At the Forefront Live: Coronavirus Questions Answered Expert Q&A

Coronavirus, or COVID-19, is having a tremendous impact on our world. Entire countries have been brought to a complete stop as people try to isolate as much as possible to slow the spread of the virus. We know schools, bars, and restaurants have been closed in Illinois and other states in an effort to try to slow the spread. And we know that people are confused and a lot of people are scared.

Information is critical at this time. Correct information is vital. That's why we're hosting this special. At The Forefront Live with two of our infectious disease experts, Dr. Emily Landon and Dr. Allison Bartlett. They'll answer your questions live on the air right now.

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And we want to remind our viewers that this program is not designed to take the place of a visit with your actual physician. First of all, I know you two are very, very busy, so we really appreciate you taking your time and spreading the correct information, which is exactly what we hope to do here today.

So let's start off. If you can tell us a little bit about yourself, just your roles here at UChicago Medicine. Dr. Bartlett, we'll start with you.

Sure. I'm Dr. Allison Bartlett. I'm a pediatric infectious diseases specialist, and I work with Dr. Landon here in our infection prevention and control program. I'm the associate hospital epidemiologist. So I take care of pediatric patients when I see them. But when we're working with a pandemic, everyone's working to help keep everybody safe.

Dr. Landon?

I'm Emily Landon. I'm an adult infectious diseases specialist here at the University of Chicago, and the executive medical director of the infection prevention program and the hospital epidemiologist. That's a mouthful. But basically, I help make sure that, at the hospital, we prevent infections in all of our patients. And when it is a pandemic, as Dr. Bartlett points out, is all hands on deck.

So, as we've already received a lot of questions over the internet and through other channels, we'll just get right to these as quickly as possible. I want to remind our viewers, we'll try to take your questions live on the air too as well, and try to get to as many as possible for the next half hour. First one is, just how dangerous is this?

Well, I think, for most people, you're not going to get-- many people who get sick will not get very sick at all. About 80% of people will not need much more than a number of days that home resting with a lot of coughing and a lot of, I don't know, chicken soup or tea.

But some people will get sicker. About 15% of people go on to have needs that require being in the hospital. Extra oxygen requirements, maybe fluids, maybe other antibiotics. And some of those patients go on to need critical care, including being on a ventilator.

In the end, if everyone is able to access the care they need when they need it, we expect to only have about 1% to 2% of people who will succumb to this illness. So 99%, 98% of us are going to be just fine. And some of us won't ever even get sick.

So the real concern here is not so much about each of our own personal safety, but the most vulnerable among us need to be protected so that they don't use up all of our resources at one time.

And Dr. Bartlett, from a pediatric or children standpoint, how dangerous is this? I think people are worried about their kids, obviously.

Absolutely appropriate to be concerned about your kids. We're both mothers, and so we also are concerned about our kids. The good news is that children seem to be incredibly spared from becoming very sick with COVID-19. I can't explain it. No one has come up with a good solution. Because usually, when we think about infections like the flu, our very youngest and very oldest tend to be the most vulnerable.

So it's really reassuring to know that your children are going to be safe. Even if they get sick, they'll have a little cold. But again, as Dr. Landon mentioned, the concern is Grandma and Grandpa or other people that they come in contact with who could become much more sick if they become infected.

So we're seeing restaurants shut down in Illinois, bars, you know, trying to keep people apart from other people, at least in big crowds. Talk to us about social distancing. First of all, what is it and why is it so important?

So in this pandemic, we don't have a vaccine and we don't have antiviral medications. Those are two important things that we use to help slow the spread of infections like influenza every single year. Without them, the only way that we can keep the number of infected people out and about low is by asking everyone to stay home.

That way, people won't be having as many contacts with other people, and the virus, hopefully, when each person gets sick, they won't be able to infect as many other people. So a good example of this is, if you have one person who's sick and they infect two other people, that's a lot better than if they infect three other people.

And it would be even better if they only infected one other person. If we let everyone go around and do whatever they want and hang out with everybody, then they'll make three different people sick, every single person, and we'll have what you see right now in the graphic as the big red peak.

Unfortunately, that peak means that many patients will need to be cared for that we may not be able to manage in our hospitals. Our hospitals are not set up to have 20% or 15% of our population sick at one time and needing their care. And so we need to do what everyone is calling flattening the curve.

