Everything We Know about COVID-19—A Professor of Infectious Disease Answers All Your Questions

A discussion on what we know, and what we are still researching for answers

By Professor Barry C. Fox, M.D., University of Wisconsin

During a recent discussion with The Great Courses, Dr. Barry Fox, M.D. addressed the top questions related to the novel coronavirus. In this article, Professor Fox discusses everything we currently know—from where the virus originated, to vaccines and prevention, and even whether or not our pets can spread the virus.

First Off—What Is the Novel Coronavirus?

According to the National Institutes of Health, when viewed under an electron microscope, the spherical particles of the novel coronavirus “have proteins called spikes protruding from their surface. These spikes latch onto human cells, then undergo a structural change that allows the viral membrane to fuse with the cell membrane. The viral genes can then enter the host cell to be copied, producing more viruses.” These protruding spikes look like the outer surface of the sun when there’s an eclipse—otherwise known as the corona.

The virus that’s currently affecting us is closely related to two other coronaviruses that have played an important role in infectious diseases: The first is SARS, Severe Acute Respiratory Syndrome (SARS-CoV), and the second is MERS, Middle East Respiratory Syndrome (MERS-CoV).

An epidemic of SARS occurred from 2002–2003, originating in southeast Asia. It was limited to only that geographic region, without massive spread throughout the world. An outbreak of MERS was first seen in 2012, originating in the Arabian Peninsula. Although cases are still seen in the Middle East, the numbers are low.

A genomic comparison of SARS-CoV and MERS-CoV shows similarities with key differences in structural proteins. In severe cases of human infection, each type of coronavirus causes severe to lethal atypical pneumonia; the overall mortality rate of the SARS epidemic was 9%, while the overall mortality rate of the MERS epidemic continues to be 40%. The large outbreaks of SARS and MERS caused significant public health and economic consequences.

And now in 2020, the novel coronavirus (SARS-CoV-2), which causes the COVID-19 disease, has brought a global pandemic. According to the World Health Organization, the classical definition of a pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people,” as defined in A Dictionary of Epidemiology, 4th edition. The overall mortality rate varies per nation of the world. Currently, it is 4.2% for the United States. For current statistics, visit the Coronavirus Resource Center of the Johns Hopkins University of Medicine at coronavirus.jhu.edu/data/mortality.

According to Johns Hopkins Bloomberg School of Public Health, “coronaviruses are a family of RNA viruses that typically cause mild respiratory disease in humans” and the “SARS-CoV-2 is one of seven coronaviruses know to infect humans.” Of those seven, four types of coronaviruses lead to the common cold (229E, NL63, OC43, and HKU1).

The source of and the geographic point of origin for the novel coronavirus (SARS-CoV-2) have both been under worldwide scrutiny and investigation.

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Where Did the Novel Coronavirus Originate?

Now, the virus itself, where did it originate? Well, it probably… First of all, it originated in bats.

Epidemiology researchers study emerging germs from bats and other wild animals; and multiple coronaviruses have been isolated—not this specific strain—from a bat host.

So the virus most likely originated in bats. And because of the changing forces with emerging and reemerging infectious diseases, it found its way into other animal hosts, and then eventually into a human host. And it probably circulated in an undetected fashion for a number of weeks or a couple of months before there were sufficient numbers of cases for it to be recognized by medical officials as an emerging threat.

Scientists have also mentioned the animal called a pangolin as a possible intermediary host, as they had been for some of the other coronaviruses. And it is possible that this particular animal was a kind of an asymptomatic shedder of the virus. It’s an edible in the Chinese delicacy, so it may have played a role in the initial proliferation and spread of the virus. But that role is still being studied.

How Is the Novel Coronavirus Transmitted?—Aerosol Versus Fomites

A novel coronavirus particle (or virion) is very small, an extremely tiny particle. When we think of the air and we think of dust particles, dust particles in the air are about three microns in size. Well, how much is a micron? A micron is one-thousandth of a millimeter. And the actual virus particle is under or less than one micron in size.

The question is: How do these very small virus particles get transmitted? The main means by which it is transmitted is by aerosol particles and fomites. What is the difference between aerosol transmission and fomite transmission?

