On Wednesday, March 25, Michael Lu, Dean of the UC Berkeley School of Public Health, hosted a virtual Q&A, “Coronavirus: Facts and Fears,” open to the public. For 90 minutes, experts from the school and other campus health services responded to listeners’ day-to-day fears and practical concerns about navigating life during the pandemic.
Participants include: Dr. Anna Harte (Medical Director of University Health Services), Dr. Nicholas Jewell (Professor of Biostatistics at Berkeley Public Health), Dr. Arthur Reingold (Professor, Division Head of Epidemiology and Biostatistics at Berkeley Public Health), Dr. Lee Riley (Professor, Chair of Infectious Diseases and Vaccinology at Berkeley Public Health), and Dr. John Swartzberg (Clinical Professor, Emeritus at Berkeley Public Health and Chair of UC Berkeley Health & Wellness Publications).
California magazine tuned in for the session. This conversation has been edited for length and clarity.
What can the general public do right now to help?
Anna Harte: Avoid getting infected! Take care of yourself. If you’re sick, call ahead before showing up at the clinic/hospital. Don’t hoard protective health supplies and other things. Donate masks, hand sanitizer, etc. Look up how to donate online or call your public health official.
Is there any truth to the following: People with certain blood types are more susceptible? The virus can’t survive in warm climates, under UV, in windy areas, or in refrigerators (like on contaminated milk cartons)?
Arthur Reingold: There was a study from China that says blood group A is slightly more represented in coronavirus patients. I personally, as blood group A, am not worried. Is there a biological reason for this? I’m not sure. It’s plausible, but I don’t think anyone from blood group A needs to do anything different.
To the climate question: We’re waiting to see. We have cases around the world and in the southern hemisphere where it’s a different season. Admittedly, we haven’t seen large outbreaks from tropical regions. I don’t know. I think we’re all waiting to see.
Lee Riley: I think Art is right, we are beginning to see increasing cases in the Southern Hemisphere. For example, Brazil is really coming up rapidly. They’ve instituted school closings and are closing bars and restaurants, and restricting work. They have over 2,000 cases and 77 deaths.* But the reason we are seeing this is because Brazil has the ability to do the testing, while other countries may not.
To the UV question: Yes UV will kill coronaviruses. The wind? I don’t know how, biologically, that would happen. To the refrigerators question: If it’s not exposed to any detergents or anti-infectives, it would probably survive.
*Note from the editors: This has been updated to reflect the most up-to-date numbers from The New York Times.
How should one handle fresh produce/groceries?
LR: A study recently looked at inanimate objects and surfaces. The virus was able to survive a few hours on cardboard, on plastic surfaces for up to 3 days, on steel surfaces less, and on copper surfaces even less. I would say there is some duration of survival on these surfaces. From these fruit markets and produce stands, they’re probably washed and that would kill the virus. But if people are eating the produce uncooked, they should probably wash it, preferably with something containing detergent. If the water in your house is chlorinated that would probably suffice.
How do I minimize my exposure while hiking outside, visiting a park, or passing someone on a narrow trail? How long are droplets suspended?
LR: If you’re outdoors and it’s a sunny day, the virus will probably be killed immediately by the UV light. Outdoors it’s highly unlikely that the virus will be transmitted. I guess if someone is coughing and passes by really closely on a trail, it’s possible.
In still air, the virus can remain suspended for up to three hours. If you’re in a room and walk in after somebody has been coughing, it’s possible you could get infected.
John Swartzberg: You have to have substantial exposure to someone within a close proximity to really be infected.
Is it ok to bring in my newspaper from outside? Do I need to clean it?
JS: That’s a difficult one. I’m of the belief that the most important way this virus spreads is through droplets when in close proximity to others. I don’t have enough science to support what I’m saying. So we have to be careful with everything conceivable at this point.
Is six feet of space enough if I’m walking side-by-side with friends, hiking at a distance, passing people on the street, etc?
AR: My own view is that 6 feet is plenty.
What hand soap should we use? Does it need to be antibacterial? Is bleach effective for surfaces? When it’s almost impossible to get wipes/Clorox, are there other approved substances?
LR: They all work! It’s the soap itself, not the antibacterial, that’s needed.
JS: Don’t buy antibacterial products. They’re terrible for the environment; it doesn’t do you any good at all. Interestingly, soap kills the virus—it doesn’t just wash it off your hand. Bleach works, except it can be hard on some of these surfaces. I wouldn’t use any product that isn’t EPA-approved as a disinfectant. For example, there are no studies to support the claims of Seventh Generation.
AR: There’s lots of misinformation on the web about this—people trying to sell certain products, people telling you to gargle bleach. I can tell you that’s not going to work. Getting information from reputable sources is a really good idea.
AH: You really have to make sure you lather up and get under your fingernails, around jewelry, and around your thumb. The best products on earth aren’t going to work if you don’t use them right.
Do we still need to get the flu shot?
AH: It’s a really good idea still to get an influenza vaccine because it’s still circulating. And it’s a very good idea to protect yourself from getting a secondary infection. The people who are most vulnerable to coronavirus are also most vulnerable to the flu.
