UVU College of Science COVID-19 Faq

Living through an emerging infectious disease and worldwide pandemic can be a stressful and difficult time for many people. There is currently a lot of misinformation regarding the ongoing coronavirus pandemic circulating on social media and other internet outlets. When making decisions that affect you, your family, and your community it is important to get information from reliable sources based on strong scientific and medical research. Below are answers to some commonly asked questions from the public which reflect the current scientific knowledge. 

Information throughout the pandemic has changed over time and some scientists even seem to have changed their view. How can I trust information if it is always changing?

It is important to realize that in the scientific world, new data builds on past data. Sometimes the new data supports past information, but sometimes it does not. Scientific information, and guidelines based on that scientific information, are revised over time as we learn more about a situation. This means a single article or report about a scientific experiment is not enough to make an absolute conclusion. One article may suggest a particular conclusion and lead to additional studies, but data from multiple studies and reports must be used to draw strong conclusions.

We have seen this iterative process of science in real time during the pandemic. For example, the WHO and CDC initially advised against wearing masks. At that point in the pandemic we did not have the data that later indicated a large number of people without symptoms were infectious to others. The original no mask recommendation was to prevent the public from hording masks needed for medical professionals. However, as more studies were done, we gained more data about this pandemic. The data showed people are contagious for multiple days before having symptoms, and some never showed symptoms. Based on this new data, the advice to stay home if you have symptoms is no longer useful. Instead the guidelines had to be revised to take into account that people who feel healthy might be infectious. To prevent them from spreading the virus, guidelines were changed to recommend masks. This should not be thought of as scientists not being able to make up their minds. Instead this illustrates the true process of science.

 

What is a novel coronavirus and why are there so many different names (coronavirus, COVID-19, SARS-CoV-2) associated with this pandemic?

Coronaviruses are a family of viruses that are known to cause disease in both animals and in humans. There are seven known coronaviruses that cause respiratory symptoms in humans. Four of them cause standard common-cold like diseases, while the other three are examples of novel, or new, coronaviruses. Novel coronaviruses are of concern because they cause much more severe disease. They are called novel coronaviruses because humans have never been exposed to them before. These viruses were normally found in animals but are able to jump into humans if they come into contact with the infected animal host. The three novel coronaviruses are SARS CoV, which emerged around the world in 2003, MERS CoV, which appeared in 2012, and the current pandemic coronavirus SARS CoV-2. SARS-CoV-2 is the name of the virus itself, while the disease the virus causes is called coronavirus infectious disease 2019 or COVID-19.

What do we know about the biology of the novel SARS CoV-2 virus?

All viruses are acellular obligate parasites that are not able to generate their own energy or grow on their own. Instead, human viruses must enter a human cell and use our own cellular machinery and energy to replicate. To do this, the viral genome is protected by a protein shell (called a protein coat), and sometimes a lipid membrane, that delivers the genome to the inside of our cells. Specific proteins are found on the outside of the viral particle, for coronaviruses these are called spike proteins. These proteins allow the virus to attach to the cell it is going to infect using molecules on the surface of our cells, much like a lock and key. Viruses can only get into a cell if they have the right “key” for the “locks” on that cell.

The SARS CoV-2 virus contains a ribonucleic acid, or RNA, genome that is surrounded by a protein coat and additional layer called the viral envelop. The viral envelop is a lipid layer similar to the cell membrane of your human cells. This viral envelop is key to our ability to destroy the viral particle and prevent infection. Similarly to how soap will dissolve cooking grease, the lipid envelop can also be dissolved with soap or destroyed by disinfectants. Destruction of the viral envelop prevents the virus from entering human cells. The viral spike protein sticks out of this viral envelop and is easily observed when the virus is viewed using an electron microscope. The SARS CoV-2 spike proteins bind to our human ACE2 receptor molecules. These receptors are found on cells that line our respiratory tract, which is what allows the virus to infect those cells and cause respiratory disease. However, these ACE2 receptors are also found on other cells, such as cardiac and nerve cells, which explains why the virus can cause so many other symptoms in severe cases.1

If you want to learn more about the biology of the virus you can go to this article:

https://www.scientificamerican.com/article/a-visual-guide-to-the-sars-cov-2-coronavirus/

 

How is the virus spread from person-to-person?

