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Experts answer your COVID-19 questions: ‘I am wondering how it could be possible to see my significant other during the coronavirus pandemic.’
COVID-19
Have a question about coronavirus, also known as COVID-19?
We will ask the experts.
Send questions to tribdem@tribdem.com.
“I am wondering how it could be possible to see my significant other during the coronavirus pandemic. We live separately, and I have been quarantined while he has continued to do basic things such as grocery shop and goes to work two times per week, always following recommended precautions. We are wondering if he were to do a PCR test for coronavirus RNA combined with an IgG and IgM antibody test, could this provide a sufficient picture upon which to base a decision to see one another, or not? “
The answer:
Social distancing is so hard! All of us have someone we want to see.
In public health there is something called risk reduction. It refers to using strategies that minimize the risk or harm certain human behaviors come with – for example, wearing a bicycle helmet when riding a bike. If you wear a helmet, you are less likely to have a traumatic brain injury if you wreck. You still ride the bike, just in a safer way.
With SARS CoV-2, becoming more lax on your social distancing is not the same as wearing a bicycle helmet when riding a bike. SARS CoV-2 is spread via airborne droplets by people who may not know they are sick yet. Even people who are practicing social distancing may not know they have been exposed because they could have come in contact with people who don’t know they are infected yet.
Testing can help. The test for genomic RNA of SARS CoV-2 will let a person know if he or she is actively infected at that time. The antibody tests would show that you are in the first stages of an adaptive immune response (IgM) or that you are in the later stages or recovered from COVID-19 (IgG).
However, this is only a snapshot of the infection risk. It only says that at the time of the test, the individual is SARS CoV-2 free. If that individual goes out in the community the next day, he or she could be exposed to someone with the virus and become infected.
Until we have more testing, two-thirds of our population recovered, or a treatment is found, it is best to keep socially distant.
As always the risk assumption is yours; however, the recommendation is to maintain social distance.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
• • • • •
“Are drug users, especially intravenous, more likely to spread COVID-19 or other viruses and diseases than non-drug users?”
The answer:
SARS CoV-2 is spread via respiratory droplets. Anyone can spread the infection if they have symptoms and we are seeing studies that show asymptomatic transmission in about 35% of individuals (recent studies from the New England Journal of Medicine).
Now is a good time to remind everyone that human behavior contributes to the spread of any infectious disease. When we consider COVID-19, we can reduce the spread by wearing a mask in public, washing our hands, and maintaining social distance.
Injection drug users are at a greater risk for blood-borne pathogens, such as Hepatitis and HIV, as well as having a greater risk for sepsis, a bacterial infection in the blood. As for other drug users, according to the National Institute of Allergy and Infectious Diseases, because SARS CoV-2 attacks the lungs it could be a serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health.
In short, anything that decreases lung functioning can lead to more severe COVID-19 disease.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
• • • • •
“I am a nanny and was asked to enter the family’s home wearing a mask. I assumed they (mom, dad and 41/2-year-old) would also be wearing masks. They did not. I wear one to protect them and vice-versa, correct?”
The answer:
There are no formal guidelines on what should be done in this situation. Childcare is a necessity for many families, even if they are working from home. In this situation, I would recommend that you all (mom, dad, child and nanny) keep each other apprised of your health situation. Have a discussion about your exposures and risk factors for SARS CoV-2 (for example, do you live in a home with an essential worker) be truthful about each other’s movement (or lack there of) in the community. If you are nannying for another family, be sure to inform all parties involved.
After this conversation, decide together on a safety plan that makes everyone comfortable.
For example, everyone has their temperature taken daily before work starts. If symptoms become apparent, all are notified.
Maybe you have certain rooms that are for family only in the home, maybe you and the child remain in one area of the home.
Through working together as a unit, you can be sure to address all concerns and come to an agreement in which everyone feels safe.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
• • • • •
“The news keeps saying people under 18 rarely transmit the disease. However, what evidence is this based on? I read that children under 18 don’t get the disease, or very mildly and don’t transmit. But how many children have had the disease? How many children under 18 have actually been tested? If we do not have facts on children under 18 how can we say that they rarely get it and they do not transmit it?”
The answer:
We don’t have all the facts yet on how COVID-19 affects different populations, or know how many people have had the virus. And this is especially true with children.
It seems that children may not have symptoms that are severe, but we do know they get the virus. There have been a few cases (not locally) where kids are intubated, and respirators were used for children. Children can still pass the virus to their older family members who can have much more severe symptoms.
Everyone, including children, should follow the recommended precautions to prevent the spread of the virus.
– Dr. Uchenna Okereke, infectious disease specialist, Conemaugh Physician Group.
• • • • •
“Is it safe for my young children to visit grandparents? We have not left the house since March 12, aside from work. My husband and I are both health care workers. Grandma has also been self-isolating at home. Now that some restrictions are being lifted, we were wondering if family visits are OK. My 2-year-old misses his grandparents terribly.”
