According to the World Health Organization, the somewhat severe disease known as coronavirus has infected more than 1.3 million people and killed more than 74,000 worldwide. Billions of people around the world are living in fear and want their questions answered. With that intent in mind, Blind invited five United States based-physicians in internal medicine and psychiatry to host an “Ask Me Anything“. The intent was to answer healthcare delivery and public health-related questions about COVID-19. We summarized all of our user’s questions into key topics to bring you the highlights of advice, knowledge, and information provided on the platform.
Disclaimer: The doctor’s responses are for informational purposes only and should not be used as direct medical care or advice. If you have specific questions or concerns about your current medical condition, please contact your own, local healthcare provider or report to the nearest emergency department.
Questions About Covid-19 - Key Learnings
Should you be wearing a mask when I go outside?
- “CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.
- “This recommendation was new as of yesterday, the reason being some people infected with COVID-19 can be asymptomatic or pre-symptomatic yet still contagious. Non-medical masks can help prevent these people from spreading the virus to others. It is not intended to protect yourself from others, the best thing for that is staying home as much as possible, stay 6ft or greater away from others when outside the home, wash your hands frequently, and avoiding touching your face.”
New information of transmittance of Covid-19:
- “Right now the best evidence (and the best assumptions for your safety and others!) is that COVID-19 is spread through aerosols, droplets, and on un-treated surfaces. This means it's spread through the air and can survive on some surfaces, such as metal and plastic, for up to 3 days.
- What does this mean? Social distancing and hygiene is super important.
- Because of aerosol and droplet transmission, its unsafe to be in the same room as someone who is infected (including those that are not showing symptoms yet). This is why social distancing is important.
- While standard face masks and cloth coverings are not 100% at preventing aerosol and droplet transmission, they do help reduce transmission.
- Because COVID-19 is stable on surfaces for up to 3 days, this is why washing hands and not touching your face is important. If you touch a contaminated surface you give yourself the virus by then touching your face, especially around your eyes, nose, and mouth.
- GOOD NEWS! Soap is super effective at killing the COVID-19 virus. That's why regular thorough hand washing is a great preventive measure.”
Lifetime of the Virus on surfaces and Asymptomatic patients:
- According to a New England Journal of Medicine study, "[COVID-19] was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel." Its ability to live on clothes, paper and food items are within a range of those studied, most likely. It is definitely recommended to wash and/or disinfect object surfaces, including after going to the grocery store. Granted, what is measured in the lab may differ from what is experienced in "real life".
- Finally, yes, asymptomatic carriers are definitely able to transmit the virus. Though this is speculation, a symptomatic patient coughing in a closed space next to you is likely more contagious than an asymptomatic carrier.
Who the virus effects most:
- “While the severity and mortality (risk of death) is likely higher in older people and those with other chronic medical problems, it has not been unexpected to affect young healthy people as well. I do not think there is concern for the virus mutating but more that we are just learning more and more about the virus with the increasing number of cases we can track. Playing basketball in a park alone would be ok in most locations with shelter in place orders but would be good to check with local or state restrictions. Just stay 6 feet away from others, don't share equipment with other people at the park, and wash your hands after playing and before touching your face!”
- “The psychological and financial effects of this I agree are truly devastating. However, COVID-19 is different from H1N1 in that there is more asymptomatic spread and unfortunately is requiring significantly more healthcare resources. Social distancing has been shown as an effective way to slow the spread of the virus and as of right now is the best strategy we have.”
When will it be safe to go outside?
- Safe is going to be the relative word here. Until we have a vaccine for COVID-19, or you know you've been infected and recovered, it's going to be necessary to use the same precautions we are doing today. Please follow the guidance of public health officials and not politicians when it comes to this issue. There will be an itch to return to normal when we're on the down-slope of the curve. Don't. That is going to be a period of a false sense of security and going back to "normal" can trigger a second surge; this happened during the 1918 Flu Pandemic.
Duration of quarantine
- “It is difficult to answer this and may vary between communities. Note that quarantine, isolation, shelter in place, and stay at home are all different. Quarantine is typically for people who are exposed to the virus whereas shelter in place/stay at home are orders for the general public. I would expect months of some type of restrictions in most places, but very hard to say.”
- “Some models predict that if social distancing is continued through May, then the first wave of the epidemic will be completed by June. However, stopping too early with social distancing can lead to a second peak of infections, which is what we want to avoid. Below is a visualization tool for the US and state by state showing estimated time for infections/resource use.”
Uncommon symptoms and self treatment:
- “There are cases of COVID where patients only have mild symptoms and experience loss of smell. People experiencing these symptoms should practice social distancing, quarantine at home, and hand hygiene.”
- There is no endorsed treatment for COVID at this time based on the lack of good data.
- “The majority of mild cases of COVID get better without intervention.”
- “Going to the hospital with mild symptoms risks exposing others and exposing yourself to more COVID virus. Additionally, the loss of smell resolves over time.”
- This answer varies significantly based on where you live and you should contact your local health systems. Different locations have different protocols on who to test. If you are having mild symptoms, it is better to self-quarantine and monitor for worsening symptoms. Knowing whether or not you have COVID19 will not change treatment and the best thing to do is self isolate. However if you have worsening symptoms (trouble breathing, chest pain, worsening cough), then you should certainly call your local health care providers.
