Patient Information: Protecting Yourself from Viral Infection (Including COVID-19)
During an uncertain time as we realize the impact of the COVID-19 outbreak on the local communities, here are a few questions and answers regarding the virus and ways in which we can reduce spread:
Why is it called novel “coronavirus”?
Coronavirus is named for its appearance of the virus’s outer membrane on electron microscopy, which resemble a crown. These zoonotic (animal derived) viruses were first discovered in the 1960’s and likely makes up approximately 15% of all colds.
The designation of “novel” comes from the fact that the virus is genetically distinct and emerged from animals and was capable of infecting humans, and then made the jump to human to human infection. Scientists call the phenomenon of a virus being able to infect another animal as a “spillover.”
There are four major strains of coronavirus that cause common colds during the respiratory virus season. COVID-19 is different from these in that it possesses different features on the viral outer layer that is foreign to our immune system.
Our bodies come across viruses frequently and our bodies have innate (meaning built-in) and adaptive (developed) mechanisms to protect us from them. With COVID-19, the virus has not circulated in humans before, so the protections that normally dampen the response to infections are not present.
Therefore, there is an imbalance of managing this, resulting in increased viral stealth and an increased inflammatory response. The body knows something is wrong but it cannot temper the response. A mixture of these interactions contribute to varying severities of infection that could lead to a threat on life.
How is a virus spread?
Like most respiratory viruses, COVID-19 is spread in respiratory droplets. Just to illustrate the magnitude of spread, take one simple cough. One cough can spread thousands of droplets into the air at up to 50 miles an hour for 6 feet. The size of the droplets measures from 10 microns to 100 microns. Just to give you an example of size of 10 microns, it would 100 droplets of this size together to make it visible (e.g. 1mm). If the virus is 100 nanometers (or 0.1 micron) a droplet can have from 100 to 1000 viruses riding within it. A single cough then is capable of shedding millions of copies of a virus.
How far the droplets can be spread depend on their size and wind currents – the majority of which fall within six feet, the space that doctors advise for social distancing. There is no compelling evidence that the virus is easily transmitted in the air, or airborne. Likely, as with all viruses, there is a continuum. Small droplets known as droplet nuclei can travel on air currents for longer distances or float in the air. Although people likely have a personal cloud of droplets around them, it is unlikely that this virus can be transmitted easily beyond 6 feet.
Studies have demonstrated that COVID-19 can remain viable, or “infectious” for 2-3 days and perhaps several days on surfaces. This is not likely to constitute the main mechanism of spread and is also not unlike other respiratory virus characteristics.
The important thing to communicate is that the virus operates by natural laws and although new to our immune system, as we gain greater information of its mechanisms and employ rapid testing to mitigate risk and target containment, the chain reaction that is this outbreak can be blunted and interrupted.
How can I prevent the spread or protect myself from a virus?
General measures are still helpful to try to reduce the risk of getting this virus. Respiratory viruses notoriously difficult to protect against. The CDC estimates that between 10 million and 50 million people get the flu yearly. Nevertheless, an increased vigilance in these practices may still provide some protection:
- Good hand-washing with soap and water for 15-20 seconds or the use of alcohol-based sanitizers
- Social distancing and avoiding anyone who is coughing or sneezing. If you are sick, ensure that you are practicing measures of social distancing, handwashing and sneezing/coughing into your arm sleeve and not shaking hands.
- “Corona elbow-bump” or ankle hit, instead of shaking hands. These are now “in” and accepted ways of showing respect, acknowledgement and affection.
- Avoid touching the face, nose, eyes or mouth, which could lead to ingestion of the virus particles.
- Wipe contact surfaces down before and after use, e.g. in the gym or in a common area or avoid touching your face or washing your hands after use.
- Wash you hands before preparing food and before eating.
Can I get a viral infection after handling a package from someone who was infectious or that was delivered from a country where there is a high caseload?
COVID-19 is predominantly spread by respiratory droplets, where millions of viruses can be spread in one cough. As other respiratory viruses, it can be transmitted by shaking someone’s hand who is infected and had coughed, sneezed or touched his/her face, touching a contaminated surface or an inanimate object (fomite) that have infected respiratory droplets.
It is unlikely that the virus can survive on absorptive surfaces such as cardboard for very long or in packages for longer than several hours, so it would be unlikely that the virus could be spread effectively in this fashion. Some studies of coronaviruses (including those that cause the common cold) as well as other the coronaviruses SARS and MERS have shown that viruses are capable of remaining infectious for 2-3 days, and in some cases several days. Fortunately, they are easy to wipe off with alcohol-based solutions, dilute bleach and other cleaning solutions.
