There is a lot of information, and misinformation, circulating about COVID-19.
Dr. Robin Trotman has been at the forefront of our response to the pandemic. He has spent the last several months treating patients and keeping up with the latest literature on the novel coronavirus.
He recently shared his expertise in a Facebook live session and at a Springfield City Council meeting about the city’s new masking ordinance.
Below are a few questions we have heard a lot, along with Dr. Trotman’s insight:
What is the difference between influenza and COVID-19?
COVID-19 is in the class of coronaviruses, a class that is the same as common cold. But, this is a novel coronavirus.
This is very different than influenza. Our bodies haven’t seen anything like this. Our immune system is completely naive to this virus.
We have also never had a vaccine against anything like this.
Another difference: We have no treatment. Tamiflu works well with influenza. With flu, we have vaccines and therapeutics, and, we have a baseline arsenal of immunity from previous years’ infections and vaccines.
This is different. It is very contagious. You can shed the virus during an asymptomatic period – 1-2 days before symptoms appear.
Your peak time for transmitting the virus may be in the hours before you start showing symptoms. That results in widespread transmission.
Is the novel coronavirus airborne?
It is not airborne. An airborne disease behaves like measles. If there were a measles case on an airplane, the whole plane would be exposed. We are not seeing people infected across the room and in other rooms. That’s not what we’re seeing in our tracing.
This can be aerosolized, that is mixed with water droplets and spread farther.
For the most part, it is transmitted in large water droplets, in a 6-8 foot radius. It can also be transmitted, to a lesser degree, on surfaces.
Why is masking so important?
This is stressing public health. We are left with human behavior as our only tool to slow this down.
If we can have global buy-in on masking, we could slow the basic reproductive rate down so that each case might infect just 1 person, rather than 2.5 people. That’s the goal.
This is more contagious than SARS and MERS. What scares us the most is ability to transmit while asymptomatic. Data from cruise ships, navy ships and contract tracing tell us asymptomatic patients transmit at a fairly high rate. That is a unique feature of this virus.
We also have morbidity that is not death. The literature is rife with long-term medical consequences not captured in death statistics. There are serious financial concerns, and medical complications that are lasting. We have to keep an eye on metrics other than deaths.
The science is evolving. What we know now is not what we will know tomorrow. We are doing the best we can with what we have.
We do know that for our hospitals, treatments will be burned out soon. That is 100% predictable. Without mitigation, we will be behind – on testing and contact tracing. We know that with 100 percent certainty, we will stress the system and we will have worse outcomes.
Does masking actually work?
People ask: Does a mask prevent spread of disease or does it keep me from being infected? The answer to both is “yes.”
This disease is spread through droplets, when you sneeze, or cough or talk. It goes about 6-8 feet. Some procedures and circumstances may make it travel farther.
Unlike SARS and MERS, which affect cells in the lungs, the novel coronavirus can infect cells all the way from the nose to the lungs.
As we talk, we are expelling droplets. That is demonstrated in the lab.
A facial covering keeps me from expelling respiratory droplets, and protects other people from what I expel. It prevents your respiratory droplets from landing on someone else. That is no longer questionable.
We know from empirical scientific evidence in the health care setting that when people wear a mask, they don’t get sick as often.
Now that the virus is ubiquitous in the community, any barrier we use is going to help. A double-layered cloth mask is pretty good for most exposures. A bandana is less good, but if all you have is a bandana, that’s what you go with.
Are there negative health effects from masking?
The CDC is using the phrase “correct and consistent facial coverings when appropriate.”
A surgical or cloth mask is not intended to filter air. It is intended to filter droplets. Droplets are where the virus is located.
You are not going to have respiratory problems with a facial covering or a mask. Health care workers wear masks all day with no problems.
You will not get carbon dioxide poisoning. That is physiologically impossible.
Masks are safe.
Don’t mask mandates infringe on people’s rights?
If you don’t feel comfortable with municipalities and governments telling you what to do, I completely understand.
There is a precedent for this. Think of it like wearing a shirt and shoes in a restaurant.
There are things we do and liberties we give up to be a good citizen. That’s true on a global scale and a local scale.
Masks aren’t an exhaustive, perfect solution but they are worth it.
Let’s say, for example, they work 50 percent of the time. If I have 10 deaths in the hospital from COVID-19 and masking reduces that by 50 percent, I think we would agree that is worth doing.
This is not political. It’s time to put that to rest and move forward.
Why did some of the models not turn out to be correct?
The models are just predictions. They are tools, and if you are using them correctly, they will always be wrong.
