Coronavirus Q&A with Dr. Kavita Patel: Social distancing, handling packages and more
Dr. Kavita Patel, a Yahoo medical contributor and a non-resident fellow at the Brookings Institution, participated in a Friday question-and-answer session about the coronavirus, how it affects individuals as well as their families’ health and well-being.
Patel, speaking at a virtual event for Verizon Media employees, gave advice about social distancing, when to seek medical care, whether it’s safe to go outside for a run or a walk and handling packages, among other topics.
A transcript of her conversation, edited for brevity and clarity, is below.
Guru Gowrappan, CEO of Verizon Media: What’s the latest news on the virus?
Dr. Kavita Patel: Here is the most important headline: social distancing is working. We are starting to see a decrease, not just in New York City. We're starting to see the decrease in what we call “the doubling rate of cases.” The bottom line though is even when we think things are better and we might want to relax some of the social distancing, we know it's working and we need to continue it aggressively.
Unfortunately, we're having more and more deaths that we're discovering — even before we had testing for COVID-19, that people probably had this disease early on. January, early February and we didn't actually have the diagnosis.
It's a positive message overall. Even though it's frustrating for all of us to feel like we can't live our normal lives, we are keeping everyone in the world healthier and there are some interesting treatments.
We're getting early data back about some very hopeful signs about treatments. If you are sick with the coronavirus, we actually do have — not for everybody, it's certainly still preliminary— we are getting data about certain antiviral drugs that can actually make sure you get out of the hospital and you return to a functional healthy life.
Unfortunately, though, we're still very early. We're also seeing, out of South Korea, Taiwan, China, we're seeing cases of what we might call reinfection. We're looking at those very closely and many of us in the science and public health community believe that maybe they weren't reinfected. It’s possible they had low levels of the virus that were not detected and then they had a little bit of what we would call a flare. Those are probably the most important things for people to realize overall.
What are the signs and symptoms to seek medical care?
We still think fever, anything over 100.4 in an adult or higher. Fever and then what I'll call kind of the “respiratory tract” in this area, so kind of upper respiratory. Not necessarily the head cold, but a little bit more in the throat and then sometimes, feeling like it's in the lungs. A cough can certainly be a symptom.
You have probably seen unusual symptoms of loss of smell. Not everybody gets that, but it can be a sign. Up to 10% of patients have reported feeling an upset stomach. Again, those are not reasons to panic, but if you have any symptoms, period, we now should be able to get you tested a lot quicker.
Anything that's concerning, reach out to a health professional. We now know at least one in four or one in five people who have the coronavirus have no symptoms whatsoever. It's hard to know what to do if you have no symptoms but that's all the more reason why we need to continue to stay at home unless you have an essential job and can’t avoid going to work.
But non-medical masks — you can [take] a pillowcase, cut it and tie it around your nose and mouth — should help protect others from getting sick from you, even if you don't know you're sick.
Among your friends and family, have you had anyone close to you infected by COVID-19?
I have. Unfortunately, both being in health care and just having families that are in urban areas like New York, I have. I've had both family members and I actually have had friends die from this. A 48-year-old emergency room physician who was otherwise healthy and we think had just been exposed to the coronavirus so repeatedly because he works in an emergency room. Unfortunately, he went on a ventilator, went into a coma and ultimately passed away.
When people ask me, “Why are we doing this? The coronavirus is not so bad in my community.” We don't live in these little perfectly sealed bubbles. We have to realize that we're global and should all practice the same distancing measures.
On the positive note, I do have friends who have gotten sick and been able to stay at home and recover, including friends who are in health care. It's rough. You get fevers. People are having some kind of weaknesses. So I've had all of it. I myself have been tested multiple times. I'm negative but I'll be honest, a lot of us in health care operate under the assumption that at some point, we're going to get it. It is real and it is a little scary.
What are the top three things that you would advise people to do in order to keep healthy in their day-to-day lives?
We talked about distancing but at some point, all of us are going to want to come out of our apartments or homes. Many of us have to work even throughout this time period. So if you are outside, wear a non-medical mask. Even I'm going to wear one of those non-medical masks myself. Not just at the grocery store, but I'm going to probably start to do that if I return to going to other places like the bank or the dentist's office. Anywhere with a waiting room type of thing.
I do not think you can be too crazy about carrying hand sanitizer. If you can wash your hands everywhere you're going, great — but carry a little bottle. We don't know if Purell or any of those brands work on the coronavirus but we do know they help beyond doing nothing. So take that with you.
If you are going to the grocery store or riding an elevator, I would get comfortable wiping the handles with just a set of pocket sanitizer wipes or spraying the sanitizer and using the cloth to do that.
People ask about wearing gloves. I'll be honest, gloves get really easily contaminated. The only reason to wear a glove would be to not touch your face. But if you're wearing a mask, you're not going to touch your face. At work, we're going to have to deal with having a work environment where you can maintain some distance.
