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Expert Responses

Our experts will be answering submitted questions, which you can find here. Please check back daily for added answers from the community's questions. 
(last updated 3/10/20)

Will Tennessee implement drive through testing so that patients do not have to go to a doctor office or ER, leading to potential cross contamination of staff and other patients?

Can the virus be transmitted by pets?

When can we expect a vaccine to be ready?

What is the difference in symptoms between the flu, the coronavirus and the common cold?

Could MERS and Covid-19 "crossbreed" in middle-east to create a virus that has long incubation period and high mortality rate similar to MERS?

Does wearing N95 masks protect one from being infected? If not, what should one do besides washing hands often and thoroughly?

Will the Coronavirus be less contagious during specific times of the year, similar to the flu?

Is the Coronavirus more contagious to specific groups of people or do all people have an equal chance of infection? I recently received an immune suppressing infusion. One of the side effects is "increase in infections." Am I at higher risk of catching this virus?

With the United States having confirmed cases now, should families cancel travel plans within the US? My family and I currently have trip to a state in which several cases have now been reported.

What is the procedure if you show symptoms? (Fever, cough, shortness of breath) What locations in the Memphis area have testing available?

Will traditional garb such as heavy scarves or the Arabian Keffiyeh protect against the coronavirus if masks are not available?

What impact, if any, is COVID-19 having on the pediatric population, specifically children under the age of 2? Are there any special precautions that should be taken for this population?

We share common areas of our office with another firm and do not have control over their travel. Should we be concerned?

Could you be quarantined involuntarily oversees?

How long can the virus live on surfaces? Your FAQ mentions mailed items, but what about items at the grocery store?

What should the general public be doing to prepare? Is it necessary to acquire 2 weeks’ worth of food and other supplies, 30 days’ worth of medication, etc.?

What level of exposure to coronavirus qualifies someone for quarantine?

What is the current age distribution of deaths due to novel coronavirus?

How up to date will you keep this page?

Since Memphis is a major hub for Fed Ex, and they are still flying planes to infected areas, is it possible that a freight handler in an affected area could have the virus, somehow pass the virus to cargo, the cargo lands in Memphis, is unloaded here, and those handlers come in contact with the virus, and it is transmitted to people in Memphis. Also are the pilots confined to their aircraft or are they allowed to enter a possibly infected area and bring the virus back to Memphis?

In light of current concerns in the US What advice is there regarding travel by air and hotel lodging for individuals over the age of 70 with underlying respiratory related issues?

Why are we not using O3/Ozone treatment with this virus when we can lysis the cell wall and effectively disrupt the virus and boost the immune system...especially if we are having to extend time to make an effective vaccine?

What do you think will happen to all the immunocompromised patients who have aids or on the biologics for arthritis or psoriasis?

Does the covid-19 test remain positive after recovery?

I have recently experienced a flu-like illness and am planning to return to work. Should I be tested for COVID-19 prior to return?

If the CDC allows a test for covid-19 how long does it take to get the results if it’s a swab or if it is blood?

If one has symptoms should they notify health facility ahead of time or go directly to the office or ER?

With the number infected with the Coronavirus and the morbidity and mortality similar to the common flu why is this infection considered such an important issue since it’s numbers are minuscule compared to the flu? You don’t see the same hysteria with the flu numbers that are much more significant.

Considering isolation precautions are not used initially when patients present to the hospital, what do you recommend healthcare workers who are pregnant or have underlying medical conditions do?

Should I fly if I (or my spouse or other relative) is over 60 and has chronic cardiac or respiratory conditions? (multiple similar questions)

If I have a patient with recent domestic flight travel from states with known virus and they present with flu like symptoms that test negative for flu etc. - how would I access testing if they aren’t badly sick (yet)?

Is it possible to have the common novel Coronavirus and it not turn into Covid-19? Are the test kits on the market testing for the novel Coronavirus or specifically for the strain Covid19?

Is is true you have potentially found a cure?

As an older person with allergies including chronic bronchitis what must I do to protect myself? I intend to wear a mask if I go out, what else can you suggest?

