Top COVID-19 Questions, Answered: An Interview with ASM President Robin Patel  

March 20, 2020

ASM President Robin Patel discusses COVID-19.
Terms like social distancing, self-quarantine and pandemic are punctuating household conversations and raising  pertinent questions. Robin Patel, M.D., President of ASM, Chair of the Division of Clinical Microbiology and Director of the Infectious Diseases Laboratory at Mayo Clinic, in Rochester, MN answers in an open interview about the novel coronavirus, SARS-CoV-2. 

Can you briefly explain what this novel coronavirus is?

Coronaviruses are a large family of viruses. They’re pretty common in people, and they usually cause just the common cold. They’re also found in many different species of animals. Very rarely, animal coronaviruses can infect and spread between people. Examples of animal coronaviruses that infect humans include: Middle East respiratory syndrome coronavirus (MERS-CoV), Severe acute respiratory syndrome coronavirus (SARS-CoV) and the one we’re dealing with now, called SARS Coronavirus-2 (SARS-CoV-2). 
The disease caused by SARS-CoV-2 has been named Coronavirus Disease 2019 and abbreviated COVID-19. We first saw this virus in late 2019 in Wuhan, China. SARS-CoV-2 is a Betacoronavirus, like MERS coronavirus and SARS coronavirus. And all 3 have their origin in bats. [MERS-CoV likely jumped from bats to dromedary camels in the distant past before appearing in humans.] 

How does SARS-CoV-2 spread? And why is it spreading so quickly? 

SARS-CoV-2 spreads very easily from person to person, and that’s why it’s spreading so quickly. It spreads between people who are in close contact with one another (within about 6 feet), through respiratory droplets. When an infected person coughs or breathes out, those droplets are released. They travel a very short distance then drop down onto surfaces around the patient.
This explains why it is also possible for a person to get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose or possibly their eyes.

What are the incubation period and symptoms of COVID-19?

The incubation period (amount of time between exposure to the virus and development of symptoms of COVID-19) ranges from 1-14 days. It is most commonly 5-6 days, and in some rare cases has been reported to be longer than 14 days. 
The most common symptoms of COVID-19 are fever, dry cough, fatigue and myalgia (achy muscles). Other less common symptoms include runny nose, headache, sore throat, abdominal pain and diarrhea. 
The most worrisome outcome of this infection is pneumonia, which occurs if the virus infects the lungs. If that happens, it will typically occur around the end of the first week of infection to the beginning of the second week. 
About 80% of people who are infected will have a mild-moderate illness that consists of fever and dry cough. This will last about 2 weeks, and then they will get better. About 14% will develop severe illness, and 6% will develop life-threatening illness that consists of respiratory failure, septic shock and organ failure. 

Who is the most vulnerable/high risk population?

The most vulnerable population for this particular virus is those of older age, and also those who have serious chronic medical conditions such as heart disease, lung disease or diabetes. 

How can I protect myself from the coronavirus?

There are several ways you can protect yourself from SARS-CoV-2. The best way to prevent acquiring this virus is avoid contact with someone who has it. That’s where social distancing and hand hygiene come into play.

What is “social distancing” and will it help?

Social distancing is a term that’s applied to actions taken by public health officials to stop or slow the spread of a highly contagious disease. Social distancing measures restrict when and where people can gather in order to stop or slow the spread of infectious diseases. Such measures include limiting large groups of people coming together, closing buildings and canceling events, as well as deliberately increasing the physical space between people to avoid contracting an illness. Staying at least 6 feet away from other people lessens your chance of catching this virus. 

Why is staying at home and “social distancing” important even for groups who are not at “high risk?”

Anyone can become infected, and anyone can transmit this virus to someone else. The goal is to prevent the spread of the virus. A low risk individual, or someone who has minimal or even no symptoms, can pass the virus on to someone who is high risk. That’s what’s really concerning about this. The person may not feel sick at all, and yet they can be a vehicle for passing this virus to someone who is going to get very sick or even die from this virus. 

How often and after what activities should you cleanse your hands?

Wash your hands with soap and water for at least 20 seconds after going to the bathroom, before eating, after blowing your nose, coughing or sneezing or after touching a surface or object potentially contaminated with the novel coronavirus. 

There's been a spike in people purchasing antibacterial hand soap. Will that actually help kill germs more than regular soaps?

Soap and warm water are my recommendation, with hand sanitizer being an option when you do not have soap and water available. COVID-19 is caused by a virus. Regular soap is suitable. You don’t need antibacterial soap; antibacterial agents can hypothetically harm or kill your body's beneficial bacteria. It is not advised to create your own "at-home" hand sanitizer, since, in addition to alcohol, hand sanitizers often contain other components to protect the skin, and getting the alcohol content right can be challenging. The important thing is to be cleaning your hands. 

