Chat transcript: What to do if you have a compromised immune system and the best ways to prepare for the coronavirus

Mar 02, 2020

The coronavirus continues to spread around the world, with more than 80,000 confirmed cases. In the U.S., health officials urged the public to prepare for the "inevitable" spread of the illness.

Washington Post reporters answered your questions about coronavirus and the best ways to prepare.

Read coverage from The Post:
What we know about coronavirus
Where the virus has spread
How to prepare for coronavirus in the U.S.
How to think about travel as the coronavirus threat evolves
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Hi everyone, thanks for joining us today and submitting questions! Reporters Lena Sun and Marisa Iati will be kicking off the chat. You can ask a question any time by hitting the 'ask a question' button at the top of the chat. 

I understand there have been numerous deaths regarding this virus, however, no one has mentioned the age of those who have died. Is this virus more deadly to the elderly, young and immune compromised like the flu? Thank you.

Hi, and thanks for joining us today. Initial studies of the virus show that older people and adults in poor health face the highest risk from coronavirus. For people in their 70s who contract the virus, roughly 8 percent don't survive. The death rate is around 15 percent for people 80 or older. 

Unlike the flu, however, there's no evidence that coronavirus is more deadly for children. So far, people younger than 50 have died in roughly 1 of every 325 cases. 

If you get the virus, do you develop immunity against getting it again?

That is a question all the scientists have been trying to figure out. They're not really sure.

What is the likelihood of the virus subsiding in the Summer months and then returning in the Fall? And what is the chance of the virus mutating into a more deadly form like the Spanish Flu?

There has been a lot of talk about the virus subsiding in the summer. President Trump has said, for example, the virus will be gone by April. The scientists are not so sure. This is a new virus, a new pathogen. No one truly understands how it will behave. IF it behaves like other respiratory viruses, like the common cold and the flu, which tend to decrease in the summer months, then that is what scientists are referring to. 

Is it safe to travel domestically?

I think everyone has to use common sense. We know this is a highly contagious virus that is spread through close personal contact--respiratory droplets when an infected persons coughs or sneezes. If you are taking a lot of trains and planes and going through crowded areas, it would be wise to keep distance from people who seem sick. Also, wash your hands really thoroughly and don't touch your face. Everyone thinks this advice is not important. But it is the SINGLE MOST IMPORTANT THING a person can do. And you have to do it the right way: wash vigorously back and front, in between fingers, under nails, for 20 seconds. Sing happy birthday twice. 

At what level of public outbreak would it be wise to consider avoiding public events? And would that be a decision based on local area infection rates, state, regional or national?

Public health officials have said there will be more cases, and already we are seeing more state and counties reporting them. The decision to cancel or postpone mass social gatherings will be a local one, and that will depend on what is happening in local communities. I would not be surprised to see Kirkland, Washington and some of the communities in California that have reported cases take action to minimize people's face-to-face contact. So it would be a local decision, certainly at this point.

I'm curious, why do Iran and Italy have so many cases, compared to other countries in the Middle East and Europe?

Spread of the virus has largely been linked to international travel. Once someone brings the virus to another country, like Iran or Italy, it can spread rapidly through person-to-person contact. In Italy's case, some infectious-disease specialists have speculated that one or more people with negligible symptoms may have been carrying the virus in the country for weeks before it was detected.

Can people transmit the virus before they have symptoms?

There seems to be growing evidence that some people can transmit the virus when they have very mild symptoms. There have been published reports in journals that say this has happened with people have no symptoms, but I think we need to remember that people can sometimes say they don't have symptoms because they downplay small things, like a tiny sniffle, or attribute that to allergies or something else. 

Given that this virus isn't particularly lethal, can a person self-manage mild symptoms at home? Is there a need in such a case to get tested or notify someone?

Good point. Remember that the evidence from the more than 80,000 cases that have been reported in China shows that about 80 percent of people have mild illnesses, and that about 20 percent have severe illness. If you have mild symptoms, health officials definitely want you to stay home and self-manage because they want the hospitals to be able to take care of the truly sick folks. If everyone who has a tiny tickle rushes to the hospital, those places will get overwhelmed and not be able to treat the truly sick.

