Pandemic preparation: Epidemiologists answer reader questions about coronavirus COVID-19
Last week, we talked to a panel of top epidemiologists to understand the infection risks involved in touching the porous and non-porous surfaces we encounter daily with tech devices. The general advice was not to worry too much about it, but wash your hands. Since then, the coronavirus has reached pandemic-level classification, and our readers have numerous questions and concerns.
Coronavirus
Over the course of the weekend, we packaged up a bunch of those questions and sent them off to Dr. Amesh Adalia of Johns Hopkins and Dr. Brian Labus of UNLV. Amesh A. Adalja, MD, FIDSA, FACP, FACEP is a senior scholar at the Johns Hopkins Center for Health Security. Brian Labus, PhD, MPH, REHS is an assistant professor at the School of Public Health, University of Nevada Las Vegas. He's also a registered environmental health specialist and an expert in outbreak investigation.
Without further ado, let's get to the questions and answers. Afterwards, I have some informal survey results to share with you about how your fellow readers are dealing with this threat.
How long will it last?
How long are we really looking at with this situation? When will this run its course or be under control? Will it get better during the summer?
Dr. Adalja from Johns Hopkins: "I do believe we will see some seasonality with this virus like what occurs with other coronaviruses. However, it is unclear when we will see a peak because we have not done enough testing in the United States to really understand the true extent of infection. Without a vaccine, I do believe that this virus will be with us and be part of fall's respiratory virus season, however there is no evidence that it will be 'worse'."
Dr. Labus of UNLV: "It's impossible to say how long this outbreak will continue or what path it will take until it is finally over. Outbreaks spread because of the unique set of circumstances found in each community, so even if we could predict the broad path the outbreak would take, we still couldn't say what that means for you or for a particular city.
"No one knows what is going to happen with this virus next month, let alone next winter. While that is a possibility, there is no way to know if it is a realistic one at this point.
"Like the flu, respiratory diseases often circulate in the colder months. The biology of the organisms is one reason, with cooler temperatures helping some organisms survive longer outside the body. The other reason is that the weather changes our behavior. As the weather warms and we open windows and spend more time outside, we decrease our contact with other people. Warm weather could change the spread of the outbreak for these reasons, although we really can't say for certain."
Can we go out to buy food?
Many of us who work from home can avoid public gatherings, but we still have to either go out to buy food and supplies or have it delivered. What are concerns and best practices here?
Dr. Adalja from Johns Hopkins: "The only thing you can really do is to touch your face less and wash hands more; avoid people who are coughing or sneezing."
Dr. Labus of UNLV: "There is no way to completely isolate yourself from the world. There will always be some contact with other people, and contact with sick people can always bring a risk of disease. Wash your hands after having contact with contaminated surfaces or sick people, and that will reduce your risk of infection from not just coronavirus, but from all the bacteria and viruses you regularly come in contact with."
Will our food supply be safe?
You previously mentioned the international supply chain was pretty safe from contamination (or at least we don't need to modify our behavior). What about the food supply? Can we trust packaged and fresh foods we buy?
Dr. Adalja from Johns Hopkins: "This is a respiratory virus not a foodborne virus."
Dr. Labus of UNLV: "There is no evidence that coronavirus can be spread through food, and no need to change your behavior as a result."
Should we fear deliveries?
Should we worry about catching Coronavirus from deliveries? Clearly, it can't live on packages for long.
Dr. Adalja from Johns Hopkins: "I do not think this is a major mode of transmission that people should worry about."
Dr. Labus of UNLV: "It doesn't matter how long the virus can survive if someone hands you a package they just sneezed on. Viruses will not die instantly, and even the most sensitive viruses can survive for at least a few minutes on surfaces. If you are concerned about being exposed through packages delivered to your house, discard the box and wash your hands after handling it. You can be infected by touching the contaminated packaging then touching the mucous membranes of your face. If you remove the virus from your hands, you break the chain of transmission."
Related: Instacart just announced new guidelines for shoppers, including a "leave at my door program" and a promise to provide extended pay for any Instacart shopper who is sick or diagnosed with the virus.
Should presidential campaign events be cancelled?
Do you think it will persist to the point where the presidential conventions in August should be cancelled or held entirely online? Should all the gatherings related to the campaigns (debates, debate audiences, rallies, etc) be conducted online?
Note: In the few days between when we asked this question and are publishing it, the Biden, Sanders, and Trump campaigns cancelled upcoming rallies, and CNN announced that Sunday's debate will be conducted without a live audience.
Dr. Adalja from Johns Hopkins: "It is unclear as of now what this virus will look like in August and what impact mass gatherings will have at that time. I do not believe blanket cancellations are the right decision and each cancellation should be approached in the context of what is going on in that community and the country at the time."
