covid-photo5

What we all need to know from infectious disease specialist Steven Marlowe MD

Ipsum Diagnostics is one of the first local, privately held, independent diagnostic labs to be testing for coronavirus in Atlanta, GA. We want to provide support to the healthcare needs of our community. We can offer results quickly, once the scientists receive the samples they can be processed and take less than 90 minutes to get the results.

Our hope is that by being able to provide such rapid results may lead to a quicker recovery.

Please read this most important information, we believe our question and answer summary will help to answer your most urgent questions about the coronavirus and help to alleviate some of your fears.

Our Medical Director of Molecular Diagnostics at Ipsum Diagnostics, Steven I. Marlowe, MD, FACP, FIDSA, wrote this to answer questions from his own family and friends about the coronavirus.

He is a highly rated by his patient base and well-respected by his colleagues as an Infectious Disease Specialist in Atlanta. We’re so fortunate to have the honor of working with him and appreciate that he has chosen to share this information with all of us.

Dear Family and Friends —

In response to questions many of you have asked I’ve prepared this description of what I’m doing and what I’m recommending to protect against the new coronavirus.

As you know I have been a clinical infectious diseases physician with special interest and training in virology and epidemiology for many years.

Background:

COVID-19 is transmitted by infectious droplets. Infectious droplets are produced when an infected person coughs, sneezes or speaks. The droplets travel 3-6 feet in the air before falling down. Direct infection occurs when the droplets land in our eyes, nose or mouth. Indirect infection occurs when droplets land on a surface, we touch the surface with our hands and touch our eyes, nose or mouth.

Coronaviruses, including COVID-19, generally persist on surfaces for a few hours to several days. A recent study showed MERS and SARS viruses (predecessors to COVID-19) remain contagious on hard surfaces up to 9 days!  

Hand contact is the most important way coronaviruses are transmitted.

Most people use their hands to touch their nose, eyes or mouth three times or more in an hour, often unconsciously. Watch people in a meeting room sometime and count!

So the single most important preventive measure is good hand cleaning – wash and/or sanitize your hands frequently.

Do’s and Don’ts

1. DON’T SHAKE HANDS!

Hands are potentially loaded with coronaviruses, flu viruses and other pathogens. Politely decline and offer an elbow bump, fist bump or head nod.

If you shake someone’s hand by accident, wash your hands or use hand sanitizer ASAP.

2. Don’t touch frequent touch surfaces with bare hands including door handles especially in rest rooms, handrails, elevator buttons, common use computer keyboards, electronic device buttons, shopping cart handles, gas pump handles etc.

3. Do use an elbow, shirt sleeve, or knuckle to press elevator buttons, open doors, etc.

After hand washing, use a paper towel to turn off the water and open the bathroom door.

4. Do disinfect shopping cart handles, etc. with antiseptic wipes. Disinfect your hands with hand sanitizer (or soap and water for 10-20 seconds) after touching high risk common surfaces. Hand sanitizers need to contain 60-95% alcohol. Consider making your own – search DIY hand sanitizers.

5. Don’t use gloves to prevent transmission of cold viruses. You’ll tend to wash your hands or apply sanitizer less often increasing the likelihood of contaminating yourself and others. If you take them off improperly, you’re at very high risk of contaminating yourself. Gloves are useful to prevent certain occupational exposures. See the glove removal procedure on CDC’s website.

6. Do wear a mask if you have cold symptoms, to prevent spread to others. Use cough and sneeze precautions regardless and use disposable tissues instead of sneezing into your elbow and contaminating your clothing.

7. Don’t wear a surgical mask to prevent yourself from getting coronavirus. Surgical masks have been shown ineffective in preventing people from getting coronavirus from direct droplets. Some feel masks may be useful in preventing people from touching their nose and mouth but that’s speculative.

8. Do consider wearing an N-95 mask along with good hand hygiene if you are a high risk individual (underlying immunodeficiency, diabetes, heart or lung disease, age over 60) and in a high risk environment (international airports/flights, subways, buses, and crowds in general). N-95 masks prevent 95% of infectious particles from reaching your nose and mouth, if fit snugly. Use the ones with a valve for longer term comfort.

