COVID-19 Q&A: Transmission, testing, who's at risk and more
TORONTO -- As Canada’s total number of confirmed cases of COVID-19 increases, health-care professionals are being inundated with questions about how the virus spreads, who’s at risk, and how people can protect themselves.
To sort through some of the noise, several doctors answered some of the most frequently asked questions about the ongoing pandemic.
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Can the virus linger on surfaces or be transmitted through the air?
While the research is still in its early stages, the World Health Organization (WHO) says that preliminary evidence suggests the new coronavirus can persist on surfaces for a few hours or up to several days, but this might vary depending on conditions, such as the type of surface, humidity, and the environment.
As for whether the virus can be transmitted through the air, the WHO states that “the virus that causes COVID-19 is mainly transmitted through droplets generated when an infected person coughs, sneezes, or speaks" instead of through the air.
However, a new study from the U.S. National Institutes of Health and published in the “New England Journal of Medicine” has found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, was detectable in aerosols for up to three hours. The researchers discovered this by using a device to dispense an aerosol with duplicated microscopic droplets of the virus, which would be released by a cough or sneeze. The tests showed the virus in aerosols could still infect people for at least three hours.
The study also found the virus was viable, or contagious, for varying amounts of time on different surfaces. For copper it was viable for up to four hours, up to 24 hours on cardboard, and up to two to three days on plastic and stainless steel.
Dr. Isaac Bogoch, an infectious diseases specialist, said the study provided doctors with helpful guidance on the matter.
“This really just reinforces what we’ve been saying all along, ‘wash your hands, wash your hands, wash your hands,’” he told CTV’s Your Morning on March 18.
Can you contract COVID-19 more than once?
There have been media reports in China, Japan, and South Korea about individuals who had the virus and eventually tested negative for it and were released, only to test positive for it again a short time later.
Scientists in those countries have speculated that testing errors could be to blame, either for a false negative that said the patients were free of the virus or for the positive result that signalled its reoccurrence.
Dr. Iris Gorfinkel, a family physician and medical researcher, said it’s really too soon to know whether an individual can contract COVID-19 more than once, and how quickly that can happen.
“We actually don’t know. We don’t know how long-lasting the immunity is to it,” she told CTV’s Your Morning on March 16. “These viruses have the tendency to morph and change.”
In fact, it’s still not even clear if people develop an immediate immunity to COVID-19, as is typically the case with other virus strains, such as the flu.
“So just like any other virus, there’s the possibility that it could shift or drift. Just minor changes could change it from a once mild infection to a more severe infection,” she explained.
Can you contract two viruses at the same time, such as new coronavirus and the flu?
While it’s still unclear if someone can contract the new coronavirus more than once, it is possible to have more than one different virus at the same time.
Dr. Isaac Bogoch said it’s absolutely possible for someone to have COVID-19 and a strain of the flu or another virus simultaneously.
“We sound like broken records in the medical and scientific community, but for the last two months we’ve been saying ‘We’ve got to prepare for this. We’ve got to prepare for this. Optimize your health,’” he told CTV’s Your Morning on March 20.
Bogoch said people should “optimize” their health by getting vaccinated for everything that they are eligible to be vaccinated for, such as influenza or bacterial pneumonias.
“It’s totally possible to have what’s called a co-infection and we know people who have multiple infections at the same time can have a worse outcome,” he said.
How do you know if you have a cold, the flu, or COVID-19?
Those who are infected with COVID-19 may have few to no symptoms, according to the Public Health Agency of Canada (PHAC). If symptoms are present, they can easily be mistaken for a common cold or the flu because of their similarities.
According to the health agency, the main symptoms of COVID-19 are fever, coughing, difficulty breathing, and pneumonia in both lungs. In severe cases, the illness can even result in death.
The World Health Organization lists additional symptoms that have been documented in some COVID-19 patients, including tiredness, aches and pains, sore throat, diarrhea, nausea and runny nose.
Gorfinkel said clinicians can’t distinguish between the illnesses based on symptoms alone. She said they can all present the same way, which is why the patient’s travel history or history of exposure to the virus is so important in determining whether someone might have COVID-19.