The answer:
Social distancing is hard on our mental health. It can be even harder for young children. My students and I created a toolkit that contains some information on how to talk to your child about COVID-19. Here is the link: www.johnstown.pitt.edu/coronavirus-toolkit.
As of now, our region, the southwestern portion of Pennsylvania, is under stay-at-home orders. This is to decrease our exposure to other individuals. We do this because of the R0 – the number of how infectious a virus is. If the average R0 in the population is greater than 1, the infection will spread exponentially. If R0 is less than 1, the infection will spread out be it slowly, and it will eventually die out. For SARS CoV-2 that number is 2.5-3. This means that one infected individual can infect up to 3 others.
If a person is expressing symptoms of COVID-19, we know to stay socially distant; however, studies have shown that asymptomatic transmission is occurring. This means that some individuals could be spreading the virus and appear to be healthy, making it difficult for anyone to know if they have been exposed or not.
The choice is, of course, yours.
But the recommendation is to maintain social distancing in our area.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown
“Do current COVID-19 tests tell you what stage of the disease you’re in? Two family members were tested, with someone going to their home and drawing blood. The next day, one of them was told they were at the acute stage of the virus and that the other was at the end stage of COVID. I have not heard that kind of testing before and am concerned they are being scammed.
“I have only heard positive, negative results; or positive or negative for the antibodies. Why these different tests?”
The answer:
Molecular testing identifies people with the virus, and an antibody test can tell whether someone has been previously infected.
Qualitative real-time reverse transcriptase Polymerase Chain Reaction (PCR) nasopharyngeal swab is either positive or negative. If positive, this indicates that RNA from the virus was detected, and that the patient is considered infected with the virus and presumed to be contagious.
There are several types of COVID-19 antibody blood tests.
One is a blood finger prick IgG/IgM Rapid Test which takes 10-15 minutes for the results and are either negative or positive (a colored line appears, just as a pregnancy test). The IgM test line is usually positive (colored) four days after becoming infected with the virus, but “false negatives” can occur if within less than four days, because the incubation period is estimated to be between 1-14 days.
IgG antibodies are usually detected (colored line) 7-21 days after symptoms develop, and this test also identifies if someone has been previously infected.
IgG testing can also be done on a lab machine – which requires a tube of blood, and takes approximately 45 minutes to 1 hour. The results are reported as positive or negative based upon a cutoff numerical result.
Therefore, a positive IgM antibody test result indicates early COVID-19 disease, and IgG indicates a later phase, or someone who has been previously infected. Antibody testing has received Emergency Use Authorization (EUA) from the FDA. Antibody testing is being reviewed by the FDA, and final FDA approval is pending.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
“What is the possibility of getting virus from meat with the problems the packing plants are having?”
The answer:
SARS CoV-2 is transmitted by respiratory droplets. While there are many reports of workers at meat packing plants getting sick with COVID-19, there are no reports of transmission via food.
It is good to remember that SARS CoV-2 is able to be viable on plastic for a few days. It is good to follow hygiene practices to prevent the spread: wipe your packages down and wash your hands after putting your groceries away.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
“My wife is returning to the United States from Warsaw, Poland. She is taking a train from Warsaw across the Polish/German border to Frankfort, Germany, directly to its airport. She is an American citizen with a valid passport, a plane ticket, and has submitted all required forms to the Polish government and U.S. Consulate in Warsaw and Berlin.
“When she arrives at her hub U.S. airport, she will be screened at Washington Dulles, and after screening is advised (not ordered) to self-quarantine upon her arrival at her ultimate destination, Indianapolis, Indiana. Is there an appropriate location where she should go for 14 days to self-quarantine alone? I assume she cannot go to our residence where our family, children and me, are already in self-quarantine.
“Finally, if I can arrange for her to be tested for the COVID-19 virus either serologically (finger-prick testing) and/or nasal swab testing, and the results are negative for the coronavirus, is it then prudent for her to come to her family at our residence and self-quarantine with us?”
The answer:
Ideally, she should self-quarantine (self-isolate) in a private apartment. If a private residence is not available and she wants to stay with her family, then she should self-isolate in a private room (basement or other private portion of the residence), and use a private bathroom if possible.
Whoever else lives in your home should also stay at home.
If she tests negative, she still needs to self-quarantine/self-isolate for 14 days in a private room and use a private bathroom, because the incubation period for the virus is estimated to be between one and 14 days. After 14 days, if she has had no known exposure to a confirmed case, and she remains asymptomatic, she can stop the self-quarantine.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
“I wanted to pass out roses on Mother’s Day. Can you get COVID-19 by someone holding the stem that has COVID-19 or will it not affect flowers?”
The answer:
We know that SARS-CoV-2 is viable on many surfaces for a few hours to a few days. However, plants are not one of the surfaces that have been tested.
Since the virus is spread via respiratory droplets, it is more likely that someone with COVID-19 would transmit the infection when they coughed near you, not from touching the flower.