What are the symptoms of the Coronavirus? I have seen misleading things online. Just curious.

Answers


Will Tennessee implement drive through testing so that patients do not have to go to a doctor office or ER, leading to potential cross contamination of staff and other patients?

This is a very innovative solution that is being used in some other countries. At present, healthcare providers are being guided by the Centers for Disease Control and Prevention (CDC) and our local and State public health professionals. The process in place currently asks persons who are potentially ill with coronavirus due to a combination of a likely exposure (travel to an affected area or contact with a known case) and matching illness (fever, cough, shortness of breath) to call their healthcare provider, but not go there in person. A public health official (from the Shelby County Health Department) would then contact them and interview them over the phone or by video. If an infection is suspected, then the Health Department would send someone to the home to test them an ask them to self-quarantine by staying put. Once disease becomes widespread, however, this process will have to change. Hopefully we will have reliable testing widely available and can offer testing in a variety of settings that prevent a potentially ill person from infecting others, including healthcare workers. And maybe some of that testing can be in drive throughs!

Can the virus be transmitted by pets?

Different strains of coronaviruses infect many different animal species, but these viruses do not often cross species barriers and infect other animals. The SARS coronavirus and this novel coronavirus were both derived from bat viruses originally and then infected an intermediate mammalian host – likely civet cats in the case of SARS. Speculation about the intermediate source of the novel coronavirus currently centers on pangolins, an armadillo-like animal that is traded extensively on the black market because its scales are used in traditional medicines. Pangolins in the Wuhan market where the first human cases occurred tested positive for a very closely related coronavirus strain. So it is possible that this virus could further cross over into domestic pets or other animals, but it is very unlikely based on what we know at present. If it did infect cats or dogs, they would be an unlikely source of further transmission. Humans are going to remain the dominant source of further spread of this virus.

When can we expect a vaccine to be ready?

Vaccines are very, very difficult to make. We still do not have a vaccine for the SARS coronavirus, which first appeared in 2003. Scientists have been researching and testing vaccines for Respiratory Syncytial Virus (RSV) since the 1960s without success. Part of this is just the complexity of our immune systems and the many ways that viruses have evolved to evade them – it is difficult to generate strong, protective immune responses to some viruses. Part of this is lack of funding and interest from the US Government. In the 2000s when our government became interested in developing vaccines against avian influenza strains, a great deal of money was poured into this problem. Scientists here in Memphis, at St. Jude Children’s Research Hospital, developed a system to make vaccines quickly and safely – a new clinical grade vaccine can be produced in weeks, tested for safety and its ability to generate immunity at sites around the globe within months, and can be available in quantity to the public in under a year. We do not have anything approaching this infrastructure for coronaviruses because the funding has simply not been available. The good news is that efforts to generate vaccines against the SARS coronavirus are at least in early human testing, so if further funding is made available and those candidates are promising, the techniques might be adaptable to the novel coronavirus. The earliest I would anticipate a vaccine coming out of that process would be about 2 years – too late to avert a pandemic, but useful nonetheless. And it might take much longer than that.

What is the difference in symptoms between the flu, the coronavirus and the common cold?

Many respiratory viruses cause a spectrum of issues from upper respiratory tract symptoms (runny nose, congestion, sore throat, sneezing, coughing up mucus) to systemic symptoms (fever, chills, muscle aches, tiredness and malaise) to lower respiratory tract symptoms (cough, chest pain, shortness of breath). There is a large group of more than 200 viruses (including some human coronaviruses) that mainly cause the upper respiratory symptoms and are generally lumped together as the common cold. Some of these, like parainfluenza viruses and respiratory syncytial virus (RSV), may cause only colds in healthy adults but may cause pneumonia in babies and in the elderly. Influenza causes upper respiratory tract symptoms in most patients just like the common cold, but can also cause systemic symptoms and pneumonia in many other persons including healthy adults. The novel coronavirus is interesting in that very few (only 2-3%) patients have any upper respiratory symptoms – fever, cough, and shortness of breath or chest pain are the cardinal symptoms without the typical common cold presentation that is usually seen simultaneously with influenza. In summary:

  • Common cold: upper respiratory tract symptoms (runny nose, congestion, sore throat, sneezing, coughing up mucus)
  • Influenza: upper respiratory tract symptoms and systemic (fever, chills, muscle aches, tiredness and malaise) and lower respiratory tract symptoms (cough, chest pain, shortness of breath)
  • COVID-19: systemic and lower respiratory tract

Could MERS and Covid-19 "crossbreed" in middle-east to create a virus that has long incubation period and high mortality rate similar to MERS?

