Livestream Transcript:

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Jed Selkowitz: Welcome to the Americares Coronavirus update, What You Need to Know about COVID-19. I’m Jed Selkowitz, senior vice president of communications at Americares, and joining us today is Americares chief medical officer, Dr. Julie Varghese. Dr. Varughese is board certified in infectious disease, internal medicine and pediatrics.

Jed: She earned a bachelor’s degree in biochemistry from Knox College and a medical degree from Rush University in Chicago [Illinois, USA] where she completed her residency. Dr. Varughese also completed an infectious disease fellowship at the Albert Einstein College of Medicine in the Bronx, New York. Impressive. Dr. Julie, welcome, and thanks for being here today.

Dr. Julie: Thanks, Jed. Glad to be here.

Jed: So there’s been a lot of rumors, roaming around social media and on the internet about coronavirus or COVID-19. And so I thought we’d start off today’s stream by trying to debunk some of those myths or telling our viewers what’s true, what’s not. So we’ve got our trusty yes-no paddles, for you. Make sure we know which one is no, which one is yes. And I’ll go rapid fire through some of these questions and then we’ll go through some of the detailed questions that many of our viewers actually asked.

Jed: So let’s start with this one. The new coronavirus can be transmitted through packages delivered from China?

Dr. Julie: No.

Jed: No. Okay.

Dr. Julie: I’d say our knowledge of how long the virus can survive outside of the body is still growing.

Dr. Julie: We’re seeing anywhere from a few hours to several days, but the World Health Organization and other reputable sources have said that the risk of the virus being transmitted on packages being shipped is unlikely.

Jed: Okay. Next one. All hand sanitizers work against the coronavirus? No. Okay.

Dr. Julie: No, and I think this is an important point, because really it’s alcohol-based hand sanitizers that will work against this coronavirus [Jed: Like this one] and it needs to be at least 60 to 95% alcohol as the primary ingredient.

Jed: Okay, great. The flu and pneumonia vaccines offer protection against COVID-19.

Jed: False again. Okay.

Dr. Julie: Yeah. So the flu and pneumonia vaccines offer protection against influenza or the flu and pneumonia. We don’t currently have a vaccine for COVID-19 infection.

Jed: Okay. Next one. From what we know so far, kids are less susceptible to getting infected with COVID-19. Oh, okay. Confusion.

Dr. Julie: So I wouldn’t say it’s confusion. I think, it’s a little too early to know if kids are truly less susceptible or if they’re just getting less of your infection. So, kids may be having either asymptomatic infection or just having less severe symptoms compared with some other age groups, but, it’s still hard to know if they’re truly less deceptive.

Jed: Okay. There was just recently in this area, in the Bronx, a seven year old child that was confirmed as being infected with coronavirus. So they’re out there but it’s not / they’re not as susceptible. Number five: Antibiotics, do not treat COVID-19.

Dr. Julie: Yes, that’s true. Okay.

Jed: Okay. So they do not, okay.

Dr. Julie: Antibiotics will work if an individual with COVID-19 goes on to develop what we call secondary infection with the bacteria. And in that case, antibiotics are helpful.

Jed: Another one that I’ve seen a lot of on social media: Masks. Will a mask protect you from COVID-19?

Dr. Julie: I’m going to have to go with “yes” and “no” for that. And masks are protective in certain individuals and in certain high risk groups, but generally speaking, I would say masks are not really the mainstay for the general public.

Jed: Okay. Some rumors out there are that there is a vaccine for COVID-19, is there?

Dr. Julie: No, not yet. It’s being worked on, but we’re probably at least another 12 months or so out from that.

Jed: Here’s the next one. You should wash your hands for at least 20 seconds every time. Big yes, yes.

Dr. Julie: Big, yes. Longer if possible, but at least 20 seconds. Yeah.

Jed: And frankly, that’s with or without a coronavirus outbreak.

Dr. Julie: Right. Absolutely.

Jed: Excellent. You should stay home if you’re sick, even if you don’t think that you have the coronavirus. Yes. Okay.