And the way we can do that, without vaccines and without medications, is to keep our distance from one another. So this is not about being personally afraid of your own bad outcome. This is about protecting the people who need to use our health care system when they do get sick by spreading it out as much as possible.

And this may be the most important thing, I think, that we can get out all day, this social distancing. And people don't understand this. But to your point, hospitals don't have a bunch of empty beds. We just don't operate that way. And so if we we're overwhelmed all at once, that makes your job next to impossible, and it also means that people who really need the help don't get it. And we want to avoid that.

Yes. I cannot stress this enough. We do not have the capacity to manage that big red peak. There will be people who die because they cannot get into the hospital to get a bed unless we all, even those of us who won't have a bad outcome and are going to be just fine, we all need to stay home so we slow the spread, so that my mom and your mom can get a hospital bed when they need one.

So we're already getting questions on the internet. What precautions should I take other than social distancing?

So, as part of your social distancing, you do need to make sure that you are keeping those with whom you're not social distanced, so your family and friends, safe. So again, the same things that we say every flu season, washing your hands, covering your mouth when you cough, I think there's more that we can be doing to be proactive about cleaning.

So wiping doorknobs and other surfaces that we touch frequently. If you are going into work and social distancing at work, same thing. Keep common surfaces and your desk cleaned off.

We actually did wipe down all of these surfaces just this morning. We really did. And with the hand washing, some good tips, we just showed a little video. That wasn't long enough, quite frankly. You need to wash your hands longer than what we just showed, so.

Yeah. The CDC is recommending 15 to 20 seconds. That's what they've always been recommending. You just haven't been doing it. So that's twice through "Happy Birthday", as my son will tell you, or twice through "Row, Row, Row Your Boat". And you don't have to sing it out loud if you're not socially distanced enough for people not to hear you. You can do it in your head.

Steve has a question online. If a woman is pregnant and gets coronavirus, will this have an effect on her fetus?

So there's a lot of unanswered questions about coronavirus, and there's very limited information at the moment. So what we do know is that the women that we know of who became infected when they're pregnant went on to deliver healthy babies, and there was no apparent increased risk of women who are pregnant.

Which again, is different than what we usually see in the flu. We don't have any information about women who may have been infected very early in pregnancy, because this has been such a rapidly moving process that they are still pregnant. So there will probably be more information to come. But again, all evidence suggests that there's no increased risk to women who are pregnant.

Here's a question online from Emily, and this goes to one that I was just going to ask anyway. For those of us that struggle with allergies, sinus problems in general, how do we best identify the differences between our seasonal symptoms and those of the virus? What are the symptoms and typical course of-- how does this run through a person?

I get you. I have seasonal allergies too. First of all, stuffy nose and a runny nose are actually not very common with the new coronavirus. And so if you're mostly having those kinds of symptoms, just a stuffy nose and just a runny nose, then you probably have something else.

But that may not be sensitive enough if you are having contact with people who are at higher risk for bad outcomes, or if you yourself are immunocompromised. I would strongly recommend talking to your own physician about how you can best control your allergy symptoms through this difficult spring season.

And it may be worthwhile to take a daily antihistamine so that your allergy symptoms are kept at bay. And then you can sort of tell the difference between a little bit of allergy and a bad infection with the COVID-19.

This kind of goes along. We've got a question from a patient, actually. Whenever I feel a cold coming on, I take elderberry zinc, vitamin C lozenges, they seem to help. Would that make a difference in this? I'm guessing I know the answer on this one, but I'll let you guys answer that.

We have no idea. I don't think they're going to do any harm. If you take them regularly and they don't interact with your other medications, I don't see any problem with using them for this. There certainly hasn't been any evidence that they're going to do you any harm.

However, you do need to be careful with using herbal supplements and other things. Because if you take other medications, they can interact with them. And some people do have bad reactions to them. So if you're not used to doing it for a cold, it may not be a good idea.

And you don't need to take triple or quadruple what you usually take, because this seems worse to you. Just what you usually do, if it's worked for you in the past, there's no reason not to try it. Just be careful.

Now, the university here and, of course, a lot of other universities are doing this exact same thing. They're going online with their classes. They're trying to get the kids to go home. Again, just social distancing is that what we're seeing here, or is there anything else going on?