As with anything we touch, it is good to practice hand hygiene and avoid touching your face until you have washed your hands.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
“My 90-year-old mother lives with me. She recently had a fall and was sent to a nursing home rehabilitation facility. While there, she tested positive for the virus without symptoms. When she does get to return home, should I be tested due to my suppressed immune system? I have most of the symptoms listed for COVID, but have not been tested.”
The answer:
Since you have symptoms, a history of immune suppression, and a known exposure to a confirmed case (your mother), I recommend that you get a PCR (Polymerase Chain Reaction) nasopharyngeal swab test – which detects RNA from COVID-19.
This test will require a physician’s order. If this test is positive, the patient is considered infected with the virus and presumed to be contagious.
You should self-isolate in your home while you wait for your result. What you subsequently should do depends on whether your PCR test is positive or negative. I recommend you follow up with your primary care physician.
I would also consider a blood test, which detects IgG antibodies to the protein of SARS-CoV-2.
This antibody blood test is being reviewed by the FDA.
It is not known for certain whether individuals infected with COVID-19 and who subsequently recover will be protected, either fully or partially, from future infection with COVID-19, or how long protective immunity may last.
Concerning when your mother can return home, that depends on her condition and progress at the rehab facility. I suggest you ask her physician there.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
“My cat has tested positive for the coronavirus. I have no symptoms and haven’t been tested. I informed my employer and after working most of my shift he sent me home stating I have to get tested and I need to have my vet send over my cat’s records. Can they do that?”
The answer:
Cats get the intestinal form of coronavirus that can cause diarrhea. They also so get feline infectious peritonitis (FIP), which is also a coronavirus that is deadly to cats. This is not COVID-19 and is not zoonotic to humans.
So when you said the cat was tested, do you mean tested and positive for coronavirus or COVID-19? If your cat is positive for intestinal corona or even FIP, then there is no risk of infection to humans. If it is COVID-19, which I highly doubt, it is a reportable disease to health officials.
According to the CDC guidelines, there is no need to get tested if you do not display any of the symptoms they mention – such as coughing and fever. Finally, until now, there is no scientific evidence of transmitting COVID-19 from animals to humans. More important, corona virus in cats (intestinal form) does not equal COVID-19 at all.
– Dr. Fayez Assad, medical director, Johnstown Veterinary Associates
• • • • •
“Should we assume the opening up to the green phase will be months away from now? When do you expect large gatherings such as wedding receptions, concerts, etc., to be allowed again?”
The answer:
The reopening of Pennsylvania, and our region specifically, to the green phase is going to be decided by case data. As it stands now, a region must have 50 new cases or fewer in a 14-day period to move to the yellow phase. The green phase will follow that – when we see a sharp decline in cases.
The decision to move through the phases is going to depend on data. That data is dependent on accurate testing and contact tracing of individuals who are infected. The Pennsylvania Department of Health is working to collect the most accurate data with Carnegie Mellon University.
An important thing to point out here is a number we call the R0.
This indicates the contagiousness of an infectious disease. For COVID-19, this number is between 2.5 and 3.0. That means that one infected person will transmit the disease to as many as three people. To move to the green phase from the yellow phase is going to require people to follow the rules.
If the public observes the rules – wearing a mask when out in public, aggressively washing their hands, and avoiding gatherings of 25 or greater – then we can move through the yellow phase more quickly.
In short, we are in this for the long haul. Viruses such as SARS CoV 2 don’t go away. We must either have a vaccine to prevent the disease or have two-thirds of the nation recovered from the illness. I implore everyone to urge officials to make more testing available, to aid public health officials when asked for information, and to limit your exposure to others (until one of the above occurs).
Together is the only way we can decrease our time apart.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
"I had severe symptoms in March, was hospitalized and tested. The test came back positive on March 16. My husband had mild symptoms, but he wasn’t hospitalized nor tested. As an essential worker, I had to be re-tested in order to go back to work, so on April 23 my husband and I got tested. I was negative and he was positive. Now what do we do?"
The answer:
The CDC recommends two strategies for returning to work. One is a test-based strategy that states you should have two consecutive negative molecular (genome) tests in which the swabbing has been done greater than 24 hours apart. The other is a non-testing based strategy where you must be fever free for 3 days and be at least 7 days removed from when symptoms started.
The CDC also recommends that an individual with a laboratory confirmed case who is asymptomatic should wait 10 days before returning to work.
This situation is in the in-between. You are negative, but your husband is positive. If we take the guidelines and adapt them to your situation, it may be prudent for you to wait the 10 days before returning to work. At the very least, it is prudent to be sure your husband is fever free for 3 days and that it has been 7 days since his symptoms started before you return to work.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
“Can coronavirus testing be done anonymously, similar to STD testing?”
The answer:
At this time, all COVID-19 testing requires an order from a health care provider, and the specimen must be collected by someone trained to do it, such as a nurse. The ordering physician shares the test results with the patient. So it is not a fully anonymous process, currently.
