We’re Dr. Eric Cioe-Peña, an emergency physician in New York, and Jayme Fraser and Adrianna Rodriguez, two USA TODAY reporters covering the coronavirus outbreak. Ask us anything!

Can you address the topic of the USA being "so far behind" other countries with testing and preparedness? It's so hard to read through the bias of different news sources and would love to hear some direct responses by the professionals themselves.

The CDC initially chose to develop its own test separate from the World Health Organization. But soon after the tests were shipped in early February, there was a flaw in one of the tests components and states could not confirm the test results. This caused the initial delay.

At that point only the CDC and the New York state department of health were testing. Now the government is allowing more and more private companies and commercial labs to test and we're basically playing catch up, but the virus is just spreading too fast. - Adrianna

I can't compare to other nations, but the next story I'm working on looks at a recent survey of community hospital leaders by a medical nonprofit. They received 575 replies from facilities in 45 states plus DC. How many have a plan for handling an infectious disease epidemic? Only 43% said yes and about 20% said they weren't developing a plan in response to COVID-19. When asked how concerned they were about their ability to manage a surge of COVID-19 cases, only 11% said they were unconcerned or moderately unconcerned. The vast majority said they were concerned or very concerned. -- Jayme

How can social distancing and self isolation possibly work when most Americans can’t work from home and aren’t being given leave (or even proper PPE) by their companies? People are already sick and still being allowed, even pressured to work with coughs and fevers.

I agree this is a huge problem. We need the political leaders of our society need to step up and remove this obstacle. -Dr. Cioe Pena

How scared should 20-something year olds be that we’re spreading the virus asymptomatically?

I think if you regularly come into contact with high risk groups, its pretty scary. Keep in mind that even though you can spread it while asymptomatic, its a lot harder. The symptoms are what allow us to spread those viral particles in droplets onto surfaces and directly to other people in close contact. If you aren't sneezing and coughing, contact has to be much closer to spread it. -Dr. Cioe Pena

I’m an EMT in Boston. How hard are we going to get hit the next two weeks? I’ve been warning everyone for weeks but just like Italy everyone treated it like a joke.

Quick clarification question so we can answer as accurately as possible, do you mean how hard is Boston going to get hit or EMTs? - Adrianna

I guess both. I’m a fairly young guy early 20s. I’m not afraid of getting the virus because it’s our job to help the sick under any circumstances. I’m more nervous for my elderly patients/immune compromised I could pass it to if I’m walking around asymptomatic. I’m nervous for all the older nurses, MDs, first responders who fall into the higher mortality rate too. Thank you for the response and stay safe my friends

We are expecting to see a lot more cases soon, so we believe that all health care workers will affected by the increased case load. Johns Hopkins says that there's nearly 200 cases in Mass. right now, however, we're predicting that number to change soon. As more cases pop up, the more inaccurate that number will be. - Adrianna

Is there a trick to telling if you have a fever without using a thermometer?

I can't buy thermometers anymore where I'm at, and I often feel "under the weather" from separate health issues so I'd like to stay cautious about monitoring my temperature as much as I can.

Unfortunately, there's no way to tell if you have a fever without a thermometer. - Adrianna

Is there a test to confirm if someone has had the virus but recovered? If someone has recovered is it safe for them to go out and be around elderly people to help them?

Not readily available. we can test for antibodies, but that is not the test we are currently using. the test we are currently using detects the virus itself, so if that test is negative you are not likely to be infectious to anyone, including the elderly. -Dr. Cioe Pena

Why are doctors and nurses not wearing full bio containment suits like other countries?

So first, its not always necessary because some activities we do as health care professionals are lower risk and we are protected with just the N95 mask or surgical mask. Secondly, wearing that suit is really hard during a 12 hour ER shift! Usually we need frequent breaks to rehydrate, etc. There are some cases where we are doing high risk procedures (like putting patients on a ventilator) where it is necessary and we do put them on. -Dr. Cioe Pena

Are people with asthma at higher risk?

Yes. However, children with asthma seem to be doing better than adults with asthma. - Adrianna

Follow up, if I’m in an inhaler should I stop? Some suggest to stop taking inhaler.

No, please use your inhaler as prescribed. -Dr. Cioe Pena

I have Reactive Airway Disease, would that count in the same high-risk group as asthma?

I just had pneumonia in December so I already know I'm at a higher risk than the average 25 year old but I'm not sure if I should be concerned or really, really concerned.

