Covid-19 with doctor

Expert Question and Answer for COVID-19

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Can the Coronavirus be spread by mosquitos?

Dr. Odelia Braun MD JD
Zoomed in on a mosquito

According to official guidance from the World Health Organization (WHO) there is no information or evidence to suggest that the new coronavirus could be transmitted through mosquito bites.

Coronavirus is a respiratory virus, and the main mode of transmission are viral droplets released into the air when an infected person coughs or sneezes. For a mosquito to become infected with a virus, it must be present in the blood the mosquito feeds on. COVID 19 is a respiratory virus that mostly remains within the lungs and respiratory tract of infected people, and rarely gets into the blood. Additionally, for a mosquito to transmit the virus, the virus must be able to first replicate inside the mosquito before transmitting it to a person. Neither the new coronavirus nor any other type of coronavirus has been shown to do that.

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Comparing CDC data on influenza deaths to Johns Hopkins COVID-19 deaths is like comparing apples to oranges.

Dr. Odelia Braun MD JD
Bar graph of influenza versus covid-19

Between 2013-2014 and 2018-2019, the CDC reported yearly estimated influenza deaths ranging from 23,000 to 61,000/year. As of May 1, 2020, 1/3 of a year, there were 65,753 deaths from Coronavirus SARVo2 (COVID-19).

But are these numbers truly comparable. The number of COVID-19 cases in the US on May 1, 2020 was reported by Johns Hopkins University as 1,131,030 and the number of deaths was 65,753. The numbers reported by the Johns Hopkins University are the actual counts of patients who are reported as having tested positive for COVID-19 and the number of deaths based on the patient’s death certificates.

The CDC does not present influenza data as actual counts of patients, but as annual calculated estimates, based on an algorithm that assumes many cases and deaths due to influenza are not reported. When the same methodology of counting actual reported cases and deaths is applied to influenza, the number of deaths/year range from 3448 to 15,620.

During the week ending April 21, 2020, 15,455 COVID-19 deaths were reported in the U.S. and 14, 478 COVID-19 deaths were reported during the previous week. The CDC has reported actual deaths, during the “peak week” of influenza seasons between 351- 1626 deaths/week. The average number of influenza deaths during the peak of influenza season was approximately 752. The average number of COVID-19 deaths during its current peak is 14,966. These numbers suggest that on average, COVID is up to 20 times more deadly than influenza.

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Can my hair or beard hold onto the COVID19 virus and make me sick?

Dr. Odelia Braun MD JD

Usually viruses survive on porous surfaces, such as hair for lesser durations than that of smooth surfaces, such as steel or glass. Our hair, including beards, is covered in natural oils that cover the strand as a protectant. These oils do contain some antimicrobial properties that can limit how well organisms bind to hair. However, we cannot rely on natural oil production alone as it varies for each person and hair type.

However, we cannot rely on natural oil production alone as it varies for each person and hair type. COVID 19 infects us through the mucosa (nose, mouth etc.), therefore the risk is low that the virus would be contracted from the hair. However, if you are concerned, I recommend washing your hair daily. Using Shampoo will kill and remove both bacteria and viruses, including COVID-19. As the risk is very low, compared to hands, there is no reason to feel you now need to wash your hair multiple time as day.

The exception to this is someone who has a beard and is also positive for COVID-19. If this person coughs or sneezes, the beard will most likely trap some of the large, virus laden droplets. If this person were to then have physical contact with someone else, such as by kissing, then there is a much higher chance of transmission.

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Am I supposed to wear a mask while in my car? Are the filters in my car enough to protect me inside or do I need to wear a mask? I was driving the other day and noticed that no one was wearing a mask while driving and my neighborhood has narrow streets/sidewalks, so people walking their dogs or out for a run were only about 1-2 feet away from my car.

Dr. Odelia Braun MD JD
Individuals wearing mask in vehicle

No, if you are traveling alone in your vehicle with the windows up, there is little chance of catching COVID19 from someone passing by. The use of car’s HEPPA filters is designed more to capture pollens and dust, so they are not manufactured, nor tested to see if they are able to capture pathogens (germs). Even if your HEPPA filter is not rated to trap viruses, some filtration is always better than no filtration.

