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What Is Coronavirus? Symptoms, How It Spreads and Prevention

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Published on March 20, 2020

Key Takeaways

  • Data of symptoms shows 98% of all patients who get this coronavirus have a fever, 55% have shortness of breath, and 66% have lymphopenia, since this virus attacks the lymphoid cells.
  • Diagnostic tests for COVID-19 are in development. None of the available tests today can be done in a doctor's office, and those developed by the CDC will be the most reliable.
  • If you feel symptomatic, call your doctor and work out a way to collect a specimen. If you go to a doctor’s office or an ER unannounced with COVID-19, you'll potentially spread it to others.

What are the symptoms of COVID-19? How does it spread? What can I do to protect myself?

Patient Power founder Andrew Schorr is joined by leading researcher in clinical microbiology and infectious diseases, Dr. Jim Griffith, to answer pertinent questions from people affected by cancer regarding the novel coronavirus. 

Watch as Dr. Griffith, from the University of Massachusetts Dartmouth, provides an expert perspective on how the outbreak started, signs and symptoms, diagnostic testing and protective measures to help prevent disease transmission.

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Transcript | What Is Coronavirus? Symptoms, How It Spreads and Prevention

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:
Hello and welcome to Patient Power. Andrew Schorr here down near San Diego. And joining us from Dartmouth, Massachusetts is a fellow who's been involved for more than 40 years in clinical laboratory science and also understanding microbiology and infectious diseases. And that is Professor Jim Griffith, who was at the University of Massachusetts for so many years. Jim, thanks for joining us.

Dr. Griffith:
Very happy to be here.

Andrew Schorr:
So Jim, the coronavirus or the version, COVID-19, that, I guess, we've never been exposed to before, what do we know about it as what happens when it gets in our body? Does it just somehow make its way to our lungs and it kind of germinates there and for some people it becomes something their body can't defeat? What do we know about it at this point in time?

Dr. Griffith:
Well, let me start by saying that there are about 10,000 bacteria that we know of, maybe 30 or 40,000 fungi, and no one in the microbiology world will attempt to give you a number as to how many viruses there are. There are a staggering number of viruses. As best we can tell, this particular virus came to humans as several others have in the past couple of decades, by a process called spillover, meaning this COVID-19 was a coronavirus happily inhabiting and interacting with fill in the blank—I think pigs, but something like that, could be birds.

So now we have a virus that normally was in this other species and now it's in us. So it's a little bit lost, but viruses are pretty good at that. So what happens is that the virus makes it to your oral tract, colonizes epithelial cells in your throat. You get a sore throat. There's a dry cough—98 percent of all patients have a fever. So that's why when you've seen things on the news, public health people are testing the temperature of people with that forehead machine. So they colonize your throat. They then make it to the lungs. There is an inflammatory process there, which over time can result in fibrosis, shortness of breath—55 percent of all patients who get sick with this coronavirus, 55 percent have shortness of breath. And then eventually the virus makes it into the cardiovascular system, and that's when maybe 66 percent of all patients have lymphopenia, because this virus is attacking the lymphoid cells.

So, we think 81 percent of all patients who have coronavirus, this COVID-19 guy, will have the mild end of this, sore throat, fever that percolates along for a couple of weeks or so, and then poof, you're out of it. That's what happens to 81 percent. And some of those 81 percent can get very serious disease and die. But of the 20 percent or so that's left over, those people may have a more moderate kind of illness. They might require hospitalization. And then some of those will develop severe disease, and that's where we have roughly, I've been trying to keep track of this worldwide, roughly it seems like the final mortality rate in China is going to be in the range of 3 percent or 3.-something percent mortality. Just by comparison, the mortality rate for influenza, which is a pretty bad guy, is about one-tenth of a percent.

Andrew Schorr:
Wow. Yeah. Dr. Fauci has been talking about how this is much more lethal. But yet, for most people, the vast majority of people, it isn't.

Dr. Griffith:
Yeah, so…

Andrew Schorr:
That's what we have to keep telling people. Okay, but our audience, Jim, are <[rticle_link,id=5088]people affected by cancer[/article_link] and some people have co-morbidities—diabetes, cardiovascular disease, some cancer patients are in treatment. Some people maybe are living more with chronic cancer. But whether it was like me, CLL, or myelofibrosis, we've had blood cancers that have affected our immune system. So we wonder is there something maybe that helps us? Like, for instance, for years my doctor has been having me take an antiviral medicine to avoid the shingles, acyclovir (Sitavig or Zovirax). And knock on wood, I've not gotten the shingles. And fortunately, I haven't been getting sick. So does some kind of antiviral I've been taking protect me from this virus or a virus is so different where if I were taking an antibiotic, it's really not protective?

