Coronavirus Quick Takes April 3, 2020
April 3, 2020
Welcome to another day of Coronavirus Quick Takes. Today we’ll be answering questions about the novel coronavirus itself, known as COVID-19. Some of the questions may seem basic to those of you who have been following the news, but as there’s a lot of misinformation circulating around, we thought it would be useful to present what is currently known as of today.
How contagious is coronavirus? Despite how quickly it is spreading throughout the world, COVID-19 is no more contagious than the viruses that cause cold or flu. But there are two major differences that have allowed it to spread far more quickly: 1) As it’s a new virus, no one was immune when it first appeared; and 2) it has an unusually long window during which asymptomatic individuals can transmit it. This second point is very important. Not only can someone be infected and contagious for up to 14 days (or more) before developing symptoms, an unknown percentage of individuals may never become ill but still transmit the disease. This is why some sort of physical distancing will likely need to continue well after the various shelter-at-home orders expire.
How does coronavirus spread? There are 3 main ways, in order of frequency: 1) Direct personal contact, either by touching (e.g., hugging, kissing, handshake) or being on the receiving end of a cough or sneeze; 2) from inanimate objects that an infected individual has touched, the riskiest being communal surfaces such as doorknobs, elevator buttons and light switches; and 3) from airborne aerosols left by a cough or sneeze. While the latter appears to be uncommon, as these droplets are heavy enough to settle fairly quickly, it’s best to assume that airborne transmission can occur on occasion. However, spread through ventilation systems, as with Legionnaire’s disease, does not appear to happen.
What are the symptoms of COVID-19? The most common are fever, dry cough, fatigue and body aches. These are basically the same as the flu. As the disease progresses, some people can become short of breath and something under 20% will need hospitalization. A much smaller percentage require ventilator support. Other symptoms include sore throat, headache, loss of appetite and, what may be unique to this disease, loss of your sense of smell or taste. The latter can last long after other symptoms have resolved. A stuffy or runny nose is distinctly uncommon, though if you have this you could still have COVID-19 and another condition (cold or allergies). Note that the range of symptoms is very broad, from little or none to extremely severe, and that even young people become get quite ill from COVID-19.
How can I protect myself and those I love from coronavirus? We’ve all heard it: Wash your hands. A lot. Don’t touch your face. Cough or sneeze into your elbow or a tissue (that you throw out). Use sanitizer liberally on your hands and objects that you touch (don’t forget your phone). Keep at least 6 feet away from other people (more if either one of you is exercising). If you have any of the common symptoms listed above, but aren’t ill enough to seek medical attention, quarantine yourself for 14 days or until the symptoms are gone, whichever is longer (except for loss of your sense of smell). If you have reason to believe you have been exposed to COVID-19, quarantine yourself for 14 days, even if you never develop symptoms.
Are there any treatments for COVID-19? At present, treatment is primarily supportive for those who are hospitalized (IV fluids, respiratory support, treatment of secondary infections, etc.). While no specific treatment has yet been approved, there are several promising candidates. One is convalescent plasma taken from people who have recovered from COVID-19. Another is an antiviral drug originally developed for Ebola, remdesivir. These and other treatments are currently in clinical trials and hopefully one or more will prove effective. If so, it could be a game changer. Note that while hydroxychloroquine is also in clinical trials, it has not been shown to be effective, and can have serious side effects, including cardiac arrest.
What about face masks? We always found it curious that WHO has been recommending that most people not wear face masks. But the tide seems to have turned: California in particular is now encouraging their use. We’re not talking about N95 masks—let’s reserve them for healthcare professionals. But simple paper or cloth masks do have a role. While they aren’t terribly effective in protecting the wearer from those who are contagious, they are up to 70% effective in preventing transmission from an infected individual to others. At this point, it seems to make sense to start wearing a mask whenever you are in public, and it may soon be awkward not to do so. If you have a commercial mask, great. If not, you can make your own. There are directions all over the internet. Here’s one good article: https://www.vox.com/the-goods/2020/4/1/21203241/coronavirus-diy-face-mask-homemade-tutorials. It’s also important to “don and doff” the mask properly to avoid contaminating your face or hands, as well as to wash it daily or have at least 5 masks that you rotate. Here’s a great video on donning and doffing: https://www.youtube.com/watch?v=OABvzu9e-hw. And for more detail on using masks: https://www.washingtonpost.com/opinions/2020/04/02/not-all-heroes-wear-capes-many-wear-masks-you-should-too/.
Will the virus start to wane when the weather warms up? Many viruses, including influenza and other coronaviruses—including those that cause the common cold—are seasonal because they are sensitive to heat and humidity. It is certainly possible that the coronavirus that causes COVID-19 is also seasonal, but we just won’t know for sure until the weather warms up. We wish we could be more definitive on this.
We’ll continue to write Coronavirus Quick Takes periodically over the next few weeks. Please feel free to comment and ask any questions that come up.
Ken Waltzer MD, MPH, AIF®, CFA, CFP®
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