I would wear a mask inside of the car under the following circumstances (not an exhaustive list):

  1. Traveling with others, such as in a carpool situation or driving someone to the store.
  2. Work in a profession where you drive others, such as Lyft, Uber, taxi, etc.
  3. Traveling with someone in a high-risk group, such as seniors and immunocompromised.
  4. You are actively coughing or sneezing, so you do not contaminate the car. This is especially important and should also include wiping down the inside of the car if the car is used by others.
  5. Are driving with the windows down and pedestrians or other vehicles could be within 6 feet of your open window.
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What is magical about the 6-foot social distancing number?

Dr. Odelia Braun MD JD
Graph showing people distancing by six feet

When an individual infected with corona virus coughs or sneezes, small drops of virus filled liquid are sprayed out. If you are standing within 6 feet, these droplets may enter your nose or mouth. Research from MIT recently discovered that a sneeze could theoretically travel up to 200 feet! So why six feet? Different sized droplets are sprayed from coughing or sneezing. The larger the droplet, the more virus particles they contain. Since larger particles are heavier, they tend to fall to the ground faster and the majority of the time they fall within 6 feet.

In addition, research suggests that the corona virus may be aerosolized through simply talking or exhaling. It is not yet understood the real-world impact of this finding. Even if no one is actively coughing or sneezing, if you are standing within 3.5 feet (WHO) of a person, you may be in their breathing zone and inhaling potentially infectious particles. This is the reasoning behind the 6-foot rule. If someone is actively coughing or sneezing, the further you are away from them the better, as smaller droplets may remain airborne for at least an hour.

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I heard that people are getting infected by the bottom of their shoes. They walk around outside and then bring their shoes home. Is there evidence to back this up? Are we supposed to disinfect the bottom of our shoes now?

Dr. Odelia Braun MD JD
Person wearing shoe coverings outside hospital

A study published in the medical journal of Emerging Infectious Diseases (EID) in April showed that healthcare workers assigned to ICU wards did have detectable coronavirus on their shoes. Unless you are working In a healthcare facility where corona patients are being cared for, it is very unlikely that the average person is at risk of coming into contact with the virus through shoes.

The CDC has said that even if a small amount of the virus does get on your shoes, it is not thought to be the main way the virus is spread. In addition to the CDC, Dr. Amesh Adalja, who is an infectious disease specialist at John Hopkins said that “while it is biologically possible to that the coronavirus can be transmitted via all sorts of objects, including shoes and fabrics, this is likely not a major mechanism of infection”. “This is not a major risk I would worry about”, Adalja said.

If you are concerned about tracking in the virus on your shoes, consider picking one pair to wear when you are out and about and remove them before entering your home. Cleaning of your shoes by hand is not recommended as you risk contaminating your hands in the cleaning process.

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Will the freezing temperatures of my freezer or chilling temperatures of my refrigerator kill the Coronavirus for food items that may have been contaminated?

Dr. Odelia Braun MD JD

Freezing fresh produce or other food in attempts to kill viral matter is not effective. Consider the fact that freezing is how they preserve viruses in the lab. The same holds true for the refrigerator.

If you are concerned about the virus, I would recommend wiping down the plastic with a soapy cloth. The soap will kill any of the virus, making the packaging safe to place in freezer or fridge. It is also worth noting, the virus lives on plastic on average between 48-72 hours, so if the packaging sits for longer than this, the chance of infection is greatly reduced.

For vegetables and fruit, as of today, the FDA does not have any evidence of anyone becoming sick from the virus being transmitted from produce. However, it is advisable that all produce be properly scrubbed under running water. It is not recommended that soap be used on produce, but the brush used for scrubbing should be washed with soap after it has been used.

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When will testing be made available to each California resident? If we aren’t all tested, how do we rule out who may have already had the disease and don’t need treatment or have developed antibodies versus the asymptomatic person?

Dr. Odelia Braun MD JD

Under current testing, we are conducting approximately 5,193 tests per 1 million of the population. When compared to other states, such as New York (18,613 per 1 million) or Louisiana (17,456 per 1 million), California is pretty far behind, and it is doubtful we will catchup. However, there is a test in development that addresses your question about antibody testing, and the intent is to roll this test out on a mass scale.

The test you currently see being used is a swab test, known as RT-PCR testing and only tests to see if the person currently has COVID19. The test does not indicate if the person has antibodies, which would mean they were already exposed to the virus and may no longer be susceptible.

