KUT hosted a special hour of Morning Edition to answer your questions about the coronavirus. For the past week, we've been taking listener and reader questions and have assembled a panel of experts to answer some of those questions.
The conversation was continued in the studio after the broadcast discussion wrapped up:
Here are the panelists who joined us for the live show:
- Serena Bumpus is the director of practice for the Texas Nurses Association. She was previously a Regional Director of Nursing for Baylor Scott and White Health; Clinical Nursing Manager - University Medical Center Brackenridge; and worked as a registered nurse at Seton Medical Center. She has been in the nursing profession for over 18 years.
- Dr. F. Parker Hudson, assistant professor of internal medicine and infectious diseases at Dell Medical School in Austin. He’s also the program director for the Internal Medicine Residency. Among his affiliations: he’s a member of the Infectious Diseases Society of America.
- Lauren Ancel Meyers is professor of Integrative Biology at the University of Texas at Austin, and a member of the External Faculty and Scientific Advisory Board of the Santa Fe Institute. She was trained as a mathematical biologist, and her research includes network epidemiology and optimization of infectious disease surveillance and control
- Jeff Taylor is the senior epidemiologist with Austin Public Health. He’s been an infectious disease epidemiologist with the Texas Department of State Health Services and the City of Austin for over 38 years. He’s currently a manager of the Epidemiology and Disease Surveillance Unit of Austin Public Health — the unit responsible for infectious disease surveillance and rare disease or outbreak investigations within Travis County.
Here's what they had to say.
Note: This Q&A has been edited for clarity.
How is the coronavirus transmitted from one person to another?
Hudson: The transmission mechanism is almost certainly from large droplets, which means when you cough or sneeze, you shed viral particles that go into the environment, usually within about a meter of your distance. Once the droplets are on your hand or your skin and then you touch one of your mucous membranes — your eyes, your mouth, your nose — that is the portal of entry into your body.
Meyers: In our work that we have done at UT and work that people have done around the world, we have seen evidence that a reasonable fraction of cases have actually been infected by people who haven't yet shown symptoms. So, they're not coughing yet, they're not sneezing yet, and yet there's evidence that they're able to infect other people. In that case, we call it pre-symptomatic transmission. Those are people who do eventually develop symptoms but haven't yet.
How much exposure do you need to become ill? Is it similar to the flu, or is it easier to contract?
Meyers: There is just a lot of uncertainty. They both seem to be spreading through respiratory droplets. We don't believe that flu spreads airborne, but we don't know yet whether COVID-19 spreads airborne. And as we learn more, public health experts and decision-makers are issuing new guidelines. As of now, the guidelines are that 6 ft is a protective distance. But as we learn more, if and when COVID-19 spreads in communities in Texas, we need to keep an eye on public health websites and public health recommendations, because those guidelines might change.
Taylor: I think from a public health standpoint, we want to limit crowds where we know viral respiratory agents are transmitted. So, in a stadium if there's 12,000 people there, there's a great opportunity in the restrooms, outside the stands and even in the stands when you think of all those cheering fans, they're expelling droplet nuclei when they're cheering.
How likely is it that those of us who are healthy with strong immune systems can catch the virus?
Hudson: The risk for healthy young adults of severe infection or death is extremely low. The concern is that young, healthy people, even if they have mild symptoms, are the source for the transmission throughout the population. We all need to take our symptoms very seriously to protect the most vulnerable, which in this epidemic appear to be people over 60 and with underlying health conditions.
If you catch the coronavirus and then get better, are you immune to it?
Taylor: With a lot of viral agents, you do develop immunity. But even with flu, which is a viral agent that we have a lot of knowledge on, infection with one flu virus may not protect you from another flu virus that may be circulating.
There is some evidence that in China, they've actually used serum from patients with infections to treat people with acute infections, and it shows that it may work. The antibodies produced are protecting that person who's receiving them. But there's no evidence right now coming out or at least no findings that say one infection will protect you from another exposure.
Are children considered a high-risk population for this disease?
Taylor: There’s not a lot of articles out right now about the clinical illness in children or young adults. But there are some suggestions it's different than flu. We considered young children, particularly school age children, as the incubator for influenza virus in the community, where they spread it amongst themselves at school and then take it home to their parents. But there's no evidence now of what the role children may play.