Not really really concerned, just take appropriate precautions to stay healthy. -Dr. Cioe Pena

Are your nurses still being provided with appropriate PPE?? What do you consider appropriate? I’m a RN. We are being given one surgical mask per patient per shift. Some other local hospitals are giving their nurses no PPE at all. As a MD, what do YOU feel is appropriate PPE for YOU to wear when you’re working with a COVID-19 positive patient?

Also, USA Today... TALK TO THE NURSES!! We are being slammed by the virus and by our employers. Hear our stories please, we need help.

Edit: Surprised to come back and see this downvoted. Says a lot about how healthcare workers are treated in this country.

So firstly, I think we do need more nurses to be spoken too, i'll mention this to USA today as well. We are being given a surgical mask per shift, not per patient. When doing procedures like intubation, nebs, bipap, etc we use N95 and more PPE like a gown, hood, gloves, goggles etc.

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Mask the patient and mask on you is fine for pretty much all non-invasive patient encounters and keeping us safe. I've been working with that for most patients. I agree though, we need to make sure we are keeping docs and nurses safe. Our healthcare systems are only as good as they are. -Dr. Cioe Pena

1. How much toilet paper should we really be buying?

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1. What is the best thing to do when your SO has the Coronavirus?

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1. What would you do if you had the Coronavirus?

1. TP - less than what we're currently buying :) I would say 2 weeks worth, and that's a good rule of thumb for any groceries.
2. Keep your SO in another room and limit contact.
3. If you have it, stay home.

- Adrianna

I work in MRI and I am currently working at a outpatient facility in PA and I am still scanning routines studies that are non emergent. I am getting little to no guidance on what I should be doing to protect myself or my patients. I have a few surgical masks. I feel bad for using a lot of wipes because I feel all supplies should be taken to the hospital. Any advice for me?

We are advising all of our clinical providers to wear surgical (procedural masks) in the clinical areas and mask any patient that has a fever or cough. This is helpful in preventing healthcare workers from getting sick. Other than that, wash your hands compulsively between patients, definitely before touching your mask. -Dr. Cioe Pena.

Why would masks be helpful for healthy doctors but not for the general public?

Because the way you get the virus in the healthcare setting is usually different from the general public, doctors are often not avoiding or distancing from sick people, we are right at their bedside. The way a doctor or nurse is going to get sick is by getting coughed on from a patient whos presumed or known positive. In the general public, you are much more likely to get it by touching a contaminated surface with your hands and then your face. I've also noticed the lay public touches their faces A LOT with the surgical masks on. -Dr. Cioe Pena

Is it true that this virus is 5x more infectious than the common flu?

No, its about as infectious as the flu, more people are getting it because there is no vaccine yet. -Dr. Cioe Pena

I’m in NYC, how long until I can go back outside and do normal things?

There's not much risk associated with being outside (going for a run, being in nature, etc.). But other normal things like bars and gyms will most likely to be closed until at least April. - Adrianna

Two questions. My temperature is naturally lower than most people and I don’t get fevers as badly. When I was sick with the flu I wasn’t allowed to leave school early because I didn’t have a fever. Is there any way that I could identify that I’m sick without a fever?

Second question. What do you think about all schools in Ohio closing for 3 weeks because of coronavirus?

1. Aches & chills, difficulty breathing, dry cough and overall fatigue are also other markers.
2. Many states are following suit i.e. New York - Adrianna

Do you believe things will become so bad that doctors will really have to choose who lives and who dies when hospital resources become too scarce?

I hope not! We need to take the public health measures seriously so we aren't put in this position. Its the worst thing in the world a doctor could have to do. -Dr. Cioe Pena

If someone has been exposed to an individual with the virus, does the 14 day quarantine start after your last contact with them?

What about people who are living with someone WITH this virus - at what point should their 14 day self quarantine start?

Correct, 14 days after last exposure. If you are living with someone with the virus, your quarantine starts 14 days after they are symptom and fever free for 24 hours. -Dr. Cioe Pena

I cant afford masks, if I just put a piece of a t shirt to cover my nose and mouth it would work?

Unfortunately a tee shirt won't work, honestly masks are not necessary if you are healthy. They are helpful if you are sick and self isolating. One surgical mask which is not very expensive (your doctor might give you one if they are sending you home to self-isolate) could last you the entire two weeks in isolation. - Dr. Cioe Pena

Some protection probably better than nothing but I'm also eager to know...

