Coronavirus Made Simple By Your Friendly Neighborhood Emergency Physician

I have been answering a bunch of questions about this virus. There is a lot of confusion, and there are a few questions that I seem to hear over and over. So, here is a simple primer.

1. Why is personal distance of 6 feet a thing? The measles virus can be spread through the air because it can literally float on the microscopic dust in the air. If you walk into a room in which someone with measles had coughed hours before, it is possible to get the measles from inhaling the floating virus. Coronavirus is primarily transmitted by droplets from the nose or mouth. When the infected person coughs or sneezes, they fire droplets from the mouth or nose that can only travel a few feet before settling out onto a surface like a floor or a counter. Standing 6 feet away minimizes the risk of being hit by those droplets. That is why N95 masks are not needed for the general public with COVID-19.

2. Why does handwashing work? If the corona infected person rubs their nose or eyes, or coughs into their hand, the virus lives in those droplets on their hands. They then touch a doorknob, TV remote or a sink nozzle and poof, the virus is now on that surface just waiting for you. You touch that doorknob or TV remote, and now it is on your hand. At this point, you are still OK! It is not until you touch your face (nose, eyes, or mouth) that you get yourself infected. The virus needs to come in contact with a mucus membrane (mouth, nose, eyes) to infect you. If you wash your hands before you touch your face with an alcohol solution or soap and water, the virus is killed, and you are safe! That is why washing your hands prevents a respiratory illness. By the way, turning on the sink with dirty hands contaminates the faucet. Once you wash your hands, turn the water off with your elbow to prevent getting the virus back on your hands.

3. Can I just use my sleeve? Using your sleeve just gives a false sense of security. You are not really protecting yourself like you may think. The virus can live in the droplets on your clothes for 48 hours. So, when you pull your contaminated sleeves up with your hands, you have now put the virus on your hand, and now you are back where you started. It is better to just wash your hands and do not touch your face.

4. Where can I get tested? Despite the repeated press conferences from the government saying that testing is readily available, it is not. Large parts of the country are still only able to test the very sickest patients. If you are healthy and are not having any severe symptoms, do not come to the ER for a test: You will not get one. I would recommend that you watch the news for when drive up testing becomes available, if you have mild symptoms or exposure to COVID-19.

5. When should I go to my doctor? The simple answer is when you can’t breathe or can’t hold down fluids. If you are having mild symptoms (fever, body aches, dry cough), stay home, and self-isolate. By going to the doctor, you risk spreading the virus to others, including us. If you go to the ER, we will see you but, if you are only having mild symptoms, you will likely be sent home with no COVID-19 test, no treatment, and a hospital bill.

6. There have been reports out of France that people that take anti-inflammatories (ibuprofen, Motrin, Midol, Aleve or Naprosyn) may have worse outcomes with COVID-19. As of 2 days ago, the World Health Organization has reviewed all of the data and released a statement that those that are using anti-inflammatories do not need to stop. While that is being studied more and the recommendation may change. As of right now, the WHO says you do not need to stop taking them. If you are concerned and don’t have liver disease or a problem with alcohol, you may use Tylenol or Acetaminophen for the aches and fever to be safe.

7. You have likely heard about chloroquine, hydroxychloroquine, azithromycin, and some HIV drugs now being used to treat COVID-19. Most of that information is irrelevant to you. If you have mild symptoms, do not ask your doctor or come to the ER to get them. While there is some evidence that these medications might help, there have not been any well-done studies yet to support their general use. These medications have NOT been cleared by the FDA for treatment and are not being commonly prescribed for mild symptoms. We have been using these drugs in the hospital on the sick and dying, but we are already low in supply. We are not going to be writing prescriptions for these medications in the mildly symptomatic, so don’t ask.

Lastly, a personal plea. Many people are stuck at home with nothing to do. While alcohol is a disinfectant of sorts, it is not going to treat COVID-19! If you are drinking, have fun, but please wear a helmet and shoulder pads so that when you fall and hit your head, you do not have to come in and see me in the ER. We already see too many alcohol-associated visits in the emergency department. In a related note, drugs will make you feel strange. If you choose to use edibles or try new things because you are idle, please don’t do drugs and come in because you feel weird. I can’t fix that. As I told a patient this week, “You are high. If you don’t like this feeling, then don’t do drugs.”

Wash your hands. Stay 6 feet from each other and stay well.

Gavin H. Inglis is an emergency physician.

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