After more than a decade working in the field of bioethics, I’ve gotten used to the blank stares on people’s faces when I tell them what I do. I usually follow up with a description like “I think through the ethical components of current or potential medical care or research and help people make decisions.” If they want to know more, I point them in the direction of a TEDX talk I gave using case studies from The Golden Girls as an introduction to bioethics, like when Sophia’s friend asked her to be with her when she ends her own life. That’s when the questions start. I remind them that I have a Ph.D. — not an M.D. — so I can’t write prescriptions or give them a check-up. Then they shift gears and start asking about sentient robots, 3D-printed organs and when men will be able to get pregnant. But the past few weeks have been different: I’ve been fielding calls and texts from friends, family members and other people who have come out of the woodwork to ask about the novel coronavirus. Their questions include a wide range of topics — everything from public health ethics to what kind of travel (if any) is safe, to whether or not they should be ordering food delivery. Here are eight of the most common questions I’ve been getting — and fair warning, there are still a lot of unknowns when it comes to COVID-19. Because things are changing daily, I also reached out to several infectious disease experts to get the absolute latest on the coronavirus outbreak.
Do you have any idea when this will all be over?
In short, not yet. But there is a lot of speculation and estimates out there, so I spoke with Dr. Jason Farley, an epidemiologist at Johns Hopkins University who specializes in infectious disease, to find out what we actually know. “Quite frankly, right now we are not seeing any signs that this is letting up,” he tells Rolling Stone. We’ve now reached more than 15,000 cases in the United States. And Farley adds that “we are doing nothing like the draconian measures of the countries that have been successful thus far in controlling the epidemic.” Dr. Waleed Javaid, the director of infection prevention and control at Mount Sinai Downtown, tells Rolling Stone that “it may take months” before an end is in sight. Within the past week, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease said that the pandemic is “definitely going to get worse before it gets better” and that it will likely be “several weeks to a few months” before life gets back to normal, but that’s just an estimate.
Is it safe to order takeout or delivery right now? I want to support local businesses, but should I be worried about people who prepare the food having coronavirus and passing it along to me?
This has been a very common question — and ethical dilemma — for those who are concerned about their health (and public health), but also want to keep their local restaurants in business. First of all, Farley says that while we have seen lots of data on how long the virus lives on different types of surfaces, none of it has been related to food. Dr. Amy Edwards, a pediatric infectious disease expert at University Hospitals in Cleveland says that many of the takeout services are taking serious precautions with their drivers, having them use hand sanitizer before and during delivery.
To even further minimize any potential risk of food delivery, you can take other precautions, like having the delivery person drop the food at your doorstep. “If you’re worried about the virus being on the outside of the delivery carton, once you get it into your house and open everything up, just wash your hands before you touch your face,” Edwards explains.
Food delivery has also been raising some ethical questions. Now that we’re being extra cautious with everything — and rightfully so — people are asking whether ordering food to be delivered is worth any (as of now unknown) risk, and whether it’s safe for workers to be out and about in public. On top of that, no one wants to see their local restaurants struggle during this uncertain time. So while they may feel hesitant about ordering, they’re torn because they want to support their favorite restaurants. Edwards and her husband have made a commitment to order takeout or delivery from a local mom-and-pop restaurant to help them stay afloat. “I am encouraging people to do take and delivery because we need to help our restaurants out,” Edwards says.
I know we’re not supposed to travel by plane now, but what about by car? Are road trips OK?
It depends. So far the CDC has focused on air and cruise travel and hasn’t really addressed whether road trips are safe, aside from telling you to consider the usual concerns, like whether you’re going to visit someone with a compromised immune system or who is older. At this point, going to a crowded tourist attraction isn’t wise, but also pretty difficult considering that so many are currently closed. And if you’re renting a car to get somewhere, you can sterilize it when you pick it up.
But even if you’re not afraid of getting sick yourself, you have to think of the bigger picture: You could be a carrier and pass the virus on to others. “All avoidable trips should be avoided,” Javaid tells Rolling Stone. “There are many reasons but most importantly, one is to keep social distancing, and the second is with the rapidly changing situation there may be more restrictions that get implemented, and may cause challenges in returning back, as well as other challenges if one has unplanned delays.” Though Edwards says that her “preference is for everybody to just stay put,” if you’re going on a solo road trip to go hiking in a desolate park, you’ll probably be fine — as long as you go in knowing that domestic travel restrictions are a possibility. Also, if you do embark on that kind of trip, make sure you bring all of your necessary medication with you.
Should I be showering or bathing more? Does it work like washing your hands to prevent infection, but for your whole body?