Some viruses, such as influenza viruses and rotaviruses, have what is know as “segmented” genomes where genes are coded on different strands of RNA. If two different viruses infect the same host, you can get some mixing of RNA strans when viruses assemble and a novel virus with genes from both could emerge. This is what happened with the 2009 H1N1 influenza virus from swine – it had genes from bird viruses, human viruses, and swine viruses. Coronaviruses do not have segmented genomes so would not be expected to do this. The virus can still mutate and likely will change over time as it adapts further to humans, but the general pattern for viruses is to get less deadly as they adapt, not more deadly.

Does wearing N95 masks protect one from being infected? If not, what should one do besides washing hands often and thoroughly?

N95 are often used by healthcare workers for protection from infectious agents. They are superior to surgical masks because they are more tightly fitted and are less likely to pass pathogens either around the mask or directly through. However, they require training and are not terribly effective in community settings. An N95 mask must be the right size and must fit tightly – in hospitals, healthcare workers are fitted and certified prior to wearing them. Facial hair may prevent a tight fit and make the mask ineffective. Masks do not cover the eyes, so infection by touching your eyes with contaminated hands can still occur, and if you contaminate the outside of the mask or contaminate your hands and reach under the mask to your mouth or nose you have lost any protection you had.

The best way to prevent infection is not to go near someone who is sick with the disease - avoid travel to areas of the world where COVID-19 outbreaks are occurring. If you are in areas with active disease outbreaks, then the best measures are to stay at least 6 feet away from anyone with symptoms, avoid close contact such as shaking hands, and practice frequent hand hygiene. The novel coronavirus can be killed on your hands or on other surfaces with normal varieties of soap, disinfectants, and alcohol solutions such as hand gels. Special disinfectants are not needed. Frequently cleaning your hands and being very careful not to touch your eyes, nose, or mouth without cleaning your hands are the best prevention if you are in an outbreak – better than even an N95 mask.

Will the Coronavirus be less contagious during specific times of the year, similar to the flu?

There are several factors that determine when a virus is more likely to transmit, and there are a lot of unknowns, even for well-studied viruses like influenza virus. We have obviously not studied the novel coronavirus in all seasons yet. Most seasonal influenza viruses transmit best in cold and humid conditions, so we see outbreaks in the winter in temperate climates such as is present most of the United States. In tropical countries, however, these viruses transmit year round despite the heat, and we can find influenza virus infections in the summer in the US if we look carefully. Viruses tend to transmit more easily if there are more susceptible hosts, and pandemic influenza viruses, such as the 2009 H1N1 strain, transmit well in the summer months as well as in winter. The major outbreak of the 2009 strain started in August here in Memphis. Based on this, we do not have any idea at present whether this virus will die down in summer months. SARS, a similar coronavirus, transmitted during the summer. The best guess of our UTHSC experts is that we shouldn’t count on it lessening the impact much or at all if the pandemic spreads here during the summer months.

Is the Coronavirus more contagious to specific groups of people or do all people have an equal chance of infection? I recently received an immune suppressing infusion. One of the side effects is "increase in infections." Am I at higher risk of catching this virus?