The holes in the t-shirt are huge, so not too helpful. Reusing the paper mask is much much better, if sick. -Dr. Cioe Pena

How much am I at risk as a 13 year old if I test positive? I’ve heard it’s about 1 in ~4,000 deaths per cases in my age group.

There have been no deaths under the age of 15. -Dr. Cioe Pena

Is it true that recovered patients are having trouble with their lung capacity? I saw something about “frosted glass” lungs.

I’ve also been seeing that people my age (early 20s ish)aren’t as low risk as everyone makes them out to be, what are your thoughts on that?

Thanks

Its a ground glass appearance on CT scan, it basically means that they have viral pneumonia and ARDS (acute respiratory distress syndrome). People can and do make a full recovery from that. Some people will have residual symptoms for weeks, but it does get better.

There are sporadic cases of 30 year olds and 20 year olds not doing well, most are doing great. Biggest risk seems to be a healthcare worker. -Dr. Cioe Pena

President Trump told a group of governors on Monday morning that they should not wait for the federal government to fill the growing demand for respirators needed to treat people with coronavirus. “Respirators, ventilators, all of the equipment — try getting it yourselves ...

Which states are handling things better than others?

Which policies and/or preparedness in terms of having previously invested in resources are working?

I don't think we'll have a solid answer to that until it's all over, but here are a few things I've noticed. Some states -- like Ohio and Illinois -- have been aggressive about implementing community isolation measures, like closing restaurants or postponing elections. (Some, of course, say those actions should have been taken even sooner.) Other states with lots of cases, like Florida, have not taken those same mitigation measures. Speaking generally, the states and counties that include an infectious disease epidemic in their emergency plans will be scrambling less than those that didn't have that component or hadn't done a practice run with it recently. Individual hospitals, too, should have emergency plans and surge plans that give them a template for responding to an infectious disease outbreak that could overwhelm typical capacity. -- Jayme

Do you think it will be possible for some states to fare far better than others? Like how in Europe certain countries are doing better. If some states take better measures... (I am in Madisom, WI)

Because no one has immunity (new virus, no vaccine), it is likely to end up everywhere. How many cases crop up in any given community or state will depend on the mitigation measures taken. That also will affect whether hospitals are hit with cases all at once and stretched thin. Because cities and states have been responding differently and at different times, I would expect there to be variances if we were to look back after a couple years. Community-wide measures help slow the spread. Social distancing, good hand washing and avoiding touching your face are the best personal protection measures. -- Jayme

Hi, What estimate do you think is NYCs real infection rate? How many people do you turn away from getting tested due to limited testing?

I think its much higher than reported admittedly all state and federal agencies are saying that too. We turn lots of people away from testing at this point, prioritizing in the EDs patients that need admission or ICU. If you can drive or walk yourself to a hospital Emergency Department right now, you probably should be going somewhere else. -Dr. Cioe Pena

If a person is tested for Coronavirus and results come back negative is it possible they have it but are still in the incubation period or does a negative test mean at that particular time they are clear?

A negative result that day means you're not infectious, but you could have it. It's possible to test positive a couple days later. - Adrianna

Should we be wearing masks when going out?

If you're healthy, you don't need to wear a mask. - Adrianna

Is it really true that 50% to 75% of Covid-19 cases are asymptomatic? If so, does that add another complicated layer of prevention that hasn't really been handled / discussed?

No. - Adrianna

No as in no?

Or no as in we don't know?

Based on contact tracing and the detailed line listings come out of multiple countries, there is no evidence that the % of people who are asymptomatic is anywhere near that high. -- Jayme

Has there been any discussion on using drugs off-label that have shown promise in the literature as treatment for SARS and SARS-CoV-2 (like Chloroquine, remdesivir etc.) on unstable patients or as routine treatment in high risk patients with COVID-19?

Some doctors are using anti-virals as a Hail Mary in hopes it slows down the progression of ARDS (Acute Respiratory Distress Syndrome). The results are being monitored, but it'll be a long time before anyone has certainty about whether they helped. Blanket guidance is a moving target with so much still uncertain about the virus. Ultimately, each doctor will have to make a judgment call. --Jayme

It might be an uninformed question, for which I apologise, but: Is it possible for a young person (20-29) with a strong immune system to kill the virus from within or would they just act as a vessel?

