Hello, I am Dr. Rebecca Katz, the director of the Center for Global Health Science and Security at Georgetown University Medical Center. AMA!

If you were fully in charge of the U.S. response what's the first thing you'd do?

started the response in early January!

Hello Dr. Rebecca Katz,

Thank you so much for doing this! There have been conflicting reports as to how long SARS-Cov-2 lasts in the air, and on certain objects. I read some articles saying hours in the air, and 9 days on certain objects at room temperature. Then I read other articles saying it lasts half an hour in the air, and 3 days on certain objects. I'm wondering if you perhaps have an idea on what the averages are for the air and on objects, or if this is something that is still being looked at?

Thank you so much, and have a lovely day!

The latest study I have seen (by authors from NIH, CDC and Princeton) show that it lasts on surfaces up to 3 days. (less time on cardboard and copper, more time on plastics and steel)

Thank you all for you questions today. I hope this has been helpful.

Stay informed. Take this seriously. And be kind to each other.

Regarding the spread of COVID 19, at what point would recommend the public stay home from work as a precaution? I'm in an area with a little over 70 confirmed cases in a city with a population of just over 1,000,000. I work closely with the general public daily and my work has no plans to close or stop business as usual. At what point should I use paid vacation time to stay home? Is this an overreaction?

I would say right now.

If you are in the US, that number of 70 confirmed cases is most likely a huge underestimate, as we have not been doing sufficient testing. Federal guidance is to work from home if possible. If not possible, take all precautions you can. Social distancing (can you stay 6 feet away from people at work?) washing your hands, not touching your face

https://www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf

What do you think people with non-coronavirus issues should do about going to the doctor? Should they avoid it and wait it out or go like normal?

Depends on what the issue is. If it is not a critical appointment, consider postponing. In fact, many providers are changing their hours or postponing non-critical procedures/appointments themselves.

But, clearly if it is a necessary appointment (like dialysis) you should keep it. Your provider will no doubt have new processes in place to keep people as safe as possible

Also, note that a lot of providers are moving to telemedicine, if possible

Is there any reliable information you’ve seen as to whether or not otherwise asymptomatic people have any decrease in lung capacity?

(Basically, I know the hold-your-breath-for-10-seconds thing going around was nonsense, but would otherwise healthy individuals with Covid-19 have any way to measure their own health given most don’t qualify for tests.)

Also thanks!

To my knowledge, there is no way for the general population to know if they are asymptomatic or not. Which means, if you have an elderly or at risk person in your family, please be very careful and maybe just connect with them virtually

Someone suggested that we should quarantine all people over the age of 65 + immunocompromised and let everybody else continue as usual. With the idea to put the virus everywhere and allow it to spread and run its course over some several months to avoid loss of jobs and school and so on. then once it has spread, and eventually dies in the environment, we can allow old and immunocompromised people 2 go out and about. What do you think about this? I thought that people that go home to older family members would be putting them at risk so that's probably not a good idea.

I think there are a lot of problems with that plan

First, everyone is at risk of contracting the virus and having a severe course of disease. The elderly and immunocompromised are just more at risk.

Second, Kaiser Family Foundation did a study to identify the number of elderly and at risk adults in each state. Please note that this ranges from 30-50% of the entire adult population, depending on location

There is a lot more I can write about this, but I firmly believe we have an obligation to our ENTIRE community

I remember reading about COVID-19 back in early January when it was still "pneumonia of unknown origin." Are there concrete steps the WHO or even individual countries can take to improve upon disease surveillance and international broadcasting/reporting?

China reported these cases to the WHO in late December. There will no doubt be arguments for a long time re: whether they could have reported earlier. But they reported the end of December, and the WHO declared a Public Health Emergency of International Concern at the end of January.

Are there steps we can take to improve capacity for surveillance and reporting? Absolutely. Under the International Health Regulations, countries are obligated to develop core capacities to prevent, detect, report and respond to public health emergencies. Many countries, however, have not had the resources to build and sustain these core capacities. The global community knows how to provide technical guidance, but requires financial resources (and national level commitment) to put these capacities in place

Can COVID-19 be classified as an airborne virus at this time?