We don’t really know the answer to this yet, as it has not been widely studied across different groups and in patients receiving medications or therapies such as steroids, immune suppressants (like cancer chemotherapy or anti-rejection drugs), or monoclonal antibodies for auto-immune diseases. Many viruses do more easily infect and/or cause worse disease in persons who are immune-suppressed for one of these reasons. However, some infectious agents don’t seem to cause appreciably different effects. The best advice from UTHSC experts right now is to assume you are at greater risk, and be vigilant in prevention measures like hand washing and avoiding infected individuals. If the virus becomes widespread in Memphis, it may be worth in some specific circumstances discussing with your treating physician whether modification of therapy makes sense to reduce your risk for a period of time.

With the United States having confirmed cases now, should families cancel travel plans within the US? My family and I currently have trip to a state in which several cases have now been reported.

The CDC is recommending against non-essential travel to China, South Korea, Italy, and Iran at present (as of Sunday). Precautions are suggested for any travel to Japan, and other countries are likely to be added to these lists in the coming days. No travel restrictions have been placed on locales within the United States. The decision to travel right now, particularly internationally, hinges on a few factors. Can you even get there? Airlines are canceling routes as countries are added to travel restriction lists (although none have been canceled domestically as of now). Are you more likely to be infected? The virus is likely coming here to Memphis eventually, and at some point, it won’t make sense to avoid certain countries or US cities, as the virus will have spread across the United States and worldwide. It will continue to make sense to avoid locales with active outbreaks until personal or significant herd immunity is established.

Will there be anything to do if you do travel? Affected cities are shutting down tourist attractions, sporting events, bars and restaurants, and many businesses, so postponing your trip may make sense if there is an active and widespread outbreak. And perhaps most importantly, will you be stuck there? If you fly to a country or across the United States and an outbreak subsequently occurs, you might not be able to fly back or might be subjected to quarantines or other unpleasant delays. At present, travel within the United States should for the most part be as safe as staying in Memphis, but this could change rapidly. The decision to travel at present is a calculus in personal tolerance for risk.

What is the procedure if you show symptoms? (Fever, cough, shortness of breath) What locations in the Memphis area have testing available?

Since the novel coronavirus is not known to be circulating in Memphis yet (as of the first week of March), you are much more likely to have influenza than coronavirus at present. In either case, you should call your doctor as a first measure, and not go out in public where you might make others ill. At present, testing is only available through the Tennessee Department of Health. The procedure if you have the symptoms (fever, cough, shortness of breath) and have traveled somewhere where there is an active outbreak is to call your doctor, who, when appropriate will refer your case to the Health Department. The Health Department will then call and interview you by phone or video. If there is concern that you might have coronavirus, a Health Department worker would come to your house to test you and you would be asked to self-isolate at home. In the coming weeks, testing should become more widely available, and if the coronavirus begins to spread widely in Memphis, the process will likely change and diagnosis will take place in a variety of settings.

Will traditional garb such as heavy scarves or the Arabian Keffiyeh protect against the coronavirus if masks are not available?

The novel coronavirus can be killed on your hands or on other surfaces with normal varieties of soap, disinfectants, and alcohol solutions such as hand gels. Frequently cleaning your hands and being very careful not to touch your eyes, nose, or mouth without cleaning your hands are the best prevention if you are in an outbreak. Common surgical masks are probably modestly effective for a short period of time, but are not a reliable method for preventing infection. If a mask is uncomfortable, it may even be counterproductive by leading you to put your hands to your face more often. It is unlikely that scarves or other traditional garments that cover the face will have much impact on transmission of the virus, since most infections are through self-inoculation from your hands. The materials used to make scarves and wraps will not stop penetration of these viruses. However, there are no studies (to my knowledge) to assess whether behavior (touching the face) changes with wearing these garments in the setting of infection so it is unclear whether this would make transmission more or less likely.

What impact, if any, is COVID-19 having on the pediatric population, specifically children under the age of 2? Are there any special precautions that should be taken for this population?

At present, most of the data on the age of patients comes from cases in China, and children have not been reported to be severely affected. However, China’s one child family policy has restricted family sizes for the last few decades in that country, so the inter-familial dynamics of virus transmission may be quite different in other countries. Until more information is available from a larger set of countries, it would be premature to assume that children under the age of 2 are at low risk. The precautions for this group are the same as for anyone in an outbreak – avoid infected persons and keep their hands clean if they are mobile and touching potentially contaminated items.

