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The Times Free Press sat down with Paul Hendricks, M.D., F.A.A.F.P., a health officer with the Hamilton County Health Department, to answer some questions about the novel coronavirus on Tuesday, March 10, 2020.

You can see more coronavirus coverage from the Times Free Press here.

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The following conversation with Dr. Paul Hendricks, Hamilton County Health Officer, was edited for clarity and length.

Question: It seems that the "regular" flu is more deadly by statistics. Is that true? If so, why are so many people worrying about the coronavirus?

Answer: A normal influenza season appears more deadly, because more people get the flu, Hendricks said. But by percentages, COVID-19 appears to be more deadly than the flu.

"It's still a little unclear. In China, they were seeing mortality rates around 2%. That's clearly a magnitude higher than the flu," Hendricks said. "Any mortality rate is tragic, and I want to emphasize that."  

Preliminary mortality rate reports for COVID-19 vary from below 1% to as high as 3.4%, according to Hendricks. Mortality rates will also be higher in developing countries and for at-risk populations, such as seniors and people with underlying conditions. 

By comparison, seasonal flu generally kills less than 1% of those infected, according to the World Health Organization. In the United States, the flu has caused an estimated 34 million illnesses, 350,000 hospitalizations and 20,000 deaths this season, according to the Centers for Disease Control and Prevention (CDC). That's a mortality rate of about .06%. 

"If you had 34 million cases of coronavirus, then we would be seeing a terrible tragedy," he said, adding that's why it is so important to learn how to limit its spread.

 

Question: What is the virus and how did it get started? I know it was in China, but exactly where and what caused it?

Answer: Coronaviruses are widespread, and most cause nothing more than a common cold, Hendricks said. They tend to initially reside in animals — birds and mammals, with bats being host to the largest variety of genotypes, he said. Occasionally, a new strain will infect people and cause more severe disease.

"Starting in December of 2019, which is why we call it COVID-19, [Chinese health officials] began noticing this new virus, and we don't have immunity to it," Hendricks said. "It has a tendency to get more in the lower respiratory tract of the lungs, so it causes pneumonias, and that's usually a more serious illness than your typical coronavirus." 

Other examples of more serious coronaviruses include MERS — Middle East respiratory syndrome — and SARS — severe acute respiratory syndrome. 

"Most people remember SARS from about 17 years ago," Hendricks said. "It was a severe respiratory illness, and it was even more serious than this current [coronavirus]."

SARS was associated with civet cats and MERS is transmitted by dromedary camels, according to the World Health Organization. Possible animal sources of COVID-19 have not yet been confirmed. However, the CDC website says: "There is no evidence that companion animals or pets such as cats and dogs have been infected or could spread the virus that causes COVID-19."

How we report on coronavirus numbers

Confirmed case data only provides a snapshot of the coronavirus outbreak and shouldn't be taken as an accurate reflection of how many people are currently infected.

Laboratories are required to report positive COVID-19 test results to local health departments, such as the Chattanooga-Hamilton County Health Department, as soon as results are available in order to support a rapid response. The Tennessee Department of Health and other state department numbers are updated at set times during the day, so there may be a lag in the reporting of state level data.

It's impossible to know how many COVID-19 tests are pending, since both public and private labs are used for testing, and providers do not report when a sample is collected. Negative results are sometimes available depending on the agency and its method of tracking COVID-19.

The Times Free Press uses numbers from credible county, state, national and international public health agency sources in our coverage of coronavirus and other infectious diseases. The newspaper also may report on COVID-19 cases that the newspaper has independently verified in an effort to keep our readers as informed as possible.

All data are subject to variations and changes based on access, availability, methods and other factors that can affect data collection, making health data rarely perfect.

— Elizabeth Fite

 

Question: Are there guidelines for how a household should prepare for a pandemic? 

