UPDATE: Thank you to everyone who asked questions.

Please follow https://APNews.com/VirusOutbreak for up-to-the-minute coverage of the pandemic or subscribe to the AP Morning Wire newsletter: https://bit.ly/2Wn4EwH

Johns Hopkins also has a daily podcast on the coronavirus at http://johnshopkinssph.libsyn.com/ and more general information including a daily situation report is available from Johns Hopkins at http://coronavirus.jhu.edu

The new coronavirus has infected more than 127,000 people around the world and the pandemic has caused a lot of worry and alarm.

For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

There is concern that if too many patients fall ill with pneumonia from the new coronavirus at once, the result could stress our health care system to the breaking point -- and beyond.

Answering your questions Monday about the virus and the public reaction to it were:

  • Marilynn Marchione, chief medical writer for The Associated Press
  • Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health and author of The Public Health Crisis Survival Guide: Leadership and Management in Trying Times

Find more explainers on coronavirus and COVID-19: https://apnews.com/UnderstandingtheOutbreak


Comments: 3268 • Responses: 31  • Date: 

OldMadLogan1877 karma

Can you describe how you see the world situation
1-In one week ?
2-In one month ?
3-In one year ?

APnews3347 karma

From Dr. Sharfstein:

1--worse than today
2--much worse than today
3--hard to predict. that's why we need to take this seriously now

scissorchest1431 karma

What’s the most positive news you’ve received over the last 24 hours?

APnews1865 karma

From Dr. Sharfstein:

My parents have decided to cancel their trip to visit my brother in Tennessee. Everyone should be looking for positive news in helping people most at risk to stay safe. More broadly, I appreciate how quickly so many states and localities are taking serious action, how the healthcare system is mobilizing, and how the conversation has shifted to #flattenthecurve. This is what needs to happen so the US doesn't experiences the challenges of Italy.

mightyseas1222 karma

Would it be fine for me to have long walk in open area ? I am a senior citizen.

APnews1817 karma

From Dr. Sharfstein: Yes, it is generally safe to take a walk outside. However, it's best to avoid close contact with other people on the walk.

NelsonMcBottom1175 karma

Everyone keeps talking about the projected estimated 40% infection rate among US citizens. With a current mortality rate of 1.2%, that would leave roughly 1.6 million dead in the US in its wake.

How much stock do we need to put in to these numbers, and what is the confidence that this scenario will actually play out? And how long will it take before we know we’ve seen the worst, and what will be the indicator?

APnews1767 karma

From Dr. Sharfstein:

So this is a big question. Some are actually estimating infections to 2/3 or so of the US population in the first year. So these kinds of numbers are not fantasy. At the same time, while we have evidence of the case fatality rate, we don't have great evidence of the infection fatality rate. Meaning, we need to include in the fatality rate the denominator the people who were infected but didn't realize it. Some people think there may be a lot of people like this, which would reduce the mortality rate well below 1.2%. So a lot of uncertainty, but yes, those numbers are possible. Another key point is that if we slow down the speed of the infections we'll be able to maintain high quality clinical care which will reduce the mortality rate.

APnews678 karma

From Marilynn: The true death rate from infection with the virus isn't known, because we don't know how many cases of mild or no symptoms have occurred. Among cases of diagnosed illness, the death rate has ranged from 1% to more than 3%, depending on location. How deadly it ultimately becomes depends a lot on how much it spreads. Flu's death rate is only 0.1% but it kills hundreds of thousands because it infects millions each year. It's why it's so critical to reduce the spread of infection now.

A story about this: https://apnews.com/545af824f44a22f7559c74679a4f1f53

rock192835 karma

Thanks for doing this.

1) Does water temperature matter when washing hands with soap and water?

2) If I order a hot dish from a restaurant as takeout, and the person cooking, preparing, or delivering my dish was sick, am I at significantly increased risk?

3) Does exhaustive exercise (iike running on a treadmill for 3-4 hours) increase or decrease my body's ability to fight off a virus?

APnews996 karma

Thanks for asking. Here is Dr. Sharfstein's reply:

There are different perspectives on whether hotter water is better. CDC recommends warm or cold water. See: https://www.cdc.gov/handwashing/show-me-the-science-handwashing.html

-- The bottom line is wash hands with soap X 20 seconds at key points and even if you just feel like it.

2) There is some evidence emerging of the potential for "fecal-oral" transmission of the virus, which means it could be passed on by people who don't wash their hands well after going to the bathroom. For this reason, some people might suggest sticking to cooked food, rather than uncooked food, for ordering out. Also super important that restaurant workers wash their hands. Restaurants should take extra steps and assure their customers. And people ordering should wash their hands well before eating.

3) Running on a treadmill for 3-4 hours? That does sound exhausting. No clinical studies with coronavirus as yet. I have not seen data on this question.

flannelpyjamas774 karma

I am an outpatient psychotherapist at a behavioral health clinic attached to a rural hospital in New England - are there recommendations for whether or not we should be cancelling appointments for clients? I am worried about my clients for whom isolation can be a life or death thing due to depression and suicidality, but it can also be life or death with covid19...