So yes, social distancing. As we discussed, the children are very unlikely to be sick from COVID-19. But they are, as far as we can tell, a very important vector in the spread of all of these infections. And so it's an important step to take, and closing schools and having children at home.

But we also need respect the reason why we did this, which is social distancing purposes. So having giant play dates in the basement is not a good stewarding of the resources. Everyone put a lot of effort into making infrastructure so that kids stay apart from each other. We need to continue to maintain that at home.

Really good question from Carmine. I'm immunocompromised, but I still have to go to work. Is there anything I can do to protect myself? And this is going to be a real hardship for a lot of people from a financial standpoint, so they're going to make themselves go to work.

Yes. So a lot of people still have to work, us included. We're here today because we're health care workers. And there are a lot of things you can do to help social distance while at work. For example, you can join meetings from-- we use-- using some sort of teleconferencing from your office instead of going to the meeting room, and your company should probably have already set that up for you.

You can also do things by phone when you would have done them in-person, even if you need to be site. And if you work in a place that has shared workspaces, you can spread those workspaces out. People who can work from home can work from home, and then you can move into their spaces so that there's more distance between everybody who does need to be in the office.

Another option for places that are-- what we're recommending for our labs and other things like that is to go to shift work, so that people are working a shorter shift in the morning, and then the other 1/2 of the people work a shorter shift in the afternoon, so there are fewer places in every shared space.

Any little bit that you can do to reduce the number of human beings that you are within six feet of at any given time will reduce the risk of this disease spreading too quickly through our community. And so you just have to be creative and think of some good ideas.

The other thing that really matters is what Dr. Bartlett mentioned before, which is to clean off your surfaces regularly. We know from some studies out of Singapore that even when you have sick people around, if you clean surfaces regularly, it really does help to decrease spread.

So if you haven't already done so, talk to your office mates and start making a plan for somebody to wipe down all the doorknobs, all the shared surfaces, the area by the copy machine, any shared workspaces that you might have. Clean them off every hour, even. I know it seems like a lot, but if you set an alarm and everybody has a time to do it, that's the way I would do it.

And wash your hands.

Yeah, wash your hands.

Just continue to wash your hands. That's kind of the first line of defense. And one thing too, a lot of phones, you can do multiple calls. You can conference people in and add lines and add lines and add lines. So you can do a lot of this via your phone. More questions from online. This is from Martin. Did flattening the curve mean delaying the spread or actually containing it?

It's just delaying. So we no longer going to be able to contain the spread. We want to be able to try and contain the spread with inside places like hospitals, and nursing homes, and dormitories, which is part of the reason why so many universities are switching to online learning.

Because in those places, you could have so many people in one place that we can manage to contain things. Like, we'll always track everybody who's been exposed in a hospital and make sure that they're all tested and they're sent home if they need to be.

But in the general community, we no longer can contain this virus. So everything is about delaying. And I know that seems really terrifying, because I personally have been working on this nonstop for many months now and would really like, in my heart of hearts, for it to be over really quickly, and as would we all, especially after spending week at home with everyone in our house. But that's not the way to do it. We need to have patients and we need to go slow, and delay, delay, delay.

How about summertime rolling around, spring and summer? Some of the chatter online, and I don't know how accurate this is, says that higher temperatures might help with this.

So I don't know if we know specifically about higher temperatures. But certainly being out in wide open spaces is a safe way to be in the world and interact with other people. And so, especially for those of us who are at home with our kids doing our new home schooling, as the weather warms, at a minimum, it's going to make us better able to cope with social distancing.

So this is from Deborah. If someone had the pneumonia vaccine, why would this not help with respiratory systems, or does it help?

The pneumonia vaccine is specifically targeted to a specific bacteria that causes most kinds of pneumonia. It's called streptococcus pneumoniae, or strep pneumo for short. And some people who get other respiratory viral infections will then subsequently develop a pneumonia with strep pneumo.

So the strep pneumo vaccine, or the pneumo vax, or the Prevnar vaccine, those can help to reduce the risk of developing these post viral infections. But to be honest with you, we're not seeing very many of them in patients that have COVID-19.