We share common areas of our office with another firm and do not have control over their travel. Should we be concerned?

CDC provides general guidance for businesses and will update it periodically as the pandemic spreads. Among several recommendations, the most relevant advice is to actively encourage sick employees to stay home, and send home any employees who develop respiratory symptoms (cough, shortness of breath). Emphasize good hand hygiene and provide soap and water and alcohol based hand gels. Perform at least daily routine environmental cleaning of all surfaces in the workplace that are commonly touched, and employees may wish to wipe down commonly used surfaces (e.g., shared keyboards, coffee makers) before each use. If the neighboring firm has employees traveling to areas where there are outbreaks, you should probably ask that those persons don’t use your shared areas for 14 days after returning.

Could you be quarantined involuntarily oversees?

Yes, countries can impose quarantines on international travelers if they feel it is in the best interests of their people. If there is a chance you were exposed abroad, you could be quarantined in place, in a governmental facility, or banned from places like airports. The United States may also quarantine you upon return home – currently travelers who have been to China or Iran can only enter the US through certain airports, will receive health screens, and may be subject to monitoring or quarantine.

How long can the virus live on surfaces? Your FAQ mentions mailed items, but what about items at the grocery store?

Most respiratory viruses, including coronaviruses, can survive on surfaces for periods from roughly a half an hour to a few days. Exactly how long depends on the size / type of particle the virus is contained in, the humidity, the temperature, and characteristics of the surface. Most viruses of this type tend to survive better in low temperatures, in high humidity or wet conditions, and on rough surfaces. Larger droplets with more liquid probably mean longer survival. Of note, scientists have not tested the current novel coronavirus of concern for these properties; expert opinion is based on studies of other, similar viruses.

What should the general public be doing to prepare? Is it necessary to acquire 2 weeks’ worth of food and other supplies, 30 days’ worth of medication, etc.?

In the 1918 great influenza pandemic, some cities such as Philadelphia concealed information about the pandemic from the public. The city government of Philadelphia censored the newspapers, assured the public that everything was fine, and even scheduled large public gatherings and a huge parade to celebrate the war effort and defy those who expressed concern about the outbreak. Philadelphia was the hardest hit city in the nation, with hospitals becoming overwhelmed, public services breaking down, and so many deaths that the bodies remained in place for days before anyone could even find them – the city had to perform mass burials because there were too few morticians left alive and well to deal with the deaths. By contrast, some cities such as San Francisco spread information through multiple channels about the threat, mobilized the citizenry to spread proper personal hygiene techniques (including a campaign against spitting on the sidewalks), and urged people not to gather in public and to stay home if ill. San Francisco weathered the pandemic well and had some of the lowest death rates in the country. In 2020 in Memphis, the general public should be preparing to take the precautionary measures outlined on this website and other sites such as that at CDC when COVID-19 emerges here. It is doubtful to me that public order will break down as it did in San Francisco, so I don’t see a need for stockpiling food or other essentials. The one suggestion I have is to review supplies of critical medications and consider setting aside some extra supply – not because I am worried that businesses like pharmacies will shut down, but because we may see shortages due to production issues in China or logistics problems related to travel restrictions impacting distribution. Anyone interested in further reading on the 1918 pandemic and considering how different things are in 2020 may want to get a copy of New Orleans author John Barry’s The Great Influenza.

What level of exposure to coronavirus qualifies someone for quarantine?

There is, at present, a complex algorithm to determine level of exposure and define risk categories which can be found here. Essentially, symptomatic persons with reasonable evidence of exposure (close contact within a household, sitting within 2 rows of an infected person on a plane, recent travel from Hubei, China) are isolated, tested, and quarantined if positive. Persons deemed at high risk, but who are asymptomatic, are quarantined at home with daily monitoring by public health officials for development of symptoms. As the virus becomes more widespread it is likely that this algorithm will be adjusted or eliminated.

What is the current age distribution of deaths due to novel coronavirus?

