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Answering COVID-19 Questions

Jul 17, 2020

The number of coronaviruses cases in Utah continue to rise, and hospitals are on the verge of ICU capacity. Doctors at University of Utah Health say there are two things we can all easily do to stop the spread of COVID-19: physical distance and wear a mask. Russell Vinik, MD, chief medical operations officer at U of U Health answered questions about COVID-19 and shared the latest information about the virus.

Describe the current COVID-19 situation in one word

Precarious. The reason, particularly in Utah, is that hospital bed occupancy has gone up significantly—over double—since May. Right now, we are averaging 650 COVID-19 cases a week. When and if Utah gets above 850 cases a week on average, most of the ICU beds will be at 80% capacity or above. That's when things get crowded and hospitals start boarding patients in emergency rooms, which is not ideal care. We are really at a precarious point right now where ICUs are on the verge of being at capacity.

As a doctor, what's the most frustrating thing to you right now about COVID-19?

When I go out in public and see people not masking. There is a tough balance between the health of our community and the economy. Masking doesn't affect the economy. We can significantly reduce about two-thirds of the transmission of COVID-19 just by wearing a mask when we are out in public around other people. It's super frustrating when that simple act isn't being followed.

The CDC just announced yesterday that if everyone wore masks, the virus would go away in two months

I think that's very fair. When we look at the transmission rate of the virus in Utah, it's currently measured 1.1. If transmission gets below 1, that's when the virus starts to go away and fewer people get infected. We don't have to turn the dial that far. If we can get that number under 1, the virus will start to disappear. Masks are shown to reduce transmission 30% to as much as 60%. If we all did it, we could beat this virus.

The biggest impact of a surgical or cloth mask is helping prevent the spread of COVID-19 to others. The most protection you get is when both people during an encounter are wearing masks. It's very hard to transmit the virus if two people who are close together are both wearing masks.

Why has there been confusion around wearing masks?

I think it's unfortunate that, early in the pandemic, some governmental agencies didn't recommend wearing masks for the public. Part of the reason for that was due to a significant shortage in masks and to make sure available masks were given to the people who needed it most. But if you look at data now from COVID-19 to SARS, MERS, and influenza, it's pretty clear across the board that masks reduce transmission. It's unfortunate the way it was unveiled to the public early on, but the science is clear. It would be hard to find any scientist that says masks are not effective in reducing transmission.

How does COVID-19 spread?

Transmission of the virus really depends on the size of the droplet. Diseases like measles spreads in a very small droplet-less than five microns—that can get into the air and spread 20 feet or more into circulation. Whereas, what we know about COVID-19, the vast majority of transmission happens in droplets that are larger and greater than five microns. Keeping that physical distance of six feet or more is most effective.

Is it safe for kids to go back to school?

That's the million-dollar question. Everything has to be weighed relatively. Data just released last week in Pediatrics changed the way we think of this virus compared to other viruses. We know kids that go to a daycare or school bring sickness home and can get people in their families sick. That's common for what we know about other colds and flu. The data that came out last week was a little different. It showed it was rare for a child to get another child sick or a child to get an adult sick with COVID-19. Only 8% of the transmission [occurs when] a child gets sick first and brings it home to their family members.

It was a relatively small study, but it's starting to mount evidence to say maybe this is safer than first thought. The American Academy of Pediatrics came out, for the most part, in favor of schools reopening. But it's going to end up being a local decision—and that has to deal with how prevalent the disease is in the community.

In France, they were very strict about social distancing and were able to open schools very safely in a short period of time. Communities that are doing a good job of stopping the virus have a much better ability to open schools safely.

Are you comfortable about this research as a doctor and parent?

I am. We know a lot more than we did in the spring. Children are less likely to get COVID-19, are less likely to transmit COVID-19, and are less likely to get hospitalized or die from COVID-19. Children are a much safer population from COVID-19 than adults.

Should kids wear masks when they return to school?

We know a lot less about children wearing masks. We know for very young people that might not be possible. Otherwise, there is no good reason why childhood transmission is going to be that different from adults. If masks work for adults, it's hard to imagine it's not going to work well for children.

How can someone positively encourage wearing a mask?

Step one would be to wear one yourself. As it becomes more common in our society, people will recognize this as the new norm at least for the next few months or possibly in a year or two. You should model the behavior yourself. Step two is variable - it depends on how you approach someone.

Is someone more likely to get infected with COVID-19 from a stranger or someone they know?

Someone they know. Most COVID-19 cases happen from known contacts. About two-thirds of COVID-19 transmission happens when contact tracers are able to point transmission to a known contact that had COVID-19. About two-thirds of those contacts are family members. That's where it gets harder because we can't socially distance ourselves well from family members.

Who is most likely to be hospitalized from COVID-19?

Older adults have the absolute highest risk of being hospitalized from COVID-19 and dying. We're also seeing older adults are less likely to get COVID-19. It's most likely because older adults are a lot less mobile than younger people, not necessarily working, and probably more cognizant of the fact they will have bad outcomes. The rate of COVID-19 transmission in older adults is about half that of people who are younger than age 65. There's a lot of young people getting hospitalized just because young people are getting infected with COVID-19 much more than older adults.

What's it like for someone who needs to be hospitalized for COVID-19?

When someone is hospitalized for COVID-19, it's because they are very sick. The average stay for those who are hospitalized for COVID-19 is 5-7 days, and those people that go home are oftentimes still very ill. Many require oxygen for weeks if not months. Some of these people may require oxygen for the rest of their lives after a really severe illness. The data is still emerging on that. Please recognize that if you get sick, you may not just bounce back after such an infection. It could cause long-term harm.

What are some long-term effects of COVID-19?

We don't know much about long-terms effects because the virus has only been with us for five months. We are starting to get an idea from those who are on oxygen months after an infection that they are unlikely going to come off oxygen.

What information is there about outdoor transmission of COVID-19?

We don't have very good data, but transmission is much less than indoor transmission. At this time, outdoor transmission of COVID-19 is actually rare. It could be because wind and air disperse the virus pretty quickly and ultraviolet light is a great disinfectant.

Does hand sanitizer with 60% alcohol really help with the spread of COVID-19?

Hand sanitizer with 60% alcohol has been proven to kill the virus. 100% alcohol is not the best thing for your hands, body, or mouth. Hand sanitizer should be spread on the entire surfaces of your hands to be effective.

How does COVID-19 compare to flu?

Flu can be a very lethal disease, particularly in older adults. There are thousands of deaths each year. For COVID-19, we are now at the hundreds of thousands of deaths. COVID-19 is just a very lethal disease. Most people don't have antibodies, don't have immunity, and the body hasn't seen the disease. This is unlike the flu, where the body has some antibodies from strains in previous years.