COVID-19 is changing, as is our reaction to it. In part one of our series, we looked at the basics of the pandemic. As we approach the end of our first month of drastic changes, we check in with Dr. Joshua Tepper, the president and chief executive officer of North York General Hospital. He shares information on how the virus is spreading, the mask question, what comes after the surge and more. If you don’t read any further — please just stay inside and help save lives.
What is asymptomatic spread?
The disease is still understood to be spread by droplet not aerosolized. However one of the most important changes in our understanding of the disease is that unlike before we believe that there can be a transmission of the disease with people who have no symptoms (asymptomatic) or very mild disease. This is a significant and unfortunate change but also helps explain some of the rapid rates of spread we have seen in some areas.
What does this mean?
Firstly, it does suggest there may be some benefit in having people wear masks to prevent them from spreading the disease when they are not aware they are sick. Unfortunately, there are simply not enough masks so it is irresponsible at this stage to have the general public using surgical masks or N95 masks. The shortage of masks at the front lines is currently very real. Please do not start using masks outside of healthcare settings because there are just not enough surgical masks or N95.
The Centre for Disease Control is talking about the general public wearing cloth masks. There are lots of online resources about how to make them. I have not seen strong evidence on these. More importantly, I do worry about a false sense of security and that people will stop staying inside since they are wearing a cloth mask. If you must go out then perhaps a cloth mask is something to consider.
The bottom line is that the evidence of spread with no or very mild symptoms is that we have to be extra diligent about social distancing. We can’t rely on people saying they feel fine because they can still be transmitting the disease.
Has what you know about symptoms of COVID-19 changed?
Another key change is symptoms. Initially we were primarily worried about cough or fever or shortness of breath. We are now hearing about the loss of smell, diarrhea and abdominal pain as other symptoms. Runny nose and sore throat appear less likely to be COVID-19, and that is something to keep in mind as the pollen comes out and allergy season starts.
Again two thoughts:
Firstly, worry less about different symptoms and focus on severity. Specifically, if you are developing significant shortness of breath then you should go to the emergency department or call your primary care provider. Also, any symptoms like abdominal pain that is significant enough that you would normally seek out medical care should still be pursued. No one should stay at home with a brewing infection, appendicitis, bowel blockage, heart attack or other serious medical condition.
Secondly, if someone is sick in your family you need them to thoroughly self-isolate around eating, sleeping, bathroom usage and cleaning surfaces they come in contact with really, really thoroughly.
What kind of research is happening right now on treatment?
We are seeing lots of basic science research on treatment and vaccines. Nothing conclusive yet but lots of great research underway. People should not be rushing out to get prescriptions of chloroquine and azithromycin.
There is lots of evolving knowledge around pregnancy as well…still small numbers. It appears that the virus may cross the placental barrier but may not cause major health issues in the baby. Please speak to whatever professional is managing your pregnancy.
How are we doing on testing?
Lots and lots has been written on testing. We have had problems with the supply of swabs, testing reagent and long turnaround times. Those seem to be largely worked out. However, at this time the criteria for who gets tested is still narrow and the vast majority of people with symptoms are not going to be tested. In most places as the criteria have narrowed, testing centres have gone from seeing hundreds a day to a couple dozen and most of those being essential services front line workers. It is possible the criteria could change again.
What lies ahead?
The province released some data and projections last Friday. The sobering news is that they predict potentially a huge number of deaths still ahead. The positive is they think we have already avoided thousands of deaths and can still avoid thousands more. The need to socially isolate is so paramount.
Also clear in the material is that like other countries, older people get killed far more by the virus so we need to really protect them especially given the asymptomatic/mild symptoms spreading risk. Connect virtually but not physically. The homeless, those in prisons and others living in very dense quarters are also at high risk.
It is difficult to predict what will happen several months from now. The virus is mutating (which is normal and why the flu vaccine is different every year and we keep getting colds throughout our life), there may be a weather element where the warmer weather slows the spread. There is also lots of discussion of second waves (smaller surges). We will watch other countries like Italy and Spain who are ahead of us very carefully. If we successfully flatten the curve thousands fewer people may die, but we may need to have a slower and more careful return to normal.