Should I be wearing a mask? Does it really help flatten the curve?
AR: We want everyone who is coughing and sneezing and who has to go out to put on a mask. We’re confident that will prevent them from putting droplets out into the environment.
I think the question that’s very confusing is: If I’m out and about and I feel fine, should I be wearing a mask? Generally in the U.S. we’ve said no, that it’s not necessary, that it creates a false sense of security, that it increases the extent to which they put their hands to their face. We have downplayed the importance of asymptomatic people wearing masks. And I can understand why it’s a confusing situation. In Hong Kong it’s a cultural norm that everyone should be wearing a mask all the time. If you’re not wearing a mask, you’re seen as not part of the team. So I think there is a cultural aspect.
Do makeshift masks with cloth work?
JS: I appreciate people doing what they can. But this is not a good thing to do. There is little evidence that they would be effective and might give a false sense of security. Take that energy and devote it somewhere else.
For colleges/universities that have asked students to go home, is that really a good idea if they might be symptomatic?
AH: Excellent question. UC Berkeley has not asked people to go home, but has given them the chance to do so. It’s a risk-benefit equation. Many students live in densely populated dorms, attend classes, socialize, etc. They can get sick and become carriers. Once they are home, especially if they are coming from areas of sustained community transmissions, we recommend a two-week quarantine. But once they are well, they may be able to help support their families. It’s a very complicated equation.
For those living independently in the retirement community, how safe is it to stay there versus moving in with a family member?
JS: That’s a tough question. We know there have been outbreaks in retirement homes. Older people are at much higher risk of mortality. If it’s possible for an older grandparent or parent to move in with a family, and that family is social distancing meticulously, that’s a good alternative. But that’s often not possible. Those homes need to be meticulous in terms of their control.
My husband and I have been practicing social distancing for two weeks. Can I visit my grandmother?
JS: Yes. If she lives independently, and you can visit her without interacting with anyone else.
Should healthcare workers maintain social distance from family members?
AH: The reality is that we [healthcare workers] also have family members that we need to interact with for our own mental health. There’s a balance in all of this. Be meticulous about your hand hygiene before you leave the health care facility. Get home, wash your hands again, don’t touch the doorknobs on the way in. If I had someone in a vulnerable population, I would be distancing myself from that person.
JS: My son and daughter-in-law are both physicians in the East Bay. They are meticulous. They take their clothes off when they get inside, take a shower and wash everything including their hair, before interacting with their children. One of the side effects of this virus is that we’re not allowed in that house. So social distancing is taking its toll on our family—not to be able to see our family, our son and daughter-in-law and grandchildren, who are ten minutes away from us.
What are the possibilities of existing treatments working for this disease?
JS: Well I don’t have a crystal ball, but I can say that there’s a tremendous amount of energy being placed into therapeutics. I counted yesterday over a dozen studies that have just begun or are beginning soon.
A word of caution about therapeutics—and I’m going back to the early days of the AIDS epidemic—but I think we’re seeing the same thing now with the executive branch and our president touting the benefits of certain drugs without any scientific evidence. We need to study these ideas we have carefully to make sure they’re going to work. [A therapeutic approach] is not going to save us from this pandemic, but it could help.
It’s conceivable that we could have a vaccine twelve months from now. We don’t really know what we’re doing with vaccines. There are very novel things we’re doing with vaccines right now, but the fruits of those things—we’re looking at least a year from now, and that’s being very optimistic.
Why does it take so long to devise a vaccine?
AR: It’s all relative. In the old days it typically took 10-15 years [to develop a vaccine]. Now, in more modern times with modern technology, people produce vaccines much more quickly and the technology is much better. And if we get to the point of mass producing vaccines, that technology is also much better. But, fundamentally, we don’t know which immune response is likely to be effective. And we need extensive testing in humans to make sure that it’s immunogenic, that it’s producing an immune response that we want, and that it’s safe.
I’ve heard that the peak may not be until June or later. Do you agree with these estimates?
Nicholas Jewell: Yes, unchecked and without any steps to mitigate it, the models tend to show that the peak would be around June. Then there’s the ironic fact of trying to flatten the curve in that, while that’s a very good thing to do, it will make the epidemic last longer and will push the peak out. But probably not more than by a month or two.
When will we know that we’re on the other side of the peak and we can let up?
NJ: To get it substantially down, you really have to suppress transmission for 12 or 20 weeks. That’s a really long time for society, and I’m not able to comment on whether we’re able to do that economically. But if a significant amount of the population doesn’t really practice shelter in place, then that can mute the efforts of others. Really the best strategy is to have a really strong intervention happen simultaneously to try to suppress transmission.
The WHO and the Chinese are very worried because they’re starting to see a resurgence because of imported cases. And they’d been down close to zero.
The first indication that we’re starting to have an effect in California and the U.S. will probably come in a few weeks. That doesn’t necessarily mean it’s the peak. We will still see a peak. We need to lower the reproductive number to less than one so that each infected person infects less than one. The problem is then you’re vulnerable to a rebound. Many of the models that show how effective very stringent methods are predict a resurgence of the epidemic. This is really not going to be eradicated by these measures. It’s going to be endemic until we get a vaccine.