So while they do help reduce the risk of bacterial pneumonia after influenza, they may not be as helpful here. But they certainly can't hurt. And so if you haven't gotten your pneumo vax, if you're going to see your doctor for something else, you should.

But I do want to bring up that this may not be the time to be heading into a doctor's office just for a vaccine that may not be super effective. Leave your health care settings for people who really need care, because everyone is overstretched already and we have a long way to go.

So one of the questions we received the other day was, what about testing? What can people do? How can they get tested? How does it work?

So there's been a lot of information in the news about testing and availability, and whether the testing even works. And this is an ever changing game as state health departments come online and private labs come online. But really, to sum it up, testing is a precious resource.

I would love to be able to test everybody with a perfect test that clears you from having COVID and not having to worry about it for the next four months. But that's not the reality that we're living in. So we need to make sure that we're prioritizing testing to identify patients who could become very sick if they got coronavirus to make sure that we can get them admitted to the hospital when they need to be.

Making sure that we're keeping our health care workers safe, and if health care workers do become infected, making sure it's safe for them to go back to work. Otherwise, we're going to run out of health care workers.

And so as much as we would love free and open access and testing for everyone, and it's going to be frustrating for some people, but we, as a community, really need to come together and be stewards of this precious resource and make sure that people who need testing get it, and that people who don't qualify for testing are socially isolating themselves and staying home and keeping others from getting sick.

Kimberly asked, my 20-year-old son had to fly from California. He's healthy, but should we keep him in for 14 days? And if he wants to hang out in a small group, is that OK?

Well, these are personal decisions that everyone is going to have to make going forward. And we have to balance our sort of emotional well-being alongside our desire to be socially responsible. Anyone who's traveled anywhere right now probably needs to take some time to be away from other people.

And that means limiting our exposure, no matter what. Even if we haven't been out traveling, we need to be limiting our exposure. So the question about spending time with other friends is going to be one that we have to make a personal decision about.

It's probably OK to spend time with one or two other people. But you want to limit it. If you can move these things online, I know some of my friends are having online sort of like, FaceTime wine parties, get togethers. I've been working too much to join them, but maybe one of these days I'll be able to sit down and relax a little bit with them.

But that's the sort of thing that I would recommend. I can't imagine doing this without the online resources that we have nowadays, so I think we should take advantage of everything that we have. I don't know that it makes sense to say, definitely not, because if people are getting really, really stir crazy, then what they need is maybe just a couple of hours with some friends.

But you want to limit it. We're recommending that groups no larger than six get together in the hospital. So if you're more than six, you need to do it remotely or be separated. So maybe that would be something to do at home. I would say even less at home. I think six is probably too many.

Michelle says, can you talk about the shedding of the virus from seemingly normal people or healthy people, I would imagine is what she's going for there.

Yes, so potentially asymptomatic, the other word that you're going for. So we don't really have a great sense of how many people are walking around potentially infected with COVID-19 without having symptoms, because we aren't testing those people.

And I think this is becoming more evident and is influencing some of the mortality information that we're getting. We really don't know how many people are getting sick. Or rather, we know how many people are getting sick. We

don't know how many are having no symptoms.
So again, that's another important part in why we're recommending that people stay away from other individuals, because we don't know who might be potentially contagious.
C

an you have COVID-19 without a fever?

Yes.

Absolutely.

OK. Ashley says, someone in my house is sick, but I'm not sure if it's the flu or coronavirus. Is it OK for me to still go to work if I don't have any symptoms and feel OK?

So that kind of depends on what kind of work you do. And it depends on what kind of risk that person has. So we're trying to make every effort to test health care workers and their families so that we know whether or not they can be safe to come to work.

It is probably our most precious resource now, are our frontline health care providers, and beds, and the equipment that we use in the hospital. And we need to keep them as safe as possible, and keep our patients, the other patients that don't have COVID, that are in the hospital for other problems, as safe as we-- they are very vulnerable. We want to keep them as safe as possible.

So for people who work in nursing homes, in group homes, or with patients, or with elderly people, so people that are very high risk for a bad outcome, you may want to check with your employer about what the rules are about when you can and cannot work based on whether or not there's someone sick in your home or whether you are sick.

