National expert from Ohio answers coronavirus questions
People should be concerned but not panicking about the novel coronavirus and its spread, said an Ohio physician who chairs the national organization of infectious disease doctors.
Dr. Thomas File is the chair of the infectious disease division for Summa Health in Akron. He also is the president of the Infectious Diseases Society of America. As head of the organization, he is one of 12 physicians who consult weekly with U.S. Centers for Disease Control and Prevention and is also in touch with other infectious disease doctors worldwide, including doctors in China.
He recently spoke with the Akron Beacon Journal to answer questions about coronavirus and what people should be doing to protect themselves.
Q: How worried should people be as the coronavirus, also known as COVID-19 or novel coronavirus, continues to spread?
A: I think people are freaking out too much. I think there’s unnecessary hysteria when people are wearing masks and it’s not necessary. Right now, we’re much more concerned about the flu than the coronavirus.
It’s obviously something to be concerned about, but there is no need to panic.
Q: There have been other coronaviruses. What’s different about this one?
A: Other coronaviruses have been circulating for years and are associated most commonly with the common cold. The novel coronavirus 2019 is genetically different, which means no one is immune to it and therefore haven’t developed antibodies against it. Everybody is potentially at risk for developing infection, some of which can be severe.
However, from data we have so far, overall there is about a 2% to 2.5% mortality rate. I think that’s an overestimate.
What is difficult with this strain is it appears people can have it, not be sick and potentially transmit it.
Q: What are the symptoms, and how are they similar or different from the flu?
A: It’s more similar than it’s different from the flu from the standpoint of how it’s transmitted. We haven’t completely understood the whole spectrum of the disease, but most patients will present with a fever, cough, muscle aches or a headache – classic influenza presentation.
Q: So what should someone do if they have flu-like symptoms?
A: Call your physician. Our society is recommending that if the patient has flu-like symptoms that the provider prescribe the antiviral medicine without even coming in the office to be tested. We have such a high level of activity (for influenza) that you don’t even need to be tested.
The physician then should also ask questions of the patient. If there are any indications the patient has been exposed to the coronavirus, they’ll want to refer the patient to the infection control or health department and have the patient wear a mask right away.
Q: Masks are flying off store shelves. Are they effective?
A: Masks are not effective for preventing someone from getting the coronavirus and should be saved for health care workers or patients who have the coronavirus to reduce the spread when coughing or sneezing. Masks also need to be fit appropriately.
You really can’t go to the drug store and buy these things and know how to use them appropriately.
Q: What prevention steps should people take?
A: It’s still not too late to get the flu shot. We’re in the middle of a very active influenza season, and it is usually active through April.
Wash your hands. A lot of respiratory infections are spread on the hands. ... Wash your hands frequently or use alcohol-based sanitizers. After a sneeze, some other coronaviruses have stayed on hard surfaces, like desktops and doorknobs and can stay active for hours. We don’t know if this happens with the novel coronavirus. A precaution is to use alcohol or bleach or any other bleach or detergent or anti-viral topical to wipe doorknobs and tabletops.
Q: Do you need a specific type of soap or anti-bacterial soap?
A: It doesn’t matter. Obviously, just soap and water is good enough. It’s the sudsing of soap and water that gets rid of the microorganisms on the hands.
Q: Should I worry about traveling internationally or even within the U.S. if other travelers are coming from around the world and may have been exposed?
A: You are much more likely to get influenza than coronavirus by flying. Within the U.S., if you’re not worried about getting influenza and flying, you should not be worried about coronavirus and flying. I would follow the CDC recommendations and not fly to the international destinations on the list.
Q: Should I delay my future travel plans, depending on where else this spreads?
A: All I can tell you is to follow CDC recommendations. I’ll be more personal. I have an infectious disease meeting in the middle of April in Paris. That’s only six weeks away. France has 18 cases right now. I am monitoring it very closely and if they start having sustained transmission (cases that spread from one person to another), I’m probably not going. But if it doesn’t change, I will be going.
Q: Some are using the Spanish flu of 1918 as a parallel to this coronavirus. That flu, which had no vaccine at the time, showed up in the spring, went away in the summer and came back with a vengeance in the fall. What do you think?
A: The mortality rate for the Spanish flu was about 2 to 4%. I think the coronavirus is going to be less than that. In 1918 and 1919, you’ve also got to remember there was a world war going on and less access to medical care.
It could be a fair parallel, but we don’t know that for sure.
Q: Have patients who have other ailments, like asthma or a weaker immune system, or older patients been more susceptible?
A: Yes, it is more possible for them to get sick. The data we are getting from China is patients who have more serious diseases or are older and have underlying conditions, are worse off.
Q: I heard a report that children are not as likely to get the coronavirus. Is this true and why?
A: That’s a true observation, and I can’t really tell you the answer. Of the patients who are testing positive for the coronavirus, children are a very small proportion.
Q: Are the deaths from pneumonia?
A: With influenza and other seasonal viruses, most of the morbidity is secondary pneumonias. From what I’m reading, that’s not the case. A lot of these patients are dying specifically of the viral infection and not from pneumonia itself.
Q: Do chances of survival increase in countries that have better access to health care when someone gets sick?
A: That happened with Ebola. Even before there was an effective vaccine ... the more intensive care that is provided for supportive care could be associated with better outcomes.
Q: At what point should health officials decide to close schools or tell people not to go to work, and could that be seen as false panic if done too soon?
A: That’s a good point and will really depend upon the extent of the virus that’s circulating within specific communities. It will depend upon absenteeism and what percentage of people in the population are infected.
We know by doing social distancing and closing schools or canceling mass gatherings, it would help to reduce transmission when there’s a certain threshold of infection within a community, even with things such as influenza.
Q: Can you explain the following terms: endemic, global outbreak, epidemic and pandemic?
A: Endemic means it stays within a community, like seasonal influenza we get every year. We have a global outbreak now because it has spread globally. An epidemic is a high level of activity in one particular area of the world. A pandemic is when you start to have large activities in other continents and sustained transmission (spread from person to person). We now have coronavirus cases on every continent but Antarctica.
I do anticipate they will eventually declare this a pandemic. We’ll have to wait and see. The last pandemic was the H1N1 in 2009.
Q: Are you more worried about this virus than others in the past?
A: The H1N1 was very easily transmitted and was a worldwide pandemic, but it had a very low mortality rate, which is good. SARS [Severe Acute Respiratory Syndrome] had a higher mortality rate – 10% – but it was not as transmissible as this novel coronavirus. In one aspect, it is worse because this coronavirus is more transmissible than SARS, but there’s less mortality, so it’s sort of a wash.
Q: What other recommendations do you have to prepare for potential quarantines or to prevent the disease?
A: Having 30 days of food and your medicines on hand are good recommendations. But good hand hygiene and good healthy habits – eat well, get good sleep and get vaccinated – are key.
This report was provided by the Akron Beacon Journal, part of the USA Today Network.