Show 1206: Live Coronavirus Update to Answer Your Questions
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Virus infections are overwhelming hospitals in many parts of the US and around the world. What do you need to know? This is the people's pharmacy with Terry. And Joe Graydon off there's so much uncertainty and anxiety around this pandemic. How can you make informed decisions about your health? What questions do you have about Cova? Nineteen our guest today as an expert in infectious diseases and epidemiology. Dr David Weber is standing by to answer your email questions. You can reach us now at radio at People's pharmacy DOT COM coming up on the People's pharmacy answers to your questions about the cove. Nineteen pandemic send them to radio at People's Pharmacy Dot com welcome to the People's pharmacy. I'm Terry Graydon. I'm a medical anthropologist and I'm Joe Graydon I'm a pharmacologist today we're offering you a live corona virus update. We've asked our guest to answer your questions over his telephone to minimize the number of people in our w UNC studio and keep everyone as safe as possible. Our technical assistant is not present so we will be taking your questions by email. Address is radio at People's Pharmacy Dot Com our guest. Today is Dr David Weber. He's professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina. School of Medicine. He's also professor of epidemiology at the killing school of Global Public Health and medical director of UNC hospitals departments of hospital epidemiology infection prevention. Dr Webber is Associate Chief Medical Officer of UNC healthcare. Welcome back to the People's firms. He Dr Webber. Thank you so much for joining us. Thank you. It's a great pleasure to be here to talk to you about how people can best managed through this pandemic Dr Webber. We want to thank all of the hard work that you have been doing at UNC to get prepared for this pandemic and we want to thank all of the healthcare providers and first responders who are taking the brunt of this Extreme situation Dr Webber you were directly involved with. Unc's SARS response in two thousand three. Can you tell us a little bit about that experience and how it was different from what we're going through today? So SARS as the did co fit originated in bats if you mentioned in two thousand and three worldwide. They're about to eight thousand cases but through physical distancing and good public health. We eliminated that virus over a period of a number of months United States only had eight cases. Fortunately and I personally took care of the eight and last lab confirmed case of SARS but we learned a great deal about krona viruses that are applicable to our prevention of covert From that outbreak now Dr Webber. I wonder if you can give us an update on the statistics regarding Covert nineteen certainly Worldwide there are more than five hundred thousand cases and more than twenty five thousand deaths here in the United States. We have more than one hundred thousand cases with greater than fifteen hundred deaths. And as you know there have been particular hotspots such as New York Detroit. A rising hotspot A Washington based around the nursing home outbreak parts of California. Now there's something called a doubling time. Can you tell us what that means and what it is as of today the doubling time is the time of which the number of cases would double this rhythmic growth so for In the United States at the present time for coated it's on the range of three to four days which means that Three or four days from now they'll be two hundred thousand cases in the United States and at the end of a week from now they'll be roughly four hundred thousand cases in the United States. Unless we see this physical distancing beginning to decrease the rate of increase and. I assume that that actually is the point of physical. Distancing is to slow down the numbers of people who are getting sick all at once and indeed and that relates to how the disease is transmitted. We know if droplet contact the primary means of transmission meaning within six feet and direct touching To some extent there's indirect contact meaning. I rubbed my nose. I touch a DOORKNOB. The virus will survive on surfaces for hours. Today someone touches that and rub stare knows. That's probably less important than the Closeness so if people stay apart from each other then there really is no way for the virus to go from person to person after wherever there have been two events that have had a huge impact. I think there was a soccer game between Italy and Spain Terry and also of course Mardi Gras and it seems like those events where huge numbers of people were in close. Contact led to dramatic increases a week or two after the event. Yes absolutely so again. It's a closely transmitted disease. So if you put people in close proximity particularly long periods of time and we've seen this of course on cruise ships nursing homes the hotel outbreak in Boston. I suspect one of the reasons that we've seen so many cases in New York. Subways again people closely packed. So yes when you put people close together and you have susceptible people infected people then you get transmission Dr Weber. What's the nature of this novel Corona Virus? Why is it worse than influenza? So of course. There are several reasons that it's worth one of course is unlike influenza. Many of us have had influenza over the years and well. The virus mutates a little bit each year. We probably have some partial immunity. Here all of us are susceptible to this new corona virus which originated in bats and then spread to humans so none of us have any susceptible any resistance to it and just intrinsically. This virus seems to have a higher mortality and cause more complications than does stand influenza. Well when he comes to complications in particular. We've heard that older people are at the highest risk but the CDC just issued a report on confirmed cases sixty five percent of them were between twenty and sixty four years old and when we just look at hospitalized patients fifty five percent were between twenty and sixty four have we given younger people a false sense of security. We have You know this may be partly that older people have been more Physically distancing than younger people certainly the mortality older people it's much at certainly increases with other viral respiratory diseases like influenza. But it's much more apparent with this disease so certainly it may just be mixing issue. The other possibility is in nineteen eighteen. Nineteen the flu pandemic we did see more of what we call a w shaped curve with substantial amounts of morbidity and younger people which may have been due