But health care providers work diligently to protect your personal health information, so you can feel confident getting a test if it is recommended.
– Emily Korns, director of marketing communications, Conemaugh Health System
“I am a 67-year-old woman, active and in good health. I rent my basement to a traveling nurse who is working at a local ER. She has already had one COVID-19 scare and was quarantined until her results came in – thankfully negative. “However, she could of course become positive at any time. Should I be concerned?”
The answer:
If this nurse is compliant with Department of Health and CDC recommendations including personal protective equipment, proper hand washing hygiene, and if she is following hospital ER infection protocols, the risks to others including yourself should be minimal.
You have already established separate living areas if the nurse is in your basement. Practice social distancing and good hand washing, and frequently clean surfaces you may both touch. I also recommend you both wear face masks when in the same area of the house.
Finally, we should all be thankful for nurses and all health care personnel for their care.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
“I am hearing more and more that this virus causes clotting in the body – causing strokes and organ failure due to bodies being riddled with clots. But we can’t take NSAIDs (nonsteroidal anti-inflammatory drugs) such as Ibuprofen, which have been known to thin the blood and prevent clotting. What can we do to prevent the clotting aspect of this virus?”
The answer:
In our cases locally, we have not yet seen the severe clotting described by the reader, or deaths attributed to clots or pulmonary embolism, but we recognize this is a complication.
Most likely, this level of clotting is due to sepsis brought on by a very severe form of the infection. In the hospital, patients may be prescribed a medication, such as heparin to avoid clotting. For the average patient at home with a mild or moderate case of COVID, anti-clotting therapy doesn’t seem to be indicated.
If you have a personal history or family history of blood clots, this is important information to share with your primary care physician or your emergency care provider. With COVID-19 or any condition where you may be inactive due to illness, it’s a good idea to try to move around a bit to keep blood flowing, even if it’s just getting up to walk around the couch.”
– Dr. Uchenna Okereke, infectious disease specialist, Conemaugh Physician Group.
• • • • •
“I’m a 50-year-old male with severe asthma and hypertension. Both diseases are well controlled with medications. I realize that I have two high risk factors for COVID-19 complications if I became infected. However, I never get sick. Given that I have a strong immune system, does that make me any less likely of becoming infected with COVID-19?”
The answer:
It is important that your asthma and hypertension are both well controlled, and that you have a good immune system. Patients that are immunosuppressed or immunocompromised are at a higher risk of infection and complications.
However, there are other important contributing factors including behavior (contact length and frequency), virulence of the virus and environment (crowding, poor air quality and pollution). Therefore, immune status is not the only determining factor whether or not you become infected with COVID-19.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
“I’m 67 and was diagnosed with the virus about two weeks ago. I’m quarantined and have shortness of breath, but have been to emergency room twice and all tests are good. How long does it take for symptoms to subside?”
The answer:
There are no specific answers for duration of illness or exact recovery time, and each patient is different. Those with milder symptoms may recover in 7-10 days. Others with more moderate or severe symptoms may take 3 to 4 weeks.
I also read medical reports of patients who were hospitalized with significant complications and were subsequently discharged, but were still not completely recovered at 10 weeks or longer.
I certainly hope that your symptoms resolve soon, and it is very important that you follow up with your treating physician.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
“Does spraying the soles of my shoes with bleach without wiping kill the coronavirus instantly, or does It take some time? Is there a better way to clean them to prevent the virus from spreading into the house?”
The answer:
COVID-19 is spread via respiratory droplets and anything that those droplets get on. The term for this is fomite transmission.
Research has shown that the virus can survive on surfaces for a few hours to a few days, depending on the surface. A disinfectant such as bleach will destroy the virus. You may spray with a bleach solution (1/3 cup of bleach per gallon of water) or use a household disinfectant spray (such as Lysol) and allow the shoes to dry. This can take a few minutes.
Another option that can be done is to wipe the shoes down with a hydrogen peroxide wipe (it only takes 30 seconds for these wipes to kill). Lastly, you may use a 70% alcohol-based solution to wipe the shoes down and allow them to dry (this can take up to a minute).
If you are worried about bringing the virus into the house, you may want to spray the shoes outside your home and bring them in after the 30-180 seconds has passed. That’s what I do!
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
• • • • •
“If someone is asymptomatic yet positive for COVID-19, how long would they be considered contagious?”
The answer:
Great question.
If you test positive:
• Notify your close contacts and let them know they should quarantine at home for 14 days. This includes your family members.
• Self-isolate in your home until each of the following conditions are met:
1. It has been at least 7 days since your symptoms first appeared, AND
2. It has been at least 3 days since you have not had a fever (without using fever-reducing medications) and your respiratory symptoms (cough, shortness of breath) are improving.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
“We have all these stories of how many caught the coronavirus and how many deaths have been recorded, but not one single number on people who have recovered from it. Is there an accurate estimate of COVID-19 recoveries in Pennsylvania?”