“We do not have the facilities or the tests to test absolutely everybody, so that history of travel if you’re basically otherwise well, that’s a critical part of it,” she explained.
Can young people fall seriously ill?
While much of the attention about who is most vulnerable to COVID-19 has centred on the elderly and those with underlying medical conditions, it can also affect young people.
According to PHAC data, people in their 20s were responsible for 12 per cent of all confirmed COVID-19 cases in Canada as of March 30, and those aged 19 or younger made up 4 per cent of the country's total caseload.
Dr. Isaac Bogoch said that everyone can be infected by the novel coronavirus and there’s always a risk that some people will have a more severe infection.
However, he said older people and those with underlying medical conditions still have a greater risk of a severe outcome than younger individuals.
“If we take a step back and look at the 30,000-foot view and look at who is more likely to get a severe infection, it is overwhelmingly those over the age of 60 and really, over the age of 80 years old,” he told CTV’s Your Morning on March 20.
Bogoch said the most important metric to look at when studying data about severe infections from this virus is death.
“If you get infected, you either live or you die, it sounds morbid, but I think that’s an extremely important distinction to make and if we look at death, it is overwhelmingly in those over 60 and disproportionately high in those over the age of 80,” he said.
Should you avoid Advil and other anti-inflammatories?
France’s health minister set off a wave of confusion when he warned that the use of ibuprofen could become an “aggravating factor” for infection in COVID-19 cases; however, the World Health Organization says there are no reports to support this claim.
In an official response, the WHO said it’s not recommending against the use of the common painkiller.
“We are also consulting with physicians treating COVID-19 patients and are not aware of reports of any negative effects of ibuprofen, beyond the usual known side-effects that limit its use in certain populations,” the WHO said in an update on March 18.
Bogoch agreed with the WHO, saying there is still not enough data on the subject.
“The short answer is we’re not entirely sure if this is going to do anything or not. It’s unlikely to have any effect whatsoever,” he told CTV’s Your Morning on March 19.
For individuals who suspect they may have COVID-19 and are suffering from a low-grade fever or another type of pain, Bogoch said they can take ibuprofen or other over-the-counter medications, such as acetaminophen.
If you have been in isolation because one person in your household is sick, do you have to continue to stay home for another two weeks if another person falls ill?
For people living in households with multiple residents, it may be difficult to avoid infecting each other. Dr. Isaac Bogoch says that if someone becomes sick with COVID-19, the best course of action is to call the local public health authority.
“It’s extremely important to call the local public health hotline to discuss the exact situation so they can give you very specific recommendations based on your unique setting,” he told CTV’s Your Morning.
In general, though, it appears the answer to that question may be a 'yes.' PHAC says that anyone who has been in contact with a suspected, probably or confirmed case of COVID-19 should self-isolate for 14 days, starting at the time of contact.
This approach was taken by Prime Minister Justin Trudeau, who entered self-isolation with his family after Sophie Gregoire Trudeau tested positive for the virus. Once his wife was given the all clear, the prime minister said he would remain in isolationuntil it had been two weeks since their last contact before the clearance.
Who is getting tested?
There is a test that can detect the presence of COVID-19 in a patient, but jammed health-care systems mean many Canadians may make it through the pandemic without ever knowing if they had contracted the virus.
Canada does not have formal criteria for determining who should be tested, meaning guidelines vary from province to province. Health-care workers are generally advised to prioritize testing only those who are showing symptoms of COVID-19, particularly if they are in hospitals, long-term care homes or other institutional settings where they could easily spread the virus, as well as symptomatic travellers entering Canada.
More than 240,000 tests for COVID-19 have been conducted in Canada as of March 31.
Anyone who is showing symptoms of COVID-19 and is concerned they may have acquired the virus should contact their doctor or other primary health-care provider.
Can you still gather with friends in small groups?
As physical distancing recommendations have evolved, it has become clear that authorities do not want anyone to get close to anyone from outside their household unless absolutely necessary.
"Stay home" has become the refrain from political and public health leaders seeking to flatten the curve of COVID-19 infectiuons.
"Physical distancing is proven to be one of the most effective ways to reduce the spread of illness during an outbreak," PHAC says on its website, which recommends that all Canadians avoid "non-essential" gatherings.
