As the coronavirus pandemic continues, new questions about the virus and how to respond in our daily lives arise every day. We posed several of these new questions to Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University Feinberg School of Medicine. Dr. Murphy also is a practicing physician at Northwestern Medicine.
Q: What’s the best way to practice social distancing? Should people avoid public transit, ride shares, taxis? Should I go out to eat or drink at restaurants or bars? Is that considered a large gathering that may put me or others at risk?
A: This depends on the setting and host (patient/person). High-risk individuals (age 60+ years, underlying cardiac, lung, cancer, hypertension, diabetes, or other immune suppressive conditions/diseases), should limit contact as much as possible with other people. Basically, stay home.
Lower-risk persons should not shake hands, should wash hands frequently with soap and water or use hand sanitizer with at least 60% alcohol. You should also keep away from anyone who is sick, keep your distance from other persons (6 feet is recommended). Avoid rush-hour public transit and packed trains or buses. If a taxi or ride-share driver appears ill, get out of the car and seek alternative transportation. Avoid crowded bars and restaurants. As the situation worsens, like in Spain, restaurants/bars may be forced to close. Large gatherings should be avoided.
Q: Now that reports of confirmed cases of coronavirus are becoming more common in our area, what happens once someone has been diagnosed?
A: If they have few or mild symptoms, stay home and treat it like you have a bad cold. If ill, seek advice from your medical provider which could result in hospitalization, especially if you have any co-morbidities. (For instance, people with chronic lung, cardiac or kidney disease, those who have already weakened immune systems, who have had a transplant, diabetes, etc.)
Q: If schoolchildren are home because school is canceled, what are the best recommendations for parents? What activities are OK? Playdates with friends? Sleepovers? Doing online learning together? Studying at coffee shops?
A: Don’t let children play with anyone who is ill. Wash their toys and their play area periodically. Avoid kiddie parties, but a few healthy kids getting together is OK. Remember, kids get a much milder form of disease but they can spread it to adults, including those who are vulnerable.
Q: If my kids are off school and I have to work, should I be concerned about leaving them in the care of an older relative, like a grandma or uncle?
A: If everyone is healthy and not sick, this is OK.
Q: Many people have seen the graphic about “flattening the curve.” Can you explain this and discuss whether that is a helpful or accurate way to think about things?
A: The epidemic in the U.S. is growing exponentially (i.e., getting bigger fast). This will reach a high point or peak, then start to decline as public health measures begin to take their effect and/or the at-risk population becomes smaller through social distancing or they all get infected, get immune and no longer can transmit virus. It’s a typical bell-shaped curve with the top of the curve being the peak.
Q: If you have a confirmed case of coronavirus, then recover, is it possible to be diagnosed again in the future?
A: Probably not.
Q: Are there any precautions people need to take when purchasing fresh fruits and vegetables at grocery stores?
A: Wash your hands or use sanitizer after getting home, wash the fruit and vegetables like you usually do anyway.
Q: Is it possible to have influenza AND coronavirus?
A: It is highly unlikely to have both simultaneously.
Earlier in the week, we posed an initial series of coronavirus questions to Dr. Robert Citronberg, director of infectious diseases at Advocate Lutheran General Hospital in Park Ridge. Citronberg has been in practice for more than 26 years. Below is that exchange, which has been edited for length and clarity.
Q: How is coronavirus transmitted? What is the incubation period?
A: The incubation period can be anywhere from two to 14 days. The incubation period is the time between the acquisition of the virus and the time that you develop symptoms. The median time is about five days.
There are two principal ways to get it, and it’s important to understand both. The first is the more obvious, which is from droplets, when someone coughs or sneezes into your face. (Or within about a 3- to 6-foot radius.) If someone coughs or sneezes, the droplets fall right to the ground, so you can walk into a room a few moments afterward, and there will be no droplets in the air.
The more interesting and important method of transmission is contact. So even though the droplets fall to the ground, they may also fall on a tabletop and other surfaces, where they can live for at least several hours. So then say you touch that tabletop and then you touch your face, then you can actually infect yourself. I think the key to understanding this, the way to break the chain of transmission is 1) to not cough or sneeze directly into someone’s face 2) stay away from people who are coughing or sneezing 3) be really mindful about keeping your hands clean and washing your hands, using hand sanitizer, all the time.
Q: How long does the coronavirus live on a surface such as door handles, desks or countertops?
A: There are a lot of factors that go into it. It tends to live longer on hard, nonporous surfaces like metal. And we don’t know exactly how long; it’s probably at least a few hours. It doesn’t live as long on porous surfaces, and most of these viruses do not live as long or fare as well in higher temperatures and higher humidity. We do not yet know if this is the case with COVID-19. We don’t know exactly how long this particular virus lives on a surface, but if it’s alive on a surface, it likely can cause an infection.
Q: What exactly are “severe” symptoms?
