I wanted to address several coronavirus commonly asked questions I’ve received. See my other recent coronavirus commonly asked questions in categories of coronavirus prevention, safe mask use, and coronavirus symptoms.
What are some foods and immunity enhancers you recommend?
This is an important consideration and one of the coronavirus commonly asked questions. There are several supplements with evidence for supporting our immune system. However, no supplements have been tested specifically against COVID-19 yet.
There are many considerations to take into account before starting a supplement. For the safety of such medical information, I need to write detailed posts to describe their risks and benefits. I am in the process of writing about several immune enhancers (zinc, elderberry, sleep, stress reduction). You can consult the available posts on curcumin and echinacea. You can contact me if you want to discuss the safety of other supplements in the meantime.
What care should pregnant women take?
Pregnant women should be considered a high-risk category. They should take all precautions that other high-risk or elderly individuals take. The most important precautions are to follow strict physical distancing, good hand hygiene, and to never touch the face. Immune boosting supplements may not be safe during pregnancy, so please consult with a specialist before starting any supplements. I previously discussed pregnancy and COVID-19 in this post.
How can we return to work without a vaccine if there are still coronavirus cases in the public?
This is one of the most frequent coronavirus commonly asked questions. We do not yet have an answer, but it will depend on several factors:
- Availability and effectiveness of treatments (eg hydroxychloroquine, remdesivir, convalescent plasma).
- Availability of widespread serologic testing to identify who is immune.
- Effectiveness of shelter in place in “flattening the curve”.
My greatest hope is to use serologic testing to identify immune individuals. Those individuals will then be able to return to work safely. This will allow for a gradual re-opening with minimal health risk. I will complete a thorough post on this in the near future, so check back again soon!
What is the likelihood of a second wave of infection when we all go back to working in the office?
The likelihood of a second wave is very high. Unless coronavirus cases drop to very low levels, a sudden return to work will result in a significant recurrence of cases. As mentioned above, serologic testing provides a strong possibility for a safe return to work. However, effective medical treatment could also help lessen the health impact of a second wave.
What should we do if the nursing home that our parents are living in has COVID-19 cases?
This is a very serious concern because the elderly are at high risk of developing severe disease. I recommend you speak with the facility to ensure all protective measures are being taken. Key measures include:
- Strict sick leave policies.
- Hand hygiene and PPE competency by all staff.
- Wound care staff, podiatry, barbers, and any volunteers must be educated in correct mask usage and hand hygiene.
- No visitors (except end-of-life visits, possibly).
- Avoid gyms.
- Ensure designated walking hours to minimize traffic.
- Cancel communal dining and group activities.
- Residents must practice social distancing and hand hygiene.
- Close common areas and dining areas.
- Residents should stay in rooms and wear a mask (appropriately) if they leave.
- Sick residents should have a private room (if none available, consider transferring out of the facility).
CDC has guidelines here on this topic, as well.
Sensitivity & specificity of the different FDA approved tests (true negatives & false positives)
This is a thoughtful question, because early reports of tests indicated low sensitivity values. Low sensitivity is important when prevalence of a disease is high. as many infected individuals will be missed by definition. Unfortunately, there are many tests being brought into active service to keep up with testing needs. Furthermore, new tests are being introduced with shorter turnaround times. If you have a specific question about a specific institution’s test you can contact me.
Elective surgeries during COVID-19 – should we cancel?
This is one of the important coronavirus commonly asked questions. It is a critical question for those needing surgery during rapid coronavirus community spread. The answer depends on many variables, including:
- What is the surgery and anesthesia plan?
- How urgent is the surgery? Not all elective cases can be postponed indefinitely.
- What risk factors does the individual patient have for developing severe disease?
- How old is the patient?
- What will the location of the surgery be? In a hospital or standalone surgery center?
- What is the surgeon’s preference?
- What is the post-operative care plan: will home assistance be needed during recovery? If home care is needed, I would consider postponing to minimize the presence of other people at home (minimize possible virus exposure).
This is a very individual question, so you can contact me with questions.
Are there multiple strains of the coronavirus?
There are multiple mutations that have occurred across the world. There are over 100 of these small mutations in the coronavirus. We can consider these different strains, however, we are not aware of any significant differences these strains have on symptoms. An exception may be in the first infections noted in China, where it was believed that a slightly different strain of virus was more prevalent. That strain may have resulted in more severe symptoms.
Can coronavirus be spread through breathing and talking?
Yes, coronavirus can be spread through breathing and talking. Whenever we open our mouths to breathe or talk, very small particles leave our mouths. In infected individuals, these particles can contain coronavirus. However, we do not believe that breathing and talking represent the most common risk of coronavirus transmission. More transmission likely occurs from directly touching the virus and from larger respiratory droplets from coughing and sneezing. As such, the importance of social distancing and sheltering in place is paramount. Wearing masks, particularly if sick, may help reduce chance of infection, as well. To be optimally effective, masks must be worn properly!