The data indicate that the main transmission mechanism for this novel coronavirus is through droplet and micro-droplet transmission. Viral particles are trapped in respiratory droplets that a person produces when they talk, cough, or sneeze. These respiratory droplets do not typically circulate through the air. Instead they travel up to about 6 feet from the person who exhaled them. The droplets then drop out of the air and settle on surfaces with micro-droplets being suspended for a short time in the air. While in the air, these droplets can be inhaled into the mouth or nose of others, causing them to be infected.

A secondary way the virus spreads is through surface contact. Once those respiratory droplets land on a surface they remain viable for up to 72 hours depending on the material the surface is made of. The virus is more stable on surfaces made of stainless steel or plastic as compared to cardboard.2 If a person touches the contaminated surface, and then touches their mouth, nose, or eyes, they can transfer the virus from the surface to their body, becoming infected.

There is limited evidence that the virus may be spread through methods more similar to airborne transmission where micro-droplets containing the virus do not fall out of the air within 6 feet, but instead remains circulating in the air of a building for longer periods of time. However, the data on this in not as clear as droplet transmission. This type of airborne transmission is likely only of importance if someone spends multiple hours in a closed space without proper precautions against transmission.3

 

What steps can be taken to protect myself and prevent the spread of coronavirus in our community?

The key to protecting yourself and those around you from an infectious disease is to think about how the pathogen is spread, and then consider what you can to do interfere with those mechanisms. In epidemiology this is called breaking the “chain of transmission”. Because the main mechanism of transmission is through the airborne droplets you want to avoid spreading droplets yourself and being exposed to droplets of others. This can be accomplished by

  • Avoid Close Contact (Social Distancing) - Stay 6 feet (or about two arms lengths) away from people who are not part of your household. Remember airborne droplets don’t typically travel more than 6 feet from an infected person.
  • Wear a Mask – Everyone should wear a cloth or disposable mask in public settings around people who do not live in your household. This is especially important in scenarios where it is harder to maintain social distancing. The purpose of the mask is to keep your respiratory droplets to yourself. This is especially important because data indicate that infected people who are not showing symptoms of COVID-19 are still able to pass the virus to others.
  • Cover Coughs and Sneezes – Always cover your mouth and nose with a tissue or use the inside of your elbow to block the spread of your respiratory droplets to others. Also avoid spitting in public. Masks can also help contain these droplets.

To prevent protect yourself from viral particles that may have settled on surfaces you will want to:

  • Clean and Disinfect – Wipe down frequently touched surfaces such as doorknobs and countertops with disinfectant. Suggested disinfectants are 5-6% sodium hypochlorite (bleach), 60-80% ethanol solutions, or other standard commercial disinfectants such as Lysol. Be sure to clean surfaces with detergent and water prior to disinfection if they are dirty. The disinfectant must come into contact with the surface and remain on the surface for at least a minute in order to destroy pathogens. If cleaning electronics follow manufacturer instructions or use alcohol-based wipes if there are no guidelines from the manufacturer.
  • Wash Your Hands – Everyone should wash your hands often with soap and water for at least 20 seconds. You should especially do this every time you come home, after handling your mask, and after blowing your nose, coughing, or sneezing.
  • Avoid Touching Your Face – If you come into contact with the SARS CoV-2 virus on a surface, the virus will be transferred to your hands. However, to be infected it must enter through your nose, mouth, or sometimes eyes. Be aware of where your hands are and avoid touching your face, especially after handling items in public spaces.

 

Why are people being required to wear a mask? Do we know if masks really work?

Multiple studies have shown that masks limit the droplets expelled from the wearer. There have been multiple epidemiological studies that show a statistically significant decrease in the transmission rate of COVID-19 in communities before and after they mandate masks. By limiting droplet expulsion, masks limit the number of viral particles that are leaving an infected person to be spread to someone else.4 This is especially important with COVID-19 because data show that some people who are asymptomatic (infected but never show symptoms) or  pre-symptomatic (infected but not showing symptoms yet) are able shed virus when they talk. It is important to remember that someone’s mask is not preventing them from picking up the virus, but is preventing them from spreading the virus to you. Mask mandates ensure that all members of a community take responsibility for keeping that community healthy. In fact, one report in the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention identified 139 clients who were exposed to two symptomatic hair stylists but no secondary cases were reported. Both clients and stylists wore masks, helping to prevent an outbreak from occurring in their client population.5

You can read more about the importance of masks in reducing transmission in the article below.

https://science.sciencemag.org/content/368/6498/1422

 

What is involved with coronavirus testing and why is testing important?

