Covid-19 proliferates freely across the region. The more people with whom you come in contact, the greater likelihood you will contract it. Your age, health and genetics will dictate whether you get sick, end up hospitalized or die.
You also may need to reconsider your Easter plans.
These are the conclusions at this point from Dr. Thomas A. Russo, chief of the Division of Infectious Diseases in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
The number of people impacted regionally will grow in the weeks to come, he said.
"Of those who are symptomatic based on data to date, about 80%, maybe 85%, have less serious disease that does not require hospitalization; about 15% require hospital treatment; and about 5% become critically ill, said Russo, who also works at the VA Medical Center in Buffalo, where at least four patients were on ventilators with Covid-19 late last week.
He talked with The Buffalo News about the dangers of the novel coronavirus and the mysteries that cloud saving the sickest of its victims. Below are excerpts.
Dr. Thomas Russo, professor and chief of infectious diseases in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. (Photo courtesy of UB)
Q: What are the symptoms?
Someone could be minimally symptomatic, which could be some combination of fever, rhinitis (stuffiness and runny nose), sore throat. They could have a mild cough, more of an upper respiratory tract infection. Loss of taste or smell were first anecdotally recognized in England and are being increasingly described. I certainly think those are symptoms that someone could develop early on as well.
Q: Are these symptoms emblematic of other conditions, too?
Flu and other respiratory viruses can mimic them. Right now, we still have circulating Influenza A, Influenza B, and some parainfluenzas (respiratory viruses that differ from the flu) around. In the absence of a diagnostic test, it's very difficult to be absolutely sure. Flu is on the downswing right now. Because coronavirus is starting to become the dominant virus in Western New York, its more likely to be coronavirus.
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Q: Do epidemiologists have a sense about how often people are asymptomatic?
That is part of the problem. Right now, the kits we use to test the RNA of the virus, the genetic footprint, arent being used on people that are asymptomatic. We're saving our tests for the most part for people with symptoms that are critically ill, so the tests are not a good tool to gauge what proportion of the population is asymptomatic.
People can be asymptomatic and be infected and able to spread the virus.
Q: Why does the disease progress in some people and not others?
The biology depends on our genetics and probably how much of the virus we get. If someone gets a huge dose of the virus, it may be such that the hosts defenses which are imperfect because we've never seen this virus before may be overwhelmed. If you get a lower dose, combined with the genetics, you may hopefully have a milder course. Everyone can be a little different.
Greater exposure to the coronavirus almost certainly raises your risk of infection and may boost the chance you will get sicker.
Q: How do you get a small dose versus a big dose?
The people who are going to be at risk for a large dose are those in close contact with someone whos infected with coughing and sneezing for prolonged periods of time. They're constantly going to be shedding virus. If you're in contact with multiple individuals, you may get sort of multiple repeat doses over time. Whether that's better or worse than with one person who is sick, who knows?
Q: What symptoms tend to first appear?
I'm not aware of any pecking order. I can tell you through years of experience in infectious diseases that were all different in terms of how we present which symptoms, what combination of symptoms, how severe. We're obviously seeing that with the new coronavirus as well.
Q: When is it time to get medical help?
Present recommendations are that if you develop an upper respiratory tract infection, even with a fever or cough, you're going to feel a little bit miserable but not critically ill. It's OK to touch base with your primary care physician. You should sort of isolate yourself at that point. The critical tell is always shortness of breath, which suggests you're developing pneumonia. That's the complication that we're concerned about. If pneumonia becomes extensive, you have problems with oxygen exchange and as that difficulty increases, that's when you end up on a ventilator.
Q: Is there anything to beat this back once you start to notice that your taste or sense of smellhas left you and that you're starting to develop other symptoms?
Using Star Trek terminology, our shields are completely down. With the flu, even if we've had a bad match in the vaccine, we've still got 30-40% of our shields. We've also got Tamiflu, which we know can both prevent disease and shorten symptoms. But so far for this new coronavirus, we have no drugs. We have no vaccine. We're all susceptible.
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Q: Who is most at risk in Western New York?
The vulnerable population with underlying cardiac disease, underlying pulmonary disease, underlying immunocompromised states due to certain cancers or drugs they may be on. Diabetes and hypertension have also been associated. It certainly makes sense that if you're a smoker, you're going to be an increased risk.
We think probably people that are older are still at increased risk, even if they don't have any comorbidities, but it seems the comorbidities are a little bit more important. I'd probably rather be a 70-year-old with no comorbidities than a 60-year-old with bad lungs and heart. The relative risk we're still sorting out. And even though younger adults and children are in terms of a bad consequences relatively spared, with significantly less risk, they're not absolutely bulletproof.
Q: Who should limit contact with others right now and what should be the threshold?
The smaller the number, the better. As the number increases, you're increasing your likelihood of getting infected, and that likelihood increases as the prevalence of infection in our community increases, which is happening right now. It's a mathematical thing. If the prevalence is increased tenfold, then it takes tenfold less people to potentially be exposed. We need to button down with our social distancing more than ever to cut the prevalence.
Q: What about big celebrations like Easter?
A common question Im getting is, I want to have a small group gathering for Easter, can I do it safely? The answer is no, you cant do so with 100% certainty. Theres the whole asymptomatic issue, which makes it impossible to be sure that you are not infected.
Both parties need to be quarantined for 14 days, not previously infected. It has to be rigorous. It can't be you running out to work, running out to Wegmans. You really can't have that contact with anyone. And as long asyou follow that and both parties are fine at the end of 14 days, then when you get together you want to really practice modified social distancing. No kissing, hugging, sharing any sort of foods and utensils, anything where there could be sort of transference of saliva or respiratory secretions. Maintain rigorous hand hygiene, especially after contacting high-touch areas such as phones, refrigerator door handles, TV remotes, etc. You're gonna minimize risk, but you can't drive it to zero.
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