We are healthcare experts who have been following the coronavirus outbreak globally. Ask us anything about COVID-19.

Are you concerned about contracting corona virus yourself? How safe do hospital workers feel caring for the patients?

Am I worried myself? Yes! But I'm a doctor and patients need care - that's part of the job. - Eric

What percentage of the population do you think will eventually catch COVID-19?

Most epidemic modeling suggests that up to a third of the population may be infected in a first pandemic "wave" -- with no interventions -- so it all depends on human actions. - Christine

Two concerns: Do I need to sanitise food packages or mail, parcels that I get from the delivery guy? How long does the virus stay on surfaces?; and some countries are comparing the doubling of infection rate to Italy, which is scary—what is the likelihood of other countries going in this direction?

To your first question, we don't know how much of a risk these represent. yes, the virus can persist on surfaces. but epidemiogic observations don't really suggest that these are important sources of infection. if you're concerned, there are several online sources recommending how to do safe disinfection. for what it's worth, I don't bother. but the rest of my family does. - Eric

What do you think of the low case count in a densely populated country like India?

The low case count in a densely populated country may reflect a lack of testing for the virus, rather than a lack of infected people. - Nancy

What techniques are you applying on your personal lives to keep you going during these tough times?

Another technique: use your non-dominant hand to open doors, take groceries off shelves in stores, etc. - because you are less likely to touch your face with that non-dominant hand. - Nancy

Yoga, spring cleaning. I bet homes in locked-down cities have never been as clean as they are now! - Christine

My husband and are are self-isolating, avoiding supermarkets, washing hands frequently, trying to get fresh air at least once a day. - Nancy

If you were to show symptoms of the virus, what is the best protocol to seek medical treatment without putting anyone else (including healthcare workers) at risk of exposure?

Increasingly, areas with a lot of disease are setting up drive-through testing centers (there's one in my suburb) where people can be tested without getting out of the car. if you have access to one of these it would be ideal. of course, it all depends on the availability of testing. that will improve but still might be constrained where you are. - Eric

Can COVID-19 become more potent as it makes its way around or does it remain static?

Any virus can evolve over time and it's most typical for them to become "weaker" - cause less severe disease. The new SARS-CoV-2 virus is so far very stable, so there is no concern that it will become more virulent than it already is. - Christine

Hi once you have the COVID 19 can you get it again?

We're not sure how immunity works or how long it lasts. the best guess is that people who are infected are likely to be protected over the short-to-medium term. we don't know about longer. - Eric

Is it safe to go out and run/cycle/workout without a mask (no contact with others)?

We also got this question during a separate chat. Here's what Dr. Isaac Bogoch, an infectious disease researcher and scientist, had to say: “Oh yeah. Most provincial or state guidelines suggest it is just fine, just space it out, and no crowds.”

What are the chances that we’re good to go after another month or so? Should we be afraid that it will come back like the Spanish flu?

It's not likely to be gone in a month. and there is the suggestion that , if we are able to control disease, it will continue at a low level or perhaps even come back as a full-blown epidemic again in the fall. until we have good interventions or a good part of the population gets infected, it's likely to be with us. - Eric

Is it possible the virus has been circulating (i.e., community spread) in areas currently being impacted (NY, LA, Spain) as early as December?

While it's possible that the virus has been around for a while in places outside of China, it seems fairly unlikely. we know that it spreads rapidly and becomes a local epidemic that would be hard to miss. - Eric

My question is for Hazel, thank you all for doing the AmA!

Hazel what do you think is the biggest concern surrounding the misinformation of the Coronavirus? Infection rates, mortality rates? Susceptibility? If you could say, where do you find the majority of this information needing to be fact checked coming from?

Thanks again!!

