Expert Responses
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(last updated 3/10/20)
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?
Will the Coronavirus be less contagious during specific times of the year, similar to the flu?
Could you be quarantined involuntarily oversees?
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?
Does the covid-19 test remain positive after recovery?
Is is true you have potentially found a cure?
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.