Any other tips for cleansing to keep yourself safe from germs?

Frequently clean high-touch surfaces. Wash or sanitize hands after opening doors, touching elevator buttons or other frequently-touched areas. 

How easy is it to get sick via germs from your phone?

According to the CDC, the virus may remain for several hours to days on surfaces like glass, metal and plastic. The CDC refers to phones and tablets as "high touch" surfaces.  
Phones are conduits for many germs. It is possible to contract germs from your phone, especially if touching it before touching your face or mouth without first washing your hands.  

Are there places where you should avoid using your phone in order to prevent picking up germs? 

Avoid putting your phone on a surface that has not been cleaned properly or where someone exhibiting symptoms of illness may have sneezed or coughed.
We don’t allow phones in the microbiology laboratory.
Make sure to wipe down your phone in the following cases:
  • Someone has used your phone (especially if they are they are exhibiting symptoms of illness).
  • You have left it on an unclean surface.

What's the best way to clean your phone?

While it is important to clean and disinfect your phone, you’ll want to do so in a way that does not damage it. Though tempting to use, everyday disinfectant and household cleaners could damage the phone. Some phone manufacturers recommend using a soft, lint free microfiber cloth with warm soapy water. Make sure to unplug and turn off the phone before cleaning. You should remove the case and clean it separately. Refer to the case’s packaging or informational materials for proper cleaning instructions. Ensure the case is dry before placing back on the phone.
It is more important to wash your hands with soap and water on a regular basis.

Do those UV lights work?

ASM is not aware of any studies examining the effectiveness of UV ray devices on SARS-COV-2 specifically. 

If I have symptoms of COVID-19, what should I do?

The symptoms associated with this virus are not any different than symptoms associated with other viruses, so you can’t tell from your symptoms alone whether you have this specific virus. Other viruses that are circulating at this time, like influenza virus and adenovirus, can cause similar symptoms. 
If you think you have symptoms of COVID-19, call your healthcare provider for advice, and stay put. You don’t want to infect anyone else. If you’re severely ill or have emergency warning signs, seek care immediately. Examples of emergency warning signs include very severe difficulty breathing, persistent pain or pressure in the chest, new confusion or unexplained drowsiness, blue lips or face. 

If I’ve been around someone who displayed symptoms, what should I do?

Many people have been around people who have respiratory symptoms. As I mentioned, respiratory symptoms can be caused by a number of viruses. Just because someone around you has symptoms, doesn’t mean they have this virus, SARS-CoV-2. I think in a case where you’re worried about exposure, you really need to assess the situation on an individual basis, based on details of exposure and local spread of the virus. 

What is the testing process for COVID-19?

First,we must collect a specimen. This is a respiratory virus. So if we’re going to test for it, we need a sample that comes from the respiratory tract. Most often this is called a nasopharyngeal swab. It can also be tested for using a throat swab. And for patients who have pneumonia or involvement in their lungs, we’ll test lower respiratory secretions, like sputum. 
I’ve noted confusion amongst the general public about what testing means. I’d like to clarify that there is much more to testing than just collecting a specimen. The actual testing for this virus, and for many other infectious diseases, is done in clinical microbiology laboratories. Testing in a laboratory is a complicated process. The virus is an RNA virus, so tests are designed to pick up the specific RNA of this virus, and not another virus or other coronaviruses. 
Before this outbreak, we had no test for this virus. So clinical microbiology and public health laboratories had to develop their own tests. Today, we also have tests made by companies and sold to clinical microbiology or public health laboratories to perform. 
In all of these tests there is a first step where RNA of the virus is extracted from the patient specimen, a second step where the RNA is converted to DNA and a third step where the DNA is amplified with DNA primers that are specific to SARS-CoV-2. This is not a trivial type of test. It needs to be performed by trained laboratorians to make sure it’s done correctly. 
Once the laboratory test is complete, the results are sent through a computer to the patient’s electronic medical record and are available for viewing by healthcare providers, and in many cases for patients to see as well. 

Should everyone with symptoms be tested?

Not everyone with symptoms needs to be tested. The severely ill and hospitalized need to be tested because we need to know whether they have this infection or not for the management of their care and also to protect healthcare workers. In more mild cases, it may not make a difference. It can make a difference in terms of knowing whether a person needs to be quarantined, but at the end of the day your healthcare provider should advise as to whether or not you should be tested. 

If I test positive, what should I do?

If you test positive for SARS-CoV-2, you should stay home to avoid infecting others, and you should contact your healthcare provider for advice.  

Author: Ashley Hagen, M.S.

Ashley Hagen, M.S.
Ashley Hagen is a science communications specialist at ASM.