An infectious diseases doctor answers questions about how its transmitted and why you shouldn’t panic.
BY PATRICK M. O’CONNELL
There are many questions about the coronavirus. We have them. You have them.
So, we asked readers to submit their concerns and inquiries about coronavirus. Then we posed them to Dr. Robert Citronberg, director of infectious diseases at Advocate Lutheran General Hospital in Park Ridge, Ill. Citronberg has been in practice for more than 26 years. This has been edited for length and clarity.
Q: How is it transmitted? What is the incubation period?
A: The incubation period can be anywhere from two to 14 days. The incubation period is the time between the acquisition of the virus and the time that you develop symptoms. The median time is about five days.
There are two principal ways to get it, and it’s important to understand both. The first is the more obvious, which is from droplets, when someone coughs or sneezes into your face. (Or within about a 3- to 6-foot radius.) If someone coughs or sneezes, the droplets fall right to the ground, so you can walk into a room a few moments afterward, and there will be no droplets in the air.
The more interesting and important method of transmission is contact. So even though the droplets fall to the ground, they may also fall on a tabletop and other surfaces, where they can live for at least several hours. So then say you touch that tabletop and then you touch your face, then you can actually infect yourself.
I think the key to understanding this, the way to break the chain of transmission is 1) to not cough or sneeze directly into someone’s face 2) stay away from people who are coughing or sneezing 3) be really mindful about keeping your hands clean, and washing your hands, using hand sanitizer, all the time.
Q: How long does the coronavirus live on a surface such as door handles, desks or countertops?
A: There are a lot of factors that go into it. It tends to live longer on hard, nonporous surfaces like metal. And we don’t know exactly how long; it’s probably at least a few hours. It doesn’t live as long on porous surfaces, and most of these viruses do not live as long or fare as well in higher temperatures and higher humidity.
Q: What exactly are “severe” symptoms?
A: The mild symptoms are body ache, maybe some fever and a cough. And those symptoms last for about a week. If someone has symptoms after a week or so, where they start to get worse, the cough gets worse, the shortness of breath gets worse, that’s a sign they may be developing more severe disease.
The severe disease actually doesn’t start right away. Let’s say you have the virus and you’re really not feeling at all better or worse after a week, then you would be at risk for severe illness.
Q: Is there a cure for coronavirus, and if there is not, what exactly are medical professionals treating people with? And how long will it take to recover?
A: There is no cure, no drug. Unlike influenza, we have drugs that treat influenza. There are trials going on around the world.
The treatment is supportive care. By that I mean IV fluids, medication, things to break your fever, to make you feel better, to support you and give your body a chance to heal. It’s a little frustrating because there is no drug you can get, but in many cases, supportive care is fine.
Remember that about 80% of people with this coronavirus infection either have no symptoms or mild illness that doesn’t progress to severe illness. So supportive care actually is important. It prevents people from getting dehydrated.
Usually people who are sick, they recover within a week or so if they have the mild illness, up to about two weeks to feeling back to normal. And remember, some of these people, especially some of the people who are in isolation, people like on the cruise ship who are in quarantine, they have absolutely no symptoms. They tested positive but no symptoms.
So, it’s kind of hard to gauge when they’re feeling better because they never felt bad. But for the people who do get symptoms, usually about a week and up to two weeks when they could be feeling a lot better.
Q: I have spring break travel plans. Should I cancel them?
A: As far as travel for spring break, I think it depends a lot on where you are going. Domestically, I’m not really concerned. It’s still very safe to travel; you have to pay extra close attention to keeping your hands clean when you’re flying.
The biggest risk when you’re flying, by the way, is what you get on your hands; it’s not what you breathe. Airplane air is actually quite safe to breathe. There’s no real medical reason not to travel domestically. Internationally is a different story.
The concern is that what if you get there, and the rules change, and it makes it very difficult to get home?
Q: I have a medical procedure scheduled at a hospital that is treating coronavirus patients. Is it safe for me to go to the hospital for the exam, or should I postpone?
A: Yes, it is safe. People with these infections are contained in very specific areas of the hospital. The virus doesn’t go through the ventilation system, like into the operating room. There’s really no risk of that at all.
There is no reason to avoid elective surgeries. And honestly, the way things are going, every hospital is going to have a patient with coronavirus. We’re certainly nowhere near that yet, but we could be in the future.
Q: Why are public health departments not testing more? Is it a problem of access to testing kits or something else?
A: It’s getting easier. Now private labs are able to do the testing. So, going forward it should be much easier to get tested. Remember, it’s a double-edged sword. We want people who think they have a reasonable probability that they have the virus to get tested, but we don’t want what we call the “worried well” coming in in droves, like the average person who has no symptoms. There’s certainly not the capability to have everyone tested, nor should everyone be tested.
Q: Is the coronavirus considered to be more easily transmitted than the flu? If not, why the current panic?
A: It is transmitted by exactly the same mechanism as influenza, which is by the droplets, when someone coughs or sneezes directly on you, or contact. I would say at this point, with what we know, the coronavirus is more contagious because nobody has ever seen the virus before.
It’s a new virus to our species, and so we don’t have any antibodies against it. With flu, we have antibodies from being exposed year after year, we have a flu vaccine, that probably makes it less contagious. Right now, it looks like the coronavirus is more contagious.
To be more technical, there is a number that we use for contagiousness of diseases, called the r0. If the r0 is 1, that means that each person with a disease is expected to give it to one other person … so the higher the number, the more contagious it is.
For background, influenza, like seasonal flu, the r0 number is about 1.3. Right now, as far as we know, the coronavirus r0 is about 2.2. So, it is higher than influenza. But just to give you a frame of reference, the measles, which is among the most contagious of all viruses, that r0 is up to about 18.
There are still things we can do to limit the spread of this. We should focus on that instead of panicking. Because panicking doesn’t help anyone or anything.
It’s a little bit scary. It’s like the fear of the unknown. We don’t know anything about the virus so don’t have a specific drug to treat it, we don’t have a vaccine yet. We don’t know what it’s going to do. So that definitely is a little bit scary. In a couple of months, we’ll probably know a lot more about it.
This is not an existential threat to our civilization. This is not like the zombie apocalypse. I think that people have to focus on mitigating this. But this is not like a hide-under-your-desk situation.