Frequently Asked Questions about COVID-19
“Shared expectations lead to predictability.”
- When patients are the most and the least infectious
Q: Is there any understanding on when and if infected patients can infect others?
A: A WHO epidemiologist and technical lead on the pandemic, Maria van Kerkhove, created an unintentional controversy recently by stating that “transmission of COVID-19 by asymptomatic patients is very rare.” To an epidemiologist, an “asymptomatic patient” is someone who is infected and has the disease resolved without showing any symptoms. Testing later shows antibodies indicating they did have the disease. But in common language, a patient who is asymptomatic means that at that time, no symptoms are present. Thus, a patient who does later become sick usually does have a few days where they are asymptomatic, and in fact is able to place others at risk. In fact, studies now show that the transmission rate of infection is actually greatest just at the point when they first begin to feel unwell.
Dr. Mike Ryan, the top emergencies expert at WHO stated, “The novel coronavirus lodges in the upper respiratory tract, making it easier to transmit by droplets than related viruses such as SARS and MERS, which are in the lower tract.” He continued, “That means you can be in the restaurant feeling perfectly well and start to get a fever. That’s the moment your viral load could be actually quite high.”
Later studies have found that even asymptomatic patients, who never experience symptoms, can actually spread the disease, but at t much lower rate (below 40%) of the contagion of symptomatic patients.
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- Therapeutic medicines for children
Q: Are there any new medications being tested to treat children who get COVID-19?
A: Starting on June 10, The National Institutes of Health (NIH) launched a study in the United States to evaluate drugs used to treat children and adolescents who are infected with coronavirus-19. The studies will include several antiviral and anti-inflammatory drugs, and will study drug dosages and safety factors for special populations including premature infants, critically ill children with Down’s syndrome, and obese children. The study to be accomplished will not be a clinical trial, but will analyze blood samples to assess how drugs move through children. As a result, this study will not be evaluating the best treatments for COVID-19 in pediatric patients. It is apparent that there is much to learn about coronavirus-19 that is still unknown – this being named a “novel” coronavirus. For now, the emphasis remains focused on the largest population of infected people, that being adults.
- High value given for universal use of cloth face coverings
Q: People still feel uncomfortable wearing cloth face coverings. Is it really worth doing this?
A: A research study led by scientists at Britain’s Cambridge and Greenwich Universities was recently published in the scientific journal, “Proceedings of the Royal Society, Part B” indicated that lockdown, or “stay at home” policies, cannot alone stop the resurgence of COVID-19. Even homemade cloth masks can “dramatically reduce transmission rates if enough people wear them in public.”
The study examined the dynamics of disease spread using population-level models to determine the reproduction rate, R value, of different situations with and without mask usage. An R value of 1 is when each infected person in a group infects just one other person – the disease remains static. An R rate greater than 1 is when the number of infected people grows exponentially.
The purpose of the cloth face mask is to reduce the spread of the disease from those who are infected but have yet to show symptoms. The study found that if everyone wears a face covering when they are in public, it is twice as effective at reducing the R value than if the masks are only worn after symptoms appear. In all scenarios examined, it was found that when 50% of the population uses cloth face coverings, the R factor was less than 1, meaning that this practice alone flattened the future disease waves and spikes, allowing for less stringent lockdowns being required.
The WHO updated its recommendations to all governments on June 5 stressing the need to ask everyone to wear fabric face masks in public to reduce the spread of the disease.
- Lack of public desire to follow CDC guidelines
Q: Why aren’t people following the guidelines as we open up?
A: Mixed messaging from Washington on the pandemic appears to enhance public confusion over the guidelines and encourage behavior that in some states is expanding the number of COVID-19 cases. The president continually refuses to wear a cloth face covering, sending the message that this isn’t really important. The White House exclusive focus on opening the economy is allowing many citizens to perceive the threat from the disease is already over. White House guidelines have been promulgated stating when states can effectively open their economies in stages, but the president then supports protesters demanding their governors ignore these recommendations. This all feeds the natural human tendency for many people to want to “get back to normal” and ignore the early warning signs as the number of cases in some states are rising exponentially.
According to Reuters, Arizona, Utah and New Mexico reported rises in new cases of 40% or higher for the week ending June 7. New cases in Florida, Arkansas, South Carolina and North Carolina rose by more than 230% in the past week. Ashish Jha, the head of Harvard’s Global Health Institute stated the United States was the only major country in the world to reopen without getting its case growth rate – people tested positive – remaining at or below 5% of the population for at least 14 days.
The lack of patience, the lack of accepting guidelines and agreeing to follow them can only lead to an expansion of the disease in the US. And the greater it spreads, the more difficult it will be to reduce its prevalence. And, more critically, the more people may become ill without the availability of hospital care as we have come to expect.
- Update on inaccurate testing
Q: Is COVID-19 testing still unreliable?
A: (This is a follow up to FAQ 32, previously published.) The Hartford Courant on June 15 published an Associated Press article by Matthew Perrone reporting that diagnostic testing as well as serum testing for COVID-19 remain inaccurate, hampering management of the pandemic in the U.S. Early in the spread of coronavirus-19, the World Health Organization (WHO) offered a specific diagnostic test to all governments to determine if a person was infected with the virus. The CDC did not use this WHO process, and developed and released its own testing method. It was found that this FDA test was unreliable, and it was withdrawn. The White House directed the Food and Drug Authorization (EUA) to turn to the private sector and issue Emergency Use Authorizations to as many business and laboratories as possible to fill this void. The FDA requires a minimum of 60 sample tests be documented by the applicant to ensure accuracy before an EUA is granted.
The AP reporter Matthew Perrone reports, “In recent weeks, preliminary findings have flagged potential problems with some COVID-19 tests, including one used daily at the White House. Faulty tests could leave many thousands of Americans with the incorrect assumption that they are virus-free.” He identifies there are more than 110 different diagnostic tests and “roughly 80” commercial serum test with an EUA available for use.
The article continues, “’Requiring bigger studies of all coronavirus tests could provide valuable information, but it could also strain the FDA’s already stretched staff and resources’ said Dr. Daniel Schultz, former director of the FDA’s medical device center. ‘Dr. Colin West of the Mayo Clinic worries doctors and patients have put too much confidence in the current crop of tests, when an unknown number of patients are likely receiving false negative results.’” Dr. West gave an example – if a test with 95% accuracy is given to 1 million people, there could be 50,000 people receiving a report they don’t have the virus and left in the population to infect others.
This article identifies many of the problems resulting from not having an early and effective national testing program.