What’s the basis for estimates that 30-50% may be infected in California?
NJ: Those estimates are known technically as the “attack rate.” They’re a direct product of how easily the virus is transmitted. You may have heard early on that reproductive numbers of two or more—meaning that every infected person infects two or more people—will lead to substantially more than 50% of the population being infected if no steps are taken. I don’t agree with the timing; it won’t happen in eight weeks. All the measures we’re doing, that each person listening is doing right now, are individual and community attempts to reduce that reproductive number as close to one or lower than one. That’s the only way we can protect a significant percent of the population from being infected.
JS: Flattening the curve is terribly important, if for no other reason than to make sure that if we get sick there is a bed for us, there is a ventilator for us, there are health care workers for us. And society has not done a very good job of assuring that. There is a dearth of masks available. But they’re also running out of gowns, face shields. Our health care providers are running out of things to keep them healthy. And if they’re not healthy, they can’t keep us healthy. As a society we can look for every way to support health care providers and their hospitals. Donate N-95 masks, etc.
How many hospital beds are we going to need in California, and do we have enough?
NJ: We have a fair number of beds currently, though not compared to Europe because of the nature of our healthcare system. Whether we exceed that capacity depends critically on whether we flatten that curve. If we don’t bring it down, we’re going to be overwhelmed. There’s no question about that. Care for COVID-19 patients and access to ventilators will be overwhelmed, and that will be catastrophic. And individuals who suffer from heart attacks and other health challenges will not have access. So the real concern is: If we don’t do something and maintain it, that will result in a higher [burden on the system] and a higher mortality rate.
Who should get tested?
AH: In an ideal world we would test many more people. We would have had access to those tests months ago and we would have a much clearer picture of what’s going on now. A lot of the recommendations we have around testing are based on the fact that we have a limited number of tests available, and we have to preserve them for those who really need it.
We are not testing people who have no symptoms, even if they’ve had contact [with someone who has]. It’s not really clear how good the test is on people who don’t have symptoms. Currently at Berkeley UHS [University Health Services] and local community providers, we are reserving testing for people where it is helpful for deciding how to take care of them or those they are around. Like hospital workers, vulnerable populations, people in residential communities, first responders.
There are also some drive-thru testing sites. The last place you should go is the ER.
NJ: South Korea had incredibly sophisticated contact tracking systems—using closed-circuit TVs, phones, etc. With privacy laws in the U.S., it’s not clear we could do that kind of contact tracing. But we need to figure out how to get around those laws.
It’s unconscionable that in the greatest epidemic of our lifetime, we don’t have the ability to test who’s been infected, who has been infected and is now immune. That’s enormously important for us to be able to control the epidemic. I don’t want to belabor the point. But right now, we are working with one and a half arms tied around our back because we don’t have that information. We’re trying to do the best we can with what we’ve got, but we haven’t got a lot. This situation reflects an enormous failure of our ability to prepare. And that’s a phenomenon that people will be studying for years.
What are the classic symptoms? What other symptoms may appear? Does it affect different people in different ways? What is the onset timeline?
JS: The classic symptoms are fever, body aches, cough—sounds a lot like influenza, doesn’t it? The cough is typically dry, not productive. But like any infectious disease, most of the time diseases don’t present in the classic way.
The question about the onset is very interesting. On average the incubation period is about five days, and that’s when you can get sick. And you may get sick with a slow onset. You can develop upper-respiratory symptoms—sore throat, runny nose, a lot like a common cold—and then that can progress. We saw that the time from when people got sick to when they went to the hospital was about a week.
The things to look for have to do with shortness of breath. If you have a fever and a cough and can stay at home, stay at home. If you’re starting to get shortness of breath, that’s when you need to seek medical help. We need to know how short of breath you are. If you feel short of breath, you should talk to your health care provider, and if you’re not getting enough oxygen you need to get help.
If you get COVID-19, can you get it again?
AR: Probably not. We’re fairly optimistic that you will develop immunity for at least a while. But the reality is that we don’t know.
In the future, when we get regular vaccinations, will we have to get our coronavirus shots too?
LR: It really depends on if there’s a zoonotic [animal] reservoir or if it’s going to adapt to the human population and become endemic or if it’s going to disappear like SARS. We need to know more to be able to predict.
What’s your takeaway message?
AH: Take good care of yourselves, stay physically away from others, if you do get sick, call your healthcare provider—don’t walk into a healthcare facility.
JS: Invest in public health. For decades we’ve been underinvesting, and now we’re seeing the consequences.
LR: This is a wakeup call for all of us, and we’re really seeing what happens when you don’t invest in public health. And this is going to come back again and again. This is really a serious issue. Public health needs to be totally revamped in this country and other countries.
AR: Other than saying emphatically that we need a lasting commitment to public health—when you see a public health worker, thank them for all the incredible work they’re doing.
NJ: Stay at home, do as you’re told, break the chain of transmission. The sooner we do it, the less people will suffer. We’re all in this together.
Posted on March 27, 2020 - 10:35am