In general, we recommend that contacts of contacts, seems a little complicated there, but if you are the one that has direct contact with someone that has COVID, you need to stay home for 14 days. If you are the direct contact of someone that you don't know whether or not they have COVID, it's a little harder to make that decision.

If you are the direct contact of someone who may have COVID because they have reason to believe that they have COVID, even if they weren't tested, then you should probably follow the guidelines for someone who had contact with a known COVID positive.

If you are the contact of a contact, so you had contact with someone who had contact with someone who had COVID, you don't need to change your behavior right now. If the person, you had contact with becomes sick, though, then they have a good reason that they might have COVID, and you should now consider yourself to have been exposed to someone that had COVID, even if that person didn't get tested.
I

know. This is like, I just said something that sounds like a Dr. Seuss book, but it really isn't. And so it's a little bit challenging. Maybe Dr. Bartlett wants to take another stab at this. But contacts of contacts don't change your behavior unless the person that you had contact with gets sick.

We-- I can't say it really any better, because it is something that we are getting questions about nonstop. Someone in my apartment building might have tested positive. Do I, you know, I don't have any symptoms. Do I need to do anything differently?

You know, again, I appreciate everyone's heightened sensitivity around this. But we are-- if you are just in the same general building and not in face to face contact with someone who may have had COVID-19 and you're not having any symptoms, I think that we need to just continue on our daily lives. Again, our new daily lives with our social distancing and increased hand hygiene and cleaning of surfaces.

Yes. So that means, if your building doesn't have a plan to clean off all the elevator buttons even more frequently and you don't have a personal plan for how to clean off your hands after touching all those elevator buttons, you probably want to get on that.

So Janet asks, should dental work be delayed?

Anything that's nonessential medical care is probably going to end up delayed. If something is essential, we want you to be able to get the care that you need here or anywhere that you need to get your care. But if something is nonessential, then you probably need to delay it for now.

I don't know about your particular problem, obviously, and so it's hard for me to answer that question. But you can always reach out to your many, many doctor's offices, and us included, are starting to have these telehealth sort of pre screening so that you can talk to someone about your medical problem and figure out whether or not it is or isn't essential before you make an appointment and come all the way to the medical center.

So Acer asks, how long can the virus be active on surfaces like clothing?

We don't know. There's a lot of papers coming out about this, and it's different in every single one. And soft services are definitely different than hard surfaces. I would say, when you wear your clothes, you should wash them. It's not the time for those dry clean only things that you try and push through a number of wears outside.

It is also not the time to be like, oh, I don't to clean off my countertops today. They're fine. It's probably a good idea to be keeping your surfaces clean and to be changing your clothes regularly and cleaning them in the washing machine.

Olivia and Rossetti also have a question that I'm going to put together. If someone must take the CTA during this time, what are the best practices can they follow, and should people wear a face mask?

So I will start with the second 1/2 first about face masks. It really feels like it should be protective to have something physically blocking your face. Unfortunately, for otherwise healthy people, it doesn't work as well as we'd like to think it does. Air and germs can get around the sides of the mask.

The other important piece to know is, masks are very important in preventing the spread of people who are symptomatic and keeping our health care workers safe. We have a shortage, nationwide, of masks, of both the regular kind and the N-95 or these special masks that we're wearing for some situations when we're caring for COVID patients.

And we need to do our best, both out in the community and even in the hospital, to ensure that we are being good stewards of that resource and having the masks available when we need them. So now, as far as traveling on public transportation or in other group settings, absolutely that is a risk, because you're in a confined location with other people who may be sick.

I know that there's a lot of work going with the public transportation authorities to increase the frequency with which they're cleaning buses and trains, but we can only do so much cleaning of buses and trains. So hand hygiene and not touching your face until after you've washed your hands are going to be important parts of how you can prevent spread.

And I just want to add in that this is another reason why social distancing is so important. Some people have to take the bus and the train in order to get to work as a health care provider. And those of you who don't need to take a bus and a train to get to work and don't need to use public transportation shouldn't use it, so that the people that need it in order to get to their essential jobs can take it and spread out so that they don't have as much risk.

That's why, even though I might not be at high risk and you might not be at high risk, our behavior can really affect what happens to everybody else in society. It's a time for us all to realize just how much we are really interconnected.

Another question online. I've heard that ibuprofen actually has a worsening effect with COVID. Is acetaminophen something better to use right now?