Aerosol Transmission and the Importance of Social Distancing

When people speak they generate force from inside their lungs, and there’s a small amount of moisture that’s generated from inside the lung as well. And the virus kind of hitches a ride along these water droplets—other types of particles that are expelled from inside the lungs or from breathing through the nose. The virus can then spread beyond the individual person.

Six feet is generally considered the outside limits by which if you were shouting or talking, within which the virus could travel. Beyond that distance, the particles fall to the ground because they’re attached water vapor particles larger than three microns in size. So most of the information about social distancing has focused on this six-foot radius.

Now, there have been certainly other reports of the virus being transmitted in areas that are beyond the six-foot radius, particularly a choir-type of circumstance or people shouting. And there’s a belief that the virus can maybe be transmitted as far as 10 feet in some of these circumstances.

There are concerns that the virus can be stagnant in the air for periods of time that are longer than expected. And can hence travel distances that might be greater than the six and 10-foot radius that we’re talking about.

So this actually is an important issue here. So this is why being outdoors is very different than being indoors. Because if the virus lingers in a circumstance where there’s no air circulation, the virus may be can spread beyond that six-foot radius over the tincture of time that’s there. And that is probably true. Again, there’s emerging information on this. It Would have quite upsetting if we thought this was the primary mode of spread, but it is likely a small mode of additional transmission of the virus.

While we’re talking about preventative aspects of things here, I will talk a little bit about social distancing.

The social distancing guidelines relate directly to the science that I described about the six- to 10-foot distances. Outside of six feet, you’re going to reduce your risk of exposure to the virus.

Certainly outside of 10 feet, you’re going to reduce the risk greatly. And an outdoor environment is going to have much more potential to dilute the virus or to blow it into locations that are beyond your radius.

So, those are factors to consider in terms of the distances to stay away from people or particularly people that are unknown, or you don’t know what the status of their coronavirus is.

Fomite Transmission—Don’t Touch Your Face!

When virus particles hit the ground, or they land on the table or other surfaces, those objects are called fomites. So the next question is, if I touch a fomite, am I going to get infected? And the answer is no, unless you also touch your face with that same hand or finger. More specifically, if you touch the mucus membranes of the eyes, the nose, or inside the mouth.

The virus itself is not going to spread through intact skin. It doesn’t barrel through the skin like battery acid out of a car. You have to touch it to a vulnerable area. And hence why we’ve been asking people, and for any kind of germ theory, not to touch your face.

On the average, people touch their face at least six times per hour. So if you touch a fomite and then you touch your face, or particularly touch your mucus membranes, you are at risk of contracting the virus.

How Many Viral Particles Are Required to Contract the Novel Coronavirus?

We still don’t know the number of viral particles needed cause an infection. But let’s consider the norovirus stomach flu as an example.

On the head of a pin, there’s something close to 10 million virus particles. It only takes about six virus particles to cause infection with the norovirus. We don’t know what that number is directly with the coronaviruses, but the point is that you might have to have a hundred or a thousand virus particles to actually get infected.

And so again, that’s another reason why airborne or inhalational infection is more prone to occur because there’s likely a larger burden of organisms required to become infected.

Also, in airborne situations, the viral particles go down directly into the back of the throat, into the back of the nose, or directly into the lungs. When considering this method opposed to fomite contact, the latter appears to be a little bit harder for the virus to take hold of people.

Symptoms of the Novel Coronavirus

The first thing is, there are many people that have asymptomatic infections. That’s kind of an oxymoron, because if you have an infection, typically you’re going to have fevers and other unpleasant symptoms. But we’re coming to learn that of all infections, somewhere between 20%–25% of individuals have minimal to no symptoms.

This is a big deal. When we dealt with SARS and MERS, virtually everyone had symptoms. And one of the reasons we were able to contain those other two coronaviruses is because we could institute quarantine. We could lock people down for a period of time when we knew they had symptoms and they would not spread it to others.

The problem with this particular virus is that people can be asymptomatic for, say, up to five days before they actually show symptoms of the illness. And during that time window, there’s a tremendous opportunity to spread the virus to others. Essentially we know about [the effectiveness of] lockdowns, but this limits some of the potential for quarantine to be effective because of this large five-day window.

Now, what happens if you do get sick with the illness? Well, you’re going to have a fever. And by fever, we technically define as greater than 100.4 degrees Fahrenheit. So you’re going to have a fever, and then you’re going to have a sore throat. And you may have some congestion. But unlike cold viruses, unlike the coronavirus cold viruses, runny nose is unusual for more than 24 hours.

