March 20, 2020 – Florida Atlantic University’s Terry Adirim, M.D., M.P.H., M.B.A., chair and professor of pediatrics, Integrative Medical Sciences Department, and senior associate dean for clinical affairs, Schmidt College of Medicine, provides answers to some of the most frequently asked questions regarding coronavirus (COVID-19). Adirim is a physician executive with senior leadership and executive experience in academic medicine and the federal government. Prior to joining FAU, she served as principal deputy assistant secretary of defense for health affairs for the United States Military Health Systems, a $50 billion complex acute care delivery system that serves 9.5 million beneficiaries. Her expertise includes pandemic planning and response, health care quality improvement and patient safety, and health policy and management.
Who is most at risk of serious disease and death by COVID-19?
The U.S. Centers for Disease Control and Prevention (CDC) defines those at higher risk of serious illness from coronavirus infection as older adults (people over age 60) and people with serious chronic medical conditions like heart disease, diabetes and lung disease. Older adults, especially over age 70 have the highest risk of death from COVID-19.
Specifically, those at higher risk of serious disease includes anyone of any age with the following chronic medical conditions, but especially people over age 60:
•Heart disease such as congenital heart disease, congestive heart failure, coronary artery disease
•Blood disorders such as sickle cell disease
•Chronic kidney disease such as people on dialysis
•Chronic liver disease such as cirrhosis and chronic hepatitis
•Any condition causing compromised immune system such as undergoing cancer treatment, status post organ or bone marrow transplant, taking high doses of steroids or other immune suppressant medications, HIV/AIDS, inflammatory bowel disease, rheumatoid arthritis and lupus.
•Endocrine disorders such as diabetes/metabolic disorders such as mitochondrial disease
•Lung disease including significant asthma, chronic obstructive pulmonary disease (COPD) or any other condition causing impaired lung function (e.g. requires oxygen)
•Neurological/neurodevelopmental conditions such as spinal cord injuries, stroke, Multiple Sclerosis, etc.
•Pregnancy or postpartum within the first month (note early studies have shown that pregnant women who have been infected have done well, mild illness, but the numbers were small)
There also is some evidence that people who are smokers or former smokers are also at higher risk for serious disease.
Did this virus really originate from a bat? How did it wind up in humans?
It is not certain right now exactly where the virus has originated. COVID-19 disease is caused by a coronavirus called SARS-CoV-2, which is similar to the SARS coronavirus that first emerged in China in 2002, which caused severe respiratory disease in humans. That outbreak emerged after human contact with civets. The later MERS outbreak in the Arabian Peninsula in 2012 was associated with camel to human contact. While the current coronavirus, causing the worldwide COVID-19 pandemic, is very similar to a bat coronavirus, there has been no documented cases of direct bat to human transmission and so this suggests that there was an intermediate host between bats and humans. However, we do not have the answer yet.
Will social distancing really make an impact? How long before we know it is working?
We are learning from other countries about the behavior of the virus and whether community mitigation measures are working. In Singapore, for example, they aggressively tested their population and anyone positive for coronavirus; they traced who they were in contact with and quarantined the people exposed while isolating people who were positive on the test in isolation hospitals. They also were prepared because they were hit with SARS in 2002 so they knew what to do. Also, their government took an “all government” approach and were very well coordinated in their response. Clearly, social distancing was a key part of their response and they only had 266 cases and zero deaths. Social distancing is the only way we will keep the numbers of patients below our health care system’s capabilities.
What are the key symptoms that I need to be aware of for COVID-19?
The CDC says that people infected with coronavirus can have mild to severe symptoms and may have fever, cough and shortness of breath. Other reported symptoms include sore throat, fatigue, runny nose and aches. There are also reports of people having vomiting and/or diarrhea. There are also reports of people having the infection and not being sick, so they may not have had fever.
Do you always get a fever with COVID-19?
There are reports of people having the infection and not showing signs of illness. The CDC says that people infected with coronavirus can have mild to severe symptoms and may have fever, cough and shortness of breath. Other reported symptoms include sore throat, fatigue, runny nose and aches. There are also reports of people having vomiting and/or diarrhea. There are also reports of people having the infection and not being sick, so may they not have had fever. As this pandemic evolves we will know more.
How is this different from the H1N1 pandemic?
The COVID19 pandemic is very different from the 2009-H1N1 pandemic primarily because they are caused by two different viruses. The virus causing COVID-19 is caused by a coronavirus called SARS-CoV-2 whereas H1N1 is an influenza virus. While both viruses were “novel” to humans, meaning no one had been exposed to the viruses so they did not have immunity to them, H1N1 caused mild disease whereas SARS-CoV-2 causes more severe disease.
Importantly, for the 2009-H1N1 pandemic, we had the capability to more quickly develop a vaccine since we have done this for influenza annually and therefore we were able to get vaccines to people during the first wave. For COVID-19, we have to develop a vaccine for a new class of virus and then ramp up the capability to manufacture, which means 12 to18 months to get the vaccine into the arms of people.