The answer:
An accurate figure does not exist. They may start collecting hospital discharges, but since only 10% of all confirmed COVID-19 cases end up in the hospital, it doesn’t mean that much. They aren’t really “recovered” when they are sent home anyway.
If someone gets a positive test, stays home while the illness runs its course and returns to the self-distancing world, that person is not being checked or reported as recovered. Not to mention hundreds, probably, who get mild symptom but are just being told to stay home, and then recover without even testing. They aren’t even showing up on the daily positive report.
– Randy Griffith, health care reporter, The Tribune-Democrat
• • • • •
“Should we be concerned, as we soon turn on our air conditioning, about airborne spread of coronavirus?”
Answer:
COVID-19, SARS-CoV-2, is droplet transmission. The airborne droplets travel through the air and can make it about six feet. When you add an air conditioner, you are adding strong airflow into the equation. This would allow the airborne droplets to travel farther.
If you are using the air conditioner in your home and no one in your household is sick, then you don’t need to worry about transmission. What can be of concern is, if social distancing is lessened and you are in a public building with air conditioning with a symptomatic (or asymptomatic) COVID-19 patient, the six-foot rule may not help. The air flow from the air conditioner would allow the droplets to transfer farther than the average of six feet.
Reference: Lu J, Gu J, Li K, Xu C, Su W, Lai Z, et al. COVID-19 outbreak associated with air conditioning in restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020 Jul [4/15/20]. https://doi.org/10.3201/eid2607.200764
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
• • • • •
"What if my car inspection is due? Is there a grace period? I really don't want to take my car to a shop right now."
The answer:
For driver licenses, photo ID cards and learner's permits scheduled to expire from March 16, 2020 through April 30, 2020, the expiration date is now extended until May 31, 2020.
– Pennsylvania Department of Transportation website (https://www.penndot.gov/pages/coronavirus.aspx).
• • • • •
"When in a risky area (such as a store), you might encounter someone within the 6-foot recommendation who is sneezing, coughing or simply asking for your help, and you could feel compromised and at risk.
"Would more personal immediate actions reduce the COVID-19 risk, aside from the obvious of keeping your mouth closed or wearing a mask or goggles?
"Although unorthodox to some, would blowing your nose (carrying tissues) and/or blinking your eyes, despite no real need to, mitigate being infected if the virus is airborne – followed by a thorough washing of your hands, mouth, nose and eyes (area or drops) when possible?"
The answer:
An excellent and practical question.
The Centers for Disease Control and Prevention recommends “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain” – grocery stores and pharmacies, and especially in areas of significant community-based transmission.
The right way to wear a face covering or mask is to cover your entire nose and mouth, which means that the face mask should be tight-fitting underneath your chin. It will be less effective if you remove it from your face when you’re in a crowded store, such as to speak to someone.
An important takeaway from the CDC’s message is that covering your face when you leave the house must not replace thoroughly washing your hands.
It’s also worth emphasizing that sewing your own face mask may not prevent you from acquiring the coronavirus in a high-risk situation, such as lingering in crowded places.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
"Can I catch COVID-19 from my cat or my dog?"
The answer:
There have been some studies that are looking into whether domesticated cats and dogs can get SARS-CoV2. These results indicated SARS-CoV2 could replicate in cats and that SARS-CoV2 could be transmitted via respiratory droplets between cats, though it appears that it is not highly contagious between cats.
They also show that dogs are not really susceptible to the infection.
These studies show that cats can catch it from you, but none have shown that cats can transmit the virus to humans. That work has not been done, so the answers is we don't know yet.
The best approach right now for cat owners is to keep their indoor cats inside and their outdoor cats outside.
For more information check out this article in Nature: www.nature.com/articles/d41586-020-00984-8. It is a good summary of the work that has been done so far.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown
• • • • •
“I would like to know if it’s normal for a person to experience symptoms (day 1) and feel better over the next few days, only to experience those same symptoms on day 10-11 that were far worse.”
The answer:
Patients may have a mild common cold-like illness and/or an uncomplicated upper respiratory viral infection with symptoms such as fever, fatigue, cough, muscle pain, sore throat, shortness of breath, nasal congestion or headache. Rarely, patients may initially have diarrhea, nausea and vomiting.
The above symptoms may improve, or progress in 7-10 days to a severe viral pneumonia leading to acute respiratory distress depending upon the immune status of the patient, age, and other chronic underlying medical conditions.
– David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
"With summer and warmer weather coming soon, can the coronavirus be spread by mosquitos?"
The answer:
I can understand your concern – my goodness, what would we do it this were true!
Infectious disease transmission types are two basic categories: Direct (person to person) and indirect (which involves an intermediate carrier). Indirect transmission can come from fomites (inanimate objects that transmit disease), vehicles (food and water) or vectors (living things that transmit disease).
COVID-19 (SARS-CoV 2) is spread by airborne droplets, a form of direct transmission. That means it is spread by coughing, sneezing and talking. There are all kinds of modes of transmission – ways that infectious diseases spread – but this one is only airborne droplets.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown
• • • • •
"We have scheduled a Bahamas trip in September with Carnival Cruise Lines. They have not canceled yet. Is it OK to keep this vacation or should we cancel?"