How vulnerable have young children been to the virus, worldwide?

There haven't been that many cases of young children affected by this virus. And that's a bit unusual because respiratory viruses tend to hit hardest those who are very young and those who are older. There have been some cases in China. One possible reason: China's family planning policy has for decades limited parents to the one-child policy. So it's hard to see what the spread is to other children if there is only one kid in the family. The evidence may look different as cases develop in other countries, especially in Africa, where the first case was reported in Nigeria this weekend.

Any advice on how I can get my Episcopal Church to stop letting the 99 people ahead of me in line for communion from all drinking from the cup directly? Anyone who says that the alcohol in the wine kills the germs should kindly tell their local bar that they have no problem if the wine glasses are never washed.

Maybe suggest to leaders in the church that there is a public health emergency surrounding a very contagious respiratory virus that is especially dangerous for those over 60 (the older you are, the greater the risk) and for those who have underlying medical conditions, such as obesity, diabetes, heart problems, COPD. If they need more convincing, you can point them to the CDC.gov website.

Since the virus seems to be able to move through the general population, could you see large scale events, Olympics, ball games, concerts, malls, etc., being shut down for an extended period of time?

There are various ways that the outbreak could play out in the United States, and no one knows for sure how much it will disrupt Americans' daily lives. Other countries have already taken steps to limit large gatherings. Japanese baseball teams have been playing in front of empty stadiums, while France has banned all indoor public gatherings of more than 5,000 people. The Louvre Museum has also shut down.

As for the Olympics, Japanese politicians have expressed concern about this summer's Tokyo Games. The head of the International Olympic Committee, however, said the organization is “fully committed” to the Olympics moving forward and refused to discuss alternative plans.

I lean toward not panicking about things like this, because panic isn't helpful. People keep telling me that it's nothing to worry about, since many more people die from the flu. But, on the other hand, I'm 61, and I have a history of respiratory issues, and typically come down with pneumonia or something similar, once or twice each winter. I catch any cold going around. This makes me more wary about this virus, should I be? Is there anything I should do differently as opposed to the general guidelines going around?

I agree that we should not panic. But given that you have a history of respiratory issues, I think it's just common sense for you to be especially careful about washing hands, or being in contact with people who seem visibly sick. I will repeat what I said about hand washing. Lots of people think that because this is a new virus, that we should have some new way or medicine to prevent it. But the answer is really, you don't want the virus to get into your mouth or eyes or nose --that's how it would get into your body--and the best way to do that is to NOT touch your face and wash hands the right way.
   That means scrub both the front and back, in between the fingers, under fingernails and do it for 20 seconds. If you don't want to sing happy birthday twice, I'm sure there are other songs out there... Most people really don't wash their hands correctly, based on my casual observations in my own office. 

Why are so many of the cases in the western portion of the U.S.? This question is asked on February 28 so the location of cases could have shifted to other part of the country by March 2.

The initial coronavirus cases confirmed on the West Coast were based on travel or contact with a known infected person. Since then, health officials have acknowledged cases of community transmission, which refers to people who became sick without travel or contact with prior cases.

“I think there’s a strong possibility that there’s local transmission going in California,” Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security, previously said in an interview. “In other words, the virus is spreading within California, and I think there’s a possibility other states are in the same boat — they just haven’t recognized that yet.”

If you have or get coronavirus, can you get re-infected? How long is the incubation period?

We've gotten this question a lot and I think the experts don't really know. Some of the top experts have said that you do gain immunity after first infection. But no one really knows because this is a new virus. Sorry to sound like a broken record. But one way to think about it is this: This virus doesn't know what it wants to be when it grows up. That is why public health experts are worried about its potential to mutate over time and cause more severe illness.

The incubation period is believed to be as long as 14 days, which is why quarantine and isolations have all been set for 14 days.

 

Are the 'bugs' out of the testing kits? Do all samples have to go to the CDC main lab? When will hospitals be able to perform the test for the virus in hospital labs?

