UChicago Medicine experts answer coronavirus questions - March 12, 2020

Hi. I'm Emily Landon. I'm the hospital epidemiologist and an adult infectious diseases specialist at the University of Chicago Medicine. 
And I'm Allison Barlett. I'm the associate hospital epidemiologist. And I'm a pediatric infectious diseases specialist here at the Comer Children's Hospital at the University of Chicago Medicine. 

We're here today to answer more of your questions about the coronavirus or COVID-19. 
So a lot of you have been hearing about this term that's called social distancing, which may be a new concept or a new term for some of you. But really, it's an old concept. It is ways that we can all work together to spread ourselves out from other people and keep ourselves safe from spreading infection in large group settings. 

In an outbreak like this one, most people are going to be just fine. However, there certainly are a lot of people that are at very high risk. Even if you're not the person at high risk, the speed at which this disease spreads throughout our community makes a big difference in terms of how many people are sick at the same time. 

You know that in your own family, everybody can get a cold within a week or week and a half of one another. And you can all end up sick at the same time. If that happens with our older and more vulnerable people in the United States, they could easily overwhelm our hospital system. And we may not have enough beds for all the patients that need to be cared for. In order to prevent that from happening, we all have to do our part to help spread ourselves out and slow the spread. 

When we talk about influenza, we usually use things like vaccines and antiviral medications to help prevent people from getting sick and slow the spread in our communities. We don't have that for this brand new disease. And more people than ever are susceptible to it. 

So what we need instead is for everyone to take precautions to keep themselves separated from every other person. You don't know when the person that you're sitting next to is going to get sick in two days. And then you might be at risk. 

This graph shows what happens when everyone gets sick at the same time. If we all keep going to the grocery store and the theater and spending time with our friends, and all our kids stay in school, and everybody keeps going to work and doing their lives the same way, then everyone will get sick quickly. Certainly, we'll get through the epidemic more quickly. And that may be preferable to some of us. But if we don't slow things down, as you can see from this line here, it could be that there aren't enough hospital beds for when my mom and your mom get sick. 

Instead, if we do the things that we're talking about, like staying home from work and working from home when your boss tells you that that's a good idea, avoiding making extra trips out to do errands, spending less time in crowds, cleaning off surfaces, and all of the other things that we are talking about today, then we can slow the curve of the epidemic. And hopefully it will fall under our capacity so that our hospitals can keep being able to take care of patients that need us. 

So there are definitely different categories of ways that we can work together to practice social distancing. The easiest is, just as Dr. Landon has mentioned, to decrease unnecessary trips and running errands and staying out of large group gatherings. 

There are other things that we may implement that are working from home, which is, again, a way to keep yourself away from crowds. When you are working from home, you're doing exactly that. You are performing your work functions at home instead of going to your usual place of business. There's no other restrictions on your ability to go to the grocery store or to run the errands that you need to do, except that we do also want everyone to be mindful of all of the time that we're spending in public. 

Then we have patients who we are placing under what we call quarantine, so people who have an infection or have been exposed that we are having purposely stay in their house. They're able to work from home, if possible, but limiting all of the other trips that they're taking outside of the home to go get groceries and run their errands. 

So I think there's a couple really easy things that we probably should have been doing all the time. But now really is our chance to show that we can shine in terms of helping keep both ourselves safe and, again, practicing social distancing and respiratory hygiene to protect everyone around us. 

So you've heard a lot about all sorts of new alternatives for the good old fashioned handshake, so fist bumps and embracing the Vulcan myself and elbow bumps and any variety of other ways to greet people and acknowledge our relationships and community without transferring germs. 

I think other things that we can be doing much better are practicing our own good hand hygiene, not just after we're using the restrooms or before we're eating, but just regularly throughout the day, keeping your work surfaces clean, wiping off your keyboard and your phone. And practicing good respiratory etiquette, coughing into your sleeve, using disposable tissues, and throwing them away when you're done and washing your hands afterwards. 

