyone can be treated.

These are sobering and scary realities. We recognize that coronavirus will not hit all parts of the globe equally hard, and we hope that Oregon is a place that is only lightly touched. Yet based on what has been seen from other countries already addressing this disease (China, South Korea, Iran, Italy) there is little to be gained by hoping for the best. There are, however, some clear and early lessons from countries that are already deep in their own emergency responses. We write to share some of these lessons, based on our lived experiences here in northern Italy and drawing on the professional training of one of us in the field of public health and knowledge gained from academic research on the history of epidemic and infectious diseases.

The situation in Oregon is far more serious than a look at the number of confirmed cases implies. Current Oregon Health Authority protocols dictate that doctors across the state only test patients who have severe enough pneumonia to be admitted to the hospital and people who have been in direct contact with a positive case. This is an incomplete testing protocol that is guaranteed to severely underestimate the number of cases in the state, because many positive cases of the disease often have few or no symptoms. These asymptomatic cases—when people feel healthy but are actually infected—spread cases to others in the community since these individuals continue with their normal activities. In the Italian town of Vo, which was an early hotspot for coronavirus 95% of the city's residents were tested. Among the 3% who were positive for the disease, the vast majority had no symptoms. Had those people continued going around town, attending to their normal work and personal life activities, each positive person would have caused between 2-3 new people to become infected.

We make four suggestions to all Oregonians in order to better protect themselves and others. The measures we outline below go beyond current recommendations from the Oregon Health Authority or the Centers for Disease Control.

1) If you are sick, do not go out. Stay in your home. If you are concerned you may have Coronavirus, call your doctor or a hospital. Do not arrive at a doctor's office, emergency room, or hospital without calling ahead since this could needlessly expose other people.

2) Even if you feel healthy, practice rigorous measures of social distancing. This means limiting public contact when at all possible. Work from home, have phone meetings rather than in person meetings, cancel all non-vital appointments. Cancel your plans in public spaces such as cinemas, theaters, pools, stadiums, or in large groups. Reschedule travel plans that require forms of public transportation or planes. When you are in public, aim to keep 3-5 feet of space between yourself and others.

3) Demand that schools be closed immediately and reduce the contact your children have with others through rigorous measures of social distancing. While children appear to be the age demographic that has the least complications from coronavirus, they are very effective spreaders of this disease.

4)    Practice good hygiene. Wash hands frequently and thoroughly with soap and try not to touch your face. After being in public, always wash hands or use hand sanitizer as soon as possible.

The steps above were recommended by the Italian government from the very beginning of the crisis. Many Italians did not believe these rules applied to them, and did not heed the message. Failure of compliance contributed to a growth in cases, and now the newly adopted measures will require us to remain in our homes for at least two weeks.

We sincerely hope that Oregon remains a part of the globe that is little touched by this disease. But we want to encourage all Oregonians to prepare themselves individually and collectively to protect the larger public's health.

Melissa Graboyes, Ph.D., MPH

Associate Professor of Medical History & African HIstory

University of Oregon

Alfredo Burlando, Ph.D.

Associate Professor of Economics

University of Oregon

Eleonora Redaelli, Ph.D.

Associate Professor of Planning, Public Policy, and Management

University of Oregon