to their over Very vigorous immune response Right now I would say it's more likely we have more contact between the younger people then with older people. Thank you so much Dr Webber. We're GONNA start taking messages from our listeners. You can join the conversation. We are live radio at People's pharmacy. Dot Com is the e mail address. If you would like to email us questions for Dr Webber we do have one phone call sandy in wake forest North Carolina. Welcome to the People's pharmacy. You have a question for Dr Webber. Yes thank you Dr Webber. I have two questions. They are about paper items and food. we still get a paper newspaper and of course mail every day and I was wondering if the virus could be on these items and if so should we disinfect them before handling them and also just in the news in our town or near that a grocery store had an employee who was found to have the Corona Virus? So as far as shopping. In your opinion what's the safest way to get groceries to shop on our own wearing masks gloves or using a stores personal shopper? Kind of concerned like a lot of the store employees might be sick or having the virus. What do we do thank you thank you for the question? Dr Webber Two questions their newspapers and other paper items like mail and then of course shopping. Let me start with the shopping. Obviously with physical distance thing to the extent one can would like to say Six feet away from other individuals. I know many foods stores are staggering. The people coming in but certainly home delivery would reduce one's risk of coming into contact With Potentially infected persons and. I should say anyone who is sick. Meaning with fever or cough or respiratory symptoms should stay home and self quarantine themselves at home. Obviously they become more ill. They should call their Provider and not go out. Unless it's absolutely essential Dr Webber. Let me just interrupt there. And say that's even if they just think it's a cold right absolutely there's nothing clinically that allows us as physicians or patients to the separate. What could be flu and we still? I sing respiratory viruses like fluent RSV and cove. The symptoms are quite the same fever cough shortness of breath. I can start off with a sore throat What interesting symptom? We've not seen with other diseases loss of sense and smell which can be an early indication of disease and the disease progresses More symptoms but this could be exactly the similar to flu. Also things like muscle aches. Fatigue can occur as well now Dr Webber Sandy wanted to know about objects so she said if somebody in the supermarket has the virus and sneezes or coughs touches items and then they are brought to your house by. Let's say the the the supermarket through a delivery service. Does she have to worry about wiping. Down the surfaces of the OATMEAL or any of the other items and the same question was true with regard to her newspaper or her mail. Let me first start and say that this virus is not carried in foods. Food is perfectly safe and we not aware of any foodborne Spread of food in terms of surface. Items well this far as can survive. I'm not aware of outbreaks related to or transmission related to paper products Money bags and so on. It's survives a better at low temperature and low humidity and I'm more solid objects such as a medal and plastics So I'm not aware that those paper products really represent the risk. Obviously if one was particularly concerned than what you would do is take the food items out You and then perform good hand hygiene and discard the bag. Now we have of course heard from the New England Journal of Medicine that the virus can be found up to. What is it now about two or three hours in air in terms of airborne? That was an experiment. It wasn't real life and they also found that things like plastic and stainless steel. There could be signs up to three days. So caution of course is appropriate Absolutely let me say that. It's not surprising. It's in the air. It is a droplet spread disease. Meaning if I cough and you're within sixty you You can become infected but this study should not be interpreted as meaning this true airborne spread which has not been demonstrated meaning more than six feet and it does survive in the air for short periods of time this was a very artificial study where they injected virus into a drum and again. It's not surprising but this does not show long-term Sprint now. There is some good news in in this. We do need to take a break when we come back from the break. We're going to take more questions from our listeners. You can join the conversation via email Terry. The address radio at People's Pharmacy Dot Com. You're listening to the People's pharmacy with Joe and Terry Graydon. The People's pharmacy podcast is sponsored in part by Kaya -biotics K. A. Y. -biotics offers the first probiotics. Which are both certified organic end? Hypo allergenic I'll probiotics are produced in Germany. Under laboratory conditions with high quality ingredients and under strict regulatory oversight the three available formulas are created for very specific purposes such as strengthening the immune system fighting east infections and helping with weight loss to learn more about Kaya -biotics probiotics and the important topic of Gut. Health you can visit their website. Kaya -BIOTICS DOT COM that's K. A. Y. A. -biotics dot com. Use the discount code people for ten dollars off your first purchase. Welcome back to the People's pharmacy. I'm Joe Graydon and I'm Terry Graydon. The People's pharmacy is brought to you in part by Verizon A- An analytical laboratory providing home health tests for hormones gut health and the microbiome online at V. E. R. I S. A. Dot Com and by Coco via maker of high potency cocoa flannel supplements that support cognitive in cardiovascular health more information at Koko via dot com. Today we have an expert on the phone to give you a live corona virus update and answer your questions to practice appropriate physical distancing. We're taking your questions by email and that email is radio at people's pharmacy. Dot Com or guest is Dr David Weber. He is professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina. School of Medicine. He's also professor of epidemiology at the killing school of Global Public Health and medical director of UNC hospitals departments of hospital epidemiology. Dr Webber is Associate Chief Medical Officer of UNC healthcare. Dr Webber can people without symptoms actually. Spread the virus. So there's no question that individuals can be be symptomatic that has become infected without any symptoms. Now obviously those people by definition not coughing sneezing So their infectivity is probably