Dr. Labus of UNLV: "It's a big step to change our political process, so we need to be doing it for the right reasons. It would make sense to modify the conventions or rallies if doing so would actually reduce the risk of infection. At this point, it's impossible to say where this outbreak is going. As we get closer to those events, we will have a better idea of what steps we need to take to reduce the risk of disease."
Will it be safe to go out and vote in November?
We expect to see crowds going to vote for primaries over the next few months, and then for the presidential election in November. How dangerous will this be for everyone voting in person? Do you think online or mail-in voting should be required instead?
Dr. Adalja from Johns Hopkins: "No, I do not think in person voting should be stopped. Individuals should just wash their hands and not touch their faces. Elderly voters and those with other medical conditions may want to vote via mail but I don't think everyone needs to."
Dr. Labus of UNLV: "It's quite premature to make decisions about our elections in November. It's like asking if you should wear a jacket to stand in line to vote because it might be cold. It might be necessary, but no one can say right now. For the primaries, people can use the mail-in option if they are concerned about being around other people. Some states have even encouraged voters to bring their own pens so that they don't have to share them with others at the polls. And of course, washing your hands after any type of interaction with others can reduce your risk of infection."
Why so much fuss compared to the flu?
Why is this causing shut-downs and community quarantines, where normal flu outbreaks don't bring such measures? Is there something we are not being told that warrants these extra steps?
Dr. Adalja from Johns Hopkins: "This is a novel virus with a lot of uncertainty. That uncertainty is prompting governments to take actions that don't occur during ordinary circumstances."
Dr. Labus of UNLV: "We see flu every year and we know that quarantines are not useful in controlling it. Coronavirus quarantines are being used to stop the spread of disease from place to place, either to try to keep the disease out of certain communities or keep infected people in one place so that we can target our response to where the sick people are. If the virus becomes widespread, the quarantines won't make much sense at that point and we will shift to social distancing, which is intended to slow the spread of the outbreak."
Is this an existential threat?
Finally, are we looking at an existential threat here where all infrastructure and food supply becomes unworkable? Where do you think we'll be on the spectrum from inconvenience to global annihilation?
Dr. Adalja from Johns Hopkins: "This will be a serious pandemic but likely mild in nature. It will not be cataclysmic but there will be disruptions to daily life that people need to prepare for."
Dr. Labus of UNLV: "Epidemiologists are always hard to pin down on a question like this because we know that anything is theoretically possible. We think in terms of probabilities and margins of error. That being said, I have not been stockpiling toilet paper and water."
Some informal reader polling
I always like to "take the temperature" (as it were) of our readers. One easy way to do that is to ask my Twitter feed. While it's far from scientific, I often find the answers to be interesting. This week, I asked two questions. The first was "Are you taking COVID-19 precautions?"
The response, shown below, is interesting. I expected a lot more people to be working from home, but just slightly more than one in five respondents are doing that. The most common response (at 43.8 percent) was social distancing. Only a very few people are self-quarantining, which means most of our audience is going out when necessary, but keeping their distance. Then again, more than a third of the respondents said they're just ignoring the whole thing. I wish I could, but any time the word "pandemic" is used, I get twitchy.
The second question I asked was designed to help understand if there's a partisan aspect to this crisis, since everything else seems to have one. Of my respondents, 81 percent self-identified as Democrat, while 18 percent self-identified as Republican. This could mean that I have a lot more liberal readers, or it could be that the topic induced more liberals to respond than conservatives.
In any case, the worried vs. not-worried ratio of both sets of respondents was very interesting. About four times more Democrats were worried vs. not worried. By comparison, about twice as many Republicans indicated they weren't worried compared to those Republicans who were worried. Interpret that as you will, but it is fascinating that there appears to be a partisan divide over even something like COVID-19. These results track with Reuters' results published last week.
Speaking personally, my wife and I work from home, and we're going to be avoiding any big gatherings. My wife had two more sessions of a class she attends, and both sessions were cancelled as of last night. When you're a blogger by trade, you tend to social distance by default, so that's not an issue for me. We are a bit nervous about going out to the supermarket or Costco, so we might avail ourselves of delivery services more than usual or even take the radical step of looking at what's in our pantry and trying to convert ingredients into food.
In the meantime, we're going to be washing our hands more often (paying particular attention to fingers and fingertips), and try to keep the puppy from licking our faces. Stay tuned. As we learn more, we'll keep you up to date. In the meantime, I have more work-from-home equipment guides coming to you next week.
What about you? How are you dealing with this coronavirus thing? Are you feeling healthy? Safe? Are you staying home? What are you doing about food shopping and necessary out-of-home activities?
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