My understanding is that a recent study has shown that the droplets can be suspended for an increased amount of time, particularly in certain healthcare settings/result from specific medical procedures, but I do not believe it should be classified as airborne at this time

Hi Rebecca, thanks for giving your time. Can you suggest some ways we can help our local doctors, nurses and healthcare providers? Is there anything regular citizens can do for them during this time?

What a great question.

Acknowledge that they are the front line responders. They are putting their health and wellbeing at risk every day to fight this pandemic. They may be tired. They made really love a nice meal- or maybe delivery to the hospital. They may be trying to figure out how to provide childcare for their families.

But ask them directly!

• Why are there such large differences between different country's tests in terms of both deployment and the rapidness with which results are found?
• Do you know if there has been any tangible ramp up of production for both testing and treatment (i.e. ventilators)?

I understand the US turned down WHO tests, but I'm still confused why some places have "rapid" tests and others don't.

I'm pretty confused to. We should be in a much better place right now re: testing.

My understanding is that testing has ramped up, but it is still difficult to get a test for everyone who wants/needs one and the results take way too long

Hellon. I am filled with anxieymty. When can TV shows and other parts of normal life resume? When do you think social distancing will end?

Honestly, it may be a while. But it will be ok.

There will not be any major disruptions in the food supply. Or water. Or electricity. These sectors are doing the best they can to provide critical services.

And we will hopefully see some of the best of humanity- communities doing everything in their power to provide support to each other.

I also fully expect to see some new ideas, interventions and technologies I've never even dreamed of. One of the few good things happening right now is that many smart people from many disciplines and sectors of society are now focussed on COVID. I imagine we are going to see things our (pretty small professional community) had never even dreamed of

I've recently read that over time it is estimated that 40% to 70% of the U.S. population will be be infected with the virus. Is this a virus that is a one-and-done per individual or is it possible to contract COVID 19 multiple times?

There are multiple models out there for how much of the population may become infected. These range from 10% to over 80%. These estimates, though, are directly related to how many social distancing measures are put in place and for how long

It appears that earlier reports of 're-infection' were really just people having a very long course of disease (or period of time when they are still testing positive). I think everyone is hoping that people who recover develop a natural immunity, but we are still waiting for additional scientific studies to confirm this, as well as to confirm how long such immunity might last. This will be critical information for the response

In the film, researchers find that the pathogen mutates as it spreads through the population. Is it something that scientists are concerned about with the new coronavirus as well?

So far this coronavirus has been pretty stable. There was some research published around two different strains of the virus, though, and that is being more thoroughly investigated.

how is the development of the vaccine against COVID-19? Is development being effective?

Vaccine development is happening at lightening speed. There is already a candidate that started Phase 1 trials this week. Know, though, that it is a long process to get through clinical trials and we are still probably about a year to 18 months out

Is our current administration taking and implementing your expert advice about managing this public health crisis?

The current administration is drawing upon its internal USG experts, but also using the National Academies for advice.

Do you recommend people watch Contagion if they haven't already? And beyond entertainment, what valid takeaways does it provide for us these days?

It is a good movie, so recommend watching for entertainment. I also think there are some aspects of it that are very educational (love that Kate Winslet explains R0), and there are some parts that feel very relevant to today (sitting in a coffee shop and realizing all of the opportunities for virus transmission.).
But there are some parts that are very much Hollywood - like self injecting an experimental vaccine. Also, the movie was based on a virus that had a much higher case fatality rate than COVID

Will this pandemic be as bad as Spanish flu?

It has a similar transmission, and a similar case fatality rate. It is,though, a different virus, so it will act differently, and we now have the ability to develop effective medical countermeasures.

All of the social distancing measures currently being discussed are in an attempt to save lives and do what we can to ensure fewer people die

What question are your family and friends asking you the most these days?

I think the most frequent question I get is 'how long is this going to last'? There is a fair amount of uncertainty around this, but I can definitely say it will be longer than 15 days

What’s the easiest way to donate supplies to hospitals right now? What kind of supplies will hospitals take? Do masks, gloves, etc. need to be unopened to be donated?