much much less. And we don't actually know to what degree such people can transmit. It may occur but it's probably much less important than those who are more symptomatic and coughing detector Weber. Tom In Buffalo New York would like to know if you become infected at Let's say noon on a Monday. How long is it before you become infectious to others? And how long after that infection before you exhibit symptoms so we do know quite a bit about the timeline? We know the incubation period from infection symptoms can range. It's CL- as quickly as two days up to about fourteen days on average. It's about Seven days and we do know that people have a very high their highest viral loads and therefore they're most infectious when the symptoms. I begin we have a question from Alan in Dallas Texas. How does a person who tested positive no when they are no longer contagious and can safely be around others so the guidance from the Senate's for Disease Control? Is You are no longer contagious. After seven days from your onset of symptoms plus at least three days A symptomatic which they don't actually define no symtas but dramatically reduce cough no fever Off of any drugs that suppress fever like tylenol and feeling better. Now this is very similar. Question is from Jan. She says our granddaughters are now home from college. If they have self quarantined for fourteen days at home except for going to the grocery and walking outside. Is it safe to have them? Come into our home alternately. Could we meet in the backyard? We are seniors with lung problems so if they've had no symptoms in fourteen days and realizing there would be some very tiny risk that they would have acquired it while they were out shopping. The answer is yes they would be felt to be not have become infected and it would be safe to have contact again. Physical distancing Is Important in all cases and if one wanted to be absolutely sure certainly. Outside and physical distancing would eliminate even the slightest chance of infection. Dr Webber. I'm really glad that you use the term physical distancing instead of social distancing. Can you explain why you now using that term certainly because what protects you being six feet or more apart we want people to be socially interactive we want them to communicate on telephones by Snapchat By A COMPUTER. We want them to be supportive of each other. It's very hard and a very stressful time. Everyone we don't want people to social distance. What really is physical distance? Dr Webber we have an email question from Charlene in Orlando. She says my daughter was taken to the hospital. Two weeks ago with cove nineteen symptoms. She was not tested because she had no recent international travel she had been on a plane flying from or Landau to New Orleans to Philadelphia. And all of those places have confirmed cases through testing. The question is how long is the virus detectable so in people The virus can be detected using a nasal fringe swab. The way we do. A little thin swab goes to the back of through the nose to the back of the throat and viruses most detectable Through the PR test from the time of symptoms for about a week after that it often is undetectable in many people. The sicker you are the longer you generally have detectable virus. There's obviously there's been a lot of controversy about the tests because we were very slow to roll tests out Tom in Charlotte wants to know if the US could have used the W. H. O. Published Test Protocol. So I'm not specifically familiar with that the issue here for the testing. You're absolutely right. The tests have come online. I'm what slowly than we would like. And we even today have less testing ability than we would like and the major impact of that is the numbers we've talked about the greater than one hundred thousand maybe an undercount because of not testing the outpatients who have mild mild illness So that is the major impact of that. We so far have really had enough test to test. All the people generally who are sick enough to come into the hospital and require care. Lewis wants to know if a person recovers from Cova. Nineteen will he or she be completely or partially immune from reinfection and for how long so the best evidence suggests that in fact you would have a partial or complete protection for months to a two years with that based on Sars and mergers and I should say very importantly for those people There are now studies underway looking at convalescent serum for those who are twenty one days since proven illness taking their bodies which protected them and allow them to recover and then giving those two people who are now critically ill. Those studies are underway. That type of passive transfer of antibodies has been shown to work for other diseases. Such is Bola. Can someone transmit the virus after they recover a and you know? How long would they be? Contagious we keep getting that question. So again the virus drops off fairly rapidly and people who are recovering and as we've said Seven days since onset of symptoms and three days since the dramatic decrease of symptoms for the great majority of people. The virus will no longer be there. And you would no longer be contagious. The sick of people who are in the hospital and have severe pneumonia. They may have prolonged virus for Till they they get before they become a symptomatic. We're not aware in this disease that there's any chronic carrier state so once you've recovered Then you don't carry the virus for weeks or months like we would carry some other viruses. That's very good news. People have also asked if after you have recovered if you are then immune to catching it again. That's are certainly in the short term of that is Almost certainly The case we have a question from Sally and Ottawa County Michigan. She wants to know about physical distancing. How far away should people remain while passing others walking out side in a Wooded County Park for example. So ideally six feet. And if you're standing near so when you just read your arm out. They stretch here their arm out if your hands touch. You're probably too close but again the virus has to travel in the air and so Passing someone even if they were a little close to four feet. Outside with wind blowing would greatly diminish the risk than being indoors. And so it's a matter of how close you are how prolonged the contact is and then things like wind and other things that would disperse virus. Dr Webber. Do we have any idea why some people are more susceptible than others? And what I mean by that is we've been told that roughly eighty percent get over covert nineteen pretty quickly without too much in the way of discomfort or serious symptoms but that other