I'd say the biggest concern, which we've seen manifest in lots of different forms, is the misinformation that claims COVID-19 is less deadly than regular flu and that all emergency measures are overblown. Often misinfo of this kind includes allegations of political conspiracy, and suggestions that authorities are using this virus to gain control over their citizens. Calculating mortality rates during a disease epidemic is difficult, in part because the numbers of deaths and patients constantly change. Calculating mortality rates during a disease epidemic is difficult, in part because the numbers of deaths and patients constantly change. But on March 11, Dr Anthony Fauci stated that it is 10 times more lethal than the seasonal flu.- Hazel

What do you think will be the biggest impact on healthcare beyond the front lines of the pandemic?

This is a huge problem for healthcare right now. In areas like NYC and northern Italy we've seen institutions that are unable to cope with the volume of patients. and don't forget about people with other diseases, pregnant women and kids who need routine vaccines. We're not prepared and there will be a lasting impact. - Eric

How are you?

A little hungry right now. in some ways I'm fortunate - Covid-19 is keeping me far too busy to get bored or go too stir crazy. but, like all of us, I'm at risk of getting infected. and since I go to the hospital to see patients, maybe a little more risk than many. but thank you for asking! - Eric

How should I think about any large public gatherings in the future? It feels like unless the virus is 100% eradicated, it will be tough to have large events in the next few years, especially if the virus is cyclical.

What will happen entirely depends on what we do and whether external effects, like the weather, actually make any difference. But this will end and likely before a "few years." Large gatherings will be possible but we don't know when. - Eric

I am 68 years old and have had the 2 year course of pneumonia vaccine. Does this offer at least some protection against pneumonia from Covid-19?

Unfortunately, the vaccine that many people receive for pneumonia is directed against a very different kind of microorganism, a bacterium, not a virus. it almost certainly has little or no effect. - Eric

Is it true that Covid-19 can stay in the air for a couple of hours? So for example if someone sneezes the virus will distribute in the air and will stay there for a couple of hours?

One study published in The New England Journal of Medicine found that at least some of the virus particles from a simulated sneeze or cough stayed in the air for at least 3 hours. But the researchers stopped measuring at 3 hours, so it's possible some virus particles are still in the air after that. - Nancy

Any update on promising vaccines? Is the 14-18 month timeline still realistic considering the extraordinary circumstances here? I.e. are expedited testing and approvals being considered by governing bodies?

With vaccines or drugs, the one thing you don't want to do is rush to make a lot of something only to find out it doesn't work. - Christine

Is it possible to be infected by those quarantining if you live in a building with central air conditioning/heating?

Should the entire country be ordered to shelter in place (accept for essential workers) and not leave their home unless absolutely necessary?

Should we still be shipping non-essential goods in the mail/ does this pose a risk?

Regarding potential transmission via central air conditioning systems in large buildings: The Federation of European Heating, Ventilation and Air Conditioning Associations recently issued guidelines for building managers. They say “Heating and cooling systems can be operated normally as there are no direct implications on COVID-19 spread.” They also advise opening windows to get “as much outside air as reasonably possible.” The full document is here: https://www.rehva.eu/fileadmin/user_upload/REHVA_covid_guidance_document_2020-03-17_final.pdf - Nancy

Does Pine Sol work for a proper disinfectant? Can't find bleach, rubbing alcohol, Clorox wipes or Lysol spray.

Almost any disinfectant should work. along with plain old soap. - Eric

Good Afternoon,

Is it true that blood pressure medications may increase the severity of Covid-19 in those that become infected?

I think that there is little compelling evidence that blood pressure medications change susceptibility to infection or severe disease. the data out there are a bit contradictory. but controlling your blood pressure is important. and most blood pressure medications aren't a worry at all. I'd stick with what you're on (as long as it's working). - Eric

Yesterday saw the virus pass the half-million infections mark. Did it really all start from just one individual? It's kind of mindboggling. Just how contageous is this thing?

The virus did start from one or a relatively small group of people who likely contracted it from an animal. but this is how many infections work - they grow exponentially rather than linearly. - Eric

Do you have any tips for maintaining our mental health during this time?