Dr. Julie: Absolutely. Both for your own wellbeing and for others.

Jed: Okay. Can you get coronavirus through mosquitoes?

Dr. Julie: Nope. No. Yeah, coronavirus is transmitted through respiratory contact, not through insects.

Jed: Here’s another one that’s going around can pouring alcohol, chlorine or bleach on your body kill the virus once you’re infected.

Dr. Julie: No, that’s also, no; there’s a lot of misinformation going on about COVID-19 infection and how to manage it. Prevent it, but absolutely no; in fact, some of the information we’re hearing can be harmful such as the one you just mentioned.

Jed: Last one. Cold weather or the snow can kill the coronavirus?

Dr. Julie: Also no, I’m again still learning in terms of the virus and how it responds to different climates and temperatures, but currently no snow and cold weather cannot kill it.

Jed: Okay, great. Well I’ll take those from you and then let’s get into some of the more in depth questions. So let’s start with this one.

Jed: Where did the new coronavirus originally come from?

Dr. Julie: So I’ll start by saying coronaviruses are actually a family of viruses that have been around for a long time. There’s a few that already had been circulating in people and in some instances, coronaviruses are more commonly found in animals and what happens is the virus changes over time and then transfers from the animal to a person and then person to person spread can occur.

Dr. Julie: And that’s what we’ve seen in this case with the newest coronavirus, which we call SARS-coronavirus-2.

Jed: Okay or COVID-19, if it is the actual infection, right?

Dr. Julie: Yeah. COVID-19 is the infection that the virus causes.

Jed: How does the new coronavirus actually spread?

Dr. Julie: So through respiratory contact, what we call droplet. And so if I have coronavirus and I’m infected, if I’m talking or speaking closely with you, I cough or a sneeze, infected particles can then land on your face or nose, your mouth or whoever you’re coming into contact with and then get inhaled into the lungs and cause infection.

Dr. Julie: That’s the primary source of transmission of COVID-19 infection. We’re still learning in terms of the ability to transmit infection when someone’s asymptomatic. We do know that that is a possibility. And again, we’re also learning in terms of the ability of the virus to survive. I, you know, on other inanimate surfaces and the ability to transfer that way.

Jed: Okay. We got one of these questions came from social media. What are the symptoms of a coronavirus or COVID-19?

Dr. Julie: So similar to what you think of with flu symptoms. So fever, dry cough, you can get chest discomfort or shortness of breath. The types of symptoms that people with COVID-19 infection get, you know, we’re still continuing to learn, so we have seen some instances where someone may have gastrointestinal symptoms like diarrhea, body aches, chills and other symptoms. But really the main symptoms are that dry cough, chest discomfort, shortness of breath and fever.

Jed: So these symptoms sound very similar to cold and flu. So if they’re so similar, how do physicians even know the difference?

Dr. Julie: Yeah, that’s been a real challenge because as you noted, there’s so much overlap between the symptoms and so that’s where the diagnostic testing for COVID-19 has been important. But we’ve had some challenges just given some of the limitations with the tests.

Jed: Okay. And so speaking of symptoms, is it true that you might actually have COVID-19, but be showing zero symptoms?

Dr. Julie: It is a possibility. Again, we don’t know what percentage of people fall into that camp. It seems like that’s a smaller percentage compared with those who transmit the infection when they actually have symptoms. But it is possible to, what we call ‘shed the virus’, when you don’t quite have symptoms yet or you’re not aware, you’re kind of in this presymptomatic phase.

Jed: A lot of folks who follow us on social media are asking, is COVID-19 more contagious than the flu?

Dr. Julie: So the way we think about how contagious, something is an “are not” value. And what that means just to simplify it, is if I’m infected with COVID-19, how many people am I then going to go onto infect, and so the numbers, you know, are continuing to change as we continue to see the number of cases and learn more about the virus. Right now, I’m seeing anywhere from 2 to 2.5—so potentially two to three people could go on to get infected from someone who has COVID-19 infection.