ETA: Are there other kinds of contributions or donations we should be thinking about right now? Blood or plasma? Food?

If you have supplies, I'm sure hospitals would be very thankful. I'm not sure what normal procedures are for donating supplies, but I do know that many hospitals and healthcare providers across the country do not have sufficient numbers of masks There are also call out right now for donating blood, particularly in more hard hit areas of the country, as there are severe shortages

Am I really safe in my home? Will self-quarantining guarantee I don’t catch it?

After a full 14 days, if you have totally quarantined yourself, and have not developed symptoms, you should be confident that you are virus free. But after those 14 days, are you re-exposing yourself?

Welcome to Reddit AMA, Dr. Katz.
My question is: why aren't US hospitals releasing clearer statistics of the deaths (age group, if they had pre-existing condition or not) in order to calm some people down?I feel like so many people are freaking out in fear, when they should be able to understand that self-isolation is a matter of precaution, to avoid mass infection of those in risk-groups.

Side note: Hah, just watched "Contagion" two days ago. :)

The public health and medical community is indeed sharing information. Data should be reported to CDC. CDC is releasing some of this (not all- which I, too, take issue with). And clinicians are publishing academic papers as fast as possible (and putting pre- publication papers online as preprints)

What are your recommendations on ambulatory elective surgery centers? I am an RN and ours remains open for business in Calif.! This seems irresponsible! Staff is worried about exposure. How effective can our screening process be if people can remain asymptotic for up to 14 days. Patients will have no idea if they have been exposed or not until its too late! It has been clear regarding recommendations regarding elective surgeries in hospitals but very confusing regarding ASC's. Some clarification would be great, although I have already emailed our CEO to voice my concerns that we should close, not only to protect staff and their families but also to protect the patients in our community.

My recommendation - and that is all this is- a recommendation- would be to stop elective surgeries. For all the reasons you have mentioned.

(although I would note that on average, people who develop symptoms most often do so between day 5 and 12)

What are your thoughts about the relatively low number of cases in Africa and what can be learned from Africa about COVID 19?

Unfortunately, I fear that there are probably many unreported cases in Africa.

But what can we learn? Senegal has developed a rapid test for COVID, Nigeria is involved in aggressive contact tracing. Africa CDC is working closely with nations to help them prepare.

Can you tell us if you have been seeing GI symptoms such as nausea and diarrhea in COVID-19 patients?

GI symptoms have been documented in COVID patients, but it is not all that common.

Hi Dr, are there currently any projections as to when the COVID-19 situation will peak in Italy?

Italy had an ~12% decrease in the number of new cases reported yesterday. They are still really struggling - particularly in the north- and their healthcare systems are overwhelmed, but it appears the social distancing measures are starting to help

Is there a chance of other respiratory illnesses like the flu going to render a person vulnerable to Covid 19? Should I get the flu shot?

Two months ago we were urging people to get the flu shot because flu was circulating, and also helped to keep people out of drs. offices. We are heading to the end of flu season now, though, so best to check how much flu is still circulating where you live

Hello Dr. Katz,

I was told the coronavirus would peak in mid-June. Can you confirm that based on your resarch/models? Thanks

It is pretty hard to tell when the peak will be, as we are still seeing new social distancing measures implemented. My best guess, though, is that we may see a peak sometime between late May and mid July

Dr Katz,

You indicated that there is a shortage of blood donations. Is there any concern that donated blood could be infected or is that not how it works with a virus? How do I know if it is safe to donate?

I don't know enough to answer that question (as the daughter of a hematologist, I know what I don't know!) But I can share that the American Red Cross has tweeted this:

American Red Cross @RedCross · Mar 17 We now face a severe blood shortage due to an unprecedented number of blood drive cancellations during this #coronavirus outbreak. Make an appointment to help patients counting on lifesaving blood: https://rdcrss.org/2weMYZI

[deleted]

A paper was released yesterday in Pediatrics that you might want to take a look at. Includes new data from a study of 2000+ children infected in China and had specific information about difficult courses of disease in babies and preschoolers.

