Answering COVID-19 Questions with Infectious Diseases Experts

Oct 05, 2020 9:00 AM Author: Kylene Metzger COVID-19 cases are rising in Utah and…

Answering COVID-19 Questions with Infectious Diseases Experts

Oct 05, 2020 9:00 AM

Kylene Metzger

Answering COVID-19 Questions with Infectious Diseases Experts

COVID-19 cases are rising in Utah and there’s many questions surrounding coronavirus vaccinations. Healthcare professionals at University of Utah Health are continuously learning about the new disease. Hannah Imlay, MD, infectious diseases physician at U of U Health provides information about the novel virus.

You can find more information about COVID-19 here.

What is an Infectious Diseases Physician?

An Infectious Diseases Physician is someone that sees patients in the hospital and clinics with infectious disease problems. Those can range from unusual or difficult-to-treat infections, bone infections, heart valve infections, HIV, and COVID-19.

Are you seeing COVID-19 patients yourself?

I occasionally see COVID-19 patients, but the bulk of the work is done by our hospitalists and pulmonologists in intensive care units.

When an infectious diseases physician/doctor is called, is there a special reason why?

Yes. Occasionally COVID-19 patients can also have concomitant infections. That’s typically the time I’m involved. I’ve also been helping answer COVID-19 questions among patient care providers in the hospital and involved with distributing potentially effective COVID-19 therapies or information about participating in clinical trials.

How can the public make decisions based on risk mitigation?

The things that are forefront in my mind when I’m considering whether this activity is safe in the time of COVID-19:

  • Are there many people involved?
  • Am I at a close distance to other people and for a long period of time?
  • What is the environment around me like?
  • Is this an open area or a small area with poor ventilation?

All individual risk decisions need to be made while taking into account ordinances in your state, city, community, etc.

What should a person consider as holidays approach?

The safest scenario is that you are with your family that you live with and have routine contact with. You’re safest when no one else comes over. Some other mitigation risks to take into account are:

  • Do you have a lot of people coming out of town?
  • How are guests traveling? Are they flying?
  • Are guests mingling with a lot of additional people outside your bubble?
  • Are you having dinner outside?
  • Are you able to physical distance?

Are we close to a COVID-19 vaccine?

We are closer than where we were three months ago. The United States has invested a lot of money into several potential vaccine candidates. A lot of the vaccine part has been politicized, but, politicized or not, everyone wants a vaccine as fast as possible. The vaccine candidates are in phase three trials. Phase three trials means they are recruiting large numbers of people on the order of tens of thousands of hopefully diverse representatives of the population to test these vaccines. The vaccine regimens include one or two doses several weeks apart, and then we wait many weeks to see whether there is a response. That doesn’t mean an answer is around the corner. After dosing in the beginning of a clinical trial, there will be a period of time where you have to wait and see who is getting sick or who is getting severe illness. Unfortunately, all of that takes a lot of time. Wrapped up into all of that are things like safety signals such as whether these vaccines are risky.

I believe in order to fully stand behind a vaccine and give it to a large number of the population, there are certain processes that vaccines need to go through. The United States is particularly trying to speed up production. On day zero, when we all feel the vaccine is safe and effective, they want to have enough doses to give them to the population—as opposed to starting to produce vaccines on day zero. With all of that, it will probably be into 2021 for a safe and effective vaccine that the FDA can stand behind and start giving to the population.

What will a vaccine do? Will it give immunity to COVID-19? Will it prevent severe illness?

A vaccine could do a number of things. Do we want to prevent hospitalizations, do we want to prevent infections at all, or do we want to prevent other complications related to the vaccine? I think all of those vary slightly from vaccine to vaccine. Having implications for who they give them to and whether that means if a vaccine is not infectible, such as the measles vaccine. But if it means it prevents severe illness, a person may still have mild disease and still could be a potential spreader.

What do we know about the current vaccines undergoing trials?

From my knowledge, most of them are looking at moderate to severe illness that requires hospital admission or other medical care. That’s the aim they want to prevent. That doesn’t mean it won’t prevent other secondary outcomes.

Does that mean the vaccine doesn’t equal a cure or immunity?

Correct. A vaccine, especially the first wave of developed vaccines, would not necessarily make people totally immune to SARS-CoV-2. This is a tool we have, just like masks are a tool, and just like COVID-19 therapies are a tool we can all use to help decrease disease. We also hope over time that the goal of vaccination can change and get better.

As a researcher, what do you think is the most up-to-date information about COVID-19 being airborne?

This has been a huge debate since the beginning of COVID-19—whether the virus is spread by droplet, aerosol, or airborne. When I say droplet, I mean a five-micrometer-sized droplet that comes out of your mouth or nose. And because droplets are big, they drop six feet in front of the person. Aerosol is smaller. These droplets get smaller over time and flow further in a room or space. The airborne virus measles is extremely contagious and can do that. Luckily, we have immunity to measles for the most part.

We are currently looking at a spectrum; we think that COVID-19 mostly spreads through droplets. However, several publications show there are specific scenarios where it seems the virus has spread further than six feet. Typically, that happens in enclosed spaces that are not well ventilated or are among people that are close together and shouting, screaming, and singing.

What is herd immunity?

Herd immunity is the thing we all wish we had. A good example of herd immunity is with measles. There’s enough vaccination now that even if there are isolated cases of measles, it is not going to spread into an outbreak. Herd immunity is this idea that if enough people were protected against getting a virus that it can’t continue to spread from person to person. It can be achieved in two ways:

  1. Natural infection can create immunity in an individual person, or
  2. Vaccination can stimulate immunity.

We do not think at the current state of infection in the US—even in cities where the virus hit very hard—that we are anywhere close to the number of people who need to be immune to stop the spread of infection. Less than 5% of the population has had COVID-19, and even if immunity is robust and long lasting, that isn’t enough people to prevent the spread of infection.

What’s the percentage you need to obtain herd immunity?

We probably need 80% or more for COVID-19. We are a long way away and the cost we pay for herd immunity includes huge numbers of deaths and hospitalizations.

What are some long-term effects of COVID-19?

Unfortunately, we don’t know. I think it’s something we are going to have to deal with as a country on a very large scale very soon. Symptoms get better for most people, but a substantial population goes on to experience continued shortness of breath, coughing, low-grade fevers, fatigue, and other symptoms as well over the next few weeks to months. That is something we see with other viruses, for example with mononucleosis. COVID-19 seems to affect everyone differently. The majority of people recover and don’t seem to have ill effects symptomatically over time. What we don’t know is whether it has future health implications 50 years down the road.

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