A coronavirus Q&A with Iora Primary Care’s very own infectious disease specialist on taking precautions and being responsible during COVID-19.
As the COVID-19 outbreak continues worldwide, there is still a lot we don’t know about the virus. Fortunately, however, there is much we do know about prevention, symptoms and safe practices.
Today, we are joined by infectious disease specialist John Po, M.D., Ph.D. for a Coronavirus Q&A. Below, Dr. John Po answers some of the most common questions around coronavirus. He’ll address symptoms to look out for, how to keep healthy and safe, as well as some of the biggest misconceptions about COVID-19. For more information about COVID-19 beyond this coronavirus Q&A, check out our Live Better Blog.
You provide a unique lens to your patients and Iora as both an Infectious Disease Specialist and a Primary Care Physician caring for the 65+ population. How has your specific background prepared you for the current landscape of COVID-19?
I have earned board certification in both internal medicine and infectious diseases, with specific experience in infection control and healthcare epidemiology (the profession of protecting patients and their healthcare providers from infectious diseases). I also have a PhD in cell and molecular biology studying age-related changes in the immune system against Influenza infections. This combination of clinical and research experiences gives me unique insight into the understanding of the latest scientific knowledge of this virus. As a result, I am able to better anticipate its spread and apply what we have learned to best serve our patients while keeping us safe.
With much focus on the older population or those with underlying health conditions, Arizona has actually seen the highest age demographic testing positive between the ages of 21-44. What is one thing you’d want to share with those individuals, maybe not in the high-risk category for COVID-19?
Though the younger demographics are affected, it is important to understand that the effects of COVID-19 are less severe compared to the elderly who are infected; in fact, up to 25% of people with COVID-19 are asymptomatic. It is also important to remember that asymptomatic individuals can be infectious. So while younger people infected with SARS-CoV 2 (the virus that causes COVID-19) may not observe signs or symptoms, they can unwittingly infect the people around them, including the elderly.
We’re experiencing great outdoor weather in many parts of the country. Is the threat of coronavirus contraction greater indoors or outdoors?
The threat of contracting COVID-19 is certainly greater indoors. Since the virus is carried in water particles in droplet or aerosol form, these particles can travel usually up to 6 feet. However, under controlled conditions it can travel up to 27 feet. Being outdoors allows for greater distances between individuals, with wind currents likely being able to carry these small water particles away and making it less likely to be exposed to the virus.
What precautions, if any, should people take for outdoor activities such as hiking, cycling, walking in their neighborhood?
Based on the latest CDC guidelines, I recommend a minimum distance of 6ft between people. I also recommend wearing a mask and using alcohol hand sanitizer if you are in contact with objects. While taking a walk, you may want to disinfect the button at a stoplight. Or, if you use exercise equipment or a bike, wipe down the parts frequently in contact with your hands.
How does the spread or treatment of COVID-19 differ from other widespread pandemics?
COVID-19 is unique to previous pandemics:
- Rapid modes of transportation make it easy for people to spread the infection from one place to another.
- Dense population centers and close-quarter environments (such as cruise ships) makes transmission easier.
- Asymptomatic, infected individuals can be infectious. Up to 25% of people infected with the virus may not demonstrate signs or symptoms of infection. However, they can unwittingly infect the people around them, including the elderly.
- The virus can survive on surfaces for a period of hours to days if not properly disinfected.
- Risk factors associated with worse outcomes in people infected with the virus, are more common in the patients we serve. These include: hypertension, diabetes, cardiovascular disease, and underlying chronic lung disease.
- Research in the treatment of viral upper respiratory tract infections has historically focused on more common seasonal diseases such as influenza and respiratory syncytial virus infections. Therefore, research on treatment and vaccine development against SARS CoV 2 is not as advanced.
Should I worry about medications and food being delivered to my house and how do I keep these things from contaminating us?
