My View: SARS-2/CONVID-19 Update for March 19, 2020

Responding to more questions on social media.

1. How long before we can get back to normal in America?

This really depends on when cases in the US reach their peak. Currently there are rapidly increasing number of new cases, so it is somewhat easier to begin to calculate the exponential curves that mirror other countries with a similar population. The spread of the disease in Italy is continuing to rise, however, in China and South Korea new cases are tapering off, suggesting that they have passed the peak.

It really is dependent on a number of factors, including the availability of testing, and the willingness of the population to maintain social distancing. If we look at the two Asian nations, China and South Korea, we can see that it took China about 8 to 9 weeks from the beginning of the outbreak to reach peak number of cases. Because South Korea practiced wide testing and social distancing and other protective measures, they reached the peak of new cases in about two weeks. So, the simple answer to the question is, will we mirror China or South Korea? Currently, it is not possible to calculate when the peak will occur in the US for many reasons, chiefly among them is that we really don’t know the true number of cases due to the limited testing and the limited availability of tests. Currently the refusal of many Americans to accept limitations to movement, combined with the slow response compared to some other nations who have been more successful in combating the pandemic, must be factored into the length of time before we can get back to normal. I think it reasonable to expect public schools to remain close for the rest of the academic year; however, I have seen nothing to suggest that the President is correct in his statement that the outbreak could last until July or August. I just don't know as of right now, and it really will depend on how we can flatten the curve of the infections. It may be too late to function purely in prevention mode, and now we are forced to simply react as the pandemic intensifies.

2. Can you catch COVID-19 more than once?

There are reports from China where people who tested positive for the illness, recovered, and later tested positive again, although they did not have severe symptoms. This could be caused by a number of testing errors, for example a false positive or an initial false negative, or a person with the flu or a cold being misdiagnosed with COVID-19 and later actually being infected, but the reality is, as with any new infectious agent, we just don’t know how long immunity will last. While people develop immediate immunity to most viruses, we’re not even certain that will occur with this SARS-2 virus. We just don’t know. There is always the possibility of genetic shift, where the virus could change from a severe infection to a seasonal mild infection. Too much is just not known as of today.

3. What is the deal with Ibuprofen?

The action of ibuprofen is THOUGHT to possibly soften the immune response, however the same may be true of all NSAIDs, but it is not recommended that those who are currently taking them stop. There are studies that suggest that ibuprofen used during a respiratory infection can result in a worsening symptoms and complications, however, an otherwise healthy individuals, it is not considered to increase the risk of complications if there are no other comorbidities.

4. Why do some people with COVID-19 get intestinal issues?

The term corona, or “crown,” defines the family of coronaviruses. They have “spiked” proteins on their surface that allows initial attachment to host cells through interactions between the “S” protein spikes and the host cell receptors. This “S” protein–host cell receptor interaction is the primary mode of infection. Epithelial cells have an increased expression of angiotensin-converting enzyme 2, or ACE-2. This enzyme helps regulate circulating angiotensin levels, helps to normalize blood pressure and helps in the regulation of intestinal amino acid transport. These cells are located in the lung, intestine, blood vessels, and kidney. Unfortunately, the cells are receptors for the SARS viruses. The viruses can be shed in waste (fecal route) as well, hence the mantra “washing hands is critical.”

5. If I cannot get alcohol sanitizer will soap and water do as well?

Please remember this: soap and water are the preferred method of hand cleaning. Alcohol sanitizer above 60% is OK when you can’t get to soap and water. I’ve also been asked about anti-bacterial soap? There are a few reasons to avoid this product. First, antibacterial soap and cleaners will do nothing against a virus. Second, you may very well destroy the beneficial bacteria on your skin that can help protect you from infections from viruses. Lastly, many of these products contain chemicals of significant concern including triclosan and triclocarban, compounds believed to be carcinogenic. Other common antibacterial ingredients in soaps include benzalkonium chloride, benzethonium chloride, and chloroxylenol. The FDA has ruled that the amount of chemicals in consumer-available products is low, concluding that regular soap and water washing is just as effective.

6. My children wash their hands with cool water.

It is perfectly acceptable to wash with cool water or even cold water provided you use plenty of soap. Remember, soap simply breaks down the surface tension of water allowing the debris, including viruses, to rinse off. Remember to wash the back of your hand, between your fingers, and underneath rings and watch bands. Rinse your hands thoroughly and dry with a paper towel or air dry. AVOID hand air dryers, as these are frequently a breeding ground for bacteria and viruses. Health experts suggest vigorously washing hands with soap for 20 seconds. However I like to wash my hands for 30 seconds, or 2 rounds of “The ABC Song.” If you can, sing out loud. It might actually be a teaching moment.

Those are the questions I've been asked in the past 24 hours. The questions are fewer so I'm assuming people are getting more information and education. As always, question the source, avoid conspiracy theories and New Age remedies. Stay safe, maintain distance, and check with the CDC or WHO if you have questions. Or, ask your friendly neighborhood epidemiologist.