The answer:
"Cruise lines all have different policies. Generally, people are waiting (to cancel)."
– Epic Journeys
For more information, contact your travel agent. For information specific to Carnival Cruise Lines, visit: www.carnival.com
• • • • •
“I work in a nursing home as a certified nursing assistant. If one of the residents goes to the hospital and tests positive, does our upper management have the right to not disclose this information to employees.”
The answer:
There is no requirement from either CMS (Centers for Medicare & Medicaid Services) or the Pennsylvania Department of Health that nursing homes or hospitals are required to inform employees of confirmed cases. But we do expect facilities to take steps to protect the health and safety of residents and share information with those who may be affected.
– Pennsylvania Department of Health
• • • • •
“I am a registered nurse and I want to know how long is a surgical mask, fabric mask or N95 mask effective?
“I do home care and can work one-on-one with one patient for up to eight hours a day in their home, or visit up to four patients in one day and am provided with surgical masks.
“In searching for an answer, I came across an article in the International Journal of Infection Control, 2013, that suggested that face masks are no longer effective beyond two hours of use!
“What renders them ineffective? Is it the moisture that accumulates? If so, could I recycle the surgical mask I wear with the same patient after it dries? My employer is unable to provide enough masks for me to change the mask every hour (changing every two hours doesn’t make sense if it’s rendered ineffective by two hours!).
“I share custody of my children (ages 11 and 14) with my ex, and my husband shares custody of his children (ages 13, 16 and 18) with his ex, so we have five children coming and going between homes and being exposed to their other parents and step-parents (but no other children) in their other homes. My step-kids’ mom is a social worker and continues to work in-person with people in the public.
“As an RN doing in-home visits and infusion therapy for medically-vulnerable patients, I fear that I have too much external exposure outside of my control to maintain a low-risk of being exposed, becoming a carrier, and therefore infecting the vulnerable population I care for.
“My fear is that I will need to choose between my husband and me being able to see our children and my continued work as a nurse in the community. What advice can you offer?”
The answers:
Excellent and interesting questions.
I’m not aware of any evidence-based data that states face masks are ineffective after two hours. In my opinion, if the patient contacts are not high risk for COVID-19, and/or not confirmed COVID-19 positive, a surgical face mask may be used the entire day, unless the mask becomes soiled. If the face mask becomes soiled, then it should be changed immediately.
A healthcare worker administering an aerosol treatment must wear a N95 mask – and a surgical mask on top of the N95. The surgical mask must be properly disposed of after the treatment. The N95 mask may be reused by the same healthcare worker that day if not soiled.
Regarding your living and working situation, your concerns are understandable. You can mitigate risks by limiting in-home visits to only those patients that are absolutely necessary, and not routine visits. You also need to follow strict Pa. Department of Health and CDC guidelines by frequent hand washing before and after each patient encounter, wearing gloves and a face mask as described above, and washing your hands when you return home.
Social distancing is very difficult with children; however, you can limit other outside family contact exposures. It’s impossible for healthcare workers (myself included) who are treating patients in the home, in doctors’ offices or at the hospital to eliminate all patient contact or exposure. This is the profession we chose.
– David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
“Why do the experts say that this week and next week will be the worst for COVID-19? I understand the virus is out of control, but how do they know what is to come in the next two weeks? What makes these weeks different?”
The answer:
The next two weeks are going to see more cases of SARS CoV2, COVID-19. This is because more testing is being done nationally.
Another thing to consider is the disease course. The incubation period, where an infected individual is asymptomatic, can be up to 14 days with an average time of 4.5 days. The symptomatic phase is about 14 days.
Mild symptoms last for about five days with severe disease to follow on days 5 through 8.
Some patients, about 20%, have some type of respiratory distress that may require hospitalization and this can last from days 8 to 12.
If we take all of these things together (more testing and the number of sick people from two weeks ago), it is quite possible that we will see a great number of new cases and a higher death toll in the coming weeks.
It is so very important to keep social distancing in place; it is our best defense at flattening this curve of new infections and slowing the spread of SARS-CoV2.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
“A vaccine for COVID-19 might be available in 12 months. How helpful will it be if this coronavirus mutates by then, as the flu does yearly?”
The answer:
This is a great question. SARS-CoV2 or COVID-19 is definitely mutating. The question is whether that mutation will happen in a part of the virus that effects transmissibility or disease course (symptom severity).
Coronaviruses have an ability that Influenza doesn’t, they proofread their genomes before they package it into a new virus. This means that SARS-CoV2 mutates at 1/3 to 1/2 the rate of Influenza.
Variants may happen with this virus, but with the slow rate of change individuals will be protected for years after acquiring the infection or getting vaccinated. This is different from the months of protection seen with influenza.
– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.