The presence of the SARS CoV-2 coronavirus is detected using a technique called real-time reverse transcriptase polymerase chain reaction or qRT-PCR for short. This is a technique that allows a lab to measure the amount of viral genome in a sample. A sample is taken from an individual by swabbing the back of the nose/throat where the swab is able to pick up cells of the respiratory tract. If those cells are infected with virus, the viral genome will be detected by qRT-PCR indicating the person is infected with SARS CoV-2 coronavirus and has COVID-19. The qRT-PCR test is also able to measure the amount of the viral genome present. This is important because the more viral particles an individual contains, the higher the chance they are spreading the virus into the air when they talk or cough.

The other coronavirus test is called a serology test or an antibody test. This test is not used to determine if you are currently infected with the coronavirus. Instead, it is measuring if you had been infected previously. Antibodies are small protective proteins that your immune system produces in response to a specific pathogen. They help the body recognize and combat that pathogen and then remain in your body to help prevent you from getting reinfected. The presence of antibodies in your blood indicates your immune system has previously seen the pathogen, so you had been infected in the past. The circulating antibodies are also important for protecting you in the future. There is still much to learn about how protective and long-lasting SARS CoV-2 antibodies are, and this is an important area of research as we work to develop a protective vaccine against the disease.

Testing for SARS CoV-2 is extremely important for controlling the pandemic when a treatment or vaccine are unavailable. It allows public health officials to isolate those who are infected and reach out to their close contacts to determine if the infected individual passed the virus to them.  These processes of quarantine and contact tracing are hallmarks of a public health response but they cannot occur without the identification of infected individuals through testing. Many research groups are developing additional coronavirus diagnostics to try and improve testing capabilities and slow the spread of the pandemic. If you would like to learn more about this research, you can read the article below.

https://www.nature.com/articles/d41586-020-02140-8

 

 

Is there a vaccine against this novel coronavirus?

Unfortunately, a vaccine for SARS CoV-2 is not available. However, there is currently an unprecedented global effort by scientists to develop a vaccine. There are currently dozens of vaccine candidates being tested for SARS CoV-2 several of which have entered Phase III testing, the final phase before release to the public.6,7 While the need for a vaccine is great, it is also important to ensure any vaccine is safe and effective before release to the public. That is the purpose of clinical trials. Phase I and Phase II clinical trials are smaller scale studies meant to test safety of the vaccine, determine how it is processed in the body, and what dose is best to give. The vaccine candidates entering larger Phase III trials have already been shown to be safe based on these earlier clinical trials and this phase will test how effective the vaccine candidate is against SARS CoV-2.

You can read more about the effort to develop a vaccine here

https://www.nature.com/articles/d41587-020-00005-z

 

Are there any medications for treating COVID-19? What about steroids or hydroxychloroquine?

Currently, no medication has been consistently shown to be effective in treating COVID-19. There have been a few small non-randomized studies that have suggested that hydroxychloroquine is an effective treatment. However, there are concerns about how those studies were done. The most reliable studies to test drug treatments are randomized, double-blind clinical trials. In these studies, people are randomly assigned to get the drug or get a placebo, and neither the study subject or the doctor knows which they are getting. Several recent studies with double-blind randomization have shown no benefit for hydroxychloroquine.8,9 A recent study in non-human primates also found that hydroxychloroquine failed to prevent infection by SARS CoV-2 and no differences in virus levels were seen. 10

Additionally, hydroxychloroquine is not without risks. The drug can cause cardiac and neurological symptoms, and cardiac distress is more common when the drug is used with azithromycin, an antibiotic commonly suggested for use with hydroxychloroquine for COVID-19. In fact, combining hydroxychloroquine with azithromycin is strongly discouraged due to the risk increased of heart failure.11  It is possible that hydroxychloroquine might have a very modest benefit for treating COVID-19; however, it is not a cure and the potential for modest benefits is far outweighed by the risks of taking the medication.

The evidence for steroid use is still developing and it is not clear how useful they will be. Although some initial studies suggest that methylprednisolone and dexamethasone might reduce the death rate in those on ventilators or receiving supplemental oxygen, no effect was seen in patients who did not require supplemental oxygen. 12 These initial results are promising; however, additional work is needed to confirm these findings, and this would only help in the most severe cases. Preventing infection with SARS CoV-2 is the best option we currently have until a vaccine is ready or therapeutic drug is found.