How do seasonal allergies symptoms differ from COVID-19 symptoms?
Bumpus: It’s my understanding that with COVID-19, the biggest differentiator is shortness of breath, versus with the flu you have the body aches along with it. With seasonal allergies, you just have the postnasal drip and the congestion. If you're experiencing shortness of breath, that's really that biggest differentiator.
What does the coronavirus do to a healthy person?
Hudson: The symptoms are quite varied, and we're learning as we study different populations. What we're seeing is that about 80% or more do eventually develop fever but may not have fever on that first day of symptoms, which can include cough, shortness of breath, allergies, flu-like illness without a lot of differentiating factors upfront.
Diarrhea appears to be a minor symptom in the sense that less than 10-15% of people will have diarrhea and it shouldn't be a diarrheal-only illness. That should not be your only symptom for it for you to suspect COVID-19.
Does asthma increase the chances of complications or death from this virus?
Meyers: There are a number of underlying conditions that we believe put people at higher risk for severe outcomes — at higher risk for hospitalization and severe disease. The latest list from the CDC website includes medical conditions like blood disorders, chronic kidney disease, chronic liver disease, compromised immune system, pregnancy, endocrine and metabolic disorders, heart disease, lung disease, including asthma, including COPD and neurological conditions.
Are there any medicines that can work in this situation?
Hudson: This is a viral disease in which common antibiotics or any antibiotics that treat bacterial infections will not work. If you have symptoms that are still more likely to be flu-related right now, Oseltamivir would help you. If you have SARS-CoV2, the name of the virus that causes COVID-19, Tamiflu or other antibiotics will not help you.
What are we supposed to do if we think we might have some of the symptoms of COVID-19?
Hudson: The first point is to call your physician or use telehealth, if you have access to that, to get medical advice, to assess whether your fever can be due to another cause. If your only symptom is fever, then you should not come to the clinic or to the emergency room of the hospital without notifying your doctor first. Fever alone is not the problem. It's the progression to shortness of breath. If you have any symptoms of trouble breathing, then you do need to respond quickly.
Who is actually testing for COVID-19?
Hudson: I just want to be clear that the tests are not widely available. They are through Austin Public Health. At this time, things are rapidly changing, which means if you're having symptoms, if you're having just a fever or a cough, we are encouraging people not to come to the clinic or the E.R. just to find out if you have the virus. That's really important because that can overwhelm the system.
How is the city going to address the cost of testing for those that are uninsured or underinsured?
Taylor: We have tested some patients in Austin. Our specimens go to the State Health Department and Austin Public Health. I'm not saying we cover the cost, but the state is doing that testing for free. So there should be no additional charge to the patient for the testing done by the State Health Department.
Bumpus: And I would say, too, there are resources online if they have access to internet services. There is a website called auntbertha.com that will provide them with the nearest local clinic. We have several federally qualified health care clinics here in the Austin area that can assist our underinsured patient population.
What options do people have if they think somebody is out in public with symptoms and not taking any precautions?
Taylor: Do not call Austin Public Health or even the state health department. If you see somebody ill, the importance is not about calling to report them. The importance is to avoid them. More importantly, if you are ill, don't put yourself out in public. If you have a fever, stay home. If your child has a fever, don't send them to school.
Why aren't masks effective in this situation?
Hudson: We're trying to preserve masks for health care settings where you have symptomatic people, and we're also trying to protect the health care force. The need to walk around UT campus or the city of Austin down the sidewalk wearing a mask just does not make sense given what we know about this epidemic.
Meyers: A couple issues with masks: one is if you use a mask incorrectly, you may end up actually touching your face more. If you happen to have acquired some masks in the in the early days, the most useful thing you can do with them is if you think you may have symptoms, wear them yourself to protect from spreading to others.
Does it matter whether you wash your hands with cold water or hot water?
Taylor: I think hot water or warm water is going to be better. But just the fact that you're using soap and water to wash your hands and you're doing it frequently is going to be more important than worrying about the temperature of the water. Sing happy birthday to yourself. That's about 20 seconds. Lather up, rubbing between your fingers, around your fingernails, the tops of your hands, and then rinse off with water when you're done.
