5 Questions about COVID-19 with an Infectious Disease Doctor

Every day we learn more about this dangerous new coronavirus, which is great news for scientists and for all of us, since we are all potentially at risk of infection. We may not yet be able to leverage this evolving knowledge into better treatment or a cure, but important progress is being made as you read this, and it is likely only a matter of time before treatment improves and one or more cures are established. 

To help clarify some of this information, we turned to Stephen A. Hoffmann, MD, a Harvard Medical School and Massachusetts General Hospital-trained internist with a subspecialty in infectious disease. The MDVIP-affiliated doctor is passionate about helping as many people as he can stay healthy through this public health crisis.

Why is COVID-19 spreading so fast? 

We believe coronaviruses spread from person-to-person through respiratory droplets, which then often land on surfaces. A key to limiting risk is washing hands thoroughly and repeatedly, especially after touching surfaces, particularly outside the home. Equally important is not touching our faces, which goes against human nature. One recently recommended strategy is to wear a non-N95 mask (those are best reserved for people on the frontlines of healthcare). Wearing a simple “surgical mask” may partly limit risk of acquiring infection, and importantly, it may be a disincentive to touching our faces.  

The coronavirus is very effective in latching onto cells, especially in the respiratory tract, but that’s only part of the reason the numbers of confirmed cases are surging. Other reasons are both the increasing spread of the virus throughout our communities and increased laboratory testing.  The good news is that there does not yet appear to be evidence of significant mutation of this virus.  

How reliable are the tests for COVID-19? 
As of right now, testing still has flaws. It can take days to get results, but newer tests that give an answer more rapidly are becoming available or will be available soon. A test approved by the U.S. Food and Drug Administration (FDA) on March 13 can have a turnaround time as short as three hours. Another test approved by the FDA on March 21 has a turnaround of 45 minutes, as does an additional test approved by the FDA on March 24. On March 27, the FDA has granted emergency approval for a coronavirus test that can deliver results in less than 15 minutes, possibly in as little as 5 minutes.  

We still don’t know just how accurate the tests are, and there is a significant potential for a false negative result. That being said, things are improving as we speak. 

What should I do if I test positive? 
A positive test doesn’t impact your treatment much, if at all at this time. In an emergency room setting, a rapidly obtained test may be helpful to prioritize care.

The major impacts of a positive test are knowing that you could transmit the virus to others and should therefore isolate yourself appropriately for at least two weeks, based on what we currently know; as well as being aware that you are at risk for progressive symptoms.

Early symptoms include dry cough, sore throat, body aches, fatigue and sometimes gastrointestinal symptoms such as diarrhea and nausea. Loss of taste and smell, we have come to appreciate, are also common early symptoms of coronavirus infection. And, of course, fever is a typical symptom. It may be one or two degrees above your normal temperature or higher. 

Some of the emergency warning signs are trouble breathing, ongoing chest or upper- and mid-back pain or pressure, confusion and bluish lips or face. If you start to experience one or more of these symptoms, you should seek medical attention promptly, even if prior testing has come back negative. The medical community recommends the wisdom of calling ahead to an ER facility in advance to make it aware of your impending arrival. 

What can I do to protect myself? 
At this time, we believe the most important things you can do are vigilant, repeated and thorough hand washing; avoiding touching your face; disinfecting frequently touched surfaces and social distancing and/or sheltering in place. Sleep, exercise and a healthy diet – the same factors that go into staying healthy at any other time – apply here as well. 

Hydration is also critically important. A hydrated airway is your best defense against respiratory infection. Put another way, the drier the tissue in your respiratory tract, the less functional your cells. They’re less mobile in a drier environment, so they’re less able to do what they need to in order to fight and repel invaders.

Most of us can safely drink about eight glasses of fluid a day or 64 ounces. You should ask your doctor how much and what type of fluid is appropriate for you. Because I recommend a low-sodium diet, my advice on fluids is that at least a third should be electrolyte-enhanced (for example, low-calorie Gatorade or Propel, especially if you have diabetes). Your body needs the sodium in order to hold onto fluid; it’s essential to keeping the airway well-hydrated. 

Some experts believe that warm or hot liquids may be particularly beneficial. The thought is that warm fluids may better move viruses that are about to bind to the respiratory epithelial tract down into the stomach, where they can be broken down and eliminated. 

Another way to decrease your infection risk is to reduce stress through meditation and activities that historically bring you peace and joy. 

Vitamin D may also help. We don’t know this for sure, but we do know, for example, that it enhances immune function in individuals with multiple sclerosis. For most of us, there is no downside to taking vitamin D supplements, but you should check with your physician to be sure it’s safe for you. 

Please be careful to avoid false advertising, which is rampant, regarding supplements and cures that are advertised on the Internet and elsewhere. 

How do I know if I’m in a high-risk group? 
There are a number of factors that put you at increased risk of COVID-19 infection and/or more severe illness, including:

• Being 65 or older
• Living in a nursing home or long-term care facility
• Having one or more particular health conditions, including: asthma, emphysema, diabetes, chronic kidney or liver disease, serious heart conditions, an autoimmune disorder and obesity, among others
• Taking medications that impair immunity, including corticosteroids, chemotherapy for cancer and disease-modifying antirheumatic drugs (DMARDs) or so-called biologics, which are widely used for such conditions as rheumatoid arthritis, psoriasis and inflammatory bowel disease, among others.   

You’ll want to check with your doctor about your level of risk based on your health, medications, and lifestyle choices. Keep in mind, though, that dehydration, lack of sleep and physical inactivity can impair immune function in anyone. And the good news is that those can be easily addressed with a bit of work and perseverance.

This blog reflects the medical opinion of Dr. Stephen Hoffman, an MDVIP-affiliated internist, diplomate of the American Board of Internal Medicine with a subspecialty of Infectious Disease, and not necessarily the opinion of all physicians in the MDVIP national network.