twenty percent including a fair number of people who are relatively young in their twenties thirties and forties. Who Don't have some pre existing condition. Some of them have gotten really sick and some have died. What is it about their immune systems or about some other factors that we haven't figured out that. Make some people so vulnerable so we do know that Particularly age. The older you are particularly going up from age sixty makes you much more likely to develop your disease and unfortunately die. Particularly people over eighty other thing is with many other diseases underlying diseases. Such as diabetes cancer on chemotherapy and others make you at higher risk of having severe complications. But that's not to say that some young people in their teens twenties and thirties. It's just much less frequent for reasons. We don't understand can develop very severe disease and some of those unfortunately will die. Dr Webber William in Chapel Hill wants to know how to take care of yourself at home if you come down with symptoms and you're you know you're sick but you're not so sick that you need medical attention the question is should you. Should you take and saids? Should you take tylenol? Can you take both? What do you do for cough and what about asthma patients? So I let me say yes that we do believe people who have underlying lung disease such as asthma or chronic obstructive pulmonary disease will be more likely this is a respiratory infection to have more severe side effects in terms of taking care of yourself. There's no specific therapy That we know of. So it's a drink plenty of fluids. Rest as much as you can Some people have nausea and vomiting but that's uncommon so eat reasonably Certainly if you're having a high fever over one hundred and two and certainly reasonable to take Either tylenol or end sense if the tylenol or the end set itself isn't working. Stay within the recommended dose for your age or weight And you can alternate The two Medications they're over the counter. Cough medicines Certainly may help relieve the coffin. Decongestions may help there but most importantly if you're having trouble keeping fluids down high fevers particularly if you have underlying diseases Then you need to call your healthcare provider and certainly. If you're very ill jude call nine one one but informed them that you might have coated so that they could take all the proper precautions for their safety. Amy Asks what can we do to mitigate the site Oh kind storm and we will ask you what that is that seems to be. The lethal part of the infection can vitamin C help. Where do you stand with elderberry? So obviously some nontraditional treatments. There have been some hospitals in New York that are I think injecting people intravenously with high doses of Vitamin C. It's been said that they've done that. In China I don't know if there is any scientific evidence to support that but I what is the site. Oh kind storm. So part of the body's reaction to any infection is we release these immune mediators that help us fight infection but they also at times can damage the lungs and the other organs and this is one of the reasons that we felt that young people had higher mortality in the nineteen eighteen seventeen eighteen influenza from the site of kinds You know there are things that could be used in the hospital such as steroids that blunt that response but actually steroids are likely to increase the risk. So we really don't have any good way of blunting that response now in terms of other things such as vitamin C. Zinc. There's not any specific data aware up yet about Cova but for other viral respiratory illnesses. Particularly helping you fight off a mild infection. There is evidence that vitamin C within a reasonable amounts and think when used appropriately can help mitigate some of those symptoms elderberry. I'm not aware of Any activity in this regard But it may maybe present to. I'm just not aware of that drunk. We have seen some absolutely fascinating videos from an organization called Med cram. Med C. R. A. M. dot com. And they've talked about the role of zinc against covert nineteen. And that's what they suggest that the hydroxy chloride win. Malaria drug actually helps zinc. Get into the nucleus of the cell into the cell itself where it can actually exhibit some antiviral activity. So that's in-vitro do. We have any evidence that this drug could work in. Vivo that is to say in people. The pilot studies have been mixed re have produced mixed results. It seems that The enthusiasm might have been a little overstated in those press conferences last week so Chloroquine is active against many viruses and the test tube hydroxy chloroquine a little less active in the test tube there have been studies of Chloroquine for other viral diseases like Dengi And flew and it is not proved to be successful for the other viral diseases. There's at least one. Viral disease took a younger fever for which Clark van actually seemed to make people worth so there are many trials on on going in the United States. There are trials and China. Obviously they're still pending and we do have to be aware that the drug does have some cardiac toxicity It can also cause problems From the nervous system and people with underlying diseases such as Gaon Beret and others So we have to use it cautiously proper doses and the trials will tell us in fact If it works probably I would guess. Within the next month to three months we'll have trials being published That are properly controlled and give us good data and that's also true for the antiviral remnants severe which is being tested around the world as we speak and the difference. Desa VIR is in the test tube. At least it is highly active against krona viruses including SARS mergers and and cove. It This drug has not been tried for any other viruses But it certainly went as high hopes that this drug might work. It's available on a number of trials and compassionate plea from the manufacturer But as yet no data really on well controlled trials. Philip wants to now if he's staying home and he's uncertain about whether he should call his doctor He hasn't been tested for Kovac. Nineteen what symptoms would impel him to seek emergency medical care so again. The symptoms of of this are the standard symptoms that we would expect to see with any viruses such as influenza particularly Cough fever and shortness of breath or the sort of the key coughing shortness of breath have been the two most prominent ones. Certainly people often have a runny nose sneezing so a throat. Profound fatigue And Myalgia muscle aches again. These could all be Just regular influenza they could be the non novel Krona viruses that we