APnews1022 karma

From Dr. Sharfstein:

This may be a good time to consider tele-therapy. Also, we have to figure out ways to practice distancing in person while not distancing psychologically. I share your concern for this vulnerable population.

Discalced-diapason652 karma

What do you think the difference between reported cases in the US are versus the actual cases?

APnews1161 karma

From Dr. Sharfstein:

My answer is we do not have a handle on the total number cases in the US because of the delays in testing. As testing becomes more available, we'll know more about actual cases of ill individuals. But that's not everyone who is infected. To know the full number, we'll need a different kind of test to be used -- one that measures evidence of past exposure. These tests are under review by FDA. These tests will identify people who were infected but had no symptoms.

armyyankee546 karma

Would a National shutdown in US be effective? Effective enough for justification?

APnews765 karma

From Dr. Sharfstein:

We're going to see what happens in Italy and Spain and France. Most likely, it will slow the spread of the virus. Right now, we're seeing local and state shutdowns of various degrees. In general, we need to educate and inform and inspire efforts at social distancing. Where people are not following (such as going to bars), the power of the state may be needed...but always with good explanation and constant revisiting of whether it's needed.

SurrealBookworm433 karma

What do you make of the UK government's response to the pandemic?

APnews856 karma


From Dr. Sharfstein: The UK is less aggressive at using social distancing than other European countries. There is a lot of concern that this will lead to a peak of infections that overwhelms the health care system. We'll see soon what happens.

PsychSiren350 karma

Why is the fact that people under 65 are susceptible to severe symptoms not being broadcast more in order to encourage social distancing in younger people?

APnews387 karma

Thanks for your question. We've stressed in our coverage that the risk of death rises with age and is greatest for the elderly and those with other health problems. Recently a couple countries have said a large proportion of ICU cases are in people under 65, and I'll be looking to include that info as it emerges. - Marilynn

APnews367 karma

More from Marilynn: Scientists estimate each person currently spreads the virus to two more on average, and pandemics end when the rate of spread falls to 1 or less.

It's the reason health officials want us to do social distancing and other measures to reduce spread.

Dr. Sharfstein adds: "Also, every young person is a bridge to an infection by someone at very high risk for serious illness or death. It could be their parent or grandparent or neighbor. Every single person needs to do their part to protect the community."

StopherDBF338 karma

There seems to be a lot of people under the impression that “we all already have it and it’s not that bad”. How wrong are those people in assuming the case of the sniffles they had 2 weeks ago was COVID-19?

APnews475 karma

From Dr. Sharfstein:

hard to say. but once we have serology tests available, we'll be able to check on how many people really have been exposed.

ADDING: But key point -- even if it's not that bad for one person, they could still have been a bridge for someone at higher risk to get the infection ... who could have much more severe illness.

PoochieNPinchy309 karma

We all know the 81% of cases are mild statistic, but do we know the distribution of truly mild cases (few days not feeling great) vs “mild” meaning pneumonia not requiring hospitalization?

APnews224 karma

From Marilynn:

The best info so far seems to be from the China CDC on nearly 45,000 cases.

This paper describes the distribution of symptoms and severity, details on age groups, etc: http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

ItsJustMeNBD231 karma

What are the earliest notable symptoms and how do they differ from a normal illness? I imagine it takes a few days to get to the fever and sore throat/dry cough stage.

APnews377 karma

From Marilynn: The most common symptoms are fever and a dry cough; sometimes fatigue and shortness of breath. Symptoms may come on slowly; for example, 44% of hospitalized patients didn't have fever at the start but nearly all developed one.

Here's a story giving tips on telling COVID-19 from flu and ordinary colds: https://apnews.com/fc233effe10f7dcf535f758fb1b0d2ce

merryartist169 karma

How long can Covid19 survive on an inorganic surface? For example, on a doorknob or phone.

APnews256 karma

From Marilynn: Tests by scientists found the virus can live up to 3 days on certain surfaces. Here's a story looking at what the tests show: https://www.sltrib.com/news/nation-world/2020/03/11/tests-show-coronavirus/

v_vexed147 karma

Has there been a lot of cases of people not experiencing any symptoms at all but still being carriers?

Is there anything new or interesting that researchers have learned about the virus?

APnews161 karma

From Marilynn: We know that people carry virus before symptoms appear and that some spread is due to that but exactly how much isn't known yet. This story looks at what we know about the virus in more detail: https://apnews.com/545af824f44a22f7559c74679a4f1f53

tsaxctown135 karma

The screening website made by Google for the US Government (https://www.projectbaseline.com/study/covid-19/) recommends you don't get screened if you are showing symptoms. What are we supposed to do in a country that seems to not care if we are reporting accurate numbers?

Edited to say it's not a US Gov site, it's a site made by Google for the US Gov.