I spend my time coming up with new zoom virtual backgrounds. seriously, it's tough to be locked down and worried at the same time. get outside if you can, exercise, play with the dog and makes sure that you set aside time for yourself. - Eric

What age is the youngest/oldest confirmed infected/death due to COVID-19 worldwide/in USA?

There have been all ages infected, from newborns to the elderly. And there have been survivors at all ages. - Eric

Sorry if this has been asked before. If one recovers from COVID-19, are they immune to it? Further, how does immunity work in general? Does this mean that if virus hits an immune person, it essentially hits a brick wall and that person can't transmit it to others? Thank you for taking questions.

We're not sure how immunity works or how long it lasts. the best guess is that people who are infected are likely to be protected over the short-to-medium term. we don't know about longer. - Eric

Given how many young and even relatively healthy people have not just been infected but killed by COVID-19, it seems like the "this mostly strikes older adults" messaging really should be changed and everyone needs to view this as a far greater threat. Would you agree?

I agree with the idea that this remains a threat to young people as well as old. while the death rate is far lower in those who are younger, it's still real and far higher than almost any other common infection. - Eric

I’ve seen several news sources claim experts from Johns Hopkins and other medical colleges are saying the virus can become less deadly as it spreads. Can you explain this phenomenon? Is it because the deadlier strains of the virus kill the patient faster and are thus less likely to spread than the less deadly strain? Or is it something else entirely.

A virus' idea of "success" is spreading to as many hosts as possible and making as many copies of itself as possible, so yes, one theory for why many viruses evolve to be weaker over time is that viruses that kill their host don't get very far. This pattern of weakening is seen with flu viruses, and many others, but not all. Edit to add: We're not there yet with the current outbreak. Whether it's weaker three or 10 years from now doesn't change anything about today's situation. - Christine

What do you think is the biggest misconception about COVID-19 or the coronavirus?

I'd say the biggest concern, which we've seen manifest in lots of different forms, is the misinformation that claims COVID-19 is less deadly than regular flu and that all emergency measures are overblown. Often misinfo of this kind includes allegations of political conspiracy, and suggestions that authorities are using this virus to gain control over their citizens. Calculating mortality rates during a disease epidemic is difficult, in part because the numbers of deaths and patients constantly changes. - Hazel

Will hot weather make this virus disappear?

The virus probably won't "disappear" in hot weather. Singapore is practically on the equator, and the average temp there rarely goes below 75 degrees F - and the virus circulated there. - Christine

What is the current stage of a vaccine or medicine for the covid-19?

For vaccines, the timeline hasn't really changed. it's conceivable that it could be a little bit faster if everything goes well. but, usually, everything doesn't go well. and that means that timelines are extended. in this case, with multiple parallel approaches, we're hopeful that something works and that it's relatively quick. - Eric

How well does the human immune system create an immunogenic response against covid19, i.e. what are the chances of being infected by the virus a second time?

We're not sure how immunity works or how long it lasts. the best guess is that people who are infected are likely to be protected over the short-to-medium term. we don't know about longer. - Eric

Why has this been treated so extremely, while other viruses (like swine flu or bird flu) we essentially left unchecked.... is COVID-19 that much more dangerous?

H5N1 and other avian flu strains are not left unchecked, they're monitored very very closely at all times to avoid this kind of scenario. The 2009 H1N1 was not really a completely novel virus -- versions of H1N1 have been infecting people since 1918. As a result, primarily younger people were vulnerable to the 2009 virus. It's possible that SARS-CoV-2 was missed, in part, because it wasn't a flu virus. And the original SARS virus was contained after infecting 8,000 people and killing 800 of them. So coronaviruses may have been underestimated as a threat. - Christine

There is a lot of “fake news” talk circulating, along with many rumors. Can you recommend good sources to get trustworthy information from? I’ve been using the CDC as a resource.