- Call you state or local health department or a medical provider to determine what testing is available in your area and the criteria for testing (CDC)
- There are several websites now that have begun compiling these locations like, https://www.covid-19-usa-physician-app.org/testing
Exit strategy of the current shelter in place and normalcy
- “ I think once we start to see the curve flatten and the US reach its peak number of cases, more attention will be put to a safe plan to lift restrictions, with the understanding we will need to watch for additional surges following the loosening of restrictions.”
- “That very much depends on the trajectory of the virus. Testing is absolutely key to ramp up dramatically to get a sense of how prevalent the disease is. Best estimation right now is that less than 1/2 of the population will get infected with this current wave of the virus.
- That means that there are still millions of people who have the chance to get the virus after this wave has passed, which leaves the door open for exponential growth again if we relax these policies too quickly. The total cases need to be extremely low before these policies can be cut back because of this chance for exponential growth. Low to the point that we can still track individual cases as they come up and quarantine effectively.”
How else to help beyond staying indoors:
- “Thank you for asking! First let me just thank you for the sacrifices you are making by staying home to protect your community. Other suggestions include donating blood if able and contacting your local healthcare facilities to see if they are in need of any support such as masks”
Using malaria virus for COVID-19:
- “There has been discussion of a malaria medication that could be useful in treating people infected with COVID-19 but a preliminary study that showed a benefit is under scrutiny for poor protocols and so the potential for benefit is very uncertain at this time. However, the medication is being given to some patients with severe disease.”
- “Remesdevir: Investigated currently in hospitals doing clinical trials. In areas without clinical trials, they give this drug to patients as part of “compassionate use”, meaning patients are allowed to try it, but we haven’t gone through the rigorous process of understanding risks/benefits/efficacy.
- Hydoxychloroquine/Chloroquine: Has been shown to help in lab studies, but no human trials. Risks are present with taking this medication. There are some clinical trials open to household contacts of people living with someone who has been diagnosed with COVID 19.”
- “There are medications and treatments being actively studied to see if they can help and some of these are being used on many patients with severe disease however I do not feel there is enough data at this time to definitively say there is anything of significant benefit.”
- “Widely available vaccinations are predicted to be at least 12-18 months away. Convalescent plasma transfusions and hydroxychloroquine are both undergoing more advanced studies to determine if they could be helpful given some positive preliminary data. However there is not enough information to know definitively.”
Permanent lung damage in recovered patients:
- “My gut says probably most patients with mild disease will recover lung function but hasn't been ongoing long enough to know for sure. Patients who are admitted to the ICU for cytokine storm and septic shock for COVID 19 for any reason take a long, long time to recover. To me it is more of a question of: How sick were were your lungs during your illness? Really sick and in the ICU? I am guessing some damage was done. Not to sick/I'm a healthy 20 year old who was sick for a couple days and then got better? Nope, you're fine.”
- “I have not seen any studies directly looking at this question. However, it is plausible that patients who experience severe pneumonia and/or acute respiratory distress syndrome may experience permanent lung damage.”
- “Following up here, our best guide is what happened to patients with severe cases of SARS in 2002 since SARS is a close relative to COVID-19. Some SARS patients with severe disease have had some permanent impairment in lung function.”
Pregnancy and passing Covid-19 onto the born child
- We don't know definitively yet, but it doesn't seem like. As per the CDC, "No infants born to mothers with COVID-19 have tested positive for the COVID-19 virus. In these cases, which are a small number, the virus was not found in samples of amniotic fluid or breastmilk.".
Antibodies and testing:
- Though there are new tests rapidly becoming available, in general, antibody tests have a faster turnaround time than PCR (measuring virus load directly) test. These tests, however, can be falsely negative especially early in the course of the infection. If symptoms persist, it may be worth re-testing (with consultation by your own physician).
- I am unsure of the current national strategy for deploying a single type of test. But, I do support wider, federally funded testing, as that appears to have major benefits for controlling the spread of this sometimes severe disease (and its timely treatment).
Was the hysteria worth it? Is Coronavirus a severe disease?
- “‘we lose 2 million people a year in the US to heart disease, cancer, alzheimer's, accidents, and the flu. the world does not slow down for these causes.’
- These causes do not completely overwhelm global healthcare capacity the way COVID-19 does. Furthermore, if COVID-19 overruns all healthcare systems, there's no ability to treat heart disease, cancer, etc, causing those death rates to increase too.”
- "’I guess what I don't understand is, CDC says influenza is a viral respiratory infection that can lead to pneumonia, spreads through contact of surfaces and enters through eyes / nose / mouth. It sends millions of people to hospitals in the US per year and kills 50-60k per year.’
- And flu season is spread out over 8 months and we have a seasonal vaccine that reduces morbidity and mortality. COVID-19 is hitting all at once. Lets put it this way: McDonalds serves over 5 billion hamburgers a year, but if you roll up to a McDonalds and ask for 2 million hamburgers... it's not going to work. It has to do with overwhelming the healthcare capacity.”
Through all the uncertainties, we are full heartedly thankful for the healthcare workers on the frontlines battling the coronavirus. Through these responses, we learned that the stakes are high and the challenges innumerable. Yet, our doctors, nurses, technicians, transporters, EMTs, pharmacists, and everyone who supports patient care are rising to the occasion and caring for our most vulnerable populations. From everyone at Blind, thank you.
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