see but it certainly could be a covert as well and seeking emergency. Care if you're having trouble breathing right. Yes certainly if you have very high fevers. You are not able to take down fluids. You're developing a severe shortness of breath to the point where you really can't breathe. That piddly can't eat All of those would be indications to call your provider. If you're a critically ill obviously call nine one one. You're listening to Dr David Weber Professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina. School of Medicine. He's also professor of epidemiology at the School of Global Public Health and medical director of UNC hospitals departments of hospital epidemiology. We are going to take a short short break briefly. A when we come back we're going to talk about some other potential treatments. We WanNA find out about a century old vaccine called BC. Gee why are they starting to administer this vaccine to health professionals in the Netherlands and in Australia and if the measures are taking now to limit people interacting with each other are successful at slowing the spread of Covet nineteen will it be safe to lift the restrictions. We're taking your questions about corona virus by email. You can join the conversation radio at People's Pharmacy Dot Com again. Email US radio at people's Pharmacy Dot Com. You're listening to the People's pharmacy with Joe and Terry Graydon. This people's pharmacy podcast is brought to you in part by VERIZON DOT COM VERIZON. A lab offers home health tests that allow you to monitor your hormones and health conditions. You can take control of the quantitative assessment of your health and learn about male and female hormone balance the stress. Hormone Cortisol Leaky Gut. Gluten intolerance or your gut microbiome take a more active role in trucking your health and take twenty percent off your first order of a mailing testing opportunity with the discount code. People that's P. E. O. P. L. E. All upper case to learn more go to verizon a- dot com that's the E. R. I S. A. N. A. Dot Com. Welcome back to the People's pharmacy. I'm Cheri Graydon unarmed Joe Graydon. The People's pharmacy is brought to you. In part by COCO via offering plant-based nutrients in the form of coq AU Flab Anos for brain and heart health online at Koko via dot com and by Kaya -biotics probiotic products made in Germany from certified organic ingredients K. A. Y. -biotics dot com today. The People's pharmacy is a live corona virus. Update with answers to your questions. Our guest is Dr David Weber. He is professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina School of Medicine. He's also professor epidemiology at the killings school of Global Public Health. He's medical director of UNC hospitals departments of hospital epidemiology infection prevention. Dr Webber is Associate Chief Medical Officer of UNC. Healthcare in Dr Webber. We're extremely grateful to have you joining us today. Live on the People's pharmacy and we want to put a shout out again to all of your colleagues all across the country around the world the physicians the first responders the nurses the allied health professionals the respiration therapist all of the people who are in the trenches right. Now trying to save lives. I want to ask you a little bit about B C g It's been around for a hundred years. We currently don't have a vaccine but be. Cg is a vaccine. Can you tell us what it stands for? Bcg and what it's been used for and why doctors are getting vaccinated in Australia and the Netherlands and a few other countries so B. C. J. stands for a strain of a bacteria Allied similar. But not the dentist to mycobacterium tuberculosis. The agent that causes to Burke Yellow Sus and the vaccine has been used for You know hundred years to help prevent particularly children from developing Active Burke Yellow says it is not specifically a vaccine against Kofi but it is a nonspecific stimulator of immune function and by boosting the antibodies in general and the ability of the body to fight infection. There is hope it might diminish the risk of people acquiring coated and. It's being tested now in Australia. I know among several thousand healthcare personnel. Who are on the front lines. Obviously caring for covert patients as a way of reducing their risk of acquiring cove. It now of course what we're worried about our shortages you know. Bcg is used for bladder cancer. It's incredibly effective. It's it's one of the early immuno therapies but it can be very hard to obtain and I'm worried that we you know if there are positive responses in those health health workers in Australia and the Netherlands and other countries will we be able to make enough B C G for the population and that would be a major problem to clean the United States in many parts of the world to BC. G is given to every a young child in the United States. We haven't used this vaccine in decades because our Rate of tuberculosis is so low so quickly in the United States unless we could get supplies elsewhere Least in an immediate short period of time. develop Having access to large amounts of it would be very difficult in addition And people who are immuno-compromised Such as with cancer as an example or other severe compromising conditions. Bcg occasionally can spread within the body and cause disease such as to burke yellow. So we'd have to be cautious in certain subgroups of our population. It is a live bacteria product and giving it to certain people Dr Webber other treatments that are being Tried out in various places that you are especially interested in so I think the most interesting one. We've already mentioned which is finding people who are now twenty one days Since the onset of the disease in a fully recovered Using getting their antibodies from them and injecting it into Individuals who are now a critically ill again. It's been shown to work In people with a Bola. There's certainly some hope. I know they're beginning to try this and trials in New York. Of course you have to be careful and not to transmit other diseases that are in the blood such as hepatitis. B Or Hepatitis C. But I think that's exciting. I know people have now screen many many different potential therapies for activity and the test tube against covert and there are more than thirty Potential other drugs that have been used. There are trials with some of the anti retrovirals Such a solo piano via Retana veer often combined with rival Viron. At least one trial did not show efficacy. But that's yet another set of drugs That's being looked at Dr Webber. We have a question from a listener. Who has identified herself as s? She says this may be a stupid question. I've tried to find the answers through