These numbers are difficult to come by at present. The only place I have seen them being collated is on this website. Of note, this is not an official website from any governmental organization and relies on publicly reported information, so its accuracy is not confirmed.  

How up to date will you keep this page?

In general, we are updating the website daily on weekdays with some important updates on weekends. Most of the “ask the expert” questions are being answered within 24 hours on weekdays.

Since Memphis is a major hub for Fed Ex, and they are still flying planes to infected areas, is it possible that a freight handler in an affected area could have the virus, somehow pass the virus to cargo, the cargo lands in Memphis, is unloaded here, and those handlers come in contact with the virus, and it is transmitted to people in Memphis. Also are the pilots confined to their aircraft or are they allowed to enter a possibly infected area and bring the virus back to Memphis?

The CDC considers pilots and cargo handlers to be at low risk for contact with the virus and is not applying special policies to them at present. Should an airline crew member or worker become ill following travel, they would be assessed through the normal public health process by the Health Department responsible for the area in which the airport resides. FedEx has issued a statement confirming that they intend to comply with all recommendations of CDC and WHO and take precautions for their employees as warranted.

In light of current concerns in the US What advice is there regarding travel by air and hotel lodging for individuals over the age of 70 with underlying respiratory related issues?

CDC is currently recommending that, in addition to avoiding travel to Warning Level 3 countries (China, Iran, Italy, and South Korea at present) that older adults and persons with chronic medical conditions talk to a healthcare provider about their travel and consider postponing travel to Alert Level 2 countries (currently Japan). There are currently no recommended restrictions on domestic travel or to countries without travel Warnings and Alerts. CDC has issued guidance to healthcare workers on precautions to take in nursing homes and other long term care facilities.

Why are we not using O3/Ozone treatment with this virus when we can lysis the cell wall and effectively disrupt the virus and boost the immune system...especially if we are having to extend time to make an effective vaccine?

Superoxides, cold plasma, ozone treatment, ultraviolet light, and other germicidal modalities have been tested against many viruses and do exhibit killing activity against many of them. Some of these are utilized in niche industries, such as in treatment of wastewater. They have not come into common use in healthcare or household settings mainly because of commercial reasons – there is little perceived need for new treatments, standard disinfectants work fine at low cost, there are cost barriers to market entry, and most of these treatments are not patentable. Ozone therapy in humans has been tested but is not at a stage where it could become an FDA approved therapy any time in the near future.

What do you think will happen to all the immunocompromised patients who have aids or on the biologics for arthritis or psoriasis?

Most patients with HIV infection in the United States are now treated with highly active antiretroviral medications and have a normally functioning immune system, so are unlikely to fare any worse against with COVID-19 than the general public. This may be more of a problem in sub-Saharan Africa, where treatment is not comprehensive. Patients on biologics that feature some immune-suppression may or may not have increased susceptibility to infection with the novel coronavirus or experience worse outcomes with COVID-19, but we don’t really have any data at this point. At present, the best recommendation of UTHSC experts is to take personal precautions as are recommended for the general public, and discuss your ongoing therapy with your physician if you are concerned about specific issues such as travel to affected areas.

Does the covid-19 test remain positive after recovery?

The COVID-19 test currently in use detects the nucleic acid (e.g., RNA) genome of the virus and should be positive during the infectious period, but then should turn negative after the virus in eliminated from the body. With similar viruses, we often see a period (of days to weeks) after the acute infectious phase where the test remains positive but we think it is just the remains of inactive virus or its components before they are cleared by the immune system. In some cases, if the level of nucleic acid in the sample is right at the threshold of detection and repeated testing is taking place, a person can be positive, then negative, then positive again, clouding the picture. In a research setting, scientists will be able to detect the presence of antibodies to the virus in the blood for months or years after infection and determine who was infected in the past. These sorts of tests are not useful for determining current infection, however.

I have recently experienced a flu-like illness and am planning to return to work. Should I be tested for COVID-19 prior to return?

