Aug 17, 2020 9:00 AM

Author: Kylene Metzger

As the virus that causes COVID-19 continues to evolve, experts at University of Utah Health are learning more about the new disease. Emily Spivak, MD, associate professor in the Division of Infectious Diseases at U of U Health, provides information about the virus.

You can find more information about COVID-19 here.

What should parents think about as their kids return back to school?

The mitigation strategies of physical distancing and masks are the most important things you can do in a school setting. If your child is returning to a hybrid model, everyone should be wearing masks while at school. Teachers are talking about wearing masks and face shields, which can add an extra layer of protection in the classroom. We don’t know if a face shield alone is as protective as a mask. It could be beneficial in some situations if a small child is having trouble with a mask, but masks are the preferred face covering.

Other things to ask your school include what are they doing about lunch? Eating is an especially vulnerable time because masks come off. There are some examples of clusters of outbreaks where people are eating in break rooms and not practicing physical distancing when they take off their masks to eat.

Some questions to consider asking:

  • Are schools having lunch in the lunchroom?
  • Are lunches being delivered to classrooms?
  • How are schools staggering lunches?
  • How are schools utilizing outside spaces?

Other questions to think about:

  • What is your school doing about gym, recess, and PE?
  • Are schools modifying physical activities?
  • Will kids avoid close contact when they are outside?

There’s talk about keeping younger kids in cohorts, but what about older kids?

As long as they are wearing a face covering, practicing frequent hand washing, and physical distancing is happening as best as it can, the risk of transmission is low. However, the mixing of people introduces a bigger complexity. If and when there is a positive COVID-19 case, it adds a lot of contract tracing to do. When you mix cohorts, it introduces new people and increases the risk of transmission.

What are long haulers? What are the long-term effects these patients are experiencing?

Patients who had COVID-19 are self-identifying as long haulers. What that means is there’s a subset of patients who have prolonged symptoms more than 2-4 weeks after COVID-19 infection, some lasting 2-3 months. The acute symptoms such as fever, myalgia, shortness of breath, and cough go away. But some of these chronic symptoms long haulers are describing are more chronic fatigue, chronic joint pain, and chronic shortness of breath, especially if they have lower respiratory tract infection with COVID-19. This, in my opinion, represents chronic inflammation and chronic immune activation from the virus. There’s precedent with other viruses, specifically EBV (Epstein-Barr virus) and CMV (cytomegalovirus), but that’s usually the minority of patients.

There are some concerns on whether these long haulers can still transmit COVID-19 to other people. From what we know, that is not the case. These chronic symptoms do not represent ongoing chronic infection that you can transmit to someone else. It is, unfortunately, your body recovering very slowly from the viral infection.

Why are some people asymptomatic and others are very sick? Is this typical of viruses?

In general, for all viral infections, there is always a spectrum of disease. For most viral infections, there is a spectrum from those who have no symptoms to people who are very sick. The spectrum may look different or be skewed one way or another for viruses different than COVID-19, but it’s not unheard of. It’s fairly normal for there to always be a spectrum of any disease and varying responses in individual people. We don’t 100% know why those responses of individual people are different. There does seem to be some correlation between people who have fewer symptoms having lower and shorter live antibody responses, while those who are sicker having more robust or higher levels of antibody production and maintaining antibodies for a longer period of time. The variation of symptoms is probably somewhat related to how an individual person’s immune system in responding to the virus. I suspect the variations in symptoms that we’re seeing are related to possible varied individual immune responses, reactions to the virus, and even the amount of the virus they are exposed to.

What do the lower COVID-19 case numbers in Utah mean?

The case numbers at the state and county level are going down. In Salt Lake County, 1 per 100,000 are becoming infected with COVID-19, which is significantly down from about a week ago. The positivity rate is now 8-9%; it was up at about 12-13% ten or more days ago. On top of that, testing volumes have gone down. We don’t know why testing volumes have gone down, but I’m hopeful it’s because fewer people are sick and getting infected with COVID-19.

I’m also optimistic that masks and the mask mandate in Salt Lake County are working. People who live in Salt Lake County know things have been visibly different since the masking mandate went into effect. I encourage people not to get complacent. If we all take off our masks, the case numbers are going to go right back up.

I want people to recognize that there has been some misinformation in the media and from the federal government about testing. The more we test, the more cases we may detect. But testing more people does not automatically increase case numbers. We are definitely testing more people that turn out positive, but testing is not driven by the number of people who get tested. We want people to get tested if they think they are sick, but what we really look at is the proportion of all tests that turn positive. 

How do we get out of community spread phase?

Until we get a vaccine, there is always going to be community transmission. A positivity rate shows how much community spread there is. It’s here now, it’s in our communities, and it’s going to continue to spread until we find a way to immunize the population from it and prevent community spread.

When there is a vaccine, does everyone need to get it in order for there to be immunity in the community?

When there is a vaccine, people need to realize there will first be a prioritization of who gets it first. I would imagine the priority would be the elderly or those at higher risk of severe infection. It will be a slow-rolling vaccination process.

There’s some discussion about not how many people should get the vaccine but who right people are to get vaccinated. Other discussions are around super-spreaders who tend to shed more droplets when they talk, eat, or sing than others. Ideally, you would want to vaccine all these people, but it’s hard to identify who those people are. When a vaccine is available, I encourage most people to get it but realize not everyone will be able to get it at first.

Kylene Metzger

Public Affairs

coronavirus covid-19 infectious diseases

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