• • • • •
A New Jersey-based reader of The Tribune-Democrat asked:
“My daughter and her entire family of five have been extremely ill with all of the symptoms of this virus including temperatures as high as 104. My daughter, an X-ray tech, and her husband, a first responder, were tested at separate times and separate sites and to our surprise, the results were negative. My daughter was also tested for influenza which was negative. Is there another virus going around that mimics COVID? Should their results be trusted? Have there been false negative results?”
The answer:
All excellent questions.
With rapid influenza tests, there can be 20-30% “false negative” results. Therefore, if you believe an individual has acute influenza, and a negative rapid flu test, you should still treat for flu.
There are other viruses going around including adenovirus, parainfluenza, and RSV (respiratory Syncytial virus). There is a viral panel test that a physician may order which tests for these other viruses.
Regarding COVID-19 testing, the PCR (Polymerase Chain Reaction) which detects RNA from the COVID-19 virus is very accurate, but a negative result does not rule out the possibility of COVID-19 based on the timing of the exposure and the incubation period of the virus.
So a negative result should not be used as the solo basis for patient management decisions.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
"My family (husband, myself, 3-year-old and 18-month-old) has quarantined for the past week and a half. We have a livestock feed business at our house that we continue to operate, but we have one or two customers at any given time and have been following the 6-foot rule, along with disinfecting twice a day. We have only done grocery pick up and drive-thru for a couple lunches just to get out of the house. My mom and sister have been quarantining at a different location for the same amount of time, following basically the same guidelines. If all of us quarantine for two weeks with absolutely no symptoms, would we be safe to then only have contact with my mom and sister? I realize you can’t predict with 100% certainty, but your thoughts would be greatly appreciated."
The answer:
Although risk may be minimal if the relatives are local, there’s still risk and kids are not good at understanding social distancing. Children especially don’t practice good hygiene, and exposing them to older adults could be risky for both.
– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.
• • • • •
"When you report about the cases of the coronavirus, why don't you name the town or city for the confirmed cases?"
The answer:
At Conemaugh Health System we understand how concerned the community is about the spread of COVID-19. And, as healthcare providers, we are obligated by law to protect the privacy of all of our patients. We will not, and cannot, share identifying information about our patients without consent.
We do share our patient data in real time with the Pennsylvania Department of Health (and in turn, the CDC). This includes test results, symptoms, diagnosis, and demographic information related to COVID19 or any other infectious disease. These public health experts are responsible for mapping the spread of disease and interpreting the data, and they do a great job of it.
It may seem important in today's environment to know details about those infected in the community – their age, where they work, their address – so you can determine your risk of exposure. However, this can have the unintended consequences of causing panic and singling people out as targets for unwelcome attention.
The public health message will be the same whether someone lives in your neighborhood or not – stay physically distant, wash your hands, don't touch your face, disinfect surfaces and watch for symptoms. The best advice right now might be to behave as if everyone has COVID-19, rather than trying to determine who does or doesn't.
– Emily Korns, director of marketing and communications, Conemaugh Health System
Health institutions must adhere to federal privacy guidelines as stipulated in the Health Insurance Portability and Accountability Act (HIPAA):
"The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections."
– U.S. Department of Health & Human Services (HHS.gov)
• • • • •
"I have rheumatoid arthritis. Am I considered high risk for contracting COVID-19?"
The answer:
The short answer is yes. Autoimmune disorders that are a result of inflammatory conditions put the individual at a greater risk for all types of infectious diseases.
With RA specifically, individuals can be on immunosuppressive drugs. This can subdue the non-specific immune response to viruses. Science doesn’t know if you are at a greater risk of contracting the virus, but you are at a greater risk of severe symptoms if you do.
For more information on inflammatory autoimmune disorders and COVID-19, I suggest you check out this website: www.creakyjoints.org.
– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.
• • • • •
"Can you contract the influenza virus unknowingly, and then contract COVID-19 virus with diagnosed known symptoms detection at or around the same time? And if so, would your risk of life be greater having both and to what extent? Also, would the flu show up when tested for COVID virus, or would it go undetected?"
The answer:
Influenza symptoms are fever, chills, muscle aches, cough and tiredness. These symptoms come on quickly; you can wake up feeling fine and six hours later be sick.
Symptoms of COVID-19 are fever, dry cough and shortness of breath, which is consistent with the viral pneumonia it causes. COVID-19 is a slower onset, the illness ramps up over a period of days. In fact, you can divide the slow onset into three stages: 1. asymptotic incubation period, where the virus may or may not be detectable; 2. non-severe symptomatic period, where you can detect the virus and; 3. severe respiratory symptomatic stage, with high virus levels in the body.
It would be unlikely that you would unknowingly have influenza. It is possible to have both infections, it is just unlikely.
Since both viruses infect the lungs, in different cell types, that presents a greater risk to your health and life.
Some tests for COVID-19 use a nasal swab or oral swab and compare the genetic material captured on the swab with the genetic code of COVID-19.