the CDC but to no luck She says they're saying people who have the virus and show no can show no symptoms. Is it safe to have sexual relations with your spouse? You couldn't accomplish that whilst Dang six feet apart and that is certainly true again. The risk is When there is no evidence for this virus that is transmitted through sacs There is no evidence in fact that when we've had pregnant women who unfortunately become infected that it's transmitted from mother to baby again as other diseases like hepatitis. B can but however if you're within six feet of someone Particularly if they're symptomatic Then there was the chance of spread from the rest to retract from one person to another. So it's a question of distance not a question of sex Dr Webber. I am not absolutely certain about this but I think yesterday I spotted A report suggesting that mother to baby transmission In utero might be happening in some cases. We'll have to check on that and we'll put it up on our website. We do have a caller from Kerry rick. Welcome to the People's pharmacy. What is your question for Dr Webber Place? Yes I've seen the Many reports of what we should do with groceries and and Packages that come through our home and they seem to be all over the map. Can you elaborate a little bit more on that? The you know the I understand. The infection comes primarily from The proximity to other people but I've seen things that keeping your groceries in the garage for two to two weeks to to no time at all. So can you provide us a little more guidance in that area? Sure let me first say there is some good news about this virus. It has an envelope which means it's relatively easily inactivated so any. If the alcohol waterless hand products will easily inactivate this on your hands and Ten seconds soap and water removes it and any standard disinfectant to wipe Will also kill it so certainly you could. Just get a disinfectant white. If you didn't have something like that you could obviously just take some clorox and dilute it. One to one hundred those types of Chemicals disinfectants would Rapidly killed this virus so he can wipe things down if one is concerned. I know there's been a lot of concern about the transmission on on people products. I have not seen good data. How long it survives on the paper products and keep in mind detecting it with some of the molecular tests doesn't mean it's live virus and I've not seen any real studies or Epidemiologic suggestions that there is transmission through paper products. But that doesn't mean it doesn't occur when wanted to be particularly cautious. We could just wipe things down with disinfectant White Terry. You've done some research on the CDC website with regard to how to dilute bleach so it has antiviral activities. Do you remember what the formula is? Roughly speaking yes. If you have a gallon of water you put in five tablespoons of household bleach. If you have a quart of water you put in four teaspoons of household bleach and again if you don't remember that scared to check on it check the CDC website they have in they have a detailed instructions on disinfection and we have it as well on our website. Dr Webber. We have an email question from madeline she says. I am a geriatric nursing care manager going out daily to see clients in assisted living communities when. I'm allowed to go in. I have high blood pressure and I've been on lysine appro. I contacted my doctor about changing the medication. And he changed it to low certain. It's my understanding that ace inhibitors may increase ones risk of contracting. Kovic nineteen and making it more complicated. Is this correct? And she also wants to know whether that's also true of arbs. Which of course is the low certain she's currently on so this is an area of active study and it is true that the studies at China's suggested people with hypertension As we talked about with older individuals are more likely to have Complications with covert Now is it because of the hypertension or because of the drugs. We just mentioned. There is a indications that these drugs do alter the ability of the virus and how it binds to the respiratory epithelium and causes disease and it may be that both of these drugs Do enhance the ability of the virus to spread how important that is in everyone. And what Overall rolled is not entirely known. There is some evidence that They are detrimental in the sense of increasing The severity of illness with Kothe it as an epidemiologist you. I am sure have watched very carefully. The statistics from China. Wuhan in particular. You've probably been paying close attention to what's been going on. In South Korea and Japan Taiwan they seemingly have made pretty good progress against this virus. Whenever you see video of anyone in China in South Korea in Japan. Everyone has face masks on. I mean it would be. I think culturally unacceptable to go out in public in China or South Korea. These days without a facemask in the United States and in parts of Europe is culturally unacceptable to go out with a face mask on. I'm just wondering whether a face mask provides any benefit either in the transmission if somebody is sick with the Kobe nineteen virus or to protect people from catching so both the troops certainly When healthcare providers come into contact with somebody with known as suspected cove it? We do wear a face mask and it does Traumatically reduce the risk of disease by filled tink viruses out. If you're sick wearing a face mask decreases your risk of transmitting. It much like Taking tissue sneezing into the tissue and then discarding it. It's probably better to have it on to protect yourself. If you're not ill because if you give a sneeze coughed any air will escape around the sides of the of the facemask. But they are protective. Unfortunately as you know Face Max face masks have been in short supply and we would prefer Allowing people particularly if they're home not wearing face masks to the extent they can to preserve those facemask the frontline paramedics and others. Who really need them? Dr Webber we have an email question from Francis who wants to know if homemade fast face masks are of any use and there has been a a swelling of Volunteers people who are stuck at home. Want to do something to help. And who are now sewing face masks to make them available where they are So very In short supply so our homemade facemasks. Any help let me. I often start off by saying from my hospital. And all over the United States we really appreciate the public's response to helping us here at UNC and across the country people have offered facemasks Some that they have that are officially made Ones other homemade food many other things that they've