SBU Infectious Disease Physician Answers Common COVID-19 Questions

SBU Infectious Disease Physician Answers Common COVID-19 Questions

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Image from CDC

By Leah Chiappino

Dr. Sharon Nachman, chief of Division of Pediatric Infectious Diseases at the Renaissance School of Medicine at Stony Brook University. Photo from Stony Brook Medicine

The physical, emotional and financial strains that COVID-19 has thrust into our lives has left the average person physically and emotionally exhausted and overwhelmed. There has been a plethora of information for the public to absorb, and it can be bemusing. Dr. Sharon Nachman, chief of Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, answered some general questions about the spread of COVID-19, the future of the pandemic and how we can all stay safe as restrictions are lifted.

Can you explain how COVID-19 spreads?

COVID-19, like other respiratory viruses, spreads from respiratory secretions. However, it also spreads by touching things that are recently contaminated with respiratory secretions and then touching your face. So, if you sneeze on your hand and touch the doorknob, and if I come by and touch that doorknob and then touch my face, I will spread infection. If you touch the doorknob and don’t touch your face, because say you were wearing gloves and disposed of the gloves, it is unlikely that you will pass infection from your hand, which is clean, by touching the doorknob.

Most of us, when we are around someone sick, think opening a window or being outside with them will help to prevent us from being infected. However, the general public has been told to wear masks or to social distance even when outside. Why is this?

The idea behind social distancing and wearing masks is cutting down on how much virus theoretically could pass from somebody talking, sneezing or breathing onto another person. The idea of being outside is that there is good air exchanged. You’re not in a closed room, and by keeping 6 feet distance, even if I’m talking loudly and I am getting some virus in my breath, and it’s passing out of my mouth, it’s not getting close enough to you. It’s important to realize there are measures for the population with the idea being, we don’t know who was infected, who is at risk for getting severe disease or has underlying issues. It’s the blanket protection for everybody.

There have been some conflicting reports on whether or not the virus can be spread in fresh air after the virus was found in stool stamples. Say somebody is walking down the street and sneezes and the next person is walking down the same street. Are they at risk? Do you believe that the virus is airborne?

We know the virus is a respiratory pathogen. What you’re referring to is some people have looked at studies of stool and found pieces of virus in stool. How did it get there? Was it a virus that you swallowed? Was it a virus that went into your GI [gastrointestinal] tract and excreted out from your stool? There are lots of different hypotheses. No one is saying that the virus that they found in stool is replicating virus. No one is saying that when they took that virus and put it into a viral media, it grew.

PCR [polymerase chain reaction] testing is testing for snippets of the virus’ DNA, or in this case RNA [ribonucleic acid]. It’s a good way of saying there was virus there, but it doesn’t translate into “that virus is contagious.”

Can you explain how a facial mask helps to slow the spread of the coronavirus?

A facial mask is a great barrier between you and the next person. If I’m wearing a mask, and I am infectious and I breathe into my mask, the facial mask is a barrier to prevent the virus from getting past the mask to the next guy. If I am infectious and wearing a mask and you are wearing a mask, the virus is [in theory] not passing my mask. If potentially, the virus is passing my mask, but you are wearing a mask and standing 6 feet away, none of the virus gets from the air to you and from the mask into you. This gives multiple layers of protection. One layer is I have the mask on, the second is we’re standing 6 feet apart, and the third is you’re also wearing your mask.

Why is the recommended distance 6 feet?

There are lots of interesting studies that have looked at how far these size droplets can spread. Every virus has a storybook to it. A viral particle that is a little heavier, spreads a shorter distance. A viral particle that’s a little lighter can spread out in the airwaves even further. The measles, for instance, can spread up to 60 feet away, and even after you go out of a room, it is still floating around in the room a couple of hours later. This virus is a bit of a heavier a particle, so it drops down quickly and doesn’t stay in the air.

Can you explain how someone who is asymptomatic can spread COVID-19?