There’s been rumors about positive effect of BCG shot, still practiced in some developing countries around the world, on ability to withstand COVID-19. Can you elaborate on that?
This is an area of active research. There have been correlation studies performed but no conclusive studies to date. Let’s stay hopeful that positive results may come from these investigations.
Should someone that has tested positive for coronavirus (and recovered) donate blood?
This is a fantastic question that has important health benefits for society. Blood donations from people who have recovered from coronavirus will likely be in high demand in the coming weeks. Using antibodies from recovered people’s blood appears to be an effective treatment for COVID-19. I discussed this is in a previous post on convalescent plasma therapy. This may be particularly effective for those who have severe COVID-19 infections. Please contact your local blood donation organization to make sure you are eligible. Most individuals typically need to wait two weeks after recovery before they are eligible to donate. The American Red Cross has a website dedicated to blood donation from recovered patients.
Thank you for considering donating, it is so important at this time to prevent a blood shortage crisis on top of our coronavirus crisis!
Reusable bags, mugs, or other reusable items in stores
Many cities are banning reusable items from being brought into stores. While the risk of contracting or spreading coronavirus from reusable bags is very low, we must comply with the stated ordinances. When these measures are lifted in the future, I recommend regularly washing your reusable bags to minimize the chance of contamination. Please remember that the most likely way to get infected is by touching contaminated surfaces and then touching your face.
For family working in a hospital, has any information been released for higher hospitalization rates there vs average public rates with higher potential viral load?
This is a very good question, but we do not have any specific information yet. One of the potential reasons for why some people develop severe disease may be related to higher viral inoculation load, as you asked. We do not yet know whether this translates to higher hospitalization or complication rates.
Do smokers have a higher risk of contracting COVID-19?
We are not certain if smoking increases your chance of becoming infected. However, the complications from smoking certainly raise your risk of developing severe disease. The complications associated with secondhand smoking also raises the risk of developing severe disease from COVID-19. The coronavirus crisis provides a valuable opportunity to consider quitting smoking. It can protect both yourself and your family members!
If a person has recovered from COVID-19, is there a waiting period for that person to interact closely with others?
This is one of the frequent coronavirus commonly asked questions. There are different recommendations from agencies across the world. In the USA, the CDC recommends self-isolating at home until you satisfy the following:
- You have had no fever for at least 72 hours (that is three full days of no fever without the use medicine that reduces fevers)
- other symptoms have improved (for example, when your cough or shortness of breath have improved)
- at least 7 days have passed since your symptoms first appeared.
These guidelines only apply to sick individuals who did not get a COVID-19 test.
Is it possible for a patient who recovered from COVID-19 to get it again?
We are not 100% certain, but we believe it is highly unlikely to get infected twice. The theory behind antibody donation from recovered patients supports this. This also has important implications for serologic testing to determine if people have been infected or not. Those who have been infected and have recovered may be able to return to work sooner.
How to manage diabetes to reduce risk of getting coronavirus infection?
This is an important COVID-19 question because diabetics are at increased risk of developing severe disease. No specific interventions have been studied to date, but managing blood sugars is the most important diabetes-specific management. This means taking your medications for blood sugar and also other conditions, such as high blood pressure.
This is also an excellent opportunity to focus on an anti-inflammatory diet focused on unprocessed foods, whole vegetables, and whole fruits.
As with everyone else, following social distancing, hand hygiene, and never touching the face are crucial to preventing infection.
Considerations for IBD patients on immunosuppressant medications? What’s the intensity level if the patient were to contract this?
It is important to consider the severity of disease in immunocompromised patients. Anyone in this category will be at increased risk of developing severe disease, and the strictest precautions must be taken. There are no studies specifically examining patients with inflammatory bowel disease on immunosuppressive medications. However, this is a group of patients that is at increased risk of mortality, unfortunately. Physical distancing and avoiding crowded areas altogether is likely the greatest precautionary technique. Wearing a mask correctly in public but will also likely be of benefit. Someone in this category will be one of the last to return to work when restrictions are loosened.
Do you know the current situation of local hospitals?
The stress on hospitals across the Bay Area varies significantly depending on region. In the San Francisco area, hospitals still have capacity. We hope this is a result of social distancing at work. It is important to not become complacent, however. Let us be grateful that hospitals have not become saturated yet. Please continue to practice social distancing to prevent that from ever happening!
Number of recovered COVID-19 patients in California
Fortunately, the number of recovered patients in California is similar to that observed across the world. There are far more people who recover from coronavirus infection than do not recover from it (ultimately passing away).
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The information provided in this post in intended for general education. It is not medical advice. While I make every effort to provide the most up-to-date information, please note that new data is continuously becoming available and may change the conclusions I present here.