There is a new test that was just approved by the FDA that will be using a clumping reaction, like what is done for strep throat. This test is quicker and produces results in 15 minutes or less. Since these test are specific for COVID-19, they would not be able to show infection with influenza. A test specific for influenza would be needed to determine infection.
– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.
• • • • •
"For other, and possibly this, coronavirus, does the route of transmission affect symptoms? Is it possible that the lungs could be spared if a person contracted the virus via the eye or digestive tract instead of through the air?"
The answer:
Viruses are specific to a certain cell type. Think of it like the key for your front door only one key will open that door, that key is specific to your door. Viruses are like the key. If the right lock isn’t present on the cell, the virus can’t get in.
So when we think about route of transmission, the virus is transmitted in the way that will best get it to the cell that it wishes to infect. For COVID-19, its specific cells are found in the part of the lungs called the alveoli; these cells help with gas exchange. So if you come in contact with the virus, it will seek out the specific lung cells to infect. If it gets in your eye, the ears, nose and throat are connected and the virus could get to the lungs. If it comes in via the digestive tract, it is harder for the virus to get to your lungs.
– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.
• • • • •
"Is anyone identifying persons who had contact with the COVID-19 infected? These contacts should be self-quarantined."
The answer:
"We identify those who were exposed, use the Pa. Department of Health Risk Assessment, and follow Pa Department of Health guidelines and recommendations.
"Regarding self quarantine: Yes, and again based upon the Pa. Department of Health risk assessment and following Pa. Department of Health guidelines and recommendations."
– Dr. David Csikos, Chief Medical Officer, Chan Soon-Shiong Medical Center at Windber.
The Pennsylvania Department of Health website can be found at health.pa.gov.
On this topic, the DOH says:
• Isolation separates sick people with a contagious disease from people who are not sick. Isolation is usually voluntary, but in an emergency, officials have the authority to isolate people who are sick.
• Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. Quarantined people may or may not become sick; but separating them from those who were never exposed helps prevent the spread of the disease. Quarantine can be voluntary, but in an emergency, officials have the authority to quarantine people who have been exposed to an infectious disease.
"If someone gets the virus and recovers, is that person immune from the virus and probably won't get it again?"
The answer:
The Los Angeles Times reports that China has seen more than 100 cases of individuals being released from hospitals and later testing positive for the coronavirus a second time. A man, 36, died five days after being declared virus-free and discharged.
Keiji Fukuda, director of Hong Kong University’s School of Public Health, said the likely reasons are testing errors and patients leaving hospitals too soon.
“If you get an infection, your immune system is revved up against that virus,” Fukuda said. “To get reinfected again when you’re in that situation would be quite unusual unless your immune system was not functioning right.”
– Los Angeles Times reports
• • • • •
"If someone has traveled to a known hot spot for COVID-19 in a state such as California or Washington or out of the country, how are other employees and clients protected if an employee refuses to do a self-quarantine after travel and/or contact with potential COVID-19 risk factors and continues to come in contact with people at the workplace?"
The answer:
The Occupational Safety and Health Administration (OSHA) recently published Guidance on Preparing Workplaces for COVID-19, outlining steps employers can take to help protect their workforce. OSHA has divided workplaces and work operations into four risk zones, according to the likelihood of employees’ occupational exposure during a pandemic. These different classifications can inform employers on how to treat their workplace during this pandemic.
Employers have a duty to provide a safe workplace to all employees, this includes exposure to COVID-19 in the workplace. Employers should be understandably concerned about providing a safe environment for their employees and, as such, may ask employees about the areas they have recently traveled to and if they may have had any exposure to COVID-19.
If an employer concludes that an employee may pose a health threat to other employees, the employer can require that the employee stay home for the duration of the COVID-19 incubation period, which has generally been assigned as 14 days. They can also ask employees to seek medical attention and/or get tested for COVID-19, but cannot require them to do so. The employer also has no obligation to report a suspected or confirmed case of COVID-19 to the local, state, or federal health departments. Only healthcare providers that receive confirmation of a positive test are mandatory reporters.
In short, the employer cannot require the employee to self-isolate, but must take steps to protect other employees from any potential exposure, including sending the potentially infected employee home.
Here is a link to some more helpful information that was recently published by my law firm: https://www.muslaw.com/covid-19-update-mitigation-of-employment-law-risks/
– Katelin Montgomery, associate attorney with the law firm Meyer, Unkovic and Scott LLP, in Pittsburgh.
• • • • •
“Can a person have coronavirus and flu virus simultaneously?”
The answer:
“It is possible to get two infections at the same time. For example, you can have a common cold, from a virus, and that can lead to a bacterial infection in the sinuses. Yes, you can get the flu and COVID-19 at the same time. It is recommended that if you haven’t gotten your flu shot yet that you do so now. It won’t protect you from COVID-19, but it will keep you from getting the flu.
“Symptoms are similar for both illnesses with the major difference being that COVID-19 causes shortness of breath due to the viral pneumonia.”
– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.
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