What about our personal items that we may touch frequently with unwashed hands like smartphones?
Bumpus: I think we do have to be mindful of those objects. I think it would be amazing to just do a little culture on my smartphone here because I'm sure it's one of those things that we don't think about wiping down with a Clorox wipe every day when we come home. I know I've gotten into the habit of trying to do that because it's out in the open and it's exposed to anything and everything.
Is it possible to be overusing hand sanitizer? And when should we use that as opposed to washing hands?
Hudson: Handwashing is just as effective. Hand sanitizer is more readily available. And now is probably not the time to be worried about overuse of hand sanitizer. We can solve that in the future. The next two months is the time to use hand sanitizer as much as possible.
How disruptive will this be in Austin? Is it really necessary to stockpile food and water?
Bumpus: I think that if you are over the age of 60, the CDC recommends that you do stockpile a few essentials. If you have the ability to get 90 days’ worth of prescription medications, then you need to obtain your 90 days’ worth of prescription meds and stock your house with non-perishables and things like that. For those of us who are relatively healthy, we don't need large amounts of toilet paper and hand sanitizer and those sorts of things. Let's save that and spread the love a little bit.
Does Austin have the hospital beds necessary if this is a full-on pandemic?
Hudson: Hospitals have disaster plans to try to increase capacity. I encourage prevention methods so that we don't reach that. Italy has more hospital beds per capita than we do. And without prevention, their system has been overwhelmed, and we have the ability to change that now.
What should people do if they have travel plans coming up?
Bumpus: I think it's important to put into perspective why some of our larger events have been canceled here in the city of Austin. We don't want to see a huge spike because we don't want to overwhelm our hospitals and our health care systems. I think people need to think very cautiously about travel and where they're going and what they're doing from that perspective.
Meyers: I think there's two parts to that question. It's, should I go and travel? And if I am in a high-risk group, should I be visiting family members, children who are going to school who may be exposed to community transmission? I think should we start seeing sustained transmission in Austin, both of those are probably things that you shouldn't be doing if you're in a high-risk group.
Why isn't there a vaccine yet for COVID-19? When will there be?
Meyers: Anthony Fauci, who's the director of the National Institutes of Allergy and Infectious Diseases, said just a couple of days ago that it'll take at least a year and a half. The trouble is this is a brand new virus.
This is not like influenza, which is a known virus where we have the machinery to develop new vaccines every year. If we're able to actually develop a vaccine in a year and a half, that would actually be a record. It typically takes, you know, five to 15 years to develop vaccines for new viruses.
How long can we expect the spread of coronavirus and COVID-19 to continue?
Hudson: The hope for me comes from Korea and China, where with aggressive public health measures they have controlled their epidemic within two months. Again, we hope to not have a peak, and even if it takes four or six months or longer, if it's a low level, that is better than the peak that's happened elsewhere.
Is there a difference between quarantine and isolation? What do those mean?
Bumpus: Isolation means separating sick people with a contagious disease from people who are not sick. Isolation is something you do when you believe someone is actually infected and you want to make sure they don't come into contact with other people.
In contrast, quarantine is an action you take to separate and restrict the movement of people who were exposed to a contagious disease before you know whether or not they're sick. That is something we do in case they may be infectious or infectious soon to prevent onward transmission from them.
How about short road trips? Little trips with family? Not mass gatherings.
Taylor: I'm not advising people to cancel their trips. Now, it depends upon where they're going. If they’re traveling to Europe, I would probably say they would need to rethink about that, particularly where in Europe.
But within Texas or the U.S., I don't see a reason to prevent traveling as long as you're aware that you got to cover your cough. Staying away from sick people and handwashing are all going to be important. It’s not the distance or where you're going. It's what your behaviors are where you're going.
Can it be transmitted through a pool?
Taylor: My response is that swimming pools are public bathing tanks, basically. There's lots of bacteria, fecal bacteria and viruses that are in the swimming pool. We know other bacteria and virus outbreaks are associated with swimming. I'm not concerned about coronavirus in a natural body of water or swimming pool. I'm more concerned about other pathogens that they may be exposed to.