What is the new coronavirus? Why is it so hard to get tested? Once I recover, am I at risk to get it again?
Paul Biddinger, MD, director of the Massachusetts General Hospital Center for Disease Medicine and Rochelle Walensky, MD, MPH, chief of infectious diseases at Mass General and Steve and Deborah Gorlin MGH Research Scholar, sat down on Saturday, March 21st, to answer these and other pressing questions about COVID-19.
Check out the video or read the transcript below:
Rochelle Walensky, MD, MPH: The coronavirus as we believe emerged from bats. Most coronaviruses come from bats. Probably jumped from bats to another animal before it comes to the human. The viruses generally cause a spectrum of diseases from very benign diseases like the common cold to more severe diseases like MERS, SARS and now COVID-19.
Paul Biddinger, MD: In order to protect yourself, it’s really important to try and not have your eyes, your nose, your mouth exposed to the droplets with coronavirus.
That means being very aware of touching your face. It means washing your hands thoroughly, more than 20 seconds each time with soap and water, and it means covering your cough if you yourself are ill. Try and stay six feet away from other persons and avoid people who appear ill.
Dr. Walensky: We know that people can present with actually no symptoms at all, whereas some people can get quite sick with the disease. About 80% of people have mild to moderate disease and do quite well at home. Another 15% will require hospitalization and an additional 5% will require critical or ICU level care.
We know that people tend to do poor with the disease if they are elderly, over 70, if they have immunocompromising disease, cardiovascular disease, liver disease, or other chronic lung disease.
Dr. Biddinger: We’ve learned how we can do our best to make sure that our healthcare resources are available for patients who most need them. We’ve learned that it’s safe to stay at home for patients with fever and mild symptoms, and we’ve learned that patients should come to the hospital if they have chest pain, trouble breathing, or severe dizziness.
We’ve also learned how to protect our hospitals and our healthcare workers and make sure that we can surge in our abilities to care for patients with intensive care needs such as needs for a ventilator and other critical care resources.
Dr. Walensky: The test is actually quite a simple test. It’s a swab that goes in your nose and in your mouth to test for the virus. Once that test is done and is sent to the lab and we look for virus in the lab. The turnaround time can be as short as several hours to a day or two, depending on where the test is done. The test can be conducted really in any site, not necessarily needs to be in the hospital.
As of March 21st, we still have some testing shortage, and we’re really encouraging people to only get a test if they are symptomatic. If they are symptomatic and they test positive, we can use that information to understand how people should be isolated.
Dr. Biddinger: We know for a fact that social distancing saves lives. It protects the lives of those who are most vulnerable, including those who are older, as well as those with chronic health conditions. But it takes every single one of us to participate in social distancing in order for the strategy to work.
I know especially young people may not feel that they are vulnerable and may not be as willing to socially distance. But parents, please tell this to your children and for those who are younger listening now, understand that we all have to play our part for this response to work.
Dr. Walensky: The coronavirus has varied similar symptoms as the flu with fever and cough. But when we talk about how the coronavirus is spread, it’s very different than the flu for two important reasons. First, the coronavirus is actually about twice as infectious as the flu. Secondly, we actually don’t have a vaccine for the coronavirus where we do for the flu, and 50% of people get vaccinated for the flu every year.
Taken together, you have both a more infectious virus and no immunity in the population from vaccination, which is why it’s so important that we take the measures we’re taking.
Dr. Biddinger: There is no way to know for certain how long this outbreak will last, but we can look to history for some guide. In previous influenza pandemics, including the most severe pandemic in 1918, the waves tend to last about two to three months, and that’s actually about what we saw in China.
No one can make a prediction for certain, of course, but we’ll know when things are starting to get better when we see the rates of new cases beginning to decline.
Dr. Walensky: That question very much depends on who you are. If you are planning on staying home with a cough and fever anyway, you’re likely do quite well and what you should do is self isolate and make sure you protect your family from getting similar symptoms.
However, if you’re at high risk, somebody over the age of 70 with immunocompromising diseases, cardiovascular disease, diabetes, chronic lung disease, then I would urge you to reach out to your primary care provider and see if they can arrange a test for you.
Dr. Biddinger: I understand why people have concerns about traveling, but some people certainly have to travel for personal or other reasons.
Airplanes are not nearly as concerning as many people may fear. In fact, the air exchanges are sometimes more than even a hospital has and really the risk of infection is limited to about two rows in front, two rows behind, and two seats to your left and right.
But when you’re out in public, whether it’s in a train or in an airport, make sure that you wash your hands frequently, you’re careful about the surfaces that you touch, and you try and maintain a distance of six feet or so between you and other people whenever possible.
Dr. Walensky: We generally keep people in self-isolation after being diagnosed with COVID-19 for around 14 days to ensure that when they come out of isolation, they’re not contagious for other people. That’s a critical control mechanism for the disease.
We don’t know actually if you can get COVID-19 again, but we believe not, and there are active studies examining this question.
Dr. Biddinger: When a new virus like COVID-19 enters a community, all it sees is opportunity because none of us is immune. However, as more and more people are infected, more people become immune and it gets harder and harder for the virus to be transmitted.
In addition, when we practice good social distancing, we take away the opportunity for the virus to be transmitted. Between that social distancing and growing immunity, ultimately this outbreak will collapse under its own weight and we will get through this wave.
Dr. Walensky: We are hopeful that things will improve with coronavirus as the warmer weather comes. We know that other coronaviruses, like the cold viruses, do get better over the summer, as does influenza. There are three important things that we’re watching.
First, by the time summer comes, a lot of people will have already had the disease and will be immune. The second is human behavior. Many people gather inside in the winter and yet outside in the summer and that will help decrease the spread. Then finally, we believe people’s immune system is quite a bit better over the summer.
Dr. Biddinger: What we know is that more than 80% of cases of COVID have mild illness and people don’t need to see their doctor or come into the hospital, but everyone should watch for their symptoms.
If you feel like you’re having increasing trouble breathing, if you have pain in your chest, if you feel very dizzy or you’re too weak to eat and drink effectively, then call your doctor or come into the emergency department, but call first.
Dr. Walensky: We don’t know if the coronavirus will come back after the summer into the fall, certainly the 1918 flu pandemic did re-emerge after the summer, and we need to be vigilant. There are three important factors that we’re going to be looking at.
First, we hope that patients who have had the disease already will be immune and that will help person to person transmission. Second, we’re hopeful that we’ll have a lot more tests. We will be able to scale up testing broadly, and that if you have the disease, you can self-isolate quickly. Third, we’re hoping that science will emerge so we will be better informed on how to best treat the virus.
Dr. Biddinger: On behalf of Dr. Walensky and myself, we would very much like to thank you for watching. We hope that we have been helpful to you in providing answers to some of the questions we know that you have. We know that in these challenging times, people want answers to help them understand what’s happening.
Dr. Walensky: I’ve spent my entire adult life learning, studying and being on the frontlines of infectious diseases. These are scary times, but we will get through it. There are legions of providers and healthcare workers out there working for you. Thank you.