So we use the word quarantine in a really specific setting. And so usually, your physician or the public health department is going to be the ones that are recommending the practice of quarantine. So quarantine is when you stay home. You aren't leaving for any of your errands. And you really are just staying in the same place for the entire duration of the quarantine period. With the coronavirus, we also have special recommendations for people who are living in the same household as you when you are quarantined to help keep them safe as well as they help care for you. 

So recommendations for people who are living with someone who is being quarantined are to stay separate from the person as much as possible, to be very careful about maintaining good hand washing, and cleaning high-touch surfaces like doorknobs and countertops. When you do need to be in the same room as the individual, mask use is really important as well. 

So that's a lot of contacts there. And it's important for us to get this answered because it's a question we're getting every single day. If you have contact with someone who is known to have a confirmed case of COVID, you will be asked to stay home and watch yourself for symptoms. That is very different than if you have contact with someone who had contact with someone who either does or may have COVID-19. 

Contacts of contacts, or people that are two people removed from an actual case or a possible case, do not need to take any precautions at this time. You have to wait and find out if the person you had contact with develops any symptoms. 

So I want to say this again. If you are two people removed from either a potential or a confirmed case of COVID-19, you need not take any precautions. However, if the person you live with gets sick, then everything changes. In other words, the only reason that you would need to take precautions, stay away from other people, or stay away from work outside of usual social distancing practices that you may be having because of your desire to help slow the spread of this infection. Unless you've had contact with someone who is actually sick with confirmed COVID, you can continue to do your daily life, just under the usual practices for the current situation. 

So school kids catch on to a lot more than I think sometimes we parents acknowledge. And so there is a lot of talk in the schools and among groups of friends about coronavirus and what it means to them. And I think the most important thing to let your children know is that they are going to be fine and safe throughout this. And there's a lot of grownups really working hard to help keep everybody safe. 

But at the same time, there's a really important job that your kids need to do. And that really is some of the social distancing practices that we've been talking about. They and their friends are going to be fine. But we want to keep everybody, especially their parents and their grandparents, safe, so following the rules. 

When there's large group gatherings that are canceled, it's disappointing. But we're doing it for a reason. And everything they can do to practice washing their hands and covering their coughs is really helping keeping everybody in their community safe. 

People who are most at risk of having a bad outcome from coronavirus are not the children, which is wonderful news. However, grandparents, in fact, anyone over the age of 60 has a much higher risk of having a bad outcome. And by bad outcome, I mean needing to be in the hospital, maybe getting so sick that you need to be on a ventilator. Even amongst these people, death is very rare if we can give everyone the level of care that they need. 

However, it's very important at this time that we do everything we can to protect the most vulnerable among us, that is anyone who is older, especially men, people who are smokers, people who have other underlying medical conditions, like even hypertension or high blood pressure and diabetes can put you at higher risk of having a bad outcome, and people who have low immune systems, people with underlying lung disease or who take medicines to make their immune systems not work as well because they have some sort of autoimmune condition or cancer. These are the people who will have the most risk of developing worsening symptoms when they have COVID-19. 

We strongly recommend that these individuals begin curtailing all of their outdoor activities in accordance with the CDC guidelines from last week. These people should not be traveling. These people should not be out in crowds. They should be staying home as much as possible. And if you haven't been instructed to work from home, you should ask about working from home if you are in one of these groups. 

We shouldn't be hunkering down because we're scared. The individual risk to any one of us is low. However, we should be hunkering down because we need to protect those of us who have higher risk. The only way we can do it is by taking these actions. These actions that keep us at home and keep us away from other people are what will protect the people who are the most vulnerable. 

We aren't doing these things out of fear for our own safety I'm going to work from home whenever I can and attend meetings by phone and definitely use my namaste hands when I greet people because I want to protect your mom and my mom and make sure that we save room in our hospitals for them when they need a bed, should they get sick. So we're not doing these things out of fear. We're doing them to protect everyone else.