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Answering COVID-19 Questions With U of U Health Experts

Jun 22, 2020
In the past week, Utah saw an increase number of COVID-19 cases and concerns have grown about individuals not wearing a face mask in public. There are also new questions about an inflammatory drug called dexamethasone that's being used in trials to treat COVID-19 patients. Richard Orlandi, MD, Chief Medical Officer of Ambulatory Health at University of Utah Health answered questions about COVID-19 and the shared the latest information about what's known about COVID-19 to date.

As the number of COVID-19 cases rise in Utah, what's changed that makes us feel safer?

We know more now than we did in January, February, and March. That's an advantage, but we still don't know as much as we want to know. More data will come out, and sometimes we will hear about one study that contradicts another study. That's just the way knowledge works.

We're also learning how the number of COVID-19 cases in Utah translates into hospitalizations, ICU stays, and the number of ventilators being used. This helps manage the capacity of our health care systems in our community, state, and nation and say, "We can open up this much and it has this much risk, but we can manage because we have resources to do it."

We want absolute, but nothing is absolute. We want to say, "If I don't do this, I won't get the virus." It doesn't work that way. Think about it this way with road cycling. How can someone avoid injury when road cycling? They can wear a helmet, bright clothing, and put flashers on the bike. Those all lower the risk, but the only way to eliminate risk is to not go road cycling. People need to decide if the risk if worth it. This is the same situation with coronavirus. If we wall ourselves off with no outside contact, there's no risk. But that's not realistic, so we have to balance those things.

Face masks were once only recommended for those who were infected with COVID-19. Now, it's being recommended as one of the best ways to protect yourself from the virus.

Early on, the CDC said it's not important for everyone to wear a mask. One reason was we didn't fully understand how effective they could be—and there was a mask shortage. We first wanted to make sure masks were available in hospitals.

More knowledge has come out, most recently in a journal called Lancet, that looked at numerous studies that showed masks reduce our risk to COVID-19. Let's be clear: it does come to social responsibility. If I wear a mask, it's not as much for my benefit as it is for your benefit, and the other person standing next to me in line or at work. Wearing masks is about caring for others at least as much, if not more, than it is about caring for ourselves. This is one way we can show in our community that we care about others.

There's a lot of conversation around someone's right to not wear a mask. I think people who feel adamant about not wearing a mask may not fully understand how much it benefits their loved ones around them. Mask wearing is one of the most important things we can do as a community to slow down the spread of coronavirus. We can do that for one another.

What are some face mask falsehoods?

I've heard people say that they can smell things through a mask, so that means they are ineffective against coronavirus. This shows a lack of understanding. It's about particle size and pore size of a mask. A mask is going to have holes in between the fabric weave. It's like saying a BB can go through a volleyball net, so that must mean the volleyball net is ineffective for volleyballs or basketballs. A smell molecule is going to go through a mask because it's a very small particle size. Molecules make up proteins, and proteins make up viruses, and viruses will glob together. That will not get through a mask as easily.

What are some important, effective things a person can do to protect themselves against COVID-19?

With the knowledge we have right now, wear a mask, use eye protection, physical distance, and wash your hands.

What are some considerations a person should take before attending a rally?

Some things to consider is the health of family members in your household, such as those aged over 65 or with diabetes, lung complications such as moderate to severe asthma, heart conditions, liver and kidney conditions, immune deficiencies, and severe obesity. If someone with one of these conditions gets COVID-19, their chance of getting severe illness and dying are much higher. It doesn't mean they have a better chance of getting infected. Participants should consider how strongly they feel about the activity, their health, and the health of family members they might infect if they bring the virus home

If you participate in a rally, you should wear a mask and eye protection, stay six feet away from people, and use hand sanitizer.

Is it safe to fly?

It's harder to socially distance on an airplane. The air is also not as well circulated as it would be outside. If a person is going on a vacation, that could be put off. If they have risk factors, that may be worth considering putting off. If a person has an urgent need to go, that's a different scenario. We are all going to have to make the decision for yourselves. There are risks, but if you can sanitize the areas around yourself, wear a mask, keep hand sanitizer nearby, and physically distance, risks will be reduced.

If you are flying with a newborn, they don't have a very adaptive immune system yet. This is why many people don't take newborns out in public for the first few days or weeks. That would be something you would want to consider. If you can avoid flying, that may be better. If you can't avoid it, use whatever protections you can.

Is there an equal risk to getting COVID-19 through the eyes as through the nose and mouth?

It's believed to be more transferable through the nose and mouth. However, if you are within a couple feet of someone while not wearing a face mask and they cough, some of those droplets may hit your eyes. Having a mask is good. Having eye protection is better. It's not as common to get infected with COVID-19 as through the nose and mouth.

It appears the mortality rate in the U.S. in decreasing. Is this because of better treatment options or masking?

We're learning more about how to take care of critically ill patients with COVID-19 and how to reduce the risk of dying for patients that are in the ICU or on a ventilator. The risk is still unfortunately high.

The use of masks and other protective barriers also varies from city, state, and region. I don't know if I can say that's making more of a difference, but the more we do, the better. We've seen through studies in areas where face masks are mandatory, there's less of a risk of transmission.

What are the threats for those exercising at the gym?

If you're near someone who has their earphones in and is talking loudly to someone, you're going to see more respiratory droplets. That's a calculated risk. If you can work out at home or outside, that's going to be safer than going to the gym. There's increased risk to go to the gym, but that doesn't mean you're not safe. It's a grey area. If you can exercise with a mask, even better, although it may be hard to do.

How does Utah compare in the number of COVID-19 cases to other areas?

It's not as bad yet, but we are seeing a rise in cases. Disease is spread not in a linear way, but in a geometric way. At some point, the number of cases hit an inflection point, which has to do with cases going sharply up. It's the difference of three plus three or three to the third power. Three plus three is six, but three to the third power is nine. The faster we grow, it hits a point where it goes up sharply. We saw that in China, Italy, and New York. I'm not saying that it's going to happen tomorrow in Utah, but we're heading in that direction. That doesn't mean we need to shut down the economy, but we need to be responsible as we go out in the public.

What can you tell us about dexamethasone?

Dexamethasone is a steroid drug that reduces inflammation. One of the things we know about people who are severely ill with COVID-19 is it causes problems in the lungs. When a patient has inflammation in the lungs, it can block air exchanges and cause the patient to be put on a ventilator. The data we have on dexamethasone right now is a press release from a study. In the press release, it says the death rate among those individuals on a ventilator that were treated with dexamethasone went from 40% to about 30%. This treatment may reduce the COVID-19 death rate but 10% is not what I would call a cure or something to be excited about. We don't know all the information, including all the side effects. There's initial promise, but we need to find out more about it.