Jed: Okay. So that’s contagion. What about the dangers? How dangerous is COVID-19?

Dr. Julie: Our understanding of how dangerous COVID-19 infection truly is, I think is continuing to grow.

Dr. Julie: We don’t truly have a good number in terms of what we call case fatality rate [CFR]. And part of that is because we don’t really understand what that denominator is. And part of the challenge with that is because of the limitations around having access to tests. So we know that the majority of people who have COVID-19 infection go on to resolve over time and may not even be seeking treatment or certainly not getting tested.

Dr. Julie: So we don’t know the full scope of how many have the infection and then go on to do just fine. So I’d say we, what we do know is that there are certain groups that are higher risk. And so when you think about your elderly individuals, especially what we’ve seen is, folks 60 years and older, but even within that, the risk grows with age. So certainly 80 years and older, we’ve seen some increased severity and also your individuals with underlying chronic disease.

Dr. Julie: So thinking about underlying respiratory infections, diabetes, heart disease, those are the individuals that could potentially be at higher risk, when getting COVID-19 infection.

Jed: Okay. So let’s talk a little bit about protection. What are the best methods to protect yourself and protect your health?

Dr. Julie: Yeah, basic preventive measures go a really long way; not just with COVID-19 infection, but also when you think about how you want to protect yourself and your loved ones from the flu and other cold and seasonal viruses. So I can’t emphasize enough washing your hands, washing your hands frequently and for at least 20 seconds. If you don’t have access to soap and water using an alcohol-based, hand rub as you so nicely have supplies here. Also, I’m practicing what we call cough etiquette. So if you have a cough or you’re about to sneeze, doing that into a bent elbow or using a tissue and then disposing of the tissue immediately and washing your hands right after.

Dr. Julie: Also as hard as it is to do, myself included, trying not to touch your face, we all touch our face so frequently throughout the day, but really being intentional about not touching your eyes, your nose, your mouth, will also help. And I’d say a couple other things is just if you yourself are sick, stay home. It’s okay, you know, in terms of taking care of yourself and protecting others to take that time. Also if you see someone who’s sick, it’s really best to keep a healthy distance. We say at least, you know, three to six feet, ideally, in terms of that distance.

Jed: One thing I didn’t hear you, you mention is masks. A lot of folks have been asking about masks. There’s a lot of different information about there. So what do you think is the case with masks? Are they protective? Can they help?

Dr. Julie: Yeah. And I think just with holding up the, yes, no, it’s, it’s a complicated issue, right? So I think masks are certainly critical in certain individual groups. So when you think about healthcare workers, they’re on the front lines taking care of people that are either confirmed to have COVID-19 infection or suspected and they’re coming to close contact, so masks are certainly protective and really important. Also caretakers, if someone has COVID-19 infection and they are being cared for by a family member or other caretaker, it would be important for that individual to have a mask.

Dr. Julie: Also, if someone is truly sick, either with COVID-19 infection or another respiratory illness, a mask can be protective for that individual to where if they have to be kind of out and about, whether that’s to a healthcare facility or a doctor’s office. So I think in those instances, masks are truly helpful. For the general public, really the Centers for Disease Prevention and Control and the World Health Organization, they’re not recommending mask use for the general public.

Dr. Julie: And I’d say there’s a few reasons for that. From my perspective, a mask can give you a false sense of security so you have a mask on. You may still be touching your face. You may be less hypervigilant about washing your hands because you have this false sense of protection. Also realistically speaking, the surgical masks or the procedural mass that the general public is using, it still has space on the sides and so you can still get infected particles landing on your face or in your mouth. And so certainly we want to have masks be available for vulnerable populations and high risk groups that really need it.

Jed: Okay. So you mentioned earlier that there’s no vaccine for COVID-19. Can you tell us a little bit about how long you think it’ll take before we have one?