Hello DRK! Would tests show if one already had the COVID19 virus or does it only confirm if presently carrying?

I believe the current test only shows if you currently are infected, and doesn't capture past infection.

As a student that's deeply interested in the interdisciplinary aspect of medicine and politics, what do you think of how various governments have reacted to COVID-19 and how do there "stack up" against each other in terms of efficiency, effectiveness, economic protection, and rates of testing/recovery? Particularly of interest are Italy, South Korea, China, and the U.S.

(Also, Georgetown is one of my dream schools!)

Apply to our programs!!!

I imagine I will be supervising dissertations on these questions for years to come

Could this pandemic lead to governments (Canada or the US) asking temporary residents (e.g. international students and foreign workers) to leave the county? In case of shortage of resources and other challenges.

I really don't know.

How can we expect the economy to restructure during this pandemic? Historically, what has happened economically in past pandemics and/or in wartime? What can we expect recovery to be like after the dust settles, and what changes will persist?

This isn't my area of expertise, but to repeat the phrase a true expert used this week....the economy may be in a coma. I imagine things will be pretty bad for a while, but then the economists and government decision makers will no doubt do everything they can to revive the economy and get us to a better place.

If a person had Covid-19 a month or so ago and didn't know or recovered would a test now or later indicate they had been infected?

probably not- at least not the tests that are currently being used

Appears a health Emergency was declared on Jan 30th, is it common practice to hide this information from citizens? https://int.nyt.com/data/documenthelper/6819-covid-19-response-plan/d367f758bec47cad361f/optimized/full.pdf#page=1

The public health emergency of international concern was declared on January 30th- announced in a live presser, watched by interested parties all over the world and open to the public. It was the reported on in the press and the subject of multiple journal articles and blogs (including some by me!)

Having spent so much of your career on disease surveillance and public health emergencies, what has surprised the most you about 1) governmental response worldwide and 2) public response to COVID-19? Does this seem like previous outbreaks/pandemics, just on a different scale?

There are a lot of things that I'm finding pretty surreal right now

I think one of the things that has surprised me is decision makers not taking this seriously enough early on. I'm also struggling with trying to convince the general public that they need to take action....now. I found it very distressing to see so many people out at bars Saturday night. This is dangerous. For you. For your parents and definitely for your grandparents.

We haven't seen anything at this scale in ~100 years

Good afternoon, and thank you for doing this! I currently live with my mom whom is 58 and use to smoke. She stopped about 6 years ago, and has never been diagnosed with any sort of immunodeficiency or breathing issues. How worried should I be for her safety compared to mine? Is she at a super high risk of critical sickness/death?

She works at a daycare that isn't closing (for now) and I'm afraid of her getting sick. It's honestly been keeping me up and night and I'm not sure what to do.

Thanks again for doing this AMA and for what you do. Stay safe!

Suggest you have your mother call her provider, who should be familiar with her health history and be able to provide specific guidance on whether she should stay home

My employer in an office of 20 has instructed me to use household spray disinfectant twice daily to clean door handles and stair rails throughout the office. I’m using a separate piece of kitchen towel for each surface. I don’t mind doing this but how affective is this likely to be?

Very. Household disinfectants work! CDC and the EPA have additional information on their websites

Good Afternoon, Dr. Katz-

How does obesity contribute to less favorable outcomes with COVID-19?

Thanks so much for taking the time to share your knowledge and insight!

My understanding is that obesity may be a contributing risk factor

What does the longer term look like for those most at risk, i.e. will outbreaks continue to occur periodically, so basically they will always be at risk until a [hopefully safe, effective] vaccine is developed?

Basically Until the population becomes immune- either through natural immunity or through a vaccine.

But you also never totally know. SARS was fully controlled through very aggressive social distancing measures.

Is this the end of humanity?

no :-)

How can you be sure. I dont see stores opening again or world ever seeing stuff like NHL NBA or even concerts

We will get through this. It may be difficult for a while. But we will get through it