So I think the concerns around ibuprofen comes as it's an anti-inflammatory medication. There is some limited data that suggests it may worsen infections. I think for the vast majority, as we discussed, of people who get COVID-19, they are not going to become severely ill.

And this use of ibuprofen are not, in terms of their severity of illness, is not going to have an impact. It will make you feel better if you have a fever, and make you able to work from home and get more things done. So I don't think that there's any reason to not symptomatically treat your fever as appropriate. I think the same thing would go for acetaminophen.

Another question from our patient panel. This is an interesting one. Can an infected person preparing food for others infect others?

Absolutely. Please don't do that.

Easy answer. So here's one from Lisa. Is it better to bring my 78-year-old grandmother to stay with me and my three kids during this time, or risk allowing her to remain in her home alone? What about a nursing home versus staying with a friend or relative? And I've got a relative in an old folks home right now. They're completely quarantined.

I will take a stab at starting that based on the text exchange I had with my mother last night, who is begging to have me send my three children to come hang out with them since they're on spring break.

Extended break.

Extended break. And she's a pediatrician. She knows what she's talking about. And one of my kids has a bit of a cold. So no, you can't hang out with my kids. I very much want them not at my house so I can be working on this 24/7. But it's not the right time to take any chances. So the nursing home is a different setting, right? That is a potential risky place to be as well.

Yeah. I think anybody that's-- I really hope that all the nursing homes and the group homes that are out there, and I know many of them are taking really strong tactics to try and sort of lock in and lock down so that no one can get in and no one can get out, that helps cocoon these populations and keep them safe from the virus.

But if a single sick health care worker gets in, it can be really dangerous for everybody involved. I think everybody needs to make a personal decision about what's the best thing to do in your circumstance. And that's going to come out as a different equation for every single one of us.

And so the best advice I can give is to, if you have an elderly family member, talk to their doctor. Talk to your family. Figure out what you're going to do. Certainly, if you have Grandma and Grandpa come and stay at your house or aunt whoever or uncle whoever come and stay at your house, you're going to have to take even more strict precautions.

That means the kids really can't play with other kids. It really means everybody has to stay inside, except maybe for going for walks and playing outside, not with other children. And so you have to make a decision about whether or not that's going to be best for your family. It's hard, it's really hard to say, and everybody's going to have a different answer.

And we've hit our time limit, and I know you two are very, very busy. So we've got to let you go. I apologize we couldn't get to everybody's questions. If you want to leave us with a final thought, each one of you, with something that probably is the most important information you think you would like to get out?

This is going to be hard. And it's different than any way we've ever lived before. And I personally can't believe that we're in the middle of this. But we have to do it. And it may take longer than we want it to take, and it may be different than we want it to be.

And no matter how much do you think that you're going to be fine, so why do you have to do all this, it's just like the flu, if you keep having that behavior and that thought process, there are a lot of older people and people that are immunocompromised that will die. And we really don't want to have that.

So it's important that everyone take a minute to start thinking more about everyone else around them, and not just about themselves. I know that a lot of you are out there staying at home already. You're prepared in case somebody needs to be quarantined. You're washing your hands. You're cleaning your surfaces.

Keep spreading the word electronically, and do your best. This will end, and we will get through this. And almost all of us are going to be just fine. So just be patient, and we'll get through it together.
Dr. Barlett?

So I echo everything that Dr. Landon said. I would ask that everyone focus on the things that you can control. You can control where you go, how you're social distancing, how you're washing your hands, how you're cleaning your surface. There's a lot of mass hysteria out there, much of which is directed.

So focus on what you can control to keep yourself safe. Focus on the importance of your role in a community, a worldwide community, to help keep everyone in the community safe. Talk to your kids about what's going on. Reassure them that there's a lot of grownups out there who are working really hard to make sure that everybody stays safe, and that they have an important role in that.

Well, thank you. You two are a couple of rock stars. We appreciate you doing this today. That's all the time we have with the program. Please remember to check out our Facebook page for future programs and health information. Also, if you want more information about coronavirus, please take a look at our website at www.uchicagomedicine.org. Need an appointment, give us a call at 888-824-0200.

Thanks again for being with us today, and please be patient with each other, and be nice to each other. Hope all of you have a good week.