done to support the people on the front lines and that's greatly appreciated but in terms of homemade face. Maths the answer is no the data suggests that just knitting a cloth mask or cutting it really actually may actually increase risks the facemask that approved and that we use a designed specifically to out a virus size particles. The cloth really doesn't have the same. The same filtering capacity and by actually getting wet and humid from the breath may actually increase the risk of infection. So we don't actually recommend that except possibly as an absolutely a last resort. I have a question from Gretchen. And Greensboro. She wants to know. Is there any evidence that high normal levels of vitamin D? Help fight off winter seasonal flu if so is a good advice to keep your vitamin D levels in high normal range and Of course we don't have any information about vitamin D against covert nineteen on the other hand the healthiest immune system. You can have presumably the better off. You're going to be overall so I think certainly in the winter it's reasonable for everyone to take a Multivitamin particularly those that have B. and C. And them for the reasons that we talked about there is really no evidence that D- as long as you are taking it with a multivitamin that pushing the level higher would help you and there are some concerns about the soluble. Vitamins A D E in K. Because if you take too high levels they accumulate in the liver and could damage the liver. Tekere Weber MINTA has a friend who is an MD Physician and wants to now. What is the advice for this person to stay as safe as possible in current practice so the first thing For any emergency department physicians and I just have so much appreciation for those people out on the front lines every single day like our paramedics providing care and with some slight We hope slight personal risk. Well the most important things are I obviously if you have any person patient who is coughing respiratory symptoms. You need to be wearing a mask Ideally Ninety five was there but certainly a mask gloves in practice good hand hygiene before and after any interaction with the person increasingly hospitals including the University of North Carolina. Many hospitals now have all of their staff. All of the patient context Wearing masks to do that sometimes we need to extend the US not one math per patient contact but extend the use and the Centers for Disease Control does have guidelines and how to how to do that so appropriate personal protective equipment. Masking the patient if they have symptoms trying to keep distance except when examining them Wearing gloves and good hand hygiene are the best ways we have for protecting oneself. Dr Webber. Can you tell us the proper technique for washing hands and using hand sanitizer? And what kind of hand sanitizer is best? So the best type of hand sanitizer is one that contains sixty to ninety percent alcohol. Most of the commercial ones often contain a monument to be nice to. And you place a drop in the center of your palm and that depends on the instructions. How much to put their and you certainly need enough to cover all the Skin Rub your palms together. Then rub the back of your hands very important. You need to into digit. Take your fingers rep in between your fingers and you need to Rub for at least ten seconds and should you leave the alcohol on your hands and let it dry or can you wipe it dry with the towel. Ideally you would leave it on your hands and let it dry and I should say soap and water is done the same way but this open to the palm Spread across the palm over back of both hands and then between the FA- fingers and again for a minimum of ten preferably fifteen seconds. Patrick wants to know what percent of the population needs to have developed immunity to reduce the risk of transmission. And is there a blood test that can tell you whether you are immune? Well I The blood tests will be coming online in the near future. And they will tell you if you had disease and therefore you are presumed immune and that can be particularly useful For those people donating some of their Sarah to help people who are critically ill but they would also know that their immune at particularly say they physicians can volunteer to see patients with a limited risk of acquiring new disease. I'm wondering if people have the blood test that reveals antibodies to the virus especially healthcare workers when they can go back to work and feel like okay. I'm protected and my patients are protected. I no longer have virus. So certainly we can get blood tests that would show that But generally the time it takes to develop positive blood test with most of the viruses is one two three weeks so it really is not going to be a very efficient way for telling when people are safe to go back. That's either based on symptoms as we talked about a week of since onset of your first symptom and at least three days with a marked reduction and no fever. You could do to repeat nasal swabs when you're A symptomatic looking for virus if those about negative twenty four hours apart Both would indicate that you no longer infectious Stewart wants to know. Can we expect the virus to move south into the southern hemisphere this spring and then back north again in in the fall? What differentiates viruses that are seasonal? And those that are not so respiratory viruses tend to be seasonal and we see them in our winter and if you go to the southern hemisphere like South Africa or Australia. They see them in their winter. Which of course is our summer and there are several reasons respiratory viruses peak in the Winter months in both hemispheres. One is where more closely endorse because of the cold? So we have more exposure to We heat our houses which dries out. Our mucous membranes may make us more susceptible plus we tend to have In the colder weather low temperatures and low humidity and the viruses survive. Better in the air and in fact. If you're on the equator you don't have those peaks they just see those viruses throughout the year. And yes I do expect that there will be a peak of of covert and the Southern Hemisphere and our summer their winter. And yes I suspect. Most likely we will see another peak here and the viral season and the next Fall Winter Dr Webber. There have been a lot of conspiracy theories that somehow this virus is man made that That the Chinese military might have been somehow involved in that process and the Chinese have said no no. It's the American Military Industrial Complex. That was involved. Can you straighten us out on those conspiracy theories place? Yeah first of all. None of them are true. Covert as did SARS and Moore's Evolved from