You can read more about the evidence for steroid use in the article below.

https://www.sciencemag.org/news/2020/06/cheap-steroid-first-drug-shown-reduce-death-covid-19-patients

 

I’ve heard that the novel coronavirus is no different than the seasonal flu. Is that true and if so why do we need to take all these precautions?

This is not correct. Although seasonal influenza infections are serious, SARS CoV-2 is more so. Last year, seasonal influenza infections were associated with 16.5 million cases of influenza, 490,600 hospitalizations and 34,200 deaths.13  So far, SARS CoV-2 has infected over 4.6 million people and caused more than 160,000 deaths as of August 5th, 2020. Additionally, SARS CoV-2 has been associated with long-term health complications including stroke and neurological symptoms. As SARS CoV-2 is still a new virus causing a new disease, we do not know all of the long-term impacts, but both SARS CoV-1 and MERS CoV cause long-term health issues in those who had the respective viruses.

To learn more about the long-term impacts of SARS CoV-2 infection read the article below:

https://theconversation.com/heres-what-we-know-so-far-about-the-long-term-symptoms-of-covid-19-142722

To learn more about how the SARS CoV-2 virus compares to influenza read the article below:

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30484-9/fulltext

 

I see the number of new cases and hospital infections being reported daily. Why is this information important and what does it tell us about the pandemic?

These numbers are important as they help us understand how well the measures we have taken are working. The total number of new cases help us understand how well we are slowing the spread of SARS CoV-2. If public health measures such as mask wearing are successful, the number of new cases each day should decrease as the virus spreads to fewer people. The total number of hospitalizations can tell us how susceptible a population is to the virus. They are also important because if the hospital system is overwhelmed with patients, they will not have the resources to treat people to the best of their ability.  We can also learn how well medical treatments are working based on the number of deaths. However, due to the incubation period for SARS CoV-2, numbers reported today would reflect efforts from several weeks prior. This delay is one of the more challenging aspects to controlling this virus compared to other viruses, such as seasonal influenza viruses which have a 2-day incubation period.14

 

References

  1. Ortiz-Prado, E. et al. Clinical, molecular, and epidemiological characterization of the SARS-CoV-2 virus and the Coronavirus Disease 2019 (COVID-19), a comprehensive literature review. Diagn Microbiol Infect Dis 98, 115094 (2020).
  2. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 | NEJM. https://www.nejm.org/doi/full/10.1056/NEJMc2004973.
  3. Prather, K. A., Wang, C. C. & Schooley, R. T. Reducing transmission of SARS-CoV-2. Science 368, 1422–1424 (2020).
  4. Howard, J., Huang, A., Li, Z., Tufekci, Z. & Vladimir, Z. Face Masks Against COVID-19: An Evidence Review. 8.
  5. Hendrix, M. J. Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020. MMWR Morb Mortal Wkly Rep 69, (2020).
  6. O’Callaghan, K. P., Blatz, A. M. & Offit, P. A. Developing a SARS-CoV-2 Vaccine at Warp Speed. JAMA 324, 437–438 (2020).
  7. Hodgson, J. The pandemic pipeline. Nature Biotechnology 38, 523–532 (2020).
  8. Cavalcanti, A. B. et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. New England Journal of Medicine 0, null (2020).
  9. Mitjà, O. et al. Hydroxychloroquine for Early Treatment of Adults with Mild Covid-19: A Randomized-Controlled Trial. Clin Infect Dis doi:10.1093/cid/ciaa1009.
  10. Maisonnasse, P. et al. Hydroxychloroquine use against SARS-CoV-2 infection in non-human primates. Nature 1–8 (2020) doi:10.1038/s41586-020-2558-4.
  11. Roden Dan M., Harrington Robert A., Poppas Athena & Russo Andrea M. Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment. Circulation 141, e906–e907 (2020).
  12. Veronese, N. et al. Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature. Front Med (Lausanne) 7, (2020).
  13. Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2018–2019 influenza season | CDC. https://www.cdc.gov/flu/about/burden/2018-2019.html (2020).
  14. Petersen, E. et al. Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. The Lancet Infectious Diseases 0, (2020).