Return to school or work is a really complex question as we really don’t have much information right now about the infectious period and how it relate to symptoms. Standard practice for many diseases is that when the fever and other major symptoms are gone, school or work return is allowed. However, we know that with many virus infections the recently infected person may remain infectious to others for some time after symptoms abate, particularly in young children. So practice is inconsistent in some cases with what the science might tell us, or with what is practical in the real world. For COVID-19 at present, we really don’t have the testing capability to screen in this manner unless someone has already had a positive test and is being held in quarantine.

If the CDC allows a test for covid-19 how long does it take to get the results if it’s a swab or if it is blood?

The current test being used by CDC and state health departments is a molecular test to detect the genome of the virus (i.e., the RNA or nucleic acids). Currently only respiratory specimens such as throat swabs, sputum, and broncho-alveoalar (lung) lavage fluid are being tested – although there are blood tests in use for other coronaviruses such as MERS or SARS, these are not currently in use to assess for COVID-19. The test itself takes a few hours to do, but at present, the CDC estimates 24-48 hours to return a result because of the need for shipping, running multiple tests at once, and the general procedures of the laboratories involved.

If one has symptoms should they notify health facility ahead of time or go directly to the office or ER?

Currently, if you are worried about coronavirus you should not go into the public or to an Emergency Room or physician’s office. Instead, call ahead to your healthcare provider and discuss your symptoms with them. If they are concerned, you would be referred to the Health Department who would call you and take the next appropriate steps, including potentially testing for the virus.

With the number infected with the Coronavirus and the morbidity and mortality similar to the common flu why is this infection considered such an important issue since it’s numbers are minuscule compared to the flu? You don’t see the same hysteria with the flu numbers that are much more significant.

We struggle every year to get the public concerned enough about influenza to get their flu shot and to take appropriate self-protective measures, despite the seriousness of this infection and the 10’s of thousands of deaths in the United States alone. However, the public is used to influenza and has adapted to its annual circulation – it is a normal fact of life. The novel coronavirus is, in a word, novel, which means it will take some time to understand and adjust. I would caution, however, that we do not actually know the extent of morbidity and mortality yet for COVID-19 – about 3.4% of identified cases are fatal, which is 100s of times worse than influenza. It is likely that that number is overinflated by 10-100 fold since we are only testing a fraction of cases for infection, but it is still likely in the estimation of UTHSC experts to be worse, particularly in sub-groups like the elderly with chronic conditions, than seasonal influenza. Hopefully we will have better data from countries other than China in the near future and can develop better recommendations.

Considering isolation precautions are not used initially when patients present to the hospital, what do you recommend healthcare workers who are pregnant or have underlying medical conditions do?

Healthcare workers are clearly at higher risk for infection and perhaps for disease than the general public, despite infection control precautions being taken to prevent them. Part of this is increased frequency of exposure, and part is due to the type of exposure – aerosol generating procedures like bronchoscopy and intubation likely deliver a higher dose of the virus. Each hospital will have specific policies for healthcare workers, so at the outset, make sure you know the policies at your institution. Pregnancy is a special situation. We know that pregnant women are at increased risk for lower respiratory tract disease and death from influenza and from the SARS and MERS coronaviruses, and influenza is a common cause of spontaneous abortion. The most important thing a women can do to protect herself from viral infections if pregnant or planning to get pregnant is to get the flu shot, which is safe and effective during pregnancy. We do not at this time have any information on the novel coronavirus infections in pregnancy, so it is unclear whether similar risks exist. Since antiviral prophylaxis against COVID-19 is not available at this time, the only additional measure that a hospital could take would be exempting pregnant healthcare workers from caring for patients with COVID-19 or limiting the scope of their care (e.g., no aerosol-generating procedures). However, the problem of unknown infections and exposures would remain.