This is something I’ve also wondered about over the past few weeks. Some people think that taking frequent showers and scrubbing down their whole body vigorously and with soap will help wash away any of the virus that may have gotten on other parts of their body. But Farley says that at this point, the recommendation is to shower and bathe on your normal pre-COVID-19 schedule. Similarly, Dr. Wayne Tsuang, a pulmonologist and critical care physician at the Cleveland Clinic, tells Rolling Stone that “every person needs to assess what their daily exposures are to the environment.” If they have come in contact with someone with COVID-19, then more frequent or more aggressive cleaning then may be warranted, he explains. The way Edwards puts it is, “unless you’re coming into a hospital room with a patient with COVID-19 and then rolling around in their hospital room, I don’t see any reason why you should need to do anything other than hand washing.”
How are things in China now? Are they over the outbreak?
China reached a milestone on March 18, when public health officials reported no new local coronavirus infections — something that hasn’t happened since the outbreak started nearly three months ago. However, the New York Times reports that this could be a statistical blip, and that they are not out of the woods yet. “The question is what will happen if there’s a second wave, because the kind of measures that China has implemented are not necessarily sustainable in the long term,” Dr. Ben Cowling, the head of the division of epidemiology and biostatistics at Hong Kong University’s School of Public Health told the Times.
Is it safe to go on a walk outside or go to the park?
Though we’ve been instructed to practice social distancing, that doesn’t mean you’re stuck inside your home at all times. The key here, like pretty much everything else right now, is to stay the recommended six feet away from other people. For example, in places like San Francisco, which was one of the first cities with a shelter-in-place policy, people may go walking, running or hiking outside, including at a park, as long as they follow the social distancing rules. Edwards says that she doesn’t mind people going out, as long as they do it in a way where they’re not coming in contact with any of their neighbors — like staying in their own backyard. And you probably want to skip taking the kids to the playground. Dr. Sean O’Leary, of the American Academy of Pediatrics’ Committee on Infectious Diseases told USA Today that he recommends staying away from playgrounds because they can’t be sanitized as frequently as needed, and the virus can live on surfaces. Ultimately, Edwards wants everyone to stay home as much as possible. “Maybe it sounds a little overly dramatic, but just chill for right now,” she says. “We’re trying to get a handle on what we know is coming.” So go ahead and spend some time outside, but stay the hell away from people.
When will there be a vaccine or cure?
The good news is that there are a lot of pharmaceutical companies and other labs working hard to come up with treatments and vaccines for coronavirus. Some are even in Phase 3 trials, meaning that the drug has already been deemed safe and effective, and researchers are now doing large-scale clinical trials to determine if the new drug is better than what’s already available. Because this is a novel coronavirus (one that we hadn’t seen in humans until very recently) the Phase 3 trials will be more about seeing how the drug does on a larger scale. On March 18th, the World Health Organization (WHO) announced that it would be conducting a multi-arm, multi-country clinical trial with participants from at least 10 countries to determine whether existing treatments for other viruses, like HIV, could be used either alone or in a combination to treat the novel coronavirus. In short: There are a lot of people working on it right now. But at this point, we don’t have a firm date of exactly when any drugs will be available to prevent or treat COVID-19. Even after Phase 3 clinical trials are finished, the drug would still need approval from the Food and Drug Administration before it can be used on the public. Javaid estimates that it may take a few months or a year before a treatment or vaccine is finalized, while Dr. Edo Paz, an internist and cardiologist and VP Medical at K Health tells Rolling Stone that it could be as long as 18 months before the vaccine is ready for market.
If I get the disease and recover, does that mean I’ll become immune to it?
This is another one where we don’t have a definitive answer yet because the novel coronavirus has only been in humans for less than three months, and it’s difficult to assess immunity, especially on a long-term basis. According to Farley, “we think we have good evidence that at this point, [people] can be reinfected.” But he says the data are still too new. “So what’s happening is [that] when people recover, we’re testing them in all different areas to make sure the virus has gone completely,” he says, adding that that’s how we know the virus could be present in stool even after a person has recovered. In addition, Farley says that they are also drawing blood from people who’ve recovered to find out which antibodies developed that helped the person recover from the virus, and whether those antibodies would lead to continued protection, should you be re-exposed.
The next question is how long these antibodies might last. “We’re all immunologically naive to this virus,” Farley explains. “We are learning a ton about what the immune system will do, what antibodies it will produce, how effective those antibodies will be and how long they will last. That will answer a lot of questions going forward about [whether] will we need to respond to this virus from now until the end of time on a seasonal basis.” At this point, we still don’t know.
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