Last week, Yahoo Canada asked readers to rank and submit their top questions about COVID-19. While many things are still unknown about the virus, we spoke to Dr. Hamzah Qureshi, an internal medicine final-year resident at University of Toronto, to answer reader questions on what we know about COVID-19 and precautions that people across the country should be taking to keep themselves safe.
How do I know if I have COVID-19, the flu or a cold?
I think both patients and even healthcare providers are worried because it’s very hard for us, from a clinical standpoint, to tell apart the flu, a cold or COVID-19, just based off of symptoms alone. It’s actually, I would say, impossible to tell the difference. That’s why we do testing on patients who we suspect have COVID. The concerning symptoms, regardless of whether it’s the flu or COVID or the cold, would be shortness of breath and high-grade fevers. The symptoms common among the flu, COVID-19 and the cold include viral respiratory symptoms, things like dry cough, sore throat, runny nose, body aches, fatigue, weakness, these are all kind of across the board and they’re not very specific to one disease or the other.
We usually say if you have any respiratory symptoms or any flu-like symptoms or cold-like symptoms, assume you have COVI-19 and just stay home, unless you’re very ill.
How long does COVID-19 stay on surfaces and how can I protect myself?
It’s a healthy concern to have because you don’t know who’s touched something and what they’ve been exposed to. The virus can live on surfaces. The studies have shown up to about 48 to 72 hours at the longest. There was the Diamond Princess cruise ship, when they finished quarantining patients from there they tested the surfaces and...COVID-19 was still present on some surfaces and that was 17 days later. The data we go by, is up to a couple of days.
That being said, the virus is easily killed. Anytime you clean a surface with an antibacterial wipe or an anti-viral wipe, like a Lysol wipe or spray, it will kill the virus. That’s why we also recommend washing hands frequently whenever you touch anything that you don’t know where it’s been, or what it’s been exposed to. We recommend washing hands for 20 seconds with warm water and soap, ideally. Alcohol-based hand sanitizers are also acceptable but the best is to use soap and water.
How should I clean the items I’ve been buying or getting delivered?
Fruits and vegetables I would wash, other food that’s sealed you don’t have to do anything about because the food is on the inside of the packaging. But if you touch that packaging, I would just wash my hands afterwards. Again, wash your hands before handling the food. You can see the common theme is washing your hands frequently. I think it depends on what you’re buying. If you’re buying clothes, assuming someone’s touched it, this is just what I would probably do in this situation, I would probably throw it in the wash before wearing it. It’s a case-by-case basis on the person’s comfort level as well.
Why is social distancing so important?
The virus itself, we know based on the microbiology and transmission pattern, it’s through droplet transmission. What we mean by droplet transmission is that the size of the virus, when someone coughs or sneezes, is a certain size that lets it travel in the air for about a two-metre distance and then it drops, usually. If you’re within that two metre distance from someone who is having symptoms, such as a cough or sneezing, you’re at risk of inhaling some of those virus particles and that leads to transmission and infection in the patient that doesn’t have it. That’s why you keep hearing six-feet apart or two-metres apart, it’s because that is the maximum distance that this virus can travel.
We mentioned that it can survive on surfaces and if someone sneezes or coughs on a surface, and then someone else comes and touches that surface, they’re not necessarily infected right away — you have your skin as a barrier to protect you. But if you then touch your face or touch your eyes or touch the inside of your mouth, or the inside of your nose, those are mucus membranes that the virus can then penetrate and cause infection. That’s why we also recommend social distancing and washing hands frequently.
What other precautions should I be taking?
The biggest thing, outside of the social distancing and the hand washing, is staying home unless absolutely necessary to leave. Obviously, if you’re an essential service that needs to go to work, that’s a different story. The people who can work from home, even though it may be difficult, they should stay home. Even though we try our best to do social distancing, it’s only as effective as the people who abide by it. I can be trying to abide by it but people can come into my own two metre space. It requires cooperation of the total population and that’s difficult to do sometimes if everyone is out and about. That’s why we also strongly recommend staying home at all times, unless absolutely necessary.
Is the virus airborne?
Medically, what we refer to as an airborne virus or airborne transmission is when it not only travelled beyond two metres but it stays in the air for a prolonged period of time, because the size of the particles are smaller. Common examples of airborne infections [or bacteria] that still exist today are measles and TB (tuberculosis).
This COVID-19 virus, as far as the data we’ve seen and the transmission pattern we’ve seen, is not airborne as of right now and that’s both the World Health Organization recommendation, as well as I believe CDC in the U.S. and the Canadian recommendations by all the infectious diseases and infection control experts. They have said that this is what we call droplet transmission, which means that it doesn’t stay in the air for a prolonged period of time and it drops after two metres.
There are some medical procedures that if done in hospital can cause what we call aerosolization of the virus and in those certain cases, it can be airborne. But that’s only when there’s certain procedures that are done. For example, when a patient needs a breathing tube, that is a common procedure, especially for COVID patients, that can aerosolize the procedure and make it, airborne. In those circumstances, we should take all the necessary precautions.
Should we all be wearing masks?
I think masks should be worn if you’re a healthcare provider and taking care of patients, or exposed to patients directly, whether they're confirmed or not confirmed. The common individual, if they practice social distancing appropriately, if they stay home appropriately, I don’t see the need for everyone in the population to wear a mask. Masks are more effective for those who are actually sick, wearing the mask to prevent them from transmitting it because then there’s that barrier for them if they cough or sneeze.
The mask itself, for a healthcare provider even, isn’t perfect. The surface of the mask can get contaminated. If someone is wearing a mask, you might not be inhaling things but if you touch the mask and then take it off, throw it in the garbage and then touch your face, then that kind of defeats the purpose of the mask. People think they’re protected when in fact, they should be taking appropriate precautions, which include hand hygiene and distancing.
Should people with underlying health issues, like diabetes and asthma, be particularly concerned about contracting COVID-19?
I think the data so far does show that patients with chronic illnesses, especially heart disease, diabetes, have a higher risk when they contract the virus. Now, we don’t know yet if the risk of having diabetes or other diseases itself makes it high risk for someone to contract it, but we know that these patients are probably at a higher risk once they have the virus to have a worse outcome. It’s just about maybe being a little bit extra vigilant and staying home and doing everything a little bit more meticulously than people who don’t have diabetes or whatever other underlying illness it may be.
The chronic illnesses that exist, there’s a whole spectrum. People with asthma, they’re probably going to be at a higher risk of having a more severe clinical course than someone who doesn’t have asthma. Someone with heart disease, the data shows that they definitely have a worse outcome than people who don’t have heart disease. That’s why it’s important to be just extra vigilant, especially in our patients with chronic diseases and the elderly population as well.
How long is the virus active and contagious?
I think that’s probably, right now, what a lot of us are struggling with in the medical community. How long the virus is really active, or at least how long a patient is infectious. Because it’s a new virus, we don’t have a lot of robust data to back our claims with, we’re just going by what’s occurred in China and other countries. I can’t even imagine how those physicians had to deal with the coronavirus when they didn't have any data.
As far as we can tell, the incubation period, which is the time the virus can be alive for, is about 14 days and some reports say even longer, 17 days, 20 days. There is some data that suggests that there may be possible asymptomatic spread or transmission, meaning if someone doesn’t have any symptoms at all they can still maybe transmit the virus, although [it’s] unclear how much this is actually occurring.
Figuring that out would be very important so that when we isolate someone and say 14 days, we’re not isolating unnecessarily too long but at the same time, not isolating for too short of an interval either. We want to make sure we’re appropriately isolating the patient and I think that is a key question that is going to be important to know.