What are we supposed to use to treat our symptoms? What about over-the-counter medications to alleviate symptoms?
Unfortunately, right now we can only recommend supportive care such as fluids, throat lozenges, cold medicines and Tylenol. Very importantly, people suspected of or confirmed to have COVID-19 must isolate themselves for 14 days from the beginning of the illness. For fever, body aches and sore throats, Acetaminophen (e.g. Tylenol) can help. Cold preparations can help runny noses.
Is it true you should not use anti-inflammatory medications to treat COVID-19?
We do not have any evidence, yet, that anti-inflammatory medications such as Ibuprofen cause harm in people with COVID-19. There is some thought that Ibuprofen (Advil, Motrin) triggers certain cell mechanisms that can cause more severe disease. If someone is concerned, then you do not have to take Ibuprofen for fever or aches because Acetaminophen (Tylenol) should work just as well.
How far can the virus travel when someone sneezes or coughs?
People should remain 6 feet apart in order to ensure that they are not exposed to someone who sneezes or coughs.
Does wearing a mask really make a difference? What about goggles?
People who are not sick do not need to wear a mask. It will not help from getting infected since the virus is thought to more often be contracted through contact as opposed through the air. According to the CDC, the virus is most likely to spread from person-to-person through close contact and respiratory droplets from coughs and sneezes that can land on a nearby person’s mouth or nose.
Only people who have a high-risk condition such as immune suppression and must go out should consider wearing a mask. Masks are very important for health care workers because they have a higher number of contacts with sick people. Goggles are also important for health care workers caring for people with the virus especially when performing procedures on the respiratory tract that can cause a spray of droplets. People who are not health care workers do not need goggles.
I cannot find any antibacterial wipes. What should I use to clean surfaces?
It has been reported that the virus causing COVID-19 is very susceptible to soap and water. The CDC recommends that diluted household bleach solutions, alcohol solutions containing at least 70 percent alcohol and most EPA-registered common household disinfectants should be effective at disinfecting surfaces against the coronavirus. Frequent hand washing is important and if using an anti-microbial gel, make sure it is at least 60 percent alcohol.
Is it true that the virus can remain on surfaces for up to three days?
It is not certain how long the virus can remain on surfaces. One study found that the virus can remain viable in the air for up to three hours, on copper for up to four hours, on cardboard up to 24 hours and on plastic and stainless steel up to 72 hours, while some conjecture that if this coronavirus is like other coronaviruses, then it can remain on surfaces for as long as nine days. The CDC recommends that diluted household bleach solutions, alcohol solutions containing at least 70 percent alcohol and most EPA-registered common household disinfectants should be effective at disinfecting surfaces against the coronavirus.
Can the virus be transmitted by food? What if someone sick prepares my food?
It is still early in the pandemic so we are still learning about how it is transmitted. It is not clear yet if someone who is sick and handles food can transmit the virus to someone else. If so, it would be a very unlikely mechanism for transmission. That said, coronavirus has been found in people’s stool so theoretically it could be transmitted between people if someone does not wash their hands after using the bathroom. With regard to cooked food, it is likely the virus would be killed since it does not tolerate heat.
Are we overreacting? After all, most of us are only going to have mild to moderate flu-like symptoms.
No, we are not overreacting. This infection causes a much higher rate of serious illness and death than seasonal flu, at least 10 times the death rate. Seasonal flu has a 0.1 percent death rate causing 20,000 to 70,000 deaths annually whereas this virus reportedly has a 1 to 3.5 percent rate of death. While it appears that those most likely to suffer severe symptoms or die are older people (> age 60) and/or people with chronic medical conditions, it also has caused severe illness and death in younger, healthier people. In addition, there is a high risk of overwhelming the health care system, which has a limited number of critical care beds and ventilators.
How am I supposed to tell the difference between a cold, the flu or COVID-19 without actually receiving testing?
The CDC provides this helpful information:
Cold or Allergies
•+/- fever with colds; no fever with allergies
•Body AchesShortness of Breath
•CoughSlower onset of symptoms
•Sudden Onset+/- Sore Throat
A patient will not know for certain he or she has COVID-19, but since testing is not easy to get, one should assume it is likely and isolate for 14 days or until testing can be done
If I have coronavirus and I get sick and recover, will I be able to get it again?
It is currently not known for how long someone who has had this coronavirus will have immunity. There were some reports of people being sick with COVID-19, seem to recover and then come down with symptoms again. It is thought that these people did not fully recover from the original illness. There is still a lot we will need to learn about this virus and disease.
Will it kill me?
It appears that those most likely to suffer severe symptoms or die are older people (> age 60) and/or people with chronic medical conditions, but it also has caused severe illness and death in younger, healthier people. The death rate has been reported to be between 1 to 3.5 percent but we will likely not know until later into the pandemic.
When should I determine whether to call my doctor or my local health department if I suspect I have coronavirus?