My advice is to start thinking now about a month from now. How can you make sure in your cubicles or open space environments that you still allow for flexibility to either work from home or have a little bit of a distance between you and your colleagues?
The same would go for schools. Schools are going to be doing the same things for our children.
I suspect the school year for most of us, if you haven't had it already canceled, will get canceled. I think we're going to have to start thinking about how to live life in a new normal.
If you have a partner or a family member who cannot shelter at home due to being part of the essential workforce, what additional precautions do you recommend to protect that person and their family?
I'll tell you what I do and what my husband, who is also a physician, does. I've gotten comfortable changing clothes. I have a set of clothes in the garage. As a doctor, I can wear scrubs and get away with it. Get a set of clothes in the garage that has been washed and change out whatever you have worn outside. Shoes including socks. Basically, completely head-to-toe changing clothes. Put the clothes in the washer and treat them like dirty laundry.
I know some people will actually shower. We don't think that the virus is just sitting and living in our hair. So hopefully, just changing your clothes and washing your hands really carefully is good enough.
I have had those same friends I told you about, who were sick with the coronavirus, they ended up either staying in a motel or moving into a basement. I don't think you need to do that. If you're an essential worker, you just need to have those precautions so you can change out of everything. Wash your hands for at least 20 seconds in warm water with soap. That's enough.
Picking up food, groceries, all of those things, again, if you follow these precautions, there really shouldn't be any reason — and wear a non-medical mask when shopping or picking up food from the curbside even — there's really no reason to go beyond that.
Because we're going to be doing this for so many weeks to months, you need to interact with your family. So, it's really about protecting them from you. Doing all of that in a garage — or if you don't have a garage, somewhere where you know your family will not spend time — is the way to do it.
With shelter in place and social distancing or physical distancing, how safe is it to go outside for a run or a walk? What is the recommended amount of time to be able to be outside?
There have been several studies, all done in labs in an incredibly controlled setting. There has been proof of the virus existing in the air for even up to three hours. But let me tell you that the majority of cases are not from someone coughing and you running by an hour later. Those are, what I'll call “experimental,” kinds of conditions that most mimic actually hospital conditions.
So, is it possible that there are airborne really small droplets that can kind of linger in the air? Potentially, yes. The majority of cases, all of the cases we're seeing in hospitals and clinics, are coming from respiratory contact directly. Either someone coughs on your face or coughs into their hand, shakes your hand. That's the kind of contact.
What I will say is that: anybody who can go outside, including myself, for 20 to 40 minutes, run, walk. That will incredibly enhance your endorphins and mental health. You should not worry about when out on a run that you see someone maybe 20 feet ahead and you are worried they were coughing. That's not the way you are going to get sick.
That’s another reason why you might want to start getting comfortable with a non-medical mask or something that you wear. It doesn't protect you from them, it protects them from you. But if we're all wearing it, then we're all protected. I would encourage people to go outside. Keep that six-foot distance.
Is there a potential that there could be something airborne? It is very unlikely. But so far, in all of the cases we're seeing, we have high confidence in how or when those people were able to catch the virus. Most of them knew somebody who eventually was diagnosed so that's the most likely way.
Are face masks critical for children as well?
There's been a lot of flexibility. I have a three-year-old and getting her to wear a mask is also near impossible. The guidance is children two and up to wear a non-medical mask. I think the critical piece of anybody of any age that's younger is going to be recognizing if they have symptoms and how to protect anybody else from being exposed to anyone with symptoms.
There are probably children who have had the coronavirus, didn't show any symptoms, might have been part of even passing it along. That we do not know about.
My advice would be if you've got a two-year-old and you know they are never going to put a mask on, like mine, and you need to go and do some essential shopping, I think you really need to start thinking about either alternative hours, coming when like you can go either later with a child or making sure you are incredibly aware of distance yourself.
If you can keep a decent distance wherever you are, that's fine. If not, I would advise you to try to make a game out of it. You're seeing a lot more creativity with children and there are going to be a lot more other children wearing them. I think they will start to get more comfortable but I would start to consider how you can mentally get your child to see that you're wearing one and that it's OK to wear one.
Should we be disinfecting the Amazon boxes, delivery, drive-through food containers that come through and the grocery store items in the bags?
I think the most practical thing is to keep packages, cardboard from Amazon, about 24 hours. There have been some studies that show it can last longer — but you would have to have so much of the virus present on that box in order to have it exist past 24 hours. It's highly unlikely. If you can, put that box into some part of your house off-limits for 24 hours, then open the box and wash your hands. I think if it's essential — you really need to open the package — you do that just do it in a more controlled way, where you wash your hands immediately afterward. Dispose of anything associated with that package directly into your garbage so nobody else touches it.
People have asked, “Should I be wiping down boxes I buy myself at the grocery store?” Again, we do not think that the majority of people are not getting this from touching the cereal box at their grocery store unless someone had just come within seconds before and actually coughed on it.
