By Emily Williams
A 1987 The Smiths lyric “panic on the streets of Birmingham,” though referring to the city across the pond, could be a descriptor of the current climate here in Birmingham, Alabama.
While it is easy to feel powerless amid the COVID-19 pandemic, there are things you can do throughout each day to help yourself and your neighbors.
Since knowledge is power, we’ve gathered facts and advice straight from the experts in the University of Alabama at Birmingham’s Division of Infectious Diseases to help empower readers.
What is COVID-19?
As of March 15, the Alabama Department of Public Health reported there were 22 confirmed cases of COVID-19 in the state, 12 of them in Jefferson County.
According to the department, the public can expect that number to continue to increase as the ability to test for the virus increases.
COVID-19 is a type of coronavirus, named for the crown-like appearance of the surface of the particle. Another coronavirus is the one that causes common colds. The difference is that this virus is brand new to humans, so people have had no prior illnesses that could prepare their immune systems to fight it. Also, because it’s new, scientists don’t know how it will behave now that it has jumped to our species.
The CDC has noted that there isn’t a complete clinical picture of the virus. Data continues to be collected and research continues to shed light on attributes of the disease, but thus far statistics show that the bulk of those affected experience mild symptoms.
The scope of the COVID-19 spread in the United States continues to grow every day, and the CDC estimated that each infected individual passes the illness on to three other individuals before they are even diagnosed.
About 15% of patients will have a more moderate reaction, according to Dr. Jodie Dionne-Odom, requiring some kind of medical care, whether that be an emergency room visit or short hospitalization.
She noted that 5% of people who get the virus experience a severe case and require ICU-level care.
The mortality rate for kids is incredibly low, but they can have light symptoms and pass it on to others.
High-risk patients include individuals over the age of 60, as well as those whose health is already compromised. This includes people who have diabetes, high blood pressure or cancer, and people who have had chemotherapy treatments, stem cell transplants or who for other reasons have suppressed immune systems.
“I take care of HIV patients. All of those patients have a reduced immune system and we think they’re probably also going to be at risk,” Dionne-Odom said. She said any of those individuals at high risk should limit their exposure by avoiding any unnecessary travel or social interactions.
How Is it Spread?
There is still much to be learned about the virus, Dionne-Odom said, but what is known is that it is transmitted by respiratory droplets, much like influenza and cold viruses.
“We tend to think of airborne illness as something like tuberculosis,” she said, which travel in very tiny droplets that have the ability to hang around in the air for up to two hours after an infected person coughs, sneezes, sings or makes other expirations.
Heavier viruses, like coronaviruses, tend to fall out of the air more quickly, she said.
The easiest way to contract the illness is by contact with an infected person’s hands or something they have touched. How long the virus lives on a surface depends on the material. Scientists have found that it lives longer on metals and hard plastics than more porous surfaces.
When someone gets coronavirus, there is an incubation period, during which the virus is growing and detectable by tests but the patient shows no symptoms.
“It’s about five days,” Dionne-Odom said. “So, in those five days, the virus is increasing in levels in your body but you feel fine until you have the typical fever, cough or difficulty breathing.”
There is no medical data to back the widely suggested claim that there is a 14-day incubation period during which the virus can be spread.
“There is some new data that suggests maybe people can transmit the virus before the symptoms start, and that’s a big concern for us,” she said.
Most of the studies continue to show that transmission is coming from symptomatic individuals, she said. Thus, testing is focused more heavily on people who are showing signs of the illness.
The top five most common symptoms, according to the CDC, are fever, a dry cough, fatigue, phlegm and shortness of breath.
“If you have symptoms, don’t go to work. Don’t send your child to school if they’re symptomatic,” said Dionne-Odom.
Keep It Clean
Dionne-Odom noted that researchers believe the virus acts a bit like the flu, remaining on surfaces for about two to seven hours.
“Like anything else, if you’re coughing into a wet Kleenex, that’s a place that a virus can live longer than if it’s a dry surface that’s cleaned frequently,” she said.
The viruses have a lipid coat, or a fatty covering, that protects them, according Dr. Jeanne Marrazzo, director of the division of infectious diseases.
“That’s why we keep telling people to wash their hands,” she said. “Soap is actually great, it’s a detergent and a detergent will really take out the virus.”
Hand-sanitizing gels also are a great option, if soap and water isn’t readily available. Though there currently is a shortage in stores, Marrazzo said, it is fairly easy to make at home.
“There’s some good guidance about that online, and that can involve something like aloe vera gel mixed with alcohol,” she said. “So, just because you go to the CVS and the hand gel is depleted, it’s not a reason to panic. There are ways around that.”
To clean surfaces, experts suggest using a diluted bleach and any cleaning product that includes a good amount of alcohol.
“This is a droplet spread cold virus, so when someone coughs or sneezes or sings, you can have droplets that hang out in the air and eventually will land on any flat surfaces,” Dionne-Odom said.
“So, it’s things that we touch. It’s the telephone; it’s the doorknob; it’s the cellphone; it’s the TV controller. Those are the things that you want to make sure to clean carefully.”
There is no need to do a deep clean of the entire house every 12 hours, she noted, but clean frequently touched surfaces frequently.