Dr. Julie: Yeah, I, I’d say generally as outbreaks have gone on, over the last decade, I think we get better and better about the speed with which we develop new medications or new vaccines. But realistically, it still takes time to be able to test new vaccines on people and to really ensure that they’re effective. And so the reports I’ve seen recently are still saying that we’re about 12 months or so out from having a vaccine.

Jed: Okay. I did read a report recently that in Thailand there were/there was a study happening with antivirals. So is there any progress with antivirals being used as a treatment?

Dr. Julie: Yeah, there is. There is a particular medication called Remdesivir, which was developed for Ebola and it’s being tested in a couple of different locations now to see what kind of impact it may have on individuals with COVID-19 infection. And some of the preliminary information we have on it looks promising.

Dr. Julie: We won’t know still for at least another month or so is what I’m seeing. But yeah, it’s being tested. I’d say it’s still not a defined treatment measure for COVID-19. The treatment for COVID-19 is still what we call “supportive care”; and what that means is treating the symptoms. So if you have a fever, if you have cough treating and managing those symptoms and really, giving it time, again, the majority of people are going to do better with those supportive care measures and with time.

Jed: Okay. So there’s no cure. So what do you do if you think you’re infected?

Dr. Julie: I’d say if you really think you’re infected, I would self isolate. So you want to stay home and you should call your doctor or a medical professional.

Jed: So don’t rush into your primary care, call first.

Dr. Julie: Yeah, I would definitely call first. A lot of health facilities are set up, are getting set up with different kinds of telephone triage systems and having that capability to field phone calls because you want to think not just about your own risk, you want to think about the risk, you know, you may pose to others. And so I think at this stage it’s best to call ahead and have a clinical staff member talk through your risk, your exposure, the likelihood that this could be or not be COVID-19 infection. And then they can walk you through next steps in terms of seeking medical treatment or being able to get tested.

Jed: Okay. So we’ve heard a lot in the news lately about self quarantining and isolation. So what exactly does that mean? Can I still interact with my family at home? Can I go out and pick up a pizza and bring it home for everybody in the family? What is quarantining mean?

Dr. Julie: Yeah, that’s a good question. And one that I think has been causing some confusion. So I’d say there’s two different, a couple different types of quarantine. One is if someone is sick enough, they may be monitored in a hospital setting. So these again may be your higher risk individuals, the elderly, other people with other medical conditions that really require more intensive monitoring and management.

Dr. Julie: Again, the majority of people are still going to do okay with COVID-19 infection and they may not need that level of care in terms of requiring hospitalization, so they fall into the category of home isolation or self quarantining, it is still really critical that they are quarantined. And I can’t emphasize that enough; you know, it’s not just, you know, still being out and about in the community. They’re really expected to stay at home. And I know there are certain challenges with that, especially if someone lives with other individuals, but really trying to stay more in a dedicated space within the home or living quarters and certainly not be, kind of out and about in the community and practicing what we call social distancing.

Jed: Okay. So when would you suggest to somebody watching that they self isolate or, or self quarantine? When do they make that decision?

Dr. Julie: Yeah, so I think if you’re concerned you can stay home and call your medical provider. As far as true self quarantine, I think you should always do that under the guidance of a medical provider. And also the CDC has really helpful information on their website. Right now, you know, self quarantine restrictions are primarily around folks who have traveled to high impact areas, so China or Italy. There are certain parameters that are, you know, requiring automatic, self quarantining, but really should always be done with the guidance of a physician or your local health department, can also provide guidance in terms of that automatic self quarantining.

Jed: Okay. Let’s talk about testing. Where do folks who are watching go to get tested if they think they might be infected?

Dr. Julie: It kind of depends on where you’re located. I think we’ll see changes just in terms of the availability of testing, especially throughout the US right now. For example, here in Connecticut, our state health department does have diagnostic tests. We also have private labs that have access to the test as well. So your physician or doctor’s office may refer you to a private lab or may send the testing to the state.

