Here are some of the questions I have been asked lately and my responses:
- What is the difference between the terms coronavirus and COVID?
The virus that is causing this current pandemic is a member of the coronavirus family. The specific name of this virus is SARS-CoV-2.
COVID, or specifically, COVID-19 is the name for the disease caused by SARS-CoV-2. For convenience, I will just refer to the virus as the coronavirus. Specifically, COVID-19 is an abbreviation for coronavirus disease and the 19 refers to the fact that this disease was first reported in 2019.
2. Are cases of COVID really going up or is the increase we are seeing just due to more testing?
The cases are really going up. Yes, we are doing more testing, but we are still greatly limited in our ability to test and because of the limitations, we are still being restrictive in who we test. We are seeing more patients with severe enough disease to require hospitalization, more patients requiring critical care services and more patients requiring a ventilator to help them breathe.
3. Why is it called the “novel” coronavirus?
We have had circulating coronaviruses since at least the 1960s. There are four strains that commonly infect humans and typically cause common colds. This coronavirus is a zoonotic infection – in other words, this virus was one that circulated in animals, but made a jump to humans in Wuhan, China late last year. This virus was a new or “novel” infection to humans. The significance of that is that no humans had immunity to this virus and all are susceptible to infection.
4. We have seen the curves depicting the number of projected cases of COVID-19 over time and we have been told that we need to “flatten” the curve. What does that mean?
Because we are all susceptible to infection, the virus can readily be transmitted from person to person. If we do nothing to prevent contact between persons who are infected with persons who are susceptible, the virus will rapidly be spread and we will experience large numbers of cases of infection very quickly. The concern about large numbers of infections is that a certain number of those infected will require hospitalization, a significant number of those will require critical care in an ICU, and a significant number of those will require a ventilator to support their breathing. Given that all 325 million people in the U.S. would be susceptible to infection, if even a small percentage of Americans were infected, it could quickly overwhelm our health care system. We simply don’t have enough hospital beds, ICU beds, ventilators, staff and PPE (personal protective equipment) to take care of all the projected cases under that curve in that short a period of time. That is why we want to “flatten” the curve.
We had an opportunity to stop this infection in its tracks. That is no longer possible. So, at this time, we must focus on slowing the spread so that our health care system can handle the load of patients.
5. When will cases peak in Idaho?
That is a very difficult question. It depends on many things. How many people are currently infected that we don’t even know about because of our lack of ability to test? How compliant will people be with the Governor’s order to shelter in place? What will happen if the Governor lifts the order to shelter in place too soon? There are many models that are all based on different assumptions. They project a peak as early as the third week in April to the very end of August.
6. Will this be behind us by end of summer/beginning of fall?
It is not impossible, but it is very unlikely. The curve that the President showed during his press conference and the curves that you have seen online associated with different models are just the first wave of the infection.
If this virus does not mutate and continues to infect those are susceptible, in general, transmission will not be slowed until the population achieves “herd immunity.” Herd immunity is the percentage of people who are immune to the virus either because they have been previously infected and developed immunity or they received the vaccine and now have immunity from the vaccine.
Some good news. Ordinarily, herd immunity often would require numbers in excess of 90 percent immunity. Not long ago, we thought based on the nature of this virus that perhaps we would only need to achieve a bit over 80 percent immunity to achieve herd immunity. Most recently, it appears that even much lower levels of immunity may be possible to achieve herd immunity, perhaps as low as 50 – 60 percent.
A vaccine is at least 12 – 18 months away. And, even once it is developed, it has to be manufactured, distributed and administered to a sufficient number of people to achieve herd immunity before we can dramatically reduce the transmission of this virus.
The only other way to achieve herd immunity would be immunity achieved from natural infection. But, even if it meant half of Americans being infected, we would overwhelm the health care system and have an unacceptable number of deaths.
Thus, the curves that you have seen that return to baseline in July, August or September are just the first wave. Past pandemics typically have two to three waves and this pandemic is unlikely to be different.
While we know that this virus likes cooler and drier conditions and we are hopeful that the transmission will diminish over the summer months, we don’t know that will happen for sure. It would be great to get a reprieve, but we should be prepared for transmission of infection to pick up again in the fall/winter.
7. Should we all be wearing masks?
Ordinarily, the answer to this question would be no. But, this is not an ordinary situation. Unlike a lot of other infections where people are not contagious until they are sick, and therefore, it is much easier to isolate people and prevent the spread of infection, with this infection, we know that a not insubstantial number of people can be asymptomatic or pre-symptomatic and yet shedding the virus with the ability to spread the infection to others.
Masks don’t prevent the wearer from being infected from someone else. On the other hand, a mask can trap droplets from an infected person when they cough or sneeze, or even just normally breathe or talk. Thus, since someone may be infectious for one or several days before becoming ill, the only way to prevent them form unknowingly infecting someone is keeping them physically away from others (social distancing), ensuring that no one else has touched surfaces where the infected person’s droplets have landed (we now know the virus may be able to survive for hours to days on common surfaces) or to put a mask on everyone since it is not possible to know who is infected.
While I have not been a proponent of people wearing a mask (I have explained why in a couple of previous blog posts), because of this transmission from asymptomatic persons, and also new information indicating that perhaps as many as 30 percent of people who were tested for COVID-19 may have a false negative test result (the test is negative despite the fact that the person really is infected).
8. Can we ease up the restrictions for young adults and children since it is only the older individuals and those with underlying medical conditions who are at particular risk of dying?
It is true that adults less than 60 who are otherwise healthy are very unlikely to die from coronavirus and it is exceedingly rare for children to get severely ill or die from coronavirus. But, young adults in their 30s, 40s and 50s still can get severe illness and end up in the ICU and on ventilators, even though they overwhelmingly survive. Thus, it would not be wise to let up on our shelter-in-place restrictions and the guidance for social distancing because these young adults still take up hospital beds, ICU beds and ventilators.
So, for now, take this seriously. Stay home except if you need to be at work because you provide an essential service or because you need to go to the grocery store. When you are out, maintain that six feet of separation from others. Wash your hands for a full twenty seconds. When you are out, try not to touch counters, banisters, elevator buttons, etc. If you must, wash your hands carefully before touching your face. Stay home if you are ill. If you have to go to the doctor, warn them you are coming so they can provide you with instructions and meet you prior to coming into the office or urgent care. If you are short of breath, go to the emergency room, but give them the heads up, as well.