Gorfinkel said people should aim to avoid all unnecessary contact with individuals to prevent further spread in their communities.
“Stop the spread because so many people have mild symptoms. That’s the problem,” she said. “They’re the source where the majority of cases are going to come from.”
Do previous immunizations, such as the flu shot, help protect against COVID-19?
While there have been suggestions that a regular flu shot can help protect individuals against COVID-19, Bogoch said that’s not true.
“They do not protect against this particular infection. They do not protect against COVID-19,” he said.
However, Bogoch stressed that vaccinations such as the flu shot are still extremely important for optimizing health.
“We should be up to date on all our routine vaccinations, our pneumonia vaccines, our flu vaccines, our regular vaccines, so that we can ensure that our health is optimized in case we come down with an infection,” he said.
Should seniors and children be separated if they live in the same home?
While children appear to be less affected by the virus, elderly people and those with other medical issues are more at risk of suffering a severe outcome from a COVID-19 infection. For families that have both seniors and young children living under the same roof, Bogoch said they should take care to separate them if anyone shows symptoms. However, he said that should be the case for anyone who is living with others and exhibits any symptoms, such as fever, coughing, and difficulty breathing.
“You just have to be very mindful if anyone has any symptoms whatsoever they should be separated,” he said.
How can caregivers protect themselves while helping someone with COVID-19 at home?
For people who are caring for a person who has been diagnosed with COVID-19, the Public Health Agency of Canada has a number of tips on how they can protect themselves while they provide care.
According to PHAC, only one healthy person should provide care to the individual with COVID-19, and that person should limit their contact with them as much as possible. They should also not share personal items with them, such as toothbrushes, towels, bed linen, utensils or electronic devices. The ill person should have their own bathroom, if possible. If not, they should put the toilet lid down every time before flushing.
Caregivers should wear a mask, disposable gloves, and eye protection when they’re in close proximity to the patient and never reuse the mask or gloves. They should also frequently wash their hands with soap and water, especially after contact with the sick individual.
What’s more, caregivers should remain vigilant about monitoring themselves for symptoms for 14 days.
Should you wipe down all of your groceries when you return from the store?
While the SARS-CoV-2 virus can linger on surfaces from anywhere to a couple of hours to a few days, Dr. Isaac Bogoch said it’s not necessary to wipe down groceries after buying them at the store.
“I think if people go to the grocery store, they get groceries, I think it’s just fair to put them away,” he told CTV’s Your Morning.
As for fruits and vegetables, Bogoch said there is no need to take any extra precautions with those and people can simply wash them with tap water before eating them, as they normally should.
How bad will things getin Canada?
COVID-19 has caused widespread destruction around the world, with even developed nations including Italy, France and Spain reporting thousands of deaths and completely overwhelmed health-care systems.
The situation was rapidly deteriorating into something similar in the U.S. by March 31, with New York City's iconic Central Park turning into a makeshift hospital and experts predicting 82,000 deaths even in a best-case scenario.
Canada has thus far avoided the worst of the outbreak, but experts are unable to say whether that will continue – in fact, they're unable to offer any credible forecasts at all.
Projecting the spread of the virus through Canada at this point is nearly impossible because of several factors, including uncertainty over how many Canadians have actually been infected, unknowns around whether Canadians are following public health recommendations well enough to curb COVID-19's spread, and the lag time between when an infection occurs and when it is reflected in the data.
"We don't exactly know where we are on the epidemic curve, and we don't exactly know where we were when we started having our strong public health response," Dr. Ashleigh Tuite, an expert in modelling the spread of infectious diseases, told CTVNews.ca on March 26.
Will there be a second wave of infections?
With public health officials warning that Canadians must adhere to physical distancing policies in order to “flatten the curve” of infections, as Hong Kong and Singapore successfully did, other experts are expressing concerns about a “second wave” of infections after those regions experienced another spike in cases when they relaxed some of those measures.
Bogoch said that it’s possible Canada will experience a similar fate, if people aren’t diligent about maintaining isolation and physical distancing orders.
“If we take our foot off the gas pedal, when we start to lift some of these measures because we start to see the curve flattening, we have to be prepared that there might be a second spike in cases,” he explained.
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