The new test under development, called an Antibody or ELISA test, will tell us who has COVID19 antibodies. Once fully implemented, the test will allow those who test positive for antibodies to resume normal activities, while keeping those who test negative at home.

Researchers at Stanford and other institutions have already made significant progress in this endeavor and are currently in the trial phase of testing. Unfortunately, there isn’t a timeline yet on when it will be approved for mass use, but many are optimistic we may see them within the next 2-3 months.

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What is the ELISA test, and why is it so important?

Dr. Odelia Braun MD JD

The current COVID-19 swab test does NOT tell us if an individual has previously been infected, and is now immune.

When the body is exposed to a foreign agent, such as the coronavirus, it mounts an internal defense. The body’s immune system produces infection-fighting proteins called antibodies, that remain in the individual’s blood long after the infection has passed. In order to determine if an individual has previously been infected with the virus, a blood test that looks for antibodies to the specific virus is required.

An effective test that measures these antibodies is the ELISA test (Enzyme Linked Immunosorbent Assays). It is a very sensitive test and is practical enough to use for mass screening purposes. The ELISA test, has been developed for many other viruses, including HIV, varicella-zoster (chickenpox virus) and has been developed for other coronaviruses, including SARS and MERS. It has not yet been developed for the coronavirus COVID-19.

Development of a coronavirus specific ELISA test would be an extremely important development that would assist public health officials in better determining the timeline of this pandemic, and the level of immunity in the general public. It would also be extremely beneficial in getting U.S. workers back to work.

Multiple genetic researchers have concluded that the coronavirus’s genetic composition is not changing dramatically, as it spreads like wildfire across the globe. This is very good news, because it suggests that once you have formed antibodies to the coronavirus, you are immune to it, and will not become ill with it again.

It also means that even if others around you may be unknowingly infected, if you are immune, they cannot infect you. This knowledge will allow us to send individuals who are immune safely back to work. Dr. Deborah Birx, a member of the National Task Force for coronavirus, challenged the most prestigious virology labs in the country to develop an ELISA test as rapidly as possible, prove its viability, and make it available as rapidly as possible. Since the ELISA test is widely available for other viruses, there is reason to believe that developing a coronavirus specific ELISA test can be rapidly developed.

Dr. Birx challenged our medical professionals and scientists to develop a coronavirus specific ELISA test by the end of April.

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How effective is the current COVID-19 swab test in telling us whether someone is infected or not?

Dr. Odelia Braun MD JD
Graph showing rate of false positives
Graph showing rate of positive tests

The current COVID-19 swab test used in the U.S. requires a healthcare professional to swab the inside of a patient’s nose and send the mucus sample to a professional laboratory. A technique known as Reverse Transcriptase Polymerase Chain Reaction,or RT-PCR, is used to look for coronavirus genetic material. The patient’s sample is added to chemicals that strip the mucus sample down to its basic RNA. In the laboratory, enzymes are added to transcribe the RNA to DNA. The test then seeks toidentify specific DNA genes found only in the coronavirus. If the testing process identifies 2 genes specific to the coronavirus, the test is considered positive. If only one gene is detected it is considered inconclusive.

A positive test means the individual has coronavirus in their system. The individual is infected and can transmit or spread the virus to others. Several research studies have concluded that the COVID-19 swab test is only 70-80% sensitive. This means that 20-30% of the time, the individual’s COVID-19 swab test result is negative, but the person is actually infected with the coronavirus.

Research demonstrates, however, that the test is very specific (98% specific). This means that if your test is positive, you are definitely infected and can spread the virus to others. Some physicians and researchers ask, “Why, if our testing fails to identify 30% of the people who actually have the illness, should we test”? That’s actually a really good question. The answer varies depending on the purpose of the testing. In the U.S. where wide-spread testing is generally not conducted, but is limited to patients who are very ill, doctors use it to confirm their suspicion, and hopefully, in the near future, to guide the patient’s treatment. Patients may be comforted by knowing what is wrong with them.

In other countries, who tested early and often, testing was used to rapidly identify infected people and immediately place them into strict quarantine. Public health officials tracked contacts of people who tested positive, tested these contacts, and ifcontacts tested positive, they were quarantined. This was a very effective tool in countries such as South Korea, Hong Kong, Taiwan and Vietnam, all in close proximity to China to slow the spread of infection.