bats. These are bat viruses not entirely clear complex. Why bath can carry so many viruses if you know. They carry rabies and other viruses There and then they've occasionally Over hundreds of years thousands of years some of these bat corona viruses leach over into humans And then we get pandemics Like we had with SARS and now we have with coasted sector Weber Iona says I received a B C g vaccination as a baby in an experimental program at the cradle in Chicago in the nineteen fifties because of this. I tested positive for TB as a kid whenever the skin tests. Were ADMINISTERED IN SCHOOL. Would that early vaccination help mitigate the effects of Kovic nineteen if I got it? The answer is probably not you certainly have By virtue having a positive skin test you have some immunity to mycobacterium tuberculosis. The bacteria that causes tuberculosis but the feeling BC G. is that it gives you this big nonspecific immune response in the weeks to maybe a few months after you have it Having had it as a child that immune responses long since diminished. And it's unlikely to be protecting you against Cosette. There has been words that the Cuban Medical Society has somehow created a Alpha to be recombinant interferon and they are administering it in various countries. I think possibly even in Italy do we have any sense at all whether a a immune modulating compounds such as this Interferon Alpha two B recumbent might be helpful so the answer is Yes it is possible that the use of Interferon might work. they Obviously increase the much like DC g the ability of the body to fight infections although in clinical treatments with interferon for SARS and Moore's they did not decrease mortality or decrease time to Viral resistance. So we don't have evidence from other corona viruses that interference work but again This is a different Corona virus and I think until we have a proven therapy We should consider all of these possibilities for clinical trials. Dr Webber Philip in Wells. Berg West Virginia says several years ago. I was hospitalized for five days with Numa sisters pneumonia. I had completed six rounds of Chemo. In two years of biologic for Lymphoma he understands that having had pneumonia once he's more susceptible and he's wondering whether in addition to washing his hands and keeping his distance Aerobic exercise or using one of those devices they have in the hospital where the patient inhales at a controlled rate to increase lung capacity would help protect the lungs so it's certainly true people with underlying diseases such as types of cancer at higher risk and it is also true that to the extent you live a healthy lifestyle. Don't smoke exercise right appropriate Diet all of those decrease your of acquiring Any of many infectious diseases. And I certainly recommend all of these for healthy life style tekere Weber. People have found a lot of stuff on the Internet. Some of it is excellent information and some of it is not at. Do you have any advice for people on how to sort the wheat from the chaff? Yes I think. The best websites are of course your local county and state health department websites. The Centers for Disease Control has an excellent website. And I think many many Academic universities including the University of North Carolina Johns Hopkins Many of those academic centers have excellent websites. That provide a wonderful information. And I would recommend going to those websites. Is there any additional advice that we should offer our listeners? Know I think what we need to do is be supportive of each other. The United States will pull together. We'll get through this. We need to minimize the effects of distancing on people who are older And have contact and we do need to have social interactions. Anything we can do to support our frontline. Personnel are critical in the long run. Obviously this is We will get through this pandemic. We'll be pandemics in the future. And so we need the federal government and the All of us need to support the infrastructure for us to fight the next pandemic by adequately training people in infection prevention and physicians and nurses in this and supporting the critical public health infrastructure. That will allow us to sex sexually. Fight this epidemic and the next one Dr Webber. We are almost out of time a very briefly. Your Crystal Ball what you anticipate over the next couple of weeks in the United States and around the world so I think that we will see increasing cases. for somewhere between two and eight weeks hopefully we will speak with our Physical distance thing and the cases will drop off. I suspect that. Different places. We'll have different hot spots and we'll have different peaks New York. I will have an earlier peak then probably Detroit. I think other hotspots will develop We need to keep in mind. That deaths will lag behind cases by about two weeks. So when the cases even though the cases start coming down unfortunately depths will increase the physical distancing will have two effects one is it will lower the number of people infected and just as important it will spread out the infection so instead of having the sharp peak over just a few weeks maybe over a a number of weeks this will allow us not to overtax hospital so everyone needs care Could be cared for in the hospitals. I worry about a second wave like we saw in nineteen seventeen eighteen with another wave and we need to be prepared for it when we have viral respiratory season. Coming up in the. Let's hope we have a vaccine by then and that is all the time we have today. Thank you for listening special. Thanks to our guest. Today Dr David Weber. He is professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina School of Medicine. He's also professor of epidemiology at the Giggling School of Global Public Health Medical Director of UNC hospitals departments of hospital epidemiology infection prevention. Dr Webber is Associate Chief Medical Officer of UNC. Healthcare Vince seagal produced. Today's show special. Thanks to our. Dr Ski who engineered. People's pharmacy is produced at the studios of North Carolina Public Radio W. UNC. There's a lot that we still don't know but if you'd like to learn more you can visit our website at people's pharmacy. Dot Com in Durham North Carolina. I'm Joe Graydon and I'm Terry Graydon. Thank you so much for listening to join us again next week. Thank you for listening to the People's pharmacy. Podcast it's an honor and a pleasure to bring you our award winning program weekend and week out but producing and distributing. This show is a free. Podcast takes time and costs money if you like what we do and you'd like to help us. 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