In addition to cleaning, the practice of social distancing can help reduce the spread of the virus by limiting the chance of person-to-person contact.
This involves a range of practices, including maintaining at least a six-foot distance between yourself and other individuals.
On March 15, the Centers for Disease Control recommended that all gatherings of more than 50 people be cancelled for eight weeks, or until the second week of May.
An individual can protect themselves from contracting the virus by not exposing themselves to people who potential carry it, Dionne-Odom said.
“What you can do to protect yourself is not put yourself in that situation, not go to large group settings, try to avoid being exposed to anyone who is sick.”
Though the illness may not usually affect younger healthy people in as potentially serious a manner as those ages 60 and older, these people can pass it to high-risk individuals without intending to.
“You want to keep yourself healthy so you don’t transmit to your mother, to your father, to your grandparents, to older aunts and uncles or neighbors who are in that age group,” said Dionne-Odom.
According to Marrazzano, there is a very short window in which social distancing can help change the trajectory of the epidemic.
“We need to make personal sacrifices in order to make an impact,” she said.
If You Get Sick
For those who do have the virus, the symptoms often manifest as a mild flu, and that is how experts suggest people treat themselves.
First and foremost, call your primary care physician or health care provider. Explain your symptoms and they will assess whether you need to be tested.
“This is not a time to be stoic or a ‘tough guy,’” Marrazzo said. “If you are feeling sick, make sure you call and get checked out.”
Immediately begin to isolate yourself if you have symptoms.
“If you have a child who has symptoms – who is coughing with a fever – you would isolate them,” Dionne-Odom said, “meaning not let them go to school. Isolate them in the house, not go out to expose other people.”
The practice of quarantine is for those who are not showing symptoms but may have been exposed to the virus.
“If you are working in an office with someone who had coronavirus, you may be asked to quarantine, feeling fine – to wait 14 days to see if you develop symptoms, so you won’t inadvertently expose other people,” Dionne-Odom stated.
For those who do have the virus and experience mild symptoms that don’t require further medical care, Marrazzano said the best treatment is to rest, hydrate and take a fever-reducer such as Tylenol as needed.
“All of that stuff is really very helpful,” she said. “It’s a virus. So there’s really not much you can do about it.”
If your symptoms do progress, notify your health care provider. People with certain health conditions are at risk of developing a form of viral pneumonia.
Otherwise, experts note that the illness seems to take about 10 to 14 days to run its course.
According to Dionne-Odom, the public can expect testing to ramp up in the area in the near future.
“We are fortunate to be working at a university that has really been at the vanguard of doing antiviral treatment and testing for some of the world, and our labs are developing an in-house, PCR-based test,” she said.
It isn’t up and running yet, so the practice currently remains to obtain a sample from the patient and send it to the Alabama Department of Public Health and the CDC, and it can take days to get a result.
Dionne-Odom added that, though the ability to test is a real need right now, it is more important to make sure the tests used are verified and high-quality so medical professionals know that the results are reliable.
It also was noted that Alabama was one of the last states to receive testing kits, so the public can expect to see a rapid rise in numbers of confirmed cases as the ability to test increases.
“We know in states that have more testing, like in Washington State, that the more you test the more disease you’re going to find,” Dionne-Odom said.
How Prepared are We?
As case numbers increase, it may begin to feel overwhelming, but rest assured that there is a light at the end of the tunnel.
Currently, there isn’t a specific anti-viral drug that is effective in treating COVID-19 or the pneumonia that it generates.
Those hospitalized are treated with fluids and possibly put on a ventilator, Dionne-Odom said, to make sure their organs get enough oxygen while their lungs are allowed to rest and try to recover.
Luckily, there may be an option for treatment on the way.
“We hope to have an experimental drug available for treatment in the coming months called remdesivir, which is an anti-viral which seems to have great activity against this virus, at least in animal models,” Dionne-Odom said.
The compound was developed as a result of research conducted through the Antiviral Drug Discovery and Development Center, coordinated out of UAB. It was shown to have significant activity against the COVID-19 strain when the outbreak began in China.
According to Dr. Molly Fleece, there also is a potential vaccine that is going through animal testing and that looks to be promising.
“Unfortunately, vaccines take a while to produce, so I think the earliest we are likely to see a vaccine come on the market – where we can receive it more broadly – is at least a year away. What I will say is that it is remarkable that this virus has been identified for a little over three months and at this point we have been able to genetically describe the virus, we have drug trials in place, and we have a vaccine candidate already through animal testing.”
While the world waits for a viable treatment and vaccine, UAB is preparing for an expected increase in patient care needed.
Dionne-Odom noted that there is a hospital emergency preparedness plan in place for situations such as this, comprosed of staff in infection control, emergency room and surgical suites.
“I can tell you that this team is meeting regularly,” she said. “They know each other very well at this point. They’re changing the plans every 12 to 24 hours based on new data that’s coming in, and the team is well-equipped.
“There are a lot of ventilators and a lot of critical care doctors here, obviously, a big group of well-trained pediatricians, adult doctors and geriatricians who know how to manage these types of diseases. So, this is what they’ve been preparing for, in a way.”
To stay accurately informed on all things COVID-19, visit alabamapublichealth.gov, jcdh.org, uab.edu/news/coronavirus and cdc.gov.