If a delivery person is dropping off a package and is infected, there is a conceivable risk of transmitting viruses, if he/she coughs or sneezes on the package. This is an exceedingly low risk to the general public. Handwashing throughout the day is always recommended during the cold virus/flu season, in addition to avoiding touching the face, eyes or nose when out in public.
What are the signs of symptoms of viruses, including COVID-19?
Respiratory viruses infect mucosal surfaces in the respiratory tract, usually from nose to bronchial airways and sometimes even the lower respiratory tract. The more severe presentations are seen where a virus causes damage to the respiratory tissue, a process known as viral pneumonitis or viral pneumonia. Many viruses can cause this type of infection, including influenza, adenovirus, respiratory syncytial virus and COVID-19.
The common cold mostly causes cough, nasal congestion or runny nose and possibly a sore throat. It is not uncommon to have some tiredness and low to high temperatures for any of the respiratory viruses. Some people will have nausea and diarrhea.
The most common symptoms of COVID-19 include fever, cough and tiredness. If you have these symptoms, you would not be able to know if this was COVID-19 or another respiratory virus, without a specific test, a PCR on nasal secretions.
Most people will have only mild to moderate symptoms from COVID-19 that will improve after a few days of staying home, resting, keeping well hydrated and nourished. In those that are of advanced age and/or who have high blood pressure, heart disease, lung disease or diabetes, they may have a worse presentation that may require advanced care, including hospitalization. A smaller amount will die from the disease.
If I have a viral infection, when should I go to the emergency department or clinic?
The concern of severity of infection can get anyone worried about their health. We hear daily the amount of those that have died from COVID-19 and not influenza. The CDC estimates that as many as 30,000 people have died in the United States from influenza this season 2019-2020.
If you are experiencing cold symptoms that are minor, that is you feel tired and achy and are coughing a little, you can stay home and allow time to recover. If you are experienced a fast heart rate, recurrent fevers and increasing problems with breathing – “catching your breath”, “having difficulty breathing” or being “concerned about my breathing” are key words – then you should seek further care in your local emergency department.
We are currently not screening everyone with cold symptoms, reserving this for those who have severe enough illness to be hospitalized for now. With the amount of cases now reported in the community, there is likely local spread. Nevertheless, in people that are being tested, various viruses are likely to show up, like influenza A/B, respiratory syncytial virus (RSV) and metapneumovirus. With the upscaling of testing, it is likely that we may be able to test even those that have mild to moderate symptoms to better address the outbreak and target quarantine measures.
- Unless your symptoms are as described above, it is recommended not to go to the local clinic or emergency department, where a respiratory virus could get transmitted to those that have chronic heath conditions and at risk to have more severe infection.
What should I do about my travel plans?
With the report of cases of more than 1400 cases in the United States (March 12, 2020), families are beginning to wonder if they should change their spring break or other trip plans. The United States has enacted nationwide measures and various states have declared local emergencies to protect the public. Large events are being canceled as a means of interrupting viral transfer in the name of social distancing.
With this increased awareness, families are trying to balance between canceling plans to protect themselves or following through with the plans and possibly putting themselves at risk or contributing to further spread. The spread of disease in this outbreak is extremely volatile and could require in a sudden shift in plans as events are canceled.
The following are some considerations for your decision:
- Did you purchase travel and/or flight insurance?
- Is your ticket purchase (e.g. an amusement park) only for “same day” or can it be transferable for a later time? Review all of the policies for cancellation of the event, and contact the venue, park or hotel to discuss exceptions,etc.
- How flexible are you to the possibility of sudden changes in your plans?
As for the risk of attending these events: The risk of acquiring any respiratory virus is increased with proximity and likelihood of coming into someone who is infected, such as in social activities. Common practices of social distancing and avoid contact of infected surfaces or inanimate objects (fomites) cannot be assured in an amusement park, for instance. The same is true with access to hand washing.
Here are a few measures that families can take to prepare themselves for their trips:
- Have hand sanitizer and handwipes available for use while traveling.
- Instruct children to cough and sneeze into their sleeves and not their hands – and other practices to avoid touching the face, nose or eyes.
- Check on outbreak information at the specific location or closest city to it before you embark. Disney just announced today that it’s closing the California park because of COVID-19.
Families can take certain precautions in advance of surprises. COVID-19, as with other respiratory viruses can have a major effect on people of advanced age or with chronic conditions such as hypertension, heart disease, diabetes and lung disease or who are immunocompromised. The majority of travelers require no further preparation than what they would do to protect themselves from viral infections during the cold season.
I hope this information is found to be useful. Please share this with your friends and please feel free to comment. This will be placed in the Health Information section as well as COVID-19 resources. Thank you for reading this.