APnews113 karma

From Dr. Sharfstein:

Actually, that website recommends testing for people showing symptoms. The highest priority for testing is for people with severe illness. As more tests become available, people with less severe symptoms should be tested. In general, the value of testing is much less for people without symptoms, even if they have been exposed. That's because the test may be negative but the person may still be developing an infection. the Quarantine period is 14 days, no matter the tests along the way.

reesmeister111 karma

Should people be getting pneumonia vaccinations? Are they effective in preventing the secondary pneumonia infections brought about by the coronavirus?

APnews187 karma

From Dr. Sharfstein:

Always a good idea to get the flu shot and if indicated the pneumococcal vaccination. Pretty much everyone should get the flu shot. To figure out if you should get a pneumococcal vaccination, check here: https://www.cdc.gov/pneumococcal/vaccination.html.

Now why is this important? First, to prevent flu and pneumococcal pneumonia, which lessens the burden on the healthcare system at this difficult time.

Second, so you don't have to go to the doctor, where you could pick up coronavirus.

And third, for pneumococcal, to reduce the chance of a simultaneous bacterial infection.

However, it looks like the pneumonia caused by the coronavirus is a result of direct viral pneumonia and appears different on x-ray and CT scan than traditional pneumococcal pneumonia. So the role of bacterial infection may not be particularly large; I'm sure future research will clarify.

grinning_man100 karma

For Dr. Sharfstein, do you have any policy recommendations for supporting service industry workers and business owners who are shutdown, underpaid, or laid off during a pandemic? Thanks to you both for taking questions!

APnews97 karma

From Dr. Sharfstein:

This is a good guidance document from CDC for businesses. The economic issues are really important -- people need income to live. That's a critical question for policymakers, and businesses should be calculating what they need to keep those who depend on them able to care for themselves and others. https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html

2468timetoinebriate96 karma

1) How likely is it that there may be asymptomatic transmission? I've been reading things but no one has a definitive answer.

2) If you come into contact with a Covid positive person, are you almost guaranteed to contract it?

Thanks for taking the time to answer these questions!

APnews144 karma

If you come

From Dr. Sharfstein: "Almost guaranteed" is a bit vague. It depends on the nature of the contact. Generally, it's thought up close contact (including sharing personal space, touching, sharing food) are much higher risk for transmission. Waving at someone across the room --> unlikely, but that's not an invitation to go and wave at people. You could touch something on the way in or the way out and get infected too.

APnews52 karma

From Dr. Sharfstein:

It's been documented. The question is how important asymptomatic transmission is to the overall spread of the virus. And the evidence coming in suggests it might well be important. Tom Inglesby , the director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, covered this well in this podcast: http://johnshopkinssph.libsyn.com/tom-inglesby-answers-your-covid-19-questions

caff_addict8882 karma

Why is Italy suffering a much higher death rate than other countries?

APnews169 karma

From Dr. Sharfstein: Good question. The disease obviously spread quite a lot before significant actions were taken. I also understand their age distribution may skew older. But the full answer is not yet known.

n1ssen65 karma

What is the best estimate of how long it take before you become infectious and when are you not infectious anymore ?

APnews106 karma

From Marilynn: Symptoms usually develop five to six days after exposure, but virus has been found in the nose or throat of people infected for a couple days before they develop symptoms, and the incubation period can be up to two weeks. Most people recover within two weeks but how long they remain infectious is still being studied.

notadykepoet54 karma

Hi! Thanks for doing this. Other than social distancing and good hygiene, what else can the average person do to help their families stay safe?

APnews95 karma

From Dr. Sharfstein:

Help out the people in your life who are at very high risk of serious consequences from coronavirus infection. That may mean getting them groceries, or convincing them how important it is to stay home. Also help others in your area understand the importance of social distancing.

APnews38 karma

From Marilynn: Here's a story with practical advice on how to prepare your home and families: https://apnews.com/f2be4d7861eb13b93104bd9412e52c55

BrockN50 karma

What are the potential long term health consequences for those that have recovered?

APnews104 karma

From Dr. Sharfstein: It's hard to know the long term consequences since the first infections appeared in late 2019, but there are certainly some concerns. The condition of acute respiratory distress syndrome can be associated with long-term challenges with lung function. This will be an important area for studies. Also, I'm sure there will be a number of psychological consequences for many people.

ShadowofStannis44 karma

What is the main mechanism from which coronavirus spreads? Is it airborne or through physical contact?

APnews69 karma

From Marilynn: Health officials think the primary way the virus spreads is through droplets, which can be spread when someone coughs. those can be inhaled or touched by uninfected people nearby, which is why doctors say we need to wash our hands a lot and avoid touching our faces.

This story gives more info: https://apnews.com/545af824f44a22f7559c74679a4f1f53

My42ndAccount41 karma

Do you think the weather warming up will affect transmission and number of cases? Will we still have to worry about this in July?

APnews65 karma

From Marilynn:

No one knows if this virus will behave like the flu and fade as the weather warms, or if it will become a seasonal scourge. Here's a story that looks at that: https://apnews.com/6c1e20759d8487fba2d8a3ebf5262766