Dr. Julie: I think an important piece to note is we’re all familiar with going into our doctor’s office or an urgent care and getting tested for the flu and having our results within minutes. That’s not the case yet with testing for COVID-19 infection. We don’t have that kind of a rapid test. It still can take up to a day or so before we find out results. So you’re not walking out of your doctor’s office with a diagnosis.

Jed: Okay. So who is most at risk of getting sick or even sadly dying of COVID-19?

Dr. Julie: What we’re seeing in terms of just the case counts and fatalities, but also some academic studies is really, again, your elderly folks. That 80 plus category is probably the highest risk from what we’ve seen in terms of the data so far. And also again, your individuals with underlying chronic conditions or immune suppression, weakened immune systems certainly are at higher risk of having more severe infections. So they may go on to develop pneumonia or other organ involvement that could potentially be severe.

Jed: Okay. What are the other impacts that you’re seeing related to this outbreak? You know, who’s going to be hit the hardest by this?

Dr. Julie: Yeah. In addition to your high risk groups, I’d say folks who may not have consistent access to health care communities with high numbers of uninsured and underinsured individuals certainly could be impacted. Also hourly workers who may not be able to take sick time when they need it. Or, for example, if we start seeing more widespread school closures or daycare closures, folks who can’t, you know, potentially stay home to care for children. And certainly, you know, those without being said, just the economic impacts both near term and long term are going to be pretty significant.

Jed: Yeah. Particularly small business owners, it seems in these communities that have these hotspots, which gets to my next question, which is, how should we restrict our behavior? Should we, you know, stop eating out, stop going to the movies, you know, stop going to concerts or conferences, you know, many have been canceled, but what should we be doing to restrict our behavior?

Dr. Julie: Yeah, it’s a good question. And it’s one that I’m getting often. I’d say it’s hard to give kind of a blanket recommendation. I don’t think we’re quite there yet. I’d say it really is about understanding and determining your own risk. So for example, going back to those high risk vulnerable groups, if you’re older, if you have a chronic condition, being proactive, but in a way where we’re trying our best not to panic, I think is important.

Dr. Julie: So being proactive, asking yourself, you know, should I potentially decrease the number of large gatherings I’m attending? Should I not be shaking hands? You know, we’re seeing a lot about elbow bumping and finding other ways to greet each other. So I think, again, determining your risk. And I’d also add that, you know, even folks who don’t fall into those categories of being high risk or vulnerable, such as the elderly and those with chronic conditions, thinking about how your behaviors may potentially impact those other individuals.

Dr. Julie: You know, for me as a mom, I’m encouraged that we’re seeing, you know, data that shows that kids are potentially less vulnerable or not getting severe infection. But I’m still concerned about my parents and you know, my husband’s parents who are elderly and other members of our community. And so I am thinking about my own behaviors and potentially not putting myself in places where I may get it and you know, may do fine with it, but if I potentially pass it along, I think about, you know, other people in my life that could be at higher risk.

Jed: Okay. Question that’s on everyone’s mind. Look in your crystal ball. Can you tell us how long this outbreak is going to last?

Dr. Julie: No, I can’t and I don’t know that anyone can at this stage. It’s a little bit too early. We don’t quite know if there’s going to be a seasonal component to this. The way we do see it with the flu, for example, the flu, we generally know in the US it runs till about May and then we have some reprieve. It’s too soon to know if this virus is just going to continue on an upward trajectory. I am hopeful because what we’re seeing in China is that there has been some leveling off in terms of the case burden and the number of new cases. So that is definitely encouraging. Again, the situation is very fluid. We’re seeing, you know, an upward trend in other locations. But I think it’s a little bit too early to know just how long this is gonna last.

Jed: We’ve got a tweet that just said, how likely am I to get it, you know, we don’t know who “I” is, but, the big general “I”, how likely am I to get it?

Dr. Julie: Yeah, I think it’s a reasonable question and concern that’s on everyone’s minds. It’s, again, I’d say thinking about those high risk individuals, folks who have traveled to heavily impacted countries, China, Italy and others, you know, certainly are at higher risk. If you’re a family member living in close contact with those individuals, you do have higher risk as well. You know, that being said, we are here in the US seeing what we call community spread or person to person spread. Individuals who didn’t travel, they aren’t close contacts of someone who travel are starting to get it. But we’re also, you know, have a lot of aggressive measures in terms of trying to slow down the rate of infection and spread by practicing basic, preventative measures.