Dr. Griffith:
The short answer to your question is we have no idea. Unfortunately, of the 120,000 cases that have been in the world, 85,000 or 90,000 of those cases have been in China, and we just have not had the level of cooperation or information sharing, that level of information anyway. We haven't had that so we don't know what the comorbidity of treatment is, comorbidity consequences, other than saying that if you have a co-morbidity factor such as your patients, that is even a better reason to stay away from this virus. Specifically in terms of antiviral agents, the closest thing we have is SARS, which happened in 2003, and those patients took ribavirin (Moderiba or Rebetol), seems maybe to have some influence, some beneficial effect. Interferon-alfa or pegylated interferon-alfa, maybe with some positive effect. Those have been tried on COVID-19. We have no idea what the results have been. In your case, the antiviral that you've been taking, we may get some information from that from the Italian cases that there are. We know nothing from the American cases so far. We just haven't had enough patients.

Andrew Schorr:
So, Jim, the idea that we could all start taking what somebody might take for herpes or hepatitis or HIV, the short answer is we don't know.

Dr. Griffith:
We don't know. If I had to guess, I would say they might be some beneficial effect from some agent that we have successfully used with other coronaviruses. That would exclude HIV and herpes. Those are not coronaviruses. But who knows? The beneficial effect may be totally unanticipated, so we'll have to see. But as of right now today, we have no idea.

Andrew Schorr:
Okay. A couple of other questions for you. So, there's work going on, on testing. So we're pretty used to tests being—trusting it. If a woman is wondering whether she's pregnant, she can go to the drug store and get a pregnancy test, or they have a test for the flu, right? Or a test for different infections, but that is the current rage now, is do we have enough tests, and when we have millions of tests out there, can we rely on the results?

Dr. Griffith:
There were, unfortunately, some problems with the first test that the CDC developed and sent out. They immediately made a correction and sent word to all of the state public health labs, "If you're using this CDC test, do this, change this, and you will have reliable results." So that was a glitch right at the beginning. And again, remember all of the tests that there are didn't exist three months ago in the world. There were no tests, because this virus didn't exist. So every country that's been working on this has been inventing the tests from scratch in just a few months. Normally, there would be lots of testing of the tests in various populations under various conditions. So I believe that we will eventually get to a spot where there are lots of tests available. Any of them developed by the CDC will surely be reliable.

And there are tests that have been developed in other countries. Germany, Hong Kong, Japan, Thailand have all developed tests. What we don't know—and for sure, the U.S. has been slow in getting enough of reliable tests out there, that's absolutely for sure. But what we don't know about the other tests in the world is, how do they perform under various circumstances, and what kind of personnel are doing the test? These are complicated tests that—they're molecular diagnostic tests. Of the ones that are available in the world today, there are none that can be done in a physician's office. I know there are a lot of physician offices who have been saying, "I don't want to have to send the tests to the state health lab. I want to do it right." Well, you don't have anybody there who can do it. So that's currently a problem. Maybe in a few years, we'll have a test that is a spot test like determining that you're pregnant or not, but that is not on the horizon right now.

Andrew Schorr:
Okay. One other area I wanted to ask you about, Jim, is I know we need to be washing our hands with soap and water frequently and avoiding close contact, obviously, with people with symptoms. And if we go out, avoiding being with large groups of people and the kind of things like that. Okay. But I've also heard, related to the immune system, that getting enough sleep, eating right, trying to lower our stress can improve our immunity. Because obviously there's no shortage of scam products out there that are people trying to take your money, and it's all over the Internet and wherever, that boost your immune system with this. But those basic things, am I right? How does that work? Getting enough sleep, lower stress, eating right is good for our immune system.

Dr. Griffith:
Well, since the virus is going to, possibly, if you get really sick produce lymphopenia, i.e., it's going to be attacking your lymphoid cells in your cardiovascular system, then surely you want to do everything you can on the other side of the equation to boost your immune system, because the viruses are going to be attacking your immune system. So yes, any of those common sense, well-known, well-tried procedures to boost your immune system, good, healthy, balanced diet, reasonable exercise, as much sleep as you can get, all of those things are exactly what you should be doing to try and balance the consequences of coming in contact with your virus.

Andrew Schorr:
One other thing, heat. So there've been reports out, well, if you drink hot water, and you mentioned about the virus getting in your throat, that that's going to kill the virus. Or even as President Trump said early on, when warm weather comes, maybe this virus will peter out. So where does heat come into infectious disease, in this case, the virus?

