Corona-virus (COVID-19) Q&A with Infectious Disease Specialist Dr. Roy Gulick

COVID-19 is the name ofa disease and a pandemic that's affecting us all here and around the world. Many people have questions about COVID-19.

What I'd like to do today is to answer some of those more common questions that people have. Knowledge is important,it helps us understand what's going on. Let's jump right in.

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What kind of virus causes COVID-19?

Is there more than onestrain of the virus?


We now know that there are several strains of the corona virus that are traveling the world. What's important to know is that these viruses are closely related to one another. In fact, they only differ from a few elements of their genetic material. That helps us to distinguish these viruses and to be able to locate them or relate them to different geographic locations, but importantly, these aren't mutations or changes that lead to a difference in the strength or so-called pathogenicity of the virus.


What are we learning about how long the virus stays alive in the air or on surfaces?


We know from recent published data that the virus that causes COVID-19 can be detected in the air or on certain surfaces such as plastic. Detection however, is not the same as being able to transmit to another person. We know that a person who's infected with COVID-19 can transmit the virus through droplets, droplets of mucus, for instance, during coughing or sneezing, or even talking. However, these droplets do not hang in the air for very long, and they aren't projected very far, perhaps only six feet or less. They quickly fall to the ground and are not at risk for transmitting to other people. More commonly would be that a person infected with the virus that causes COVID-19 touches their mouth or their eyes, or their nose, and then has a little bit of mucus with the virus on their hands, and then shakes hands with somebody else. That could transmit the virus.


What about virus found on surfaces?


It turns out that the amount of virus is greatly reduced within hours, and it's not known whether a small amount of virus two to three days later could actually set up infection in another person. Of course we have to be careful in these times. People need to be attentive about washing their hands frequently with soap and water for at least 20 seconds. Trying not to touch one's eyes, nose or mouth can also reduce the risk of exposure. If we practice these common sense ways of avoiding contact with other surfaces, that will greatly reduce our risk for acquiring COVID-19.


Does the amount of virusa person is exposed to determine how sick they'll get?


We don't actually know the answer to that question. People have suggested that the amount of virus that one becomes exposed to could trigger illness, and that perhaps people who were exposed to more illness might get sicker faster, but we really don't know that information. Are people who are asymptomatic still able to infect others? This is a question we still don't know the answer to. There's good data to suggest that there is some proportion of people who may have the virus but be completely asymptomatic. More commonly, people do get symptoms from this virus, and the most common symptoms are fever and cough.


Are people immune for a long time after they've recovered from COVID-19, such as other viral illnesses like measles or chickenpox?


What we do know is that people develop the antibody to this corona virus between two and 17 days after they've developed symptoms. What we don't know is is this antibody protective?

We know from other respiratory viral infections that once a person develops the antibody, they are relatively immune for some period of time, but we don't yet know that for this corona virus. Even if someone is immune, we don't know how long they might be immune for. It's going to take additional studies to determine that.


What are the potential treatments being investigated for COVID-19?


Today there is no proven treatment for COVID-19, but there is an enormous amount of clinical research going on trying to identify treatments that might be helpful. Some of these would be investigational antivirals. These are medications that would interfere with the virus' ability to reproduce itself. We use antivirals for other common viral infections with some success, including influenza, herpes, hepatitis C, and HIV. We don't yet have a proven antiviral medication for COVID-19, but a number of clinical trials are in progress. There are a number of immunomodulators. These are drugs that could interfere, or change the immune response, that are in clinical trials right now.


What do we know about the potential for a vaccine against the virus that causes COVID-19, and when might we have a vaccine?

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Well, the good news is there's a lot of research going on right now and just a few weeks ago, the first humans were dosed with a candidate vaccine against COVID-19. The first trials of vaccines typically want to establish that they're safe. That's really important. Then the next set of studies usually go to document that the vaccine is effective in preventing the infection in other people.


Where are we with this?


Most experts are thinking that it's going to take at least 18 months to go from the first doses, which again, were only a few weeks ago, to having an effective vaccine that might be scaled up and manufactured, and available worldwide.



Will COVID-19 go away, like SARS did, or will it be part of seasonal flues and colds?


- Well, we don't know the answer to that, and actually we don't know why SARS came, or why the original SARS went away. We really don't know that. I think most people feel that this virus that causes COVID-19 may be a recurrent virus that is a part of the seasonal infections that people get in the winter, such as other flues and colds.


So if COVID-19 does become seasonal, what can we do about it?

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And that's where the hope for an effective vaccine comes into play. It turns out that corona viruses, the viruses that cause COVID-19 and other similar illnesses, do not mutate very rapidly. That's in big contrast to influenza. That's a virus that can change itself and that leads to us needing a new vaccine every single year. What's different about the corona viruses is that they don't mutate so much, and so we may be able to find a vaccine that will be effective,and not necessarily needed to be given every single season.


What is herd immunity,and how can it help us?


Herd immunity is a term for an infection where much of the population has been exposed and has developed effective immunity to it, so you can imagine if there's population of people. Say 100 people, and 90 have acquired an infection and developed resistance or immunity to it. It's going to be very uncommon that the other 10 people would be exposed to the virus in that population. Multiply that by millions of people, and you get the same idea. If most people in a population have already had a virus and developed immunity, it protects the small number of people in that same population who are not immune to the virus. So that's the hope here. Either enough people get the infection and recover in a population, or we augment that with a vaccine that most people can take, and then you protect all of the people in that population. Because it's a new virus, essentially, and a new infection, we don't know everything about COVID-19. We're learning every day.


What are the most common presentations?..... Who will progress to more serious disease? .....What are the risk factors for serious disease?......... What are the most effective treatments for this virus?

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There are a number of unanswered questions. We're studying this here at Weill Cornell in many different ways, and trying to find answers, and we all share the goal of trying to both prevent this infectionand treat this infection in our patients.