The U.S. Department of Agriculture has actually put out a statement saying “there's been no known transmission of the coronavirus from fruit to humans.”
That should make people feel better. However, if you want a cleaning technique, take the fruit or vegetables and put it under running warm water. We have reason to believe that at higher temperatures, the virus does not live. Cooking something or running it under warm water for 20 seconds should be good enough. You shouldn't need to use soap on your fruit or vegetables. If it's something like lettuce that might have dirt in it, letting it soak in water and get the dirt out is good enough.
What we have been trying to do with takeout boxes is immediately take the takeout food and open them up into our own home glass containers or our own plastic containers and take the takeout, whatever it came in, and dispose of that and wash our hands.
Lay out a space on your counter, take out the takeout boxes, empty them out into something else. If you want to be extra cautious, take the containers out, wipe down the counter, wash your hands. Let me stress, if you forgot to do this, don't freak out! This is really, really an unlikely source but I think it will help all of us feel like we're making sure we're protecting our families as best as we can.
What are the differences between those folks and the ones who get really sick from it? If you have a positive antibody test, does it mean you had the virus and can't get it again unless it mutates?
Think of immunity as having a driver's license. Having a driver's license means, “Yes, I can get in my car and go drive.” But it doesn't protect me from an accident all the time. Immunity itself, especially for the coronavirus, we think immunity can be protective but we're not 100% sure. And we know with, just like having a driver's license, that's kind of the basics but there are some people with a driver's license who are incredibly good drivers and then there are some who are just bad drivers.
So immunity can protect you, but it can vary to degrees of how much it protects you. Immunity is also something that's different at different points in time. You can have immunity. Everybody is talking about the blood test. New York launched a more community-wide blood test and you saw people lining up to get that. The blood test tells you if you develop antibodies and there are several different kinds of antibodies. If you develop antibodies against the coronavirus, we think that that protects you, at least for several months. We're not sure if it's permanent.
I'll give you an example of why. We know with the regular flu season influenza viruses, when you get immunity from the vaccine, it only protects you in that season because the virus mutates and we get a whole different type of flu strain. This is why you need a different vaccine the following year. We don't know if the coronavirus is going to act that way or not. We do know that immunity is going to be something, especially for returning to work, a lot of people have emphasized.
The tests we have right now are still in the beginning phase. They are not that great because it's a new virus. Before you rush out and think, “I'm going to get my immunity test. It will be the golden ticket to go back to work,” I would pause.
What do we know now about people getting sick? Why are they getting sick? My friend who was at home who toughed it out didn't get sick and we think there's something about the virus itself that triggers a part of your natural immune system to kind of go crazy and release a set of inflammatory factors.
It's, unfortunately, going to take us another year or so to get a vaccine. But that vaccine is going to be what will probably be the most protective agent for all of us, including healthy people who have gotten the virus.
We talk about the high-risk population or specific populations. One of the areas that has been talked about is asthma. What are the repercussions for someone who has been infected? What's the best course of action?
Asthma was considered to be an incredibly high-risk factor because it's a lung condition and the coronavirus seems like it's predominantly a lung disease that affects the lungs most directly. We now know asthma alone, especially well-controlled asthma with an inhaler, is not a dramatic risk factor for the coronavirus. If you have poorly controlled asthma, yes, that can be a risk factor.
If you have asthma, we are seeing a shortage of those machines to give out the inhaler. So if you are an asthmatic, make sure you have at least three months of medication because you don’t want to be short at the last minute. I would argue for my own asthmatic patients, I would want to get them tested whenever I could. Sooner rather than later, just so that I could understand if they had been exposed to it. Then that individual will be able to help make decisions.
I have patients who are asthmatic who are very nervous about returning to work and getting sick. I actually think, as a doctor, we're going to have to advocate for those patients. And by the way not just my asthmatics, patients with diabetes, heart disease, I'll put this all in the same bucket.
I actually think that you should make an attempt to get tested and you're going to need to do several of these tests. Not just for immunity but to see if you have the virus. That's one of the ways we'll know if we can safely return to work or go to school, go to classes, things like that.
[How can] people boost their broader mental health during these times?
Number one is activity. Whether it's the seven-minute workout you can Google and do in the corner of your room, or trying to physically get some outside air, which I highly encourage. Even if it's on your back balcony with a little bit of sun. Absolutely exposure, exercise and emotional, kind of the three Es. Exposure to sunlight or the air, emotional and exercise.
And I'll say on emotional, I mentioned this before, there is — I would strongly encourage if you're by yourself and you're at home alone to try to have a relationship with somebody else who has also been at home or isolated. Go ahead and form like a virtual unit so that you can support each other. I highly encourage you to use a number of platforms to actually see each other.
We've been watching some studies that just being able, even on the internet or on a laptop or the phone, to physically see people has made a really big difference. And so the three E's, emotion, exercise, exposure.
Do not be afraid to ask for help because people will experience new or recurring episodes of mental health disorders. You need to ask for help.
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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