The people who are infected but have no symptoms still have the virus in respiratory secretions, so they could spread it if they're slobbering all over things you touch. (Like a child might!) There is no risk from sitting next to someone on the subway who has no symptoms. But people with mild symptoms, no matter how healthy they are, are more likely to spread the virus. Some initial studies show people with mild symptoms initially might not develop severe symptoms until week 2, if at all. -- Jayme

I'm in my early 30s work for a tour company in Florida and drive a 14-passenger van with a bunch of strangers each night. My wife is similarly aged and pregnant and I'm getting a lot of pressure from family to self-isolate, but my employers are keeping the tours going until someone orders them closed down. Should I refuse to work or just take basic precautions while driving people around?

That's a call you'll have to make based on your own personal risk assessment and all those other things in life like a budget. Most cases result from close, regular contact with someone who is infected. From what we know so far, it seems less common to contract the virus by touching an object then touching your face. Taking precautions like washing hands, not touching your face and disinfecting the van regularly will certainly help. Your regular doctor could give you advice more specific to your family's situation. -- Jayme

As an ER doc, are you already seeing a large increase in traffic at your hospital?

So we've seen some increase, combined with a decrease in ER visits for everything else though, so far its manageable. We are bracing for this week to be worse though. -Dr. Cioe Pena

There is a lot of confusing information regarding treatment in terms of diet and medication. What is the best way of home treatment in case I am infected and am unable to be hospitalized due to the overwhelming stress in the hospitals?

COVID-19 can lead to Acute Respiratory Distress Syndrome and, in the worst cases, organ failure. I personally would call your local health department, answer their questions and follow any guidance they give you. If you have an underlying condition that affects your ability to be in a hospital, be sure to mention that. Your regular doctor and local public health officials will know best which resources are available where you live. -- Jayme

Is it true that children are more immune to the coronavirus? If so, why?

They are not more immune per se, but they definitely are getting infected less and having MUCH milder symptoms or no symptoms at all. They can still get infected and transmit it without symptoms though, so keep them away from Grandma and Grandpa if possible! -Dr. Cioe Pena

What is the scene like currently in hospitals in US outbreak centers? I've seen unverified twitter threads that paint a particularly grim picture... can any of those terrible conditions be confirmed? What's it like right now to be a frontline worker against the Coronavirus?

Things are tense, providers are nervous and worried. I wouldn't call conditions terrible, we are still taking excellent care of people but the air is tense. Its not a fun time to be an ED doctor but this is why we (I) signed up to be an emergency physician. -Dr. Cioe Pena

Should we be in self quarantine in the USA?

If you have a potential exposure or are in an area of high risk, then probably. Quarantine is when you have a likely exposure to a positive case and are waiting to see if symptoms develop in isolation so you don't infect other people. Theres a lot of cases where that is true right now in the USA. -Dr. Cioe Pena

Is there a recommended medication yet? I have seen some experimental medication given to patients in serious conditions like Remdesivir.

Not really. Remdesivir is being used as a "hail-mary" for people in the ICU and there's not much evidence to back it up. -Adrianna

How many people do you believe to be infected? Is it more than what is be reported by the CDC?

Short answer is a lot. Its definitely more than reported because the CDC themselves are saying they are only reporting positive tests so between lack of available testing and people with mild or no symptoms, theres definitely an undercount. There usually is in epidemics with such wide ranging spectrums of symptoms. -Dr. Cioe Pena

Can someone have both Influenza A/B and COVID-19 simultaneously?

My not-a-scientist brain says you get sick from the common flu, have a weakend immune system and are more likely to contract the coronavirus and are taken down faster.

I'm not a doctor, so I can't say for certain if you can get them simultaneously. I have, however, heard experts talk about secondary conditions. If you get one or the other, your immune system is weakened, so you are more likely to pick up something new. Some of the deaths in China, for instance, were not from COVID-19 directly, but from secondary infections and ongoing complications. --Jayme

How are Drs. And Nurses who are treating CV patients getting infected? Are preventive measures (masks/washing hands/etc.) not effective?

Most are getting it from direct exposure, coughing in our faces, etc. Its a numbers game, we do mostly 12 hour shifts, and are exposed all day. -Dr. Cioe Pena

Compared to other diseases (like ebola, for example) how dangerous is the Coronavirus?

Ebola is much more dangerous, about 50% to 90% fatal. Coronavirus at its worst is 7% fatal in Italy and will probably average about 0.6% fatal. Flu averages 0.1%, so a little more deadly than seasonal flu. -Dr. Cioe Pena

There’s a bunch of misinformation going around and it’s hard to find any true answers so I wanted to ask.

