VCU virus doc: 'We’re in the early phases, almost just beginning in Virginia'

Posted at 3:45 PM, Apr 01, 2020
and last updated 2020-04-01 18:31:54-04

RICHMOND, Va. -- Dr. Gonzalo Bearman is the Infectious Disease Chair at VCU Health Center and an expert in the fight against COVID-19. Jake Burns interviewed Dr. Bearman on Wednesday, April 1. A lightly-edited transcript is posted below.

Jake Burns: What is the latest information on virus transmission?

Dr. Gonzalo Bearman: The most common is through droplets, large particles that are exhaled or sneezed out that can end up in someone’s mouth, nose, mucus membranes.

The virus can live on inanimate objects, such as keyboards or rails or door knobs, for a specific amount of time.

We’re not talking months, but certainly hours to days, so again to the importance of washing your hands.

Then there’s that small minority that are airborne, which are really smaller particles.

This is probably a greater risk for healthcare workers who are taking care of patients at the bed side.

Jake: So for the average person, the greatest risk is still droplet transmission within close proximity to a person who has COVID-19?

Dr. Bearman: Correct, The concept is droplets don’t travel more than three to six feet. That’s why the six feet of social distancing is critically important.

When you’re in a pandemic situation you really think of four big things:

  • Problem 1: Making a diagnosis; which the U.S. is struggling with because of scarcity of diagnostic kits
  • Problem 2: A vaccine. We don’t have one, at least not yet. It might take a year.
  • Problem 3: Treatment. Don’t have a treatment we know for sure cures patient with the virus
  • Problem 4: Non-pharmacological treatments. Things like social distancing, shutting down mass gatherings, hand washing

What is the difference between droplet and contact transmission? Which is more likely to cause infection?

The contact of a droplet on your mucus membrane, your nose, mouth, and eyes, is the one the one that’s most likely to cause an infection. To avoid that, it’s why you need to stay three to six feet apart or be socially isolated or distanced.

The contact comes from an inanimate object.

Let’s think of a door knob being an inanimate object, a keyboard being an inanimate object, even a mobile phone being an inanimate object.

If those are contaminated with coronavirus, you could then inoculate yourself, or infect yourself, by touching the fomite, then using your hands and touching your nose mouth or eyes.

Simply having a virtual particle on your skin, it doesn’t get into your skin and go through you blood and cause infection.

That’s really important.

It’s really going from you skin, your digits, your hands, going to your mouth, your eyes, your nose, the mucus membranes.

So coronavirus could be on a shelf at a store, for example. As long as you don’t immediately touch your face and go wash your hands, that’s the best preventative method?

That, along with the social distancing so you don’t come in contact with the droplets, so washing your hands is critically important.

People probably aren’t formally schooled in how to properly wash your hands.

There’s some good aids on that. Go to the CDC website, Virginia Department of Health, you can find information there.

Generally a 15-20 second hand wash or hand rub.

I’ve been asked, what if I don’t have alcohol hand rub with me, I just have soap and water. It’s great; you can do the soap and water too, 15 seconds should more than eliminate the virus on your skin.

What evidence is there that coronavirus can spread on packaging or food products?

My understanding of that is that packaging, newspaper, magazines, things you receive in the mail, the risk is very, very low. I wouldn’t say negligible, but really, really low.

If you’re handling or reading the newspaper or opening up your mail or Amazon delivery, etc., before you eat anything before you touch your mucus membranes, you mouth, your eyes, your nose, wash your hands.

Given you review the latest case data likely by the hour, where to you see the number of cases going from this point?

I think we’re in the early phases, almost just beginning in Virginia.

I anticipate an increase in cases, hospitalizations, and unfortunately fatalities over the next two to four weeks.

We probably won’t see the impact of our social distancing interventions until four to eight weeks from now, at which time the Governor will likely make the decision to continue with the current strategy or roll them back.

But to do that, I think it’s important for me to say this, if we start rolling back our social isolation strategies, we really have to be prepared with diagnostic testing, so we can diagnose and do surveillance in the communities to say with certainty we know these [people] are infected, we know the rates are going down, we can test people when they have any sort of symptoms.

We must, absolutely must have personal protective equipment in the environment, particularly for health care workers. Anything short of that would be premature to make significant policy changes.

What is your understanding about the availability of protective gear in Central Virginia?

Diagnostic testing, first is a problem for all of us, whether you’re here or you’re New York City or you’re Washington. In terms of personal protective equipment, we’re all feeling the crunch also.