Great question. The U.S. response to coronavirus in recent weeks has been hampered by problems with its testing. Experts have worried that the small number of U.S. cases we see now may be a reflection of limited testing, not of the virus’s spread. 

One of the three components in the initial test kit created by the CDC wasn’t working properly, preventing some state labs from being able to offer it. The CDC has since authorized labs to use the test using the two components that do work. They have also got a new test going out to labs that is going to bulk up testing capacity over the next few days for public labs in most states. At the same time, over the weekend the FDA also expanded policies for private labs/hospitals to use their own tests before they are cleared by the agency.

What is the worst scenario that is likely to happen: many people dying in the next 12 months, or a small number of people dying every year forever?

There are lots of people who have modeled possible scenarios. The worst-case scenario is that this pandemic is severe and many people get sick and some die. The other scenario is that the pandemic is mild, lots of people get sick and relatively few people get really sick and die. During the 2009 H1N1 pandemic, health officials were worried that the pandemic would be severe. But it turned out to be not as bad as people thought--and especially did not impact older people as badly--perhaps because they had previously had exposure to the virus earlier in life and acquired immunity. 

My colleague William Wan wrote a story today that lays out possible scenarios based on how previous epidemics began and ended. 

So what is the end game if, as it appears, this virus becomes endemic? Can we really continue isolating entire cities and telling people to stay home for 14 days if they've been exposed to an endemic virus?

Great question! ...I just published a story this morning after talking the past 3 days to epidemiologists & virologists. So it's on my mind.

1st caveat: Ultimately, how many people die of this new coronavirus depends on how widely it spreads, how prepared we are and what the virus’ true fatality rate turns out to be.

2nd caveat: There is a lot still unknown about this virus. 

That said, the best case scenario is probably what happened with SARS in 2002. It was bad but within months, SARS was brought under control, and for the most part stamped out, by international cooperation and strict, old-school public health measures such as isolation, quarantine and contact tracing.

The worst case scenario would look something more like 2009 H1N1 swine flu. It spread quickly, eventually to an estimated 11 to 21 percent of the global population. The WHO declared it a pandemic. Just in the U.S. alone, the CDC estimates that H1N1 killed 12,469 people in the United States during that first-year period from 2009 to 2010, infected 60.8 million cases and caused 274,304 hospitalizations.

Get enough sleep. Stay hydrated. Use a paper towel to open the door to the rest room as you leave in the office. When possible, open doors in public places by pushing with your hip or shoulder. Wash hands at obvious, but not necessarily convenient times - like right after taking public transportation or leaving a grocery store.

Thanks for the recommendations! 

How long are people sick with this and when they recover are they still susceptible or do they have an immunity?

How long people are sick after infection depends a lot on age, health and other illnesses they have. Older, chronically ill people are going to be the most hard hit. In severe cases, the virus causes pneumonia and severe respiratory problems. Once someone recovers, virologists so far believe they will not be reinfected. Although immunity is a relatively imprecise term...different vaccines, antibodies offer immunity for varying periods of time. There's also mutations, etc.

I have breathing issues due to asthma and while I am not in a panic, I do worry about coronavirus mostly due to the fact that even the common cold can cause me substantial bronchial distress lasting up to a month.

People with chronic illnesses, such as heart or lung disease, are at higher risk from the virus. You're right not to panic, but your asthma is a good reason to pay extra attention to the same recommendations that the Centers for Disease Control and Prevention have made for everyone: Wash your hands regularly and thoroughly for at least 20 seconds. Drink lots of fluids. Avoid touching your face. Cover your mouth and nose when you sneeze. And if you feel sick, please, please stay home. It's not just for your health, but for the health of other people.

Why are we limiting testing to people with specific indications? Shouldn't we be testing people with any symptoms to see how far it has spread in a community?

Because labs have limited capacity, health officials have wanted to keep testing to patients with a strict set of symptoms. They also have wanted to make sure that the testing meets a high standard to avoid false positives that could create unnecessary panic and sow doubt about the tests' reliability. 