As well as having an overall feeling of malaise and not feeling well, the most problematic symptom is cough, and a dry cough. And for some people, to go even further, as the infection spreads into the lungs, individuals can get shortness of breath associated with this.

Some people describe the symptom as… There’s an old saying about if you’re in a pool too long, and you’re spending six hours in the pool, about being water-logged. And if you take a deep breath, you kind of feel like your lungs are having trouble taking that deep breath.

Another analogy would be, if you had a minor burn injury, or sunburn, there’s going to be redness, warmth, and swelling. So if you have that swelling, that increased amount of fluid that’s there, you’re going to have a sensation that there’s decreased elasticity of the lungs.

One thing I will mention though, that’s important, which I didn’t say regarding the clinical illness. The clinical illness generally begins within five days of exposure. And people tend to ride this nice wave for the first three or four days. And some people ride the wave out and they write off their illness.

Health Dangers after Day Nine of the Illness

Unfortunately, there is a percentage of the population, maybe 10% or 15%, where at days number 9, 10, and 11, their oxygen saturation level precipitously drops, prompting a crisis in their illness.

So people are misled in the sense that, “Hey, I’m doing pretty well. I’ve had COVID for four days. Everything’s fine.” And then, all of a sudden, they’re not fine. People need to know that you’re not through this until you’re probably through the 11th or 12th day of the illness. It is important to have a heightened observation of individual illness from days 9 to 12.

What Are Symptoms of Decreased Oxygen in the Blood?

If you have decreased oxygen levels, you will experience increased difficulty with breathing at rest. But even before having difficulty breathing at rest, there would be difficulty breathing when you’re trying to move, when you’re trying to walk, when you’re trying to go up the stairs. It’s called dyspnea on exertion. When you have dyspnea at rest, that’s even more problematic.

How Our Own Immune System Can Harm Us

Most of the clinical manifestations of the virus are due to the virus replicating inside of cells, but there are also some symptoms that can be associated with the body’s immune system reacting to the virus. It’s not uncommon for people to have protracted generalized symptoms while recovering from the illness.

This immune system concept is important for a new disease entity that’s described in children, where children are getting hyperactive immune systems from the coronavirus. Not even immediately with their original infection—sometimes weeks later. And it’s related to an overstimulated immune system and affects all aspects of their body. Fortunately, this overactive immune system issue in children has been managed and the death rates are pretty low. While there have been a few children that have died from this syndrome, it’s uncommon in adults.

One of the thing I should mention, is that symptoms are probably age dependent. And again, these things are being studied in general. So, young children, say anywhere up to the age of five and then from five to 10, that the spectrum of illness is more likely to be asymptomatic or mildly symptomatic in children. In general, we’re not able to recover live virus from patients on the average case at anything more than 14 days.

PCR and Saliva Testing for the Coronavirus

There are two kinds of tests that are being adapted. The most important one is the polymerase chain reaction technology, or PCR test. A PCR test amplifies the amount of virus that’s present, until it can give a positive result. When you see footage of people getting something stuck down into the back of their throat and tickling the back of their throat, this is molecular PCR testing.

There are a number of companies that are making tests for other portions of the virus, and some of those may not need to go into the very back of the throat. They can go into the front of the nose and they’re almost as accurate as the PCR-based testing.

There is also been a saliva test that has been approved. This method has to test for a different particle—it’s a different portion of the virus itself—other than the actual polymerase chain reaction technology. The difficulty with the saliva test is that they’re self-collected and have to be mailed to a third-party laboratory. The turnaround time for those testings is taking somewhere between five to seven days, but it is possible to do so.

The saliva test came out before most of the states really ramped up their testing capacities on a local basis. So I think that those have become less important because we want rapid information to try to isolate people if they test positive for the virus.

Antibody Testing Technology

The other test that has seen a lot of attention in the news is something called antibody testing. Okay, so what is an antibody? When we have germs that invade our body, our body responds with the production of proteins and these specific protein particles and molecules are called antibodies. And what they are designed to do is to help our immune system capture and kill the invaders that come in.