We currently have enough, but certainly the concern is as we get more and more cases coming to the healthcare system, either for evaluation or admission and care, that’s going to stretch us even more thin.

There has been talk about extending guidance on whom should were protective masks and when. Where do you stand on this issue, particularly for people in the public?

I think first and foremost, social distancing and hand hygiene are critically important.

If we get to dispensing masks in the community, I think we should be very clear about the message, such as these masks may help, they may help. If we have to prioritize, it should certainly be to those individuals who are at the highest risk of having complications from having coronavirus.

That would include people with chronic, underlying conditions, immunosuppressive conditions, and the elderly.

The people with the greatest need are the people who are on the front lines taking care of the sick, so it’s very difficult.

It puts us in a situation where I think we’re not used to it in the United States, this whole concept of rationing. We’re really rationing care here, or in this case rationing supplies.

You get some, you don’t, we only have enough for this group and not enough for that group It's just really counter-cultural and really hard for us to understand.

I would say that now is not the time to panic, now is the time to work collectively. We are in a collective struggle.

I realize this is not World War II and that effort is different, but we’re in a collective struggle and everyone can do their part.

Even if the part is a stay at home, stay safe, wash your hands, socially distance.

Please don’t go to work if you’re not feeling well that’s a huge problem.

It’s called presenteeism going to work when you’re sick. We all know what absenteeism is, this is a presenteeism. That’s really a big problem, not only in healthcare systems, but in any industry.

For those who are following social distancing guidelines, what kind of cleaning regiment should they have for their home or workspace?

There’s no slam-dunk, data driven study that says you must do this process or protocol to get excellent results.

So what I would say is meticulous hand hygiene or frequent hand hygiene, as frequently as you can, particularly before you eat or touch your mouth, face, mucous membrane. Wiping down common use services as much as feasible.

Now I understand that if you use Clorox bleach on your computer all the time, you might destroy your computer. But look for things on the packages that say they will kill viruses. The term for that is called virucidal, or kills viruses.

Wipe down the high touch services, which should be the kitchen counters, the cellphones, the computer keyboards, maybe the remote controls for the television. Those sort of things, as frequently as possible without destroying the hardware.

Based on the evidence and from what you’ve seen, how do we know when some has recovered from COVID-19?

From exposure to onset of disease could be anywhere from 5 to 7 days, but as long as 14 days. So if you think you were exposed on the first day of the month, you’re now on day 15 or 16 or completely asymptomatic, you’re probably OK.

f you’ve had the infection and it’s mild, you didn’t require hospitalization, you’re usually better within seven days after the onset of the symptoms, usually better.

For hospitalized patients, that can vary by the degree of severity, but usually after three days of no fever or seven days with clinical improvement after onset, the patient is probably on the mend.

What has the last month or so been like for you at VCU Health Center?

We’ve been exceedingly busy here at VCU Health, and although I’m speaking from myself, in many ways, I’m speaking for the healthcare team.

There’s thousands of really dedicated people here 24/7, working in response to this COVID-19 threat, but really for all medical concerns.

We’re still open for business.

If someone’s unfortunate enough to be in a car accident or break their ankle have a heart attack, we’re here to take care of you, and we’re here to take care of you in the most safe fashion possible.

But it has been a stressful time for us. Where resilient, we collaborate, and we work as a team so we’re gonna get through this.

What is the important difference between N95 masks I’ve been hearing about and other masks available?

The N95 mask is really the medical grade professional mask, and it has to be fit tested. Remember, there’s different stock sizes and different kinds, and we all have different types of faces, different shapes.

If you have a beard, you can’t wear an N95 mask very well because it doesn’t properly fit.

So that’s really for healthcare professionals, who are fit tested and having close contact with patients: within 3 feet, spending greater than 10 to 15 minutes with patients.

That’s really considered close contact or doing procedures with the patients.

The other kind of mask, what’s called a non-medical mask, may be of benefit to minimize the mucous membrane coming in contact with droplets, but they may also function in a way to keep your hands away from your mouth and your nose. Kind of like a version of a human dog cone, you know how some dogs have cones, some version of a human dog cone so you don’t do this all the time, which we are prone to do.

How would you categorize Richmond’s response to social distancing guidelines?

I think we’re doing OK, but we could be doing better. I suspect that’s why the governor issued the stay at home order, more real more serious and not just a recommendation.