1. How bad is it really?

2. What will the US look like cases/death wise by the end of this?

3. What must happen now to stop the spread?

1. Right now, not as bad as it will be. How bad it gets ultimately depends on several factors, including: length of and diligence to mitigation measures, availability of medical equipment and pharmaceuticals, whether this virus is seasonal, and demographics in the communities where cases spread. For quick comparison, less than 1% of people who get the typical flu end up hospitalized at any level. So far, about 5% of people with COVID-19 have needed intensive care, including a ventilator.
2. Studies analyzing the % of deaths in various Chinese communities have reported death rates between 2% and 10%. It's very tough to know what could happen in the US, including for the reasons in No. 1. That said, here's some back-of-the-napkin math: If 7.4% of Americans are infected -- the infection rate for the most mild flu season in the U.S. in the last 5 years -- that would be about 24 million infections. If 2% die, that's 480,000 deaths.
3. There is no real way to "stop" spread in the U.S. at this point. We can slow the spread so we don't overwhelm health workers and we can do our best to prevent the spread from reaching vulnerable people. Social distancing and good hygiene are the best things we can do as individuals. The tough part is that we, as individuals and businesses and governments, make decisions on more than medical outcomes alone.

--Jayme

Which city do you think will "lead" the way in cases, and what will make them first?

It's safe to say whichever city is the biggest and has the most people i.e. New York. However, the Seattle area had a head start and has a high number of cases. - Adrianna

Do we need to ban/limit domestic travel to limit the spread or are current measures such as social distancing enough to curb this virus?

It depends on how long the mitigation measures are in place. Limiting travel on any scale reduces the chance of the virus reaching a new community, but some studies show that only works as long as the bans/limitations are in effect. As more places in the U.S. have cases of community spread (it wasn't a result of travel), domestic bans would be less effective at containment. These decisions likely will balance non-health concerns, too. -- Jayme

Missouri has only tested 208 people with 8 positive, none in Kansas City. How many people do you think have it and can’t get tested?

It's impossible to know. Some people who are infectious have hundreds of contacts before being isolated. Others come in contact with fewer people. Almost certainly there are lots of people who are not being tested. In most places in America, doctors and health officials won't approve a test unless someone has symptoms AND has had contact with a confirmed case OR traveled in certain countries. One early study has suggested there could be 5-10 undetected people for every confirmed case, but some experts guess its higher than that. --Jayme

What is the weakest link? A lack of respirators? A lack of staff? What is the straw that will break the health care systems back?

Everything is local. Some hospitals, towns and states might be better prepared for one of those than others. Experts widely agree, however, that protecting health care workers has to be a top priority. The number of respirators, beds, etc. are not going to decrease, even if they are not enough. But if health workers get sick or quarantined, there might not be enough qualified people to use that equipment. -- Jayme

My country aswell as other european countries take action to control the spread of the virus, planning for a slow but steady spread of the virus throughout the population. Anyone, but especially the elderly and those with comorbidities are at risk of being hospitalized from this virus.

Others have a higher chance of none to mild symptoms, able to get better at home over a certain period. This group however, will not be tested for the virus in my country and we will have to rely on estimates from our healthservices to establish how widespread the infection is.

To my question: as the description mentions this will mean a lack of true reliable info on: - the percentage of people, from whatever age group, requiring hospitalization. - the symptoms people with "mild complaints" suffer from, on average. (As this can vary alot, from agonizing headaches, fever and chest pain to virtually no symptoms)

Question: on the above two points, is there any reliable source reporting on this. What country produces reliable info on these points (southkorea?)?

Thank you

Data nerd here! Generally speaking, data quality tends to be better earlier in outbreaks because officials and researchers have more time to keep track of the details. As cases spike, it becomes less of a priority and more difficult to maintain the same level of detail. "Line listing" data is what most infectious disease experts are working with right now to try to answer the big questions, like those you mention. Groups like The MIDAS Network are compiling data and research results. It's not just the data quality that can affect the figures you see. Demographics of any given country, access to health care, underlying conditions, etc. vary between nation. For instance, we generally see older people as more likely to need hospitalization but we don't know yet if that's purely a function of age or because older people tend to have more underlying conditions, like heart disease. Results also might vary if the country's had different treatment strategies. All anyone can do right now is make the best decisions they can with the best information they have and be willing to remake those decisions if they get new or better data. -- Jayme