Symptoms and having virus in your nose are not a one-to-one relationship. For example, let’s say I have the flu. I may have a little bit of a runny nose, or nothing, but I go to work and give all of my colleagues, who I’m breathing close to, the flu. They don’t know where they got it from because they look at me and say, “You had no symptoms, of course you came to work.” COVID-19 is the exact same scenario. We have lots and lots of people who have been infected by the virus and have no idea that they were infected because they are in fact well. This is true for children, as well as adults. More often children are asymptomatic, but we have seen quite a few adults that we’re getting positive testing for that say, “I don’t know what you’re talking about. I feel fine. I never lost my taste of sense of smell and taste. I never had a runny nose. I never had a cough, and I certainly never had a fever. Asymptomatic just says to you, “Good news, you got this infection and it’s sitting in your nose,” but it does not correlate with how sick you are.

What is the extent that you think the number of deaths would have been higher if stay-at-home and social-distancing orders weren’t put into place and why?

I can’t calculate that, but I can tell you it would have been extreme based on the number of people who came into the hospital who had no underlying immune issues, and they had no reason to think they would ever get hospitalized. Those numbers were high. We expect to see patients that have multiple comorbidities [additional conditions]. When they get a respiratory illness, we’re not so surprised. We did see more of them then I would have expected, but what we also saw is absolutely young, healthy adults, who in their lives have never been to a hospital. They take no medication. They are perfectly well, and they also got COVID and came in. I’m scared to think of how much worse this could have been because it was really pretty bad.

Do researchers believe this is the type of virus that once you get it or are given a vaccine you’ll be immune, or will it be like a herpes virus that it hides in the body and can be triggered in the future? Or will this be like the flu where it will be advised to get a new vaccine every year?

The answer is that I don’t know. Anything I say would be complete guesswork because I really don’t know. It’s more important to say, “I don’t know” then to put out ideas that I don’t have a basis to stand on right now. I think that we need the time. We need to put the work in, and then we need to look back and ask, “What did that change? What changed? How did it change?” I’d prefer to be cautious.

We hear about viruses mutating and sometimes they can reappear and infect people worse than before. What are your feelings on a second wave of the virus? Is it possible to mutate and be weaker than before?

We need the time to find out. These are just guesses. Do I think there will be a second wave? I’m certainly cautious that there might be a second wave. When will it hit? I don’t know. What are the background demographics of who will get it and how sick they will be? Again, we don’t know. We have to think about it. We have to be looking for it. We have to be in close observation of populations across the country for it. We need to be prepared for what we are going to do if it does happen.

Many historical accounts suggest that after the 1918-19 Spanish flu, society permanently altered. Do you foresee permanent societal changes, such as eliminating handshaking, post-COVID-19?

Every year society changes. It’s both big and little things, from cellphones to pandemics. I think this will have a big impact, but we are still too close to understand what it will be.

As the warmer weather hits and restrictions are lifted, people will be eager to get out. Is it safe to go to the beach or a friend’s house?

With warmer weather, it will be nice to be out. I hope people do continue to maintain social distancing. I think over the summer some families may decide to cohort together, after they are tested to prove that their behaviors are acceptable. Getting tested would be the gold standard, but we also need to think about ongoing risks like going shopping vs. staying isolated for the days and weeks before mingling. A fourteen-day isolation period would be keeping in line with the guidance that is out there.

How does a virus like COVID-19 change into an inflammatory syndrome that has been seen in some children? What symptoms should parents be aware of regarding their children? Are there any extra precautions parents should take to protect their children?

I think that the book of what that syndrome is has not been written. I think we’re all cautious. The best first line of defense is if a parent thinks their child has unusual signs and symptoms, they should start with their pediatrician or family doctor. They can say exactly what is going on with their child, how they are looking, and then step further. I think running to the emergency room when all [the child] has is a fever or no symptoms is probably not appropriate at this time. We don’t know. Is this syndrome only with COVID-19? Is it after getting better from COVID-19? There are too many unknowns. People, including the Centers for Disease Control and the World Health Organization, are looking at these cases. I think we’ll have more information in the next month. We are thinking about it, we are working [on it], and we are very cautious with these children, because they are quite sick. However, the vast majority of kids who have had COVID-19 have been asymptomatic or had a mild illness that is nothing like this inflammatory illness. I think the inflammatory disease strikes the very, very few. We don’t know why. We’re trying to understand exactly when it hits, who it hits and why it does so.