9. Don’t use homeopathic zinc throat lozenges or mists. They have not been proven effective in preventing colds or cold symptoms and may prolong carriage. 

Nasal zinc gel worked somewhat (Zicam) but causes permanent anosmia (loss of smell) in some people so was taken off the market in 2011.

10. Do consider a contingency plan for widespread transmission in the US. “Social distancing” if you are at high risk, “Lock-downs” – temporary school and workplace closings/reduced staff/work at home/cancelling non-critical air travel…

Some Facts and FAQs

1. The current name of the disease is “COVID-19”, short for “coronavirus disease -2019”. 

2. The name of the responsible virus is “SARS-CoV-2”, an animal coronavirus that evolved to infect humans.

3. Early symptoms are clinically indistinguishable from the seasonal flu or common cold.

4. Exposure to onset is 1-14 days, average 5 days. Hence the 14 day quarantine period for exposed people.

5. Worldwide cases: SARS 8,000 from 2003-2004 none since 2004; MERS 2,500 since 2012 and declining; COVID-19 >100,000 (prelim, 81K in China of which 67K are in Hubei Province)
6. Case fatality rates:  SARS 19%; MERS 37%; COVID-19  2.3%(prelim) in China, lower in rest of world ?0.9%

7. Origin/Reservoir:  SARS – China/bats -> civet cats;  MERS – Saudi/bats -> camels;  COVID-19 – China/bats -> snakes/pangolins (similar to ant eaters, scales instead of fur, sometimes called “Scaly Anteater” – they are the highest trafficked mammals in the world, and scales are used in Chinese Traditional Medicine.

How deadly is COVID-19?

Less deadly than SARS or MERS but more cases so will cause more deaths. Slightly more deadly than seasonal flu but fewer cases so will most likely cause fewer deaths than flu.

When will effective vaccines and treatments be available?

Candidate vaccines will be ready for testing in several weeks. A safe and effective vaccine will take at least 12-18 months to produce and might be ready for a seasonal recurrence next year.

Candidate antivirals (like Tamiflu ® for influenza) are being tested in people now. A safe and effective treatment may be available in 6 months.

How fast is it spreading?

The epidemic curve (rate of new cases) appears to be declining at the epicenter and throughout China (validity of data a concern) and South Korea (more reliable data). This is a very encouraging predictor for a limited outbreak in the US.

It’s early in the US with much smaller case numbers, which no doubt will increase in the immediate future.  Additional testing of low and moderate risk individuals is essential for better predictions. An increasing number of US cases is expected based on increased testing alone. The number of new cases reported in the next 4-6 weeks will be important in determining the trajectory of the curve and estimating the total number of US cases this year.

Will the change of season lead to a decline and why?

Change in seasons certainly makes a big difference with seasonal influenza A and human coronaviruses infections (but not influenza B).

No one knows why for sure but less crowding in warmer months with people outside more, and “less efficient” droplet transmission (droplets falling to the ground faster and traveling shorter distances in warm humid air, UV sunlight inactivation) are hypothesized.

Can I catch it from a pet, Chinese restaurant or Corona beer?

Really?

Why is it spreading to people without a known contact with someone who has the disease?

Asymptomatic transmission (someone without symptoms, generally a day or two prior to developing the disease) has been identified and is probably responsible for “community spread” (someone getting ill without known exposure). “Super-spreaders” (one person, who is usually late in disease, infecting many others) and carriers (Typhoid Mary-like people who don’t get sick but spread to others) have not been identified to date.

Is it contained in US?

So far, yes. Our public health system is working. Countries with good public health infrastructures could possibly see the eradication of this infection in months. However given the extent of the outbreak, international travel, the limitations of screening, and in light of the limited data on transmission risk, it’s likely it will persist at a low level globally for many years, perhaps recurring seasonally as a more serious version of “the flu”.

Hope this helps!

SM

Steven I. Marlowe MD FACP FIDSA
Medical Director, Molecular Diagnostics
Ipsum Diagnostics

Share this post

Share on facebook
Share on google
Share on twitter
Share on linkedin
Share on pinterest
Share on print
Share on email