A: The mild symptoms are body ache, maybe some fever and a cough. And those symptoms last for about a week. If someone has symptoms after a week or so, where they start to get worse, the cough gets worse, the shortness of breath gets worse, that’s a sign they may be developing more severe disease. The severe disease actually doesn’t start right away. Let’s say you have the virus and you’re really not feeling at all better or worse after a week, then you would be at risk for severe illness.
Q: Is there a cure for coronavirus, and if there is not, what exactly are medical professionals treating people with? And how long will it take to recover?
A: There is no cure, no drug. Unlike influenza, we have drugs that treat influenza. There are trials going on around the world.
The treatment is supportive care, by that I mean, IV fluids, medication, things to break your fever, to make you feel better, to support you and give your body a chance to heal. It’s a little frustrating because there is no drug you can get, but in many cases, supportive care is fine. Remember that about 80% of people with this coronavirus infection either have no symptoms or mild illness that doesn’t progress to severe illness. So supportive care actually is important. It prevents people from getting dehydrated.
Usually people who are sick, they recover within a week or so if they have the mild illness, up to about two weeks to feeling back to normal. And remember, some of these people, especially some of the people who are in isolation, people like on the cruise ship who are in quarantine, they have absolutely no symptoms. They tested positive but no symptoms. So it’s kind of hard to gauge when they’re feeling better because they never felt bad. But for the people who do get symptoms, usually about a week and up to two weeks when they could be feeling a lot better.
Q: My son is to participate in a national rugby tournament in the Chicago area on March 26. Is it safe for him to participate? I have spring break travel plans. Should I cancel them?
A: So I think essentially every big event or conference is likely going to be postponed. So I think that is going to be taken out of their hands. As far as travel for spring break, I think it depends a lot on where you are going. Domestically, I’m not really concerned. It’s still very safe to travel, you have to pay extra close attention to keeping your hands clean when you’re flying. The biggest risk when you’re flying, by the way, is what you get on your hands; it’s not what you breathe. Airplane air is actually quite safe to breathe. There’s no real medical reason not to travel domestically. Internationally is a different story.
The concern is that what if you get there, and the rules change and it makes it very difficult to get home?
Q: Similarly, is it a good idea to travel to Chicago for St. Patrick’s Day festivities?
A: Certainly indoor gatherings are more worrisome than outdoor gatherings. There’s more ventilation when you are outside, and you’re less likely to touch something that might be contaminated. There are concerns for people with risk of getting really sick — the elderly, people with chronic medical conditions, immunocompromised people — that they should stay away from large gatherings of any kind. I really can’t disagree with that. It may be a bit of overkill. But this is all out of an abundance of caution. But for the young, healthy person, to go to an outdoor gathering, I would still consider it safe.
Q: I have a medical procedure scheduled at a hospital that is treating coronavirus patients. Is it safe for me to go to the hospital for the exam, or should I postpone?
A: Yes, it is safe. People with these infections are contained in very specific areas of the hospital. The virus doesn’t go through the ventilation system, like into the operating room. There’s really no risk of that at all.
There is no reason to avoid elective surgeries. And honestly, the way things are going, every hospital is going to have a patient with coronavirus. We’re certainly nowhere near that yet, but we could be in the future.
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Q: Why are public health departments not testing more? Is it a problem of access to testing kits or something else?
A: It’s getting easier. Now private labs are able to do the testing. So going forward it should be much easier to get tested. Remember, it’s a double-edged sword. We want people who think they have a reasonable probability that they have the virus to get tested, but we don’t want what we call the “worried well” coming in in droves, like the average person who has no symptoms. There’s certainly not the capability to have everyone tested, nor should everyone be tested.
Q: Is the coronavirus considered to be more easily transmitted than the flu? If not, why the current panic?
A: It is transmitted by exactly the same mechanism as influenza, which is by the droplets, when someone coughs or sneezes directly on you, or contact. I would say at this point, with what we know, the coronavirus is more contagious because nobody has ever seen the virus before. It’s a new virus to our species, and so we don’t have any antibodies against it. With flu, we have antibodies from being exposed year after year, we have a flu vaccine, that probably makes it less contagious. Right now it looks like the coronavirus is more contagious. To be more technical, there is a number that we use for contagiousness of diseases, called the r0. If the r0 is 1, that means that each person with a disease is expected to give it to one other person ... so the higher the number, the more contagious it is. For background, influenza, like seasonal flu, the r0 number is about 1.3. Right now, as far as we know, the coronavirus r0 is about 2.2. So it is higher than influenza. But just to give you a frame of reference, the measles, which is among the most contagious of all viruses, that r0 is up to about 18.
There are still things we can do to limit the spread of this. We should focus on that instead of panicking. Because panicking doesn’t help anyone or anything.
It’s a little bit scary. It’s like the fear of the unknown. We don’t know anything about the virus so don’t have a specific drug to treat it, we don’t have a vaccine yet. We don’t know what it’s going to do. So that definitely is a little bit scary. In a couple of months, we’ll probably know a lot more about it.
This is not an existential threat to our civilization. This is not like the zombie apocalypse. I think that people have to focus on mitigating this. But this is not like a hide-under-your-desk situation.