The US Food & Drug Administration’s (FDA) guidelines on food safety and coronavirus do not include the disinfecting of perishable and non-perishable grocery items. At this time, FDA officials have stated there is no evidence of human or animal food or food packaging being associated with transmission of the coronavirus that causes COVID-19.
Some people may choose to wipe or wash cans and boxes of food or medications before storing them to reduce possible virus content. You can also throw out disposable packaging.
When you’re done, it is important that you wash any tables, countertops, or other surfaces that were touched by your groceries or grocery bags.
And wash your hands again.
Does having medical conditions under control help give us a better fighting chance if we were to get infected?
Great question. Viral infections take a toll on the body. They can cause direct damage to cells in the body and spur inflammation, causing further cell damage. They also create a lot of stress since your body needs to work on fighting off the infection.
- Having lung conditions such as COPD well-controlled will allow for better lung capacity for breathing and oxygen exchange.
- Well-controlled blood pressure will place less strain on your heart and blood vessels to better handle the stress of infection.
- Good management of blood sugars will put less strain on the immune system, so it can better fight off viral infections.
- Better weight control puts less strain on your heart, blood vessels and lungs.
Therefore, having underlying conditions under control will increase your chances in preventing serious complications from viral infections.
Explain the main differences between COVID-19 and the common cold or flu. What are the main differences with regards to how the general public should be acting responsibly?
This is a difficult question since COVID-19 infections can start off like any viral upper respiratory tract infection. However, COVID-19 infections last considerably longer (2-3 weeks) compared to influenza infections (1-2 weeks). With COVID-19, once infected, many patients develop a fever (though it may be absent in some patients), and may last from 7-12 days. A dry, non-productive cough will also present very early on and persist for two weeks, if not more. These symptoms may be accompanied by headache, chills, sore throat, nasal congestion, muscle pain, nausea with or without vomiting, loss of smell, loss of appetite and fatigue.
Unlike the common cold or flu, which gradually gets better into the second week of symptom onset, the symptoms of COVID-19 are far different. About 7-8 days into the disease, those infected may develop worsening shortness of breath, peaking around the 3rd day from its onset. Clinical improvement will occur into the second and third week. In more severe COVID-19 infections, the course of fever, cough and shortness of breath starts similarly as with mild cases. However, clinical deterioration can be rapid within 2-5 days after the onset of initial symptoms, requiring urgent attention.
What should people know about wearing gloves or masks?
On initial thought, protecting yourself with gloves or masks while going about your daily activities seems to be a good idea. However, it can give a false sense of security.
Masking may give the person wearing it license to go closer to people. However, a masked person can potentially still become infected. It is important that a mask be fitted so there are no gaps along the sides and the bridge of the nose. Additionally, careful removal of the mask will prevent spreading the virus onto the face and hands. Regular washing of masks is recommended. Finally, always wash your hands once you have removed your mask.
Gloves, unless changed frequently after coming into contact with infected people or contaminated objects, will serve as a vehicle for spreading infection by inadvertently touching your face, objects, and other people. If anything, frequent use of alcohol hand sanitizer and proper hand hygiene is a more effective way of protecting oneself from infection.
About Dr. Po:
Dr. John Leander Po completed his Bachelor and Master of Science from McGill University in Montreal, then continued his studies at Drexel University College of Medicine in Philadelphia, Pennsylvania where he received both M.D. and Ph.D (Cell and Molecular Biology) degrees. Dr. Po’s thesis involved characterizing influenza-specific pulmonary CD8+ cytotoxic T cell responses in aging using a mouse model.
Dr. Po continued his internship and residency in internal medicine at Boston University Medical Center and continued on with the subspecialty of infectious diseases (ID) in the same institution, with additional training in transplant ID at the Massachusetts General Hospital. He also served as the President of the Arizona Infectious Diseases Society.
We hope this coronavirus Q&A helps you understand more about COVID-19 and identify best practices to keep yourself safe and healthy during these uncertain times.