Updated on June 8, 2020
As more people become sick from the novel coronavirus and the disease it causes, COVID-19, scientists also are gaining a better understanding of the virus and guidelines are evolving.
To help answer questions from readers as new information emerges, The Gazette pored through local and national recommendations and put some of the top quandaries to University of Iowa Health Care and its Chief Medical Officer Theresa Brennan.
Q: I have symptoms, how do I get tested?
A: On April 21, 2020, Governor Reynolds unveiled a testing program to offer more widespread testing to the public. The program at TestIowa.com invites Iowans to sign up for assessments with the goal to identify targeted outbreaks and hotspots early while systematically establishing a medical baseline whereby state officials will feel confident in reopening the state. The program initially will focus on first responders and front-line health care professionals and expand to food services and manufacturing as it ramps up to eventually cover all Iowans.
Individuals without internet access or who do not wish to fill out the form are still encouraged to do the following:
1. Contact your healthcare provider if you have one.
2. Call 2-1-1. A public hotline has been established for Iowans with questions about COVID-19. The line is available 24/7 by calling 2-1-1 or 1-800-244-7431.
Q: UIHC is not yet testing everyone who wants a test. Is the goal to get to a place where that is possible?
A: A test really is just one point in time, Brennan said. A person could test negative one day and be positive days later.
“It really doesn’t tell you a lot in someone who’s asymptomatic.”
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Q: Can you provide a list of symptoms?
A: Confirmed COVID-19 patients have reported a range of mild to severe symptoms, according to UIHC and the Centers for Disease Control and Prevention.
At the illness’ onset, 83 to 98 percent report a fever; 46 to 82 percent report a cough; 11 to 44 percent report fatigue; and 31 percent report shortness of breath.
Less common symptoms include sputum production, headache and coughing up blood Some patients have had gastrointestinal symptoms like diarrhea and nausea before developing a fever and respiratory problems.
Q: Who is most at-risk?
A: Patients of all ages — including those with or without underlying health conditions — have suffered severe illness from the coronavirus. But older patients and those with chronic medical conditions appear at greater risk, according to UIHC and the CDC.
Q: How quick can COVID-19 symptoms start after exposure?
A: The CDC believes symptoms could appear between two and 14 days from exposure.
Q: The U.S. Centers for Disease Control and Prevention emphasizes that COVID-19 is “mainly” passed from person to person via respiratory droplets emitted when an infected person coughs, sneezes or even talks. Given that, do people need to worry about catching it by touching a contaminated surface?
A: “The disease is very young, and we don’t actually know,” Brennan said. “But to my knowledge, there have not been any reported cases of surface transmission. That being said, we’re not tracing all these patients, so we don’t actually know.”
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The CDC’s guidelines, she said, note the highest likelihood of transmission is between people; and that the virus does “not spread easily” on surfaces.
“But I think that particularly high-risk patients should still have