Should I fly if I (or my spouse or other relative) is over 60 and has chronic cardiac or respiratory conditions? (multiple similar questions)

Most deaths are in persons over 60 with chronic medical conditions. The CDC currently advises persons in this category to consult with their doctor prior to flying to have a more nuanced discussion of risk. At this point, many physicians are recommending avoiding travel to areas with active outbreaks to decrease risk of infection and possible complications. As COVID-19 becomes more widespread in Memphis, the rationale for this will become less powerful since you could be infected here as easily as away from home, and the decision will rest on factors like: does my insurance cover me in another country? Is there a risk that I will become stuck away from home due to flight cancellations, quarantines, or new travel restrictions? With many businesses and public events being cancelled, will the purpose of my trip still be valid (e.g., tourism, business meetings). Travel at present is a calculus based on tolerance for personal risk and the resources to handle potential delays and disruptions in travel.

If I have a patient with recent domestic flight travel from states with known virus and they present with flu like symptoms that test negative for flu etc. - how would I access testing if they aren’t badly sick (yet)?

With the novel coronavirus now circulating in Memphis, healthcare providers are asking what to do with potentially infected patients and how to access testing. First, recommend that patients call ahead and not come into the office or go to the ED if they have symptoms suggestive of influenza or COVID-19. If they have an illness compatible with influenza, then influenza testing with proper precautions is the first thing to do – a positive result makes COVID-19 very unlikely. At present (second week of March), testing is only available through the Tennessee Department of Health. The procedure if a patient has the symptoms (fever, cough, shortness of breath) and has traveled somewhere where there is an active outbreak is to refer the case to the Health Department. The Health Department will then call and interview them by phone or video. If there is concern that they might have the novel coronavirus, a Health Department worker would go to their house to test them and likely would ask them to self-isolate at home. In the coming weeks, testing should become more widely available, and if the coronavirus begins to spread more widely in Memphis, the process will likely change and diagnosis will take place in a variety of settings including hospitals and perhaps some clinics. Once the influenza season is over and the outbreak is widespread, testing will likely not be needed as the clinical syndrome will be sufficient for diagnosis.

Is it possible to have the common novel Coronavirus and it not turn into Covid-19? Are the test kits on the market testing for the novel Coronavirus or specifically for the strain Covid19?

There are several common human coronaviruses which cause the common cold, and in some cases, pneumonia in small children (e.g., coronavirus OC43). In the last 20 years, three new coronaviruses have emerged from animals which cause severe pneumonias – SARS, MERS, and the novel coronavirus (technical name SARS-CoV-2). The severe lower respiratory disease syndrome caused by the novel coronavirus that emerged in 2019 is called COVID-19, which stands for COronaVIrus Disease in 2019. The novel coronavirus can cause inapparent and mild infections, which would not necessarily be termed COVID-19. Currently, testing for common human coronaviruses (like CoV OC43) is not done routinely because of the cost and the mild disease they cause. The new test that has been recently developed for the novel coronavirus and COVID-19 is specific for that strain, and will not detect common human coronaviruses.

Is is true you have potentially found a cure?

A recent article about our work at UT had a headline suggesting we have found a cure. That is premature at this time; we are testing a number of drugs in the UTHSC RBL that have activity against coronaviruses, and are starting to work with other companies and individual scientists who have similar drugs. Because the path to bring a new drug to market is typically years, any potential cures that come out of this work are unlikely to impact the current pandemic.

As an older person with allergies including chronic bronchitis what must I do to protect myself? I intend to wear a mask if I go out, what else can you suggest?

Allergies should not be an issue, but chronic bronchitis puts you at risk for poor outcomes if you were to be infected with the novel coronavirus. The only current advice is to avoid others who might be sick, and wash your hands frequently and before touching your face. Once the virus becomes more widespread, it might make sense for elderly persons with chronic heart or respiratory disease to stay home as much as possible. To prepare for this possibility, make sure you have a good supply of any necessary medicines at home and any other essentials you might need. Also, I would try to make household plans for what you would do if a home caretaker were to become sick or for who would care for you were you to become ill.

What are the symptoms of the Coronavirus? I have seen misleading things online. Just curious.

From our current data, the most common symptoms are fever, cough, and difficulty breathing or shortness of breath (all in more than two-thirds of patients). Symptoms of the common cold, like runny nose, sore throat, itchy eyes, and congestion are only seen in 1-2% of patients.

Last Published: Mar 12, 2021