Jed: Okay. So if someone out there is a healthy 30 year old with no vulnerable family members at home, why should they bother taking precautions?

Dr. Julie: Because public health measures are really only as good as the public using them and implementing them, or at least the majority. I’d say that especially with this outbreak, this is something that we’re all in on together. It’s not just about my risk or my family’s risk, you know, and that kind of individual piece, this is something where, you know, we’re working as a community.

Dr. Julie: And so I think even if you yourself may not be a high risk person for getting infection or even if you get infection, having severe complications, you’re still interacting with people, whether it’s in the general public, your work setting or commuting, the grocery store, you just don’t know who you’re interacting with and what their level of risk is. So I think it’s important no matter who you are to practice those basic preventative measures.

Jed: So if I do contract coronavirus, what will happen?

Dr. Julie: You’re likely to do just fine. Again, I’d go back to that what we know, you know, and looking at the data and being science-driven on this, about 80% will do just fine with supportive care and time. Your higher risk individuals that fall into that 15 to 20%, will potentially have more severe complications, require hospitalization, need that more intensive supportive management.

Jed: Okay. How likely is the virus to continue to spread throughout the US?

Dr. Julie: I think realistically we’re going to continue to see an increase in cases. You know, it’s hard to know if we’ll continue to have certain hotspots in the US or if we’ll see kind of more consistent wider spread. So I think we should anticipate a continued increase in cases. But, again, that being said, there are lots of things we can do to slow down the spread where we won’t necessarily get to that point where we see such a huge peak in cases by practicing, you know, preventive measures and just good public health practices.

Jed: So you’re the chief medical officer here at Americares. Do you want to talk a little bit about what Americares is doing to respond to the outbreak?

Dr. Julie: Sure. So we’ve sent shipments of personal protective equipment or PPE. We have sent masks and gowns, gloves, and other kinds of supplies both internationally but also to our domestic partners. So, again, we’re seeing, you know, spread here in the US and we want to help support our domestic healthcare partners as well. We’ve started to prepare and train some of our healthcare partners on preparedness, personal preparedness, also infection prevention and control and are continuing to ramp up those efforts to be able to train a broader network of our health care partners.

Dr. Julie: We’re also prepared to provide surge support as healthcare facilities may become overburdened and are starting to see an increased number of individuals with potential COVID-19 infection. I think a big piece of what I see our role is in terms of providing accurate information. So there’s such a huge amount of misinformation that’s being provided and just, it’s understandable. This is something new, people are concerned and absolutely reasonable to feel that. And so I think it’s important to make sure that the general public and we as an organization are really looking to trusted resources in terms of where we’re getting the information. So a role that I feel Americares is playing and will continue to play is to be that voice in terms of providing accurate information.

Jed: Yeah. A trusted resource, sure. So speaking of information access, things are changing very rapidly on an hour to hour basis. So where do you go for information—that our viewers can go and reference?

Dr. Julie: So  a couple of my go to resources are World Health Organization or WHO, also the CDC for more US-focused information, cdc.gov. John Hopkins has a great tracker in terms of following kind of day-by-day case counts internationally and it’s a fantastic resource. And then also some academic resources as well.

Jed: Okay. And a lot of those references are available if you go to americares.org/coronavirus, you can get access to a lot of those resources.

Jed: Dr. Julie. Thank you. I guess we should sort of elbow bump; appreciate that—this was incredibly informative. If you want to follow Dr. Julie on Twitter, she’s @DrJulieAC. And we really do appreciate you joining us today.

Jed: You can go to americares.org/coronavirus to stay informed on not only what Americares is doing to respond to the outbreak, but to access other information and resources. Thank you so much for joining us today and stay healthy out there.