Dr. Griffith:
Most viruses are not very tolerant to heat. Viruses tend to be a little more tolerant to cold. There are some viruses that can be frozen solid, and they're perfectly viable. But they're not so good with heat, because they're just bags of protein and nucleic acid. So they're not good out in the world. If one of these coronaviruses lands on a stainless steel rail, it can probably survive there for nine hours or so. If it's sunny and hot, it could survive a lot less. So heat is definitely a thing.

Now, if you go as far as—I had somebody ask me about this yesterday. This person asked, "Suppose I drink a sip of water every 15 minutes. That will wash the virus down into my stomach and the stomach acid will dissolve it." And so I told them, "Yes, that's true. But if you're going to do this as an antiviral, every 15 minutes is leaving 14 minutes where the virus can get in there and get established. And if you do it more often, it's kind of impractical." Whether the water is hot or not, I'm not sure there would be a different—viruses are not good with heat. So technically it might be, but I have seen no studies. There is no evidence that any of those kinds of ideas are going to be beneficial.

Andrew Schorr:
Okay. But if I lived in Arizona, where at least before long it can be 115 degrees, is that going to be less common there than it's going to be in Seattle?

Dr. Griffith:
Well, it'll be less common in the sense that if you're touching the doorknob or the handrail and the virus has been there for a while, it might be croaked out by then—yes, in that sense it will be. Whether the summer coming on is going to have that effect, I don't know. You have to remember that—which is why the public health officials have been saying no big gatherings. A reasonably healthy sneeze effectively distributes droplets, respiratory droplets, which is how this virus is spread, nine to 20 feet. So if you think of yourself being in a public place, somebody has a good sneeze around you, that tells you how far the viruses have been spread. And once they get there, they're going to last longer on a hard surface, less long on a soft surface like fabric. So I think that's the dynamic for that.

Andrew Schorr:
One last thing, Jim. I know that some hospitals and emergency room visits had been clogged with people who have mild symptoms that could be the cold, or it could be flu and were terrified, is this a potentially more lethal condition? So what can we do as patients to try to triage ourselves, if you will?

Dr. Griffith:
Well, actually in an infectious disease environment, let's say an emergency room, people show up there, all of the things that you just mentioned would be categorized as ILIs, influenza-like illness. And early on, there is almost no way to tell just by looking at a patient that they have influenza, which this is the season for that. We've had 18,000 deaths from influenza in the United States alone this year so far. So there's no way to tell the difference between influenza and COVID-19—absolutely no way. So the best thing to do is if you think you are becoming symptomatic, call your physician and say, "Look, I have this, that and the other thing symptom." And they will then work out some way to get a specimen. The usual specimens are a nasal swab and a throat swab that can be obtained by visiting nurses or a variety of circumstances.

There are some states like Washington that have set up drive-through specimen collection. So they collect the specimen there. You don't breathe or sneeze on anyone else. And those people then are going to have the test, and we get the answer that way. If you go straight into your physician's office unannounced or an emergency room unannounced, if you do have COVID-19 or influenza, you're potentially spreading it to people who are in there because they hit their thumb with a hammer. So my advice would be, if you think you're becoming symptomatic with an ILI, any influenza-like analyst, call your physician's office, not the emergency room.

Andrew Schorr:
Okay. One last thing. My 22-year-old son, who tends to be a little anxious, is worried to be around me, because he feels if he was exposed or a carrier for the coronavirus within the last couple of days and has not yet developed any symptoms during that time, he could transmit it to me. So in this interaction in families where you may have a younger person who is either not symptomatic or not symptomatic yet, how do we carry on?

Dr. Griffith:
The best way to do it is hand-washing. Cover your cough. Cough into your elbow. He would have to have some mechanism to get his acquired virus to you, and it has to reach your eyes, your nose, your mouth. It can't go through the skin. Got to reach one of those areas. That's how it gets in. So if you prevent that from happening, everybody washes their hands, you're careful with washing dishes, cups, plates, and he's not going to be sneezing in your face, or if he does sneeze for some reason, the cat was dusty, then watch out for that nine to 20 feet and just be aware of that. I think it is absolutely possible to cohabitate someone who's being protected inside of a dwelling with someone who's going out into the world. These common sense rules will, I think, with a reasonable degree of certainty, prevent the transmission that he might be worried about.

Andrew Schorr:
Wow. Okay. Jim, we've covered so much ground. I want to thank you, Dr. Jim Griffith, who's been a professor in this area for decades, in staying on top of it. Jim, we'll come back to you on this. Thank you so much. And I should mention to our audience, Jim is the life partner of another regular guest on Patient Power, Dr. Susan Leclair, who we talk to about lab test results all the time. You two are the dynamic duo. Jim, thank you so much for joining us today.

Dr. Griffith:
You are very welcome. Good luck.

Andrew Schorr:
Okay. Andrew Schorr, being much better informed now, having talked to Jim. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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