EB: This depends on how ill the person gets. It may be limited to a week or 10 days, or as long as several weeks.
TT: It varies according to each person’s immune system. If you have a good immune system, you will be able to recover from COVID-19 more quickly. If you have engaged in unhealthy habits that reduce your immune system, your immune system will have to work harder to fight the infection. Remember, most people will recover from COVID-19.
EB: Most people only require typical over the counter cold and flu medications. Beyond that, good isolation of the ill, distancing, hand hygiene, and cleaning/disinfection of high touch surfaces… these are our best defenses.
TT: There is no treatment specific for COVID-19. It is treated with supportive therapy at home. Unless you have GI problems, then it is not recommended to overload yourself with ibuprofen. If you have liver problems, it is not recommended that you take acetaminophen. If you are infected with COVID-19, make sure you’re in a room that is only for you. You should not be sharing utensils, bathrooms, or common household items with healthy family members.
Social distancing is key to mitigate the risk of developing COVID-19 infection. Get in the habit of cleaning and disinfecting surfaces and common objects (door knobs, etc.) that we touch.
EB: I think the answer to this depends on the severity of illness. For mild illness, I would not expect long term effects. I anticipate that after we weather through the COVID-19 storm, we will have a more comprehensive understanding of the long-term effects of COVID. I do expect that there will be profound long term health system effects of this COVID-19 pandemic.
TT: We are still learning about the long-term effects of COVID-19. Because it is a novel coronavirus that hasn’t been studied in great depth, our understanding of how this virus works is evolving. I have been reading a great deal about the work of world’s leading epidemiologist, Gabriel Leung, MD, MPH. He has made good predictions about the global impact of COVID-19. Here is a link to some of his research articles.
EB: No confirmed studies have settled this question at this time. I think it is reasonable to consider COVID-19 like other coronaviruses. This may mean that over time your immune system will forget the virus and the potential for reinfection exists.
TT: We don’t have enough information to say whether someone can get COVID-19 twice. The research on COVID-19 is emerging. While the global community is working quickly to conduct and disseminate research, there is also a great deal of misinformation.
EB: We know COVID-19 is a coronavirus, and we know that most coronavirus illnesses (like the common cold) are easy to transmit. We are still not sure of the exact transmission of the disease, but we tend to have a posture of use of respirators with most novel infections in order to best protect our healthcare workers.
When we talk about worker protection, we talk about something called the “Hierarchy of Controls.” PPE is at the very bottom.
We can remove hazards or things that are difficult to clean. We can replace hazards like glass bottles for blood cultures with plastic ones. We can put our patients in Airborne Infection Isolation Rooms (AIIR). We can arrange our cares differently. We can ask a patient to put a mask on when we enter the room to care for them. We need to be mindful of our safety as we work to care for patients with COVID-19. Be especially attentive of actions that might generate aerosols or air movement.
TT: Here is an analogy to help explain the difference between droplet and airborne. When you sneeze, you feel and see visible droplets of fluid. Your droplets can land anywhere. On the other hand, it is difficult to see aerosolized/airborne particles. An example of this is when you use hairspray. Although you are done with using hairspray, you can still smell it because some of the hairspray remains floating in the air.
We don’t fully understand the true transmission of COVID-19. Some suggest the transmission lies between droplet and airborne transmission. The science of transmission is still evolving. We must be patient in giving leading epidemiologists and researchers all over the world time to study the exact transmission of COVID-19. What we do know is COVID-19 is a novel coronavirus, and most coronaviruses are not airborne.
I want to add to Dr. Beam’s statement and reinforce what I posted earlier. In Dr. Beam’s Hierarchy of Controls, PPE is at the bottom. The general public thinks that PPE is the best way to protect from COVID-19. This is not true. As I have stated previously, PPEs do not protect you from a specific disease. The FDA has made a claim that PPEs are supposed to serve as non-disease specific barriers to fluids, solids, and airborne particles. The most effective ways to respond to COVID-19 is to eliminate or substitute hazards or advise people to do social distancing to keep them from being exposed to the hazard.
EB: I always have people search for the Centers for Disease Control and COVID. This link includes great information for both the community and healthcare professionals. The CDC is always updating their site and ensuring that their information is current.
TT: The White House and CDC have put together a page to provide specific guidance to certain groups such as travelers, health departments, pregnant women, small business owners, laboratory professionals, and those who are already infected with COVID-19. There is also a resource on what you need to do to plan and prepare while at home.
Every state is a sovereign entity. Based on the needs of each state, each state is permitted to create, enact, and enforce its own laws during this pandemic. Follow your local county public health department and state public health department for current and reliable information about COVID-19. The CDC provides guidance but it is up to each local and state public health department to determine whether they want to follow national guidance on COVID-19. You can find state and territorial health department websites here.