So, we do mount an immune response to COVID-19. There are two types of antibodies that are produced. One is the IgM, what’s called the immunoglobulin M class, which is the first class. And then, the second is an IgG antibody that’s produced.

Now, the IgM probably appears at day number 10 after the clinical illness, and then the IgG appears somewhere between 14 to 28 days. So, these antibody tests are really not very good to try to detect acute illness, because it takes that long to develop them.

Where the antibody tests might be important is in trying to figure out if you might have already had the virus. Particularly early in the coronavirus outbreak, when we didn’t have wide availability of testing, an antibody test might have been useful.

Also, in population studies, say in New York, trying to get a handle about what percentage of infections were really asymptomatic, by estimating the disease prevalence by antibody testing, we can get a better handle on how many people were actually infected.

Current Case Statistics in the United States

There is a bit of controversy that’s ongoing with antibody testing, and it has to deal with population statistics. If you test someone in what we call a low-prevalence area and they have a positive result, the result could be a false positive test.

A true positive test is much more likely to occur if, for example, you were testing a New York; Houston; or Austin, Texas, population right now, and you were trying retrospectively to determine how many people were actually infected.

Now, we’ve also heard from the Centers for Disease Control and Prevention (CDC) that there could be as many as 10 times more cases than we’re actually finding by testing. That was based on some preliminary antibody testing that the CDC had done in some of the higher endemic areas.

I think this really remains to be confirmed. I think this was kind of a preliminary result and I’m a little bit skeptical that the number is as high as 10 times more cases than the actual cases that are detected. But again, this is an evolving situation and more remains to be determined.

So what about cases? It doesn’t take much to do a search to find the cases that are ongoing in the country and in the world. I’m not going to go through all the population statistics, but United States and Brazil are number one and two at the present time, respectively.

The prevalence of the disease does vary very much by state and county. I would encourage everyone to look at their state health department site and look at their county-based information.

It is true that we’re doing more testing, but that’s not the only reason that we have more positive results. We have a much higher percentage of positive results within those tests. So, for example, here in Wisconsin, in my county, it had been as low as 3% of all the tests that were done, but now, we have a higher rate of positive results.

The frightening part is that it had been hoped that as the country “reopened from its lockdown,” that providing these additional measures of freedom, the number of cases would either stay the same or they would gradually go down. But what’s really happened is, the number of cases has been going up. I’m not sure it’s been in an exponential fashion, but it’s been gradually rising. And this is a difficult situation that we’re facing here, right now.

Methods of Preventing the Novel Coronavirus

So, in terms of prevention medicines, for other viral illnesses, people have certainly touted vitamin C and zinc products for reduction in infection. I get this question relatively frequently, and my response is: If you feel comfortable taking those medications, and there are some effects of these medicines on the immune system, and it’s not causing any harm, then go ahead and take it.

The actual data on vitamin C and zinc for preventing COVID-19 is limited. But again, we’re in a state of evolution of our knowledge here. And, it’s possible that something like that could come out to be protective at some point in time in the future. So as long as you’re doing no harm, then I think that would potentially be okay.

The Dangers of Chloroquine and Hydroxychloroquine

When do we get into the area of harmful treatments? Well, I think everyone’s probably familiar with the issue of the chloroquine and hydroxychloroquine—several influential people were advocating taking these for prevention of the virus.

It’s interesting to note that neither one of those medications actually acts directly on virus replication, but the medicines alter the acid-based status of the cells that get attacked by the virus and cause a more prohibitive environment for the virus to flourish.

Hydroxychloroquine and chloroquine were touted for a little while, but there is limited to no information that they can prevent the coronavirus. There are still a couple of prevention studies that are ongoing, and healthcare workers that have not been stopped [from using them], but it’s unlikely that either those two malaria-based medicines are going to be of benefit for prevention purposes.

The data have been somewhat negative and also the issues of causing harm have been significant. Patients in the studies have actually had more heart-rhythm related problems, and there have been a few deaths. So, the United States and the World Health Organization stopped their chloroquine/hydroxychloroquine studies.

Using Masks to Reduce the Risks of the Novel Coronavirus

So, initially I think as most people are aware, there were no recommendations for wearing masks in public, either to prevent disease or to prevent the spread of disease. A lot has changed since then.