I recommend the WHO website (https://www.who.int/health-topics/coronavirus#tab=tab_1). Be sure to take a look at the myth busters section. And of course, I have to say Reuters! You can see our live updateshere (https://www.reuters.com/live-events/coronavirus-6-id2921484) and our fact checks on false claims surrounding coronavirus here(https://www.reuters.com/fact-check) - Hazel (Edit to fix broken links)

There is a video on YouTube advising to sanitize each item you buy from the grocery store. Do you think this is necessary or excessive?

https://m.youtube.com/watch?v=sjDuwc9KBps

We don't know how much of a risk these represent. yes, the virus can persist on surfaces. but epidemiogic observations don't really suggest that these are important sources of infection. if you're concerned, there are several online sources recommending how to do safe disinfection. for what it's worth, I don't bother. but the rest of my family does. - Eric

Thank you,

What is the R(0) now?

Is there any validity to the doctors coming out now saying that the infection projections are overblown?

Is hydroxychloroquine's effectiveness being overblown?

How do you respond to the question of balancing public health and the economy?

R0 is determined by lots of things, not just the virus. it is constantly changing and different in every individual community so there is no one R0.

I think that we have little idea based on the evidence thus far if anything, including hydroxychloroquine, is effective. we need better quality research.

Balancing the economy is a tough question. while there's a huge cost to closing down, there's also an enormous cost in hundreds of thousands of extra deaths. and there is a moral issue as well. - Eric

Regarding pregnancy, I’ve seen different responses with regard to whether or not COVID-19 can pass to a fetus. However, I’m worried about the effects of constant fever or low oxygen sat. Can you tell us anything about concerns for the fetus should a mother start experiencing COVID-19 symptoms? Or what may happen if the mother has to undergo treatment, hospitalization or otherwise?

There are reports coming out of China of pregnant women who successfully delivered full-term babies while sick with COVID-19 pneumonia. Some were able to deliver vaginally and some had C-sections. - Nancy

Some experts are saying that this virus shares many similarities with HIV. I’ve seen some news articles on how some patients(not many yet though) have been hospitalized again after recovering from their initial contraction, meaning they tested positive again days after they were discharged. Is it possible that covid-19 could become a chronic disease?

I doubt that this will be a chronic disease and strongly suspect that most of those people who are testing positive had falsely negative tests in the interim. the test is far from perfect. - Eric

What single article or piece of evidence (from a reputable source) can I show a family member who believes this is no worse than our yearly influenza?

I think that some of the on-the-ground reporting, including that done by people here, is the most effective. to hear about the experiences of clinicians in Lombardy, Italy or currently in NYC is horrific. - Eric

Is there evidence of dogs infecting humans? Should we allow our dogs to visit small dog parks and mingle with other dogs?

I'm sitting with my dog now. and I'm not afraid of him. well, the teeth are kind of intimidating. but there is no evidence that pets are a significant source of infection. right now I'd err on the side of letting pets maintain your mental health and not worry so much about disease transmission. - Eric

What are the effects of N-SAIDs like ibuprofen? Are the concerns merely speculative, or is there enough compelling anecdotal evidence to warrant avoiding them?

The concerns about NSAIDs are pretty theoretical at this point. I don't think that the data suggesting that they're deleterious is particularly convincing. We'll need better studies to figure this out. - Eric

Do you foresee this number of deaths in the US surpass China and Italy? Will there be a need in the US to triage known Covid-19 patients; selecting who will need a ventilator m, who will actually receive the ventilator based on a point system based on “survival of the fittest??

We don't have enough equipment and in Italy hospitals have had to make horrible decisions about who lives and who dies. I hope that the supply can catch up with the needs. And there are people working on solutions like sharing ventilators or homemade devices (I just saw a picture of one made from gardens hoses and a lamp timer). We haven't been great at planning ahead for our needs but we really need to do better. - Eric

I want to get back to work. How long is your educated guess until things get back to normal? (No bullshit pls)

I'd need more education to make an educated guess. but what's normal? the virus will be with us, likely until there's a vaccine or widespread immunity. - Eric