EB: This question is out of my personal scope of knowledge related to virology in general. The word “evolving” is used often to explain how the outbreak is moving. We certainly see the number of confirmed cases increasing. Johns Hopkins has a great resource to watch the evolution of the outbreak.
TT: I cannot answer that question. I have to leave it to WHO Director, Tedros Ghebreyesus; President Trump and his team of experts; and, the CDC to answer the question, “Is the virus getting worse?” I do agree with Dr. Gabriel Leung, the world’s leading epidemiologist and an expert on SARS and infectious disease, that we will see notable disparities in care. If the country has PPEs, ICUs, and ventilators, then we could save more lives. If we wait to respond to the outbreak, more lives will be lost.
To respond to COVID-19, you have to prepare and act right away. We saw that with South Korea. The minute the South Koreans heard about COVID-19 cases in China, they immediately mobilized their resources (PPEs, labs, healthcare workforce, ICUs, and ventilators) to prepare for this global pandemic.
Our lack of preparation for COVID-19 is not a surprise. The Ebola outbreak was a warning to all governments to prepare the healthcare system to handle a global pandemic. In 2015, Bill Gates warned the need to avoid a global failure by preparing now. No one listened to his prediction and recommendations. His famous TEDx video can be found here.
EB: Low (but not zero), if we are careful and work together as a team to keep each other safe. A culture of safety is really important. This is not a time to keep quiet about something a colleague might be doing that is unsafe. A nurse has to be willing to tell a doctor that they are doing something incorrectly. Create a level playing field for all health professionals.
The likelihood of nurses getting sick at work is low as long as infection prevention measures are taken. For instance, after you take care of a COVID-19 patient, do not wear your PPE into the hospital cafeteria or walk out into the parking garage. If you are not well, stay home. You don’t want to get your co-workers sick.
Be mindful about mitigating the risk of infection at work. Protect your co-workers. If you see your co-workers not washing their hands before, between, and after patient care, kindly tell them to wash their hands and get in the habit of good hand hygiene. In a good sense, the COVID-19 is a reminder to all the healthcare workers to always practice good infection prevention and control.
EB: This seems to be the most current information.
TT: There is a great deal of misguidance about this. There is no solid evidence that says NSAIDs worsen COVID-19 symptoms. WHO made the statement “Based on currently available information, WHO does not recommend against the use of ibuprofen.”
If the patient wants to take NSAID such as ibuprofen to bring down her fever, then taking an NSAID is acceptable. Keep in mind that many people have fever phobia. Having a fever is good to allow your body to naturally fight the infection. If you bring down the fever too quickly by taking ibuprofen, you are not giving your body time to naturally fight the infection.
The concern about ibuprofen worsening COVID-19 is an example of how rumors, biases, and misinformation brings fear to the community about COVID-19. After the French Health Minister, Olivier Veran, made that inaccurate statement based on a speculative letter. The French Health Minister advised everyone to use paracetamol, a generic for acetaminophen. Although he provided the recommendation for paracetamol, there was no research to support his claim that paracetamol is better than using ibuprofen. The science community intervened and corrected the misinformation. There is no solid clinical evidence about NSAIDs exacerbating COVID-19 symptoms. Unfortunately, the French Health Minister’s misinformed statement about ibuprofen and its link to COVID-19 fueled a global panic about NSAIDs.
In the midst of panic and constant search for definitive answers about COVID-19, people tend to want quick fixes to a problem. As a clinician, it is acceptable to provide ibuprofen or acetaminophen to symptomatic patients. Providers need to know the risk factors for each patient and determine whether ibuprofen or acetaminophen is appropriate. For example, if a patient has liver complications, it’s best to give the patient ibuprofen provided that the patient does not have any GI problems.
EB: Work with your administrators to identify a low risk area to work in. There are several key response activities that would limit exposure to aerosol generating procedures. Beyond this, a lighter load is safer for both the mom and baby. As delivery becomes imminent, it may be important to isolate the mother from risk to ensure she is not ill when the baby arrives.
TT: There haven’t been any studies done on the impact of COVID-19 on pregnant nurses. Research protocols do not allow research studies to be done on vulnerable populations such as women, children, prisoners, individuals with mental disabilities, and those who are economically and/or educationally disadvantaged.
For pregnant nurses, it is best to keep them away from the floor that houses predominantly COVID-19 patients or any airborne patients. Having COVID-19 is stressful but putting a pregnant nurse on an infectious floor will give her added stress. The pregnant nurse can work in low-risk areas such as telehealth, L&D, NICU, or postpartum.