I’ve said it half a dozen times already, this is a dynamic situation, and we’re learning more about the virus each day. So, what’s changed? Think about the 20%–25% asymptomatic spreading statistics. If you think about the statistics, the masks that people wear have the potential to prevent someone who is asymptomatic from coughing, sneezing, and generating those aerosols for six to 10 feet. And also, if they’re in the walk zone of someone else who is in the asymptomatic zone, it’s going to reduce their chances of getting the disease.

At this point in time, there’s no doubt that masks can be helpful in preventing disease.

A Variety of Mask Types

On TV you may see officials wearing hazmat suits. Those suits provide a hundred degrees of prevention of getting the virus. But the next option down is something called the N95 mask. This is a mask that has the ability to filter about 95% of all virus particles. These are typically reserved for healthcare workers, but as we quickly learned, there are not enough available to properly stock all of our healthcare facilities.

Some people ask, “How is it that these masks have the ability to filter particles that are less than one micron in size?” It has to do with the layers of material that the N95 masks are made out of, as well as with electrostatic charges that are adjacent to the material.

An analogy here is that masks are not like having a handful of sticks and then pouring water over them, where the water goes through the areas between the sticks. It’s more complicated than that.

So, the next kind of best masks that we have, are cloth masks. Now, these cloth masks have various fiber capacities. The closer together the fibers are, the better capacity the masks are going to have to filter the virus.

It’s estimated that a cloth mask is going to have filtration efficiency of between 70%–75% in preventing the virus transmission from inhalational transmission.

Wear Your Mask over Your Nose!

One point to emphasize here, is that if you have a mask on, you’ve got to wear it right, okay? If I turn on the news and they show any kind of gathering, you see people with the masks are only covering their mouths with noses exposed. Keep in mind that you exhale through your nose as well. If you think you’re wearing a mask correctly but your nose is not covered, you’re not.

Also, if your mask is not on snugly then you’re going to reduce the effective filtration—that 70%–75% number goes down to 15%–20%. Even if you have it over your nose, it’s going to be reduced by that amount as well. If you’re going to wear a mask, you’ve got to do it correctly.

Wearing Face Shields to Protect against the Novel Coronavirus

Face shields can be helpful, but they do not have any kind of filtration device that’s over your nose or mouth. You’re breathing around the face shield, so you are potentially exposed to the virus itself.

It’s possible that the face shield can deflect virus particles, but nowhere close to the same efficiency of a mask. Face shields are mostly for preventing splash injuries and having the virus go into eyes or nose or mouth. The face shields have been used most effectively by healthcare workers. Healthcare workers who are taking care of patients are wearing both masks and face shields.

What Treatment Options Exist for the Novel Coronavirus?

We’re fortunate that we do have a couple of treatments, particularly for the more seriously ill patients, that have been partially effective. As I mentioned previously, hydroxychloroquine and chloroquine were touted as possible treatment options due to some laboratory-based information on the standard cold coronavirus that were done many, many years ago. Again, those drugs shift the internal dynamics and the acid-based status of cells which made the cellular environment less hospitable for the virus. What happens in the test tube does not necessarily happen in real humans. It’s doubtful that either one of these products, hydroxychloroquine or chloroquine, will be effective, as I mentioned previously.

The Use of Remdesivir in Treating the Novel Coronavirus

One hopeful drug that is being tested is an antiviral drug known as remdesivir. This is a medication that affects virus replication, and it was used for the Ebola virus. However, it didn’t seem to make much of a difference for the Ebola virus, but it was tried experimentally over time in other coronaviruses and it was found to be effective.

Then it was introduced into human trials, and there’ve been a couple of publications on remdesivir use in the sicker patients in terms of reducing mortality and reducing length of hospital stay. But this is just a drop in the bucket. It’s good that we have it. At the moment it’s being reserved for the more seriously ill individuals in the hospital. And it’s certainly not something that we’re giving for outpatients because they just happen to have the virus, so we’re reserving this.

Another reason we’re reserving this is because the supplies of the virus medication are relatively limited; we’re concerned that the virus supplies may run out before the end of July, even though production is being ramped up by the Gilead company.

The Use of Dexamethasone in Treating the Novel Coronavirus

The other medicine that holds promise is called dexamethasone. Dexamethasone was tested in a large British study of more seriously ill patients in the intensive care unit. It is a steroid that doesn’t act on the virus itself. Instead, it reduces the body’s immune response to the infection. Why do we want to do that? Don’t we want the body’s immune response to be as forceful as possible?