Answer: Hendricks said it's always good to have an emergency plan. He recommends following advice from the CDC website. Some major takeaways include:

* Get up-to-date information about local COVID-19 activity from public health officials

* Create an emergency contact list

* Choose a room in your house that can be used to separate sick household members

* Take everyday preventive actions, such as frequent handwashing and avoiding touching your eyes, nose and mouth

* Stay home when you are sick

* Clean and disinfect frequently touched objects and surfaces

* Make sure you have access to several weeks of medications and supplies in case you need to stay home

* Limit close contact with others, especially if you're older or have underlying health issues 

 

Question: If we cannot buy hand sanitizer, does cheap vodka work also?  

Answer: No, he said, wash your hands.

"If you don't have hand sanitizer — I know there's been a run on it — wash your hands with soap and water," Hendricks said. "That is much better than going through a lot of silliness and wasting good vodka." 

 

Question: How long can this virus live on surfaces? Can it live longer on hard surfaces vs. fabrics? 

Answer: It is not certain how long the virus that causes COVID-19 survives on surfaces, but it seems to behave like other coronaviruses, Hendicks said.

"It's hard to know for sure. ... Hard surfaces tend to be a bigger risk just because people touch them more," he said. "On the other hand, fabrics, upholstered things, are harder to clean."

While some studies suggest that coronaviruses may persist on surfaces for a few hours or up to several days, the survival times vary based on the type of surface, temperature and humidity. Hendricks recommends regularly cleaning surfaces with an approved disinfectant. It may also be a good idea to avoid using upholstered furniture and furnishings in high-risk patient-care areas, he said.

 

Question: Should the first line of action be to isolate myself or get a test? Also, where should I go for testing? Local hospital or health department or my private doctor? Are there tests available in Chattanooga? What about in the region?

Answer: If you're sick, you should avoid other people and contact your personal physician or practitioner, Hendricks said.

"That's what you want to do. You want to have separation, the number of 6 feet away from people seems to be based in some good science," he said.

A provider can help you decide if your symptoms are severe enough to require an office, and most private physician's offices or medical clinics should be able to obtain specimens to send for testing, Hendricks said.

Emergency departments also have the capability to collect samples for testing, but Hendricks said people should avoid going to a hospital unless they are seriously ill. The Health Department does not see sick walk-in patients. It is definitely possible for providers to collect COVID-19 specimens in Chattanooga, although the test will likely be done either in Nashville or at a commercial lab.

 

Question: What proportion of infected elderly people will experience severe symptoms? 

Answer: Some estimates range up to 8 to 10% of older adults infected with COVID-19 experience severe illness, Hendricks said. 

"We know that this virus seems to affect people who are older and/or have chronic health problems," Hendricks said. "Even though the numbers are low, it's starting to spread around the country. People who are older, people who have chronic health problems really need to pay extra special attention to the advice that's being given out by the CDC and local health departments." 

However, unlike the flu, the coronavirus has not had a significant impact on children, he said. 

 

Question: Is the test effective when the patient has the virus but is asymptomatic?

 

Answer: That is not clear at this point, since asymptomatic patients generally are not being tested in the United States, Hendicks said.

 

Question: When spring and hotter weather gets here, will the virus decrease? 

Answer: This would be the usual pattern for viruses, but since this is a new virus, Hendricks said it is impossible to know at this point.

 

Question: Could deliveries to USA households, like packages, foods, meals, clothing, medical items etc, bring the virus into homes from other countries/states?

Answer: There is no evidence of transmission through these items since the virus does not appear likely to survive the travel time. WHO states: "The likelihood of an infected person contaminating commercial goods is low and the risk of catching the virus that causes COVID-19 from a package that has been moved, travelled, and exposed to different conditions and temperature is also low."

 

Question: What have health officials — broadly — learned about this virus so far and how to help communities respond appropriately? 

Answer: The best protection is to follow the usual precautions for any respiratory illness.

"We're encouraging people not to overreact to this, but to treat it as they would any respiratory illness with, obviously, extra special attention to the fact that it is contagious," Hendicks said. "If you get the illness, your job is to protect other people from getting it from you."

 

Call the Chattanooga-Hamilton County coronavirus hotline at 423-209-8383 weekdays from 8 a.m. to 6 p.m. or the Tennessee Department of Health hotline at 877-857-2945 from 10 a.m. to 10 p.m. central time daily.

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