You should call your doctor if you have any concerns about your symptoms, especially if you are an older adult and/or have chronic medical conditions. If you are not having difficulty breathing or do not have chest pain, avoid going to the emergency department. If you do have difficulty breathing or chest pain, then call 911 or go to the emergency department. Many sites set up by health care systems or public health departments require appointments and/or a doctor’s prescription.
What if two or more people are living in the same household and one person gets it? What are we supposed to do, especially if we have limited space?
Do the best that you can to stay separated. Sleep in different rooms and do not use the same towels or utensils. It is best to consider family members of someone who is sick to be exposed so they should remain quarantined for 14 days after exposure.
What does testing for coronavirus entail?
Testing for active infection is done by obtaining a specimen with a swab up the nose (a nasopharyngeal swab). Sometimes a throat specimen is obtained as well.
Is there anything promising on the horizon to treat coronavirus? Vaccines are going to take a while.
Currently, antiviral medications are being tested such as Remdesivir, which is showing promise against coronaviruses and others are being tested as well. In addition, post infection sera, with antibodies, is being tested for the sickest patients.
We live in Florida and the weather will be warming up very quickly. Will this help us get rid of the virus faster than colder climates?
The behavior of the virus in cold versus warm climates is not yet known. We should not assume that the warmer climate would help Florida get rid of the virus quicker.
Should I be worried about my pets?
There is no evidence that pets, such as dogs and cats, get this virus.
Are we going to run out of food? The shelves in the grocery stores are empty and like everyone else, I cannot find toilet paper anywhere.
It does not appear that we are running out of food and grocery stores remain open. There are grocery items that people are buying up more than other items such as toilet paper. Hopefully, manufacturers will be able to keep up with the demand so that people do not feel like they need to hoard certain items.
How long does it take to contain a pandemic if everyone complies?
The right term at this stage of the pandemic is mitigation. Our goal now is to keep the peak of infections below the capacity of our health care system. We only have a finite number of ICU beds and ventilators so social distancing of the entire U.S. population is very important to achieve that goal.
What is the best-case scenario for the U.S.? How about Florida? Where are we compared to other states?
Best-case scenario for the U.S. and Florida is that we keep the number of serious cases below our health care system’s ability to care for patients. There is variation in response across the U.S. Florida is behind the best states because we are not being aggressive enough in instituting community mitigation measures, testing and contact tracing.
Since this does not really affect children, why are we closing down our schools?
It is not true that this is not affecting children. A study published in Pediatrics the week of March 16 found that children at all ages were susceptible to COVID-19, but symptoms were generally less severe than those of adult patients. However, young children, particularly infants, were vulnerable to coronavirus infection. The reason why we close schools is not so much to protect school-age children who are not likely to get very sick from coronavirus, but to prevent spread to more vulnerable people. Children are known to be active spreaders as they congregate in groups more often than adults do.
Is a two-week self-quarantine sufficient?
Based on what we know to date, 14 days is sufficient for self-quarantine.
If people are asymptomatic, how will they know to stay away from their loved ones?
If someone is not sick and does not know they are infected, then they will not know to stay away from loved ones. This is why public health officials are strongly encouraging social distancing for everyone.
Are hospitals a safe environment? What if you have to have surgery and you do not have coronavirus?
Hospitals tend to be higher risk sites for contracting an infection. Most hospitals are canceling elective (not urgent) surgeries. If you are scheduled for an elective surgery, a surgery that can wait, talk to your doctor about postponing,
Is my doctor’s office safe? I am afraid to sit in the waiting room with many other people.
If you have to go to the doctor’s office in person, then make sure to sit at least 6 feet apart from other people. Wash your hands frequently while there and make sure your doctor and nurse does as well.
Should we hold off on regular doctor’s visits or checkups if it is not urgent and can wait?
Routine appointments such as checkups should be postponed until it is safer to leave home. If you have chronic conditions, are immune suppressed or are not sure, call your doctor for guidance.
About the Charles E. Schmidt College of Medicine:
FAU’s Charles E. Schmidt College of Medicine is one of approximately 152 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 70 full and part-time faculty and more than 1,300 affiliate faculty, the college matriculates 64 medical students each year and has been nationally recognized for its innovative curriculum. To further FAU’s commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The Consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology.
About Florida Atlantic University:
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University, with an annual economic impact of $6.3 billion, serves more than 30,000 undergraduate and graduate students at sites throughout its six-county service region in southeast Florida. FAU’s world-class teaching and research faculty serves students through 10 colleges: the Dorothy F. Schmidt College of Arts and Letters, the College of Business, the College for Design and Social Inquiry, the College of Education, the College of Engineering and Computer Science, the Graduate College, the Harriet L. Wilkes Honors College, the Charles E. Schmidt College of Medicine, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan: Healthy aging, biotech, coastal and marine issues, neuroscience, regenerative medicine, informatics, lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAU’s existing strengths in research and scholarship. For more information, visit fau.edu.