As we talk about in my lecture on sepsis in my infectious disease course, [An Introduction to Infectious Diseases produced by The Great Courses], there’s a very delicate a line between the body’s immune response and an overreaction of the body’s immune response. Given at the right time in a person’s illness that’s in the intensive care unit, if dexamethasone is given, it’s been shown that there’s potential reduction in mortality, as well as reduction in the severity of illness. It’s not for everyone—it’s for a certain select group of individuals who are hospitalized, and [administered] under the guidance of experienced medical care providers.

The Use of Antibodies and Plasma in Treating the Novel Coronavirus

The final treatment concept has to deal with antibodies.

First off, vaccines work by stimulating antibodies. What we’re doing now is harvesting plasma from people who have recovered from COVID-19. From that, we’re taking antibodies and injecting them into individuals with serious illness related to coronavirus.

Now, again, there are certain precautions that are taken to make it safe to administer, but this is moving forward. It seems to be relatively successful. The side effects are relatively minor. This is something also that was done with Ebola virus due to the lack of treatments that we had.

Now to take the antibodies concept one step further, there are a number of companies that are actually trying to make synthetic antibodies, not human derived antibodies; but they’re trying to genetically construct antibodies that may be effective for coronavirus.

Herd Immunity for Novel Coronavirus

Our current situation is not going to resolve until we have a vaccine. Why do we need a vaccine? Because we need to introduce the concept of what’s called herd immunity. If you get the virus, you would be responsible for infecting somewhere between one to two other individuals. Now, we can’t slow the virus spread, unless that number of new individuals is less than one. Only then, can we shrink the current pandemic circumstance.

That’s why social distancing and lockdown/isolation is important—because we’re trying to reduce the spread. But we also need to establish some kind of immunity in the general population. By which if someone is infected, they say, “Aha, I have the antibodies to this. I’m not going to be infected; therefore, we’re going to make this number less than one.” And the technical term for this is called R nought or R subzero. We need to get that number [to be] less than one.

We need to induce herd immunity that is somewhere between… Well, the low estimates that I’ve seen are 60%, but more typically for most infectious diseases, herd immunity has to be somewhere closer to 85%.

The CDC has done some immunity testing on in high COVID areas. And the actual immune status, I think the highest number I saw was maybe 20% in some places. But more typically in the average general location it is lower—less than 5%. We’ve got a long way to go on herd immunity, which is why vaccine development is so crucial for ending this pandemic situation that we’re in.

Novel Coronavirus Vaccine Candidates

The list of coronavirus vaccine candidates are beyond what I can discuss here today. There’s some exciting technology with the use of what’s called messenger RNA vaccines that are being trialed.

And then there are some more standard vaccine approaches that are being used to kill the virus. And then there is something that’s called an adenovirus that introduces components of the current virus in order to stimulate the immune system.

Phases of Vaccine Trials

There are various phases of doing vaccine trials. In phase one, you use a small number of people and look to see if there’s an immune response and that people don’t die from getting an injection.

In phase two, you repeat this test in a limited population of maybe 50 people. And then you see if the amount and the immune response, these antibody response; and again, you look to see that there’s no major side effects.

In phase three, you take it into much larger populations—thousands of individuals—and watch for the same side effects and immunities within that larger group.

The exciting news is that right now in the United States, there are two phase-three studies that are about to start in the month of July. There’s another one scheduled to start in August, and another in September. And this is, again, faster than we’ve ever had it. There’s this Operation Warp Speed or Project Warp Speed the government is deploying to try to get us there as quickly as possible.

One of the reasons they’re able to do that is because drug companies have had experience with the other coronaviruses. They were starting to develop vaccines against SARS or MERS, 10 or 15 years ago, and they’ve now mimicked their previous trials and substituted some of the nucleic acid, some of the core nucleic acid proteins, and the proteins from the current virus, and they put those into the vaccine vectors that they previously developed. We’re a little bit ahead of schedule to some extent on the vaccines and that’s because of the research that was done years ago on these vaccines.

How Can People Stay Safe from the Novel Coronavirus While Attending a Protest?

If you want to participate in a protest, the ideal situation is to follow two rules. Number one, wear a mask that’s properly fitted, and number two, socially distance at a six-foot distance outside.