Here’s why: You have data points that inform a calculation of what is going to happen. Then you do something in response to the projection. So, the reality becomes different, because you did something different.
Models are not to predict reality. They predict what would happen at the current pace if you did not act to mitigate the circumstances.
The death rate doesn’t seem that high, are we blowing this out of proportion?
The infection fatality rate is fairly low. Right now.
The rate of disease is determined by two things: the bug and the host.
We are seeing more cases in younger people. The age of people getting the disease right now is what is keeping the rate low.
Younger people are more likely to take risks. In the community, you see more younger people out and congregating in places like restaurants and bars.
When you have healthy, 18 year-old hosts, you’re not going see a lot of deaths. But, those hosts will make their way to a nursing home or a family reunion and you will see an uptick in cases.
Are the numbers inflated? Are presumptive positives counted?
Any time you see a case in Greene County data, that is a positive test. It is a myth that people are reporting symptoms and it is reported a COVID-19 case. That is false.
The numbers are only for positive tests with a nasopharyngeal PCR.
What about fatalities? Are people dying of other causes and counted as COVID-19 deaths if they are positive?
No. In those cases, COVID-19 is not the prevailing cause of death.
A death certificate is a highly scrutinized document. Doctors fill it out with precision and there are criminal charges for filling it out wrong.
When you see deaths attributed to COVID-19, those are cases where COVID-19 is the prevailing cause of death.
What about a vaccine?
We cannot rely on a vaccine. Vaccines are a moving target. If we base our plan on the possibility of a vaccine in fall, we will be misdirected.
There is no evidence a vaccine will be durable in the long term and be protective.
Vaccines can illicit an immune response, but we don’t know if that will be a protective response, or how long that response might last.
Even if we had one that produced durable, protective antibodies, it’s not coming anytime soon.
What about herd immunity?
We have no evidence that herd immunity is a fact for COVID-19. We have no evidence that there is durable immunity that is protective in people who are infected.
At this point, the concept of herd immunity is not something we can rely on.
Should I get tested to see if I have antibodies?
We don’t recommend antibody testing. The testing we rely on is based on swabbing the nose, having a lab extract RNA, and looking for active virus. That’s how we determine a positive.
Antibodies are chemicals detectable in the blood that the body has made in response to an infection. We do not know yet how long COVID-19 patients have antibodies, or if they prevent reinfection.
We have data showing 1/3 of people with mild disease don’t have durable antibody levels.
A positive antibody test does not mean you are protected, and it wouldn’t change any of our clinical recommendations.
Where are we with treatments?
There is a glimmer of hope with a few treatments. We have had some patients for whom we would’ve predicted a bad outcome. Some of these strategies have helped.
- Remdesivir: We have data that it is beneficial for patients who need oxygen. It is one of the treatments that is in limited supply.
- Convalescent plasma: We have some evidence that proteins in the blood in plasma, matched to blood type, can help bridge until the body can make its own supply. If you have had COVID-19, contact your doctor about donating plasma. You might be able to save someone who is severely ill.
- Steroids: We are using steroids cautiously and seeing some benefits.
Overall, we are doing better with treatments than we were doing a few months ago. That is exciting.
LIVING INSIDE A PANDEMIC
Many people have mild or moderate symptoms and recover. Why should we be freaked out?
You shouldn’t be freaked out. You should do the best you can to be
mindful of three key things:
- Maintain physical distancing.
- Pay close attention to your circumstances.
- Wear a mask.
We have a lot of patients who are sick. You hear about mild cases, and I hope many are that way.
If only 2-3 percent of people get really sick, but you lay that over the million people we serve, you are going to have a lot of bad outcomes.
We have limited resources. Limited testing, PPE, medications and beds.
I don’t want someone’s grandma to come in when we have run out of remdesivir. That is going to happen. We have to slow this down. If we let it run its course, we will stress the health care system.
How do we live through this?
I am struggling with this was well. I have a life and a family I want to see.
I want to keep society running. We need to take measures like masking so the things we love to do, the places we love to go, and our employment don’t have to be shut down again.
Human behavior is the only tool we have right now. I want people to understand that. No other intervention or tool beside your own human behavior will prevent the transmission or mitigate this.
It is going to take a complete rearrangement of the norm.
I can’t see an immediate future of us going back to normal, where you walk through an airport without a mask and you’re not being mindful of your surroundings.
As citizens, we have to learn to conduct ourselves in a different way for the forseeable future.
It will take people being conscientious, altruistic, and thinking about other people.
We are an innovative, ingenuous society and culture. It will not look the same, but we will be able to get through this.