Importantly, due to the relatively low sensitivity of the COVID-19 swab test, if you have typical symptoms of coronavirus such as fever, dry cough, fatigue and muscle aches, you should assume that you have the coronavirus, irrespective of your test results. Your physician may request that you re-take the test if you continue to have symptoms that do not get better, or symptoms that progress, such as shortness of breath, the hallmark of “getting worse.”

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I have only "industrial vinyl" gloves, which say they are for "non-medical use only". Does this mean they are useless against this virus and I should not bother or are they better than bare hands?

Dr. Odelia Braun MD JD

Industrial gloves will absolutely provide protection. Here’s the real difference between the two types of gloves:

Medical grade gloves must pass a series of technical tests to see if they meet the safety requirements put forth by the FDA. Gloves are tested for puncture and abrasion resistance, they are run through tension and elongation tests, and are also tested for chemical substance resistance.

The guidelines and requirements from the FDA are hard and fast, if the glove does not pass the tests, it is not considered “approved” by the FDA, however, this does not mean that if a glove is not safe to use. These gloves are safe to use as they must still meet certain levels of chemical penetration and puncture resistance. It just means that they missed the mark to be considered medical grade gloves.

Therefore, unless you are working in a hospital or other healthcare setting where medical gloves are required, the industrial grade gloves will afford you more protection than not using gloves at all.

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Can you catch coronavirus from blood?

Dr. Odelia Braun MD JD

Many diseases can be spread through blood and blood products. Fortunately, COVID-19, like many other respiratory diseases, does not seem to be one of them. To date, there have been no reported cases of blood transfusion-transmitted coronavirus.

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How serious is the coronavirus compared to other viral outbreaks? Is it more deadly?

Dr. Odelia Braun MD JD
Graph comparing deadliness between COVID and other viruses

The mortality rate (death rate) is higher than some, such as Influenza A, but lower than other viral pandemic/epidemics we have encountered.

Mortality Rates
Influenza A: .1%. (1 person out of 1000 people who contract Influenza A will die).

COVID-19: currently estimated at 2.5-4.5% (25-45 out of 1000 people who contract COVID-19 will die)—(This number may be inflated due to lack of testing. A large number of asymptomatic or mildly symptomatic people who are infected are not tested).

Other recent viral pandemic/epidemics have higher mortality rates or case fatality rates (CFR) For example:

  • Ebola – 50% CFR (500 people per 1000)
  • MERS – 34.4 CFR (340 people per 1000)
  • SARS – 14% CFR (140 people per 1000)
  • H1N1 – 11% CFR (111 people per 1000)
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Why are people buying toilet paper?

Dr. Odelia Braun MD JD

Panic buying behavior occurs when the brain switches into survival mode. Panic overrides rational decision making. According to Dr. Ali Fenwick, human behavior expert at Nyenrode Business University, there are 4 main reasons why people behave in this fashion:

  1. Survival mode
    When the brain detects a threat, such as the current pandemic, the more primitive part of the brain takes over, and its main objective is to keep you alive. This suppresses or distorts rational thinking. As an example, despite repeated government assurances there will not be a disruption to the food supply, the primitive part of the brain continues to fear the lack of food, and buys and hoards food, to ensure survival. Under these circumstances, people desperately need to feel in control. Purchasing toilet paper allows them to achieve a sense of control.
  2. Herd behavior
    The fact many people are purchasing toilet paper, leads still others whose rational thinking process has been diminished toassume that purchasing toilet paper must be important. Mimicking the behavior they see around them makes them feel safe.
  3. Sense of control
    In uncertain times, individuals can feel a frightening loss of control. They seek out actions that give them the perception of control. We don’t feel as though we can control the spread of disease, the stability of the financial markets, the ability of our healthcare system to support us. However, in our plentiful consumer-oriented economy, we can purchase goods easily. We want and need to be successful. We can purchase online, we can have products delivered, we can pick up at the store, we can shop in the store. Since, goods are plentiful, we will succeed when we attempt to buy food, drinks, and cleaning products. And therefore, we will buy, buy, buy. We have succeeded, we are in control.
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Why are all the bars closing?