The closer you get to individuals, particularly people that you might not know, you’re going to increase statistical risks. It’s going to vary by how many people you might be thrust in the middle of. Again, the ideal circumstances to have to participate: Try to maintain as much distance as possible and wear a mask while you’re doing so.

Initially after the protests started, there were reports that there was no increase in the number of cases. But now we are realizing that those reports are wrong. A lot of things are happening at once, so we don’t know whether this increase is due to reopening of various venues or due to protesting, or a combination of both.

How Can People Stay Safe from the Novel Coronavirus While Getting a Haircut?

I think it can be done properly. If the barber wears a mask and, ideally, wears a face shield; then, I think they’re doing their part in trying to protect you. I do think it’s important for you to also try to wear a mask. I know there may be times when the mask has that he moved or adjusted accordingly to get your hair cut properly, but I think that’s the best situation you can have.

If I were going to have my hair cut by a professional, I would want to have it done outdoors, which is not very feasible. This is a little like the dentist’s office and the doctor’s office now, where they’re having people wait outside and they’re calling them in.

I don’t think it’s really a great idea to have people go to a barbershop where there’s three people waiting to have their hair cut and you’re sitting in the chair right there. That’s an indoor environment with limited social distancing and all the risk factors that we’ve previously talked about. Can it be done? Yes. The ideal circumstances, I think, are outdoors with a barber with a face shield and mask, and with you wearing a mask as much as possible to get the hair done.

What about Going Back to School during the Pandemic?

This is, again, an evolving situation. Planning for going back to school in the fall began a month or six weeks ago, when it was hoped that the numbers of virus infections was going to be on the decline. And combining a declining number ratio with the fact that children that would be going to school have a low risk for developing serious illness from coronavirus, and that some social distancing would be done in the schools, those three things kind of combined and officials said, “Yes, we should move forward to moving back for school because the distance learning is not only going to work for a certain limited period of time.”

In general, I was in favor of moving forward in that direction. I am a little hesitant to give the nod and the seal of approval to that right now because of what we’re seeing with the rise in virus cases. I think what may be good for one area of the country may not be good for other areas of the country, when it comes to opening schools. Again, there are whole other aspects of opening schools with daycare and parents, and parents going back to work and things like that. There’s a whole secondary gain for that system there.

You might ask, “Aren’t you concerned that school children are going to asymptomatically spread the virus and be vectors for bringing this home to their parents?” The answer is yes, I am concerned. I’m concerned about that for parents. Although parents of school-age children are going to be at less of a risk for the severe complications for coronavirus, I have much larger concerns of contact with school-aged children with [those ages] 50 and above.

Are Coronavirus Germs Spread by the Food We Eat?

Food is not likely a vector of contracting the coronavirus.

It is possible that you might have virus particles that are in, or on food, but there are two things to remember. Number one, those numbers of virus particles is likely to be very small. And number two, there are certain receptors in the human body that are waiting for the virus.

And those receptors are in the respiratory system and not in the intestinal system. So because we lack those virus receptors in that location and because the number of virus particles is likely to be low, we can usually say that food is not going to be a means of a transmission of the virus.

Is It Safe to Travel during the Novel Coronavirus Pandemic?

Ideally, driving in one’s own vehicle—by car—is the best circumstance. You’re social distancing from others, [keeping] within your family circle.

I wouldn’t use packed buses, trains, or subways. Those are going to be places where there’s the potential for spread. Not only because there’s people that may not be wearing their mask—and you can’t really do the social distancing—but also because there’s confined air environments in those circumstances.

Plane travel is a little tricky in that you either have to wear a mask or they won’t let you on the plane, or they may not let you on the plane next time. The air filtration on airplanes is actually very good. I think the circulation is something like 25 times per hour, and they also have high-efficiency particulate air filters that are on the airplanes.

And again, if people are wearing masks, and hopefully performing a little bit of limited social distancing—I’m not endorsing airline travel right now necessarily—but I would say that it might be the safest way to go.

Are Pools Safe to Swim in during the Novel Coronavirus Pandemic?

The coronavirus can not essentially be transmitted via use of chlorinated pools. So I think it is safe to swim, but the social distancing aspect is the biggest part for the community pool circumstance.