Experts have warned that the relatively low number of cases in the United States could be due to limited testing and not accurately represent the virus's spread. On Saturday, the Food and Drug Administration significantly expanded testing by saying that it would allow certain hospitals to use their own tests before being approved by the agency.

Why are masks deemed not effective for the general public but considered essential protection for health care workers?

Masks! It's a question of limited capacity and those who need it more. If you're in a hospital or nursing home, you are much more at risk of infection than just regular Joe sitting at home. It's also a matter of how effective average Joe is in using the mask. U.S. surgeon general Jerome Adams just gave a pretty good explanation of this. Adams said that as a health-care worker, he has to get “fit tested” when wearing protective masks, and those who do not wear the masks properly tend to fidget with them or touch their faces, which “actually can increase the spread of coronavirus.”

When it comes to masks, there are masks and then there are MASKS. The N95 is the most effective at combating infection, and there is fear of huge shortage of those in coming days which is absolutely essential for hospitals. So keep calm. Save the masks for those who actually need it : ) 

What is known about how long, and by what means, a person can spread this virus after "recovering" from it, i.e., having no more symptoms? I believe we found that Zika could be spread thru bodily fluids for months.

Experts believe the virus has an incubation period of 14 days. That's why the quarantines and isolation policies have been for that period. Once you're beyond that point, you should not be contagious.

Coronavirus is mainly transmitted through respiratory droplets from coughing and sneezing. Those can linger on surfaces and be picked up by others. Comparatively, Ebola and Zika were less contagious, because they were mainly transmitted by bodily fluids, which you can prevent more easily.

Following up on the earlier question from another reader, what do we need to have for managing a typical case? At home?

If you'd feel most comfortable having medicine at home, experts recommend typical respiratory-virus medicine: decongestants, anti-inflammatory drugs and acetaminophen for fevers.

There's no need to buy gloves or face masks. In fact, please don't buy face masks. It cuts down on the supply available to health-care workers. 

Why do some people recover from getting the corona virus, and others recover?

This is a great question to which there isn't a clear answer. One of the mysteries of this coronavirus is how little children and young adults are affected by it. The 1918 Spanish flu by comparison hit those younger groups pretty hard. The common cold too transmits so readily in schools and kindergarten. The elderly and sick are the most vulnerable to this one and no one knows why...yet.

And that concludes our chat. Thank you to everyone who submitted questions, and to reporters Lena Sun, Marisa Iati and William Wan for sharing their expertise. 

We got many questions about travel, so I'll share this guide from The Post on how to think about traveling and what to do if you're considering canceling a trip. 

And if you want to follow our coverage, you can sign up for our health newsletter with the latest updates as we track the virus in the U.S. and around the world.

Thanks for joining us! 

In This Chat
Kanyakrit Vongkiatkajorn
Kanyakrit is the community editor at The Washington Post, with a focus on comments, live chats and reader submissions.
Lena Sun
Lena Sun came to The Washington Post in August 1983 from the now defunct Baltimore News American. She had previously worked as a local politics reporter for a small daily newspaper in Union City, N.J. At The Post, she has worked as a metro reporter, financial reporter, assistant foreign editor and immigration reporter. Sun now covers health, health care policy and hospitals. Sun, a graduate of Cornell and Columbia Universities. speaks Spanish, French and Chinese (Mandarin).
William Wan
William Wan is The Washington Post's health & science correspondent. During the past decade at The Post, he has reported from more than 20 countries and covered mass shootings and disasters, national security, the Obama presidency, foreign policy and religion. For three years, he was The Post’s China correspondent in Beijing. He has won several awards for his coverage of religion and for his stories on human rights abuses in China. He was part of the 2010 Pulitzer finalist team that covered the Fort Hood shooting. Before joining The Post, he worked as a reporter for the Los Angeles Times and the Baltimore Sun.
Marisa Iati
Marisa Iati is a reporter for the General Assignment News Desk at The Washington Post. She previously worked at the Star-Ledger and NJ.com in New Jersey, where she covered municipal mayhem, community issues, education and crime. She also covered white-collar crime at Global Investigations Review while living in Washington and cataloging the District’s best coffee shops in her spare time.
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