Dr. Odelia Braun MD JD

This virus is easily transmitted from person to person, without the infected person even knowing they are infected. As such, it is critical for everyone create and maintain a 6ft buffer (social distancing) around them. This is impossible in a packed bar. Think of the environment in most bars: lots of people, music or other noise so you are forced to move closer to a person in order to talk; the sharing of drinks, and maybe even physical contact on a good night. Simply ordering your drink forces you to lean in so there is less than 2 feet between you and the bartender. All these actions create the absolute perfect scenario to spread COVID-19.

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I am over 80, what is your advice on whether I can go to the store to buy groceries?

Dr. Odelia Braun MD JD

The current store recommendations are that anyone over 65 years of age should remain indoors. This is important because research has concluded that anyone you encounter could be capable of transmitting the virus, even if they’re not showing any signs, such as coughing. You are also at risk of picking up the virus when you touch a shopping cart, handles in the refrigerator/freezer section and countertops that virus filled droplets have fallen upon, then inadvertently touching your mouth nose or eyes. If at all possible, take advantage of grocery delivery services, or have family, friends, neighbors to do your shopping. As a last resort, if you must shop for yourself, many stores have set up special hours for seniors.

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I keep hearing things about drinking alcohol will help; Is this true?

Dr. Odelia Braun MD JD

There isn’t any truth in this at all. Alcohol will not kill the virus. While it may have a short-term uplifting effect, more likely it will proceed to depression and hopelessness.

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Because I am young, does this mean I am far less likely to contract the virus?

Dr. Odelia Braun MD JD

Current data does indicate that the younger population (less than 30y/o) is better able tolerate the coronavirus infection. Less than 2% of symptomatic young people require hospitalization.{' '} This does NOT mean that young people are less likely to become infected. {' '} Since most young people have mild or no symptoms even if they are infected, they are rarely tested.

Emerging data from Europe shows an increase in hospital admissions in the 20-50 year old age group, as high as 40% of new admissions. We are not sure why. It is important to understand that even though you do not feel ill, or have symptoms, you may still be infected with the virus, and are able to infect others. We need our young population to understand that they are extremely important in curbing the virus. This is why social distancing in all age groups is so important.

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What is my probability of infection for COVID-19?

Dr. Odelia Braun MD JD
  • Several studies published in the past few days create even more uncertainty, as they have confirmed both the existence of airborne transmission, and asymptomatic transmission
  • An article in the New England Journal of Medicine published yesterday concluded that the coronavirus can be transmitted when an infected person exhales, or breaths out normally. The infected person exhales viral particles into the air just by breathing normally. Therefore, we can no longer assume that we will avoid being infected just by avoiding people who are coughing and sneezing. The study demonstrated that virus particles that are exhaled can live in the air for up to 3 hours, and that these particles can transmit infection. So, anyone, including young people, who appear perfectly healthy, may be exhaling contagious viral particles.
  • In a second study out of Northern Italy, investigators randomly tested 3000 individuals in their community. 50-75% of the individuals who tested positive for coronavirus, did not have any symptoms. This suggests that transmission of disease from asymptomatic healthy people is not only possible, but may be a major source for spreading the disease.
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What is my probability of infection while grocery shopping?

Dr. Odelia Braun MD JD
  • Generally speaking, you should not go to the grocery store at all, if you can order your groceries online and have them delivered.
  • This is especially true if you are older (>60 years old, or have underlying chronic diseases such as heart or lung disease, diabetes, cancer or other diseases that affect your immune system. Serious disease in the elderly rapidly increases by the decade, as does the associated mortality.{' '}
  • If you are under 40, and you visit the grocery store, you may well contract the infection, but the likelihood is that your disease will be like a mild flu. However, although you may feel perfectly healthy, the Italian study suggests you may already be infected, and your presence in the grocery store may serve to transmit the disease to others.{' '}
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What is my probabilty of infection while traveling through an airport?

Dr. Odelia Braun MD JD
  • Airports are even higher risk because of the greater numbers of people, the close proximity between people, and the likelihood of close contact, having people breath, sneeze and cough on you, and touching surfaces that virus droplets may have landed. Each of these factors, would result in a greater likelihood of becoming infected.
  • Right now, in the US, I recommend that you order your groceries online and have them delivered, and avoid all public transportation especially airports, except in the most critical of circumstances.
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