I know that a number of people who were concerned that getting into a pool that somebody might’ve already swam in who was asymptomatic and had the virus is like getting into a petri dish. That’s not really true.

One of the firmer statements on the Centers for Disease Control and Prevention (CDC) website is that we have no evidence that there could be coronavirus transmission via chlorinated swimming pools. Chlorine and chlorine dioxide are actually disinfectants that can be used, and hydrogen peroxide vapor. For disinfectant for the coronavirus, it actually destroys the virus. So if the community pool keeps its chlorine standards up to snuff, then there should not be any transmission via the water itself.

Is It OK to Get Tested for the Novel Coronavirus Even if You Feel No Symptoms?

I think that would be probably stretching it too far right now. And the reason I say that is because it’s not that you don’t have the right to do that, but right now, there are still limitations on the amount of tests.

Each molecular test requires specific reagents and there’s a cost to doing so. There’s time, there’s costs, and there’s reagents that go along with that. And there are certain times there are national shortages and there continue to be shortage of these reagents. So I think people have to really weigh in on—do I really need to get tested or can I wait and see how things are going?

Can Cats and Dogs Spread the Novel Coronavirus?

So there have been case reports of cats and dogs acquiring the virus, but these are very limited. But to the best of my knowledge today, there’s been no direct sequential link between household pets and actually transmitting the virus.

Now, is there going to be a circumstance where someone proves that it actually did occur? Maybe. But right now, the risk is extremely limited. So I wouldn’t say that people need to give up their domestic animals just because there’s coronavirus in the household.

Okay. So if there’s coronavirus going around or symptoms here, please do not kiss your dog or cat on the face. And vice-a-versa, here. So again, hopefully common sense will prevail.

Should I Buy a Pulse Oximeter if I Contract the Coronavirus?

A pulse oximeter is a device that goes on the fingertip and it measures the degree of oxygen levels that are in the body that are circulating. Normally, the saturation of oxygen in the blood—more specifically, the hemoglobin molecule in red blood cells—is somewhere between 98%–100%. What happens when the virus attacks the air sacs of the lungs is that it leads to impaired oxygen delivery to the hemoglobin in the red blood cells in the body.

So when the saturation level falls in the body below 90%, people can have difficulty breathing. When it gets below 90%, it can get dangerously low. So the pulse oximeter is a device that, [to be used] for the right circumstances, can be bought either online or in a pharmacy.

Now, is that important for everyone? No, it’s not, but if you contract COVID-19 and you’re not sick enough to be in the hospital, the illness can be monitored with the pulse oximeter, not necessarily continuously, but two or three times a day to see if you’ve gotten below that 90% level. If you get below 90%, then you probably need to go to a doctor.

How Long Are You Contagious for after Contracting the Novel Coronavirus?

It’s possible that you may be contagious 14 days from the acquisition of the virus. The more conservative approach is 14 days from the onset of symptoms.

And how do we know that? It comes back to the fact that we have not been able to demonstrate live virus from individuals beyond the 14 day mark, even though they may continue to test positive.

So we consider 14 days on the onset of symptoms as a good conservative estimate. There are certain patients that I’ve taken care of in the hospital that have been sick in the intensive care unit, and in order to move from one hospital to another, they’ve had molecular testing done. And for the more seriously ill patients, we have kept them in isolation for up to 28 days.

Closing Thoughts on the Current State of the Novel Coronavirus Pandemic

I have to make a pitch for social responsibility. When I did an interview several months ago, I was in communist China and the virus hadn’t taken hold in the United States. One of the things that I said during the interview was that I’m afraid that when the virus gets to where there’s Western freedoms, we’re going to see really extended spread and problems with the virus.

And this is where we are right now in the United States. People have to take social responsibility for both themselves and for others. It’s do unto others as you would have others do unto you. That rule has to apply.

So again, socially distancing, being courteous about wearing masks, and wearing them in a proper fashion is what we need to do for the next X numbers of months until we have a vaccine. The more breaches that there are with that kind of basic common sense, the longer this is going to go, and the more it’s going to put people at risk.

Image of Professor Barry Fox, M.D.

Dr. Barry Fox is a Clinical Professor of Infectious Disease at the University of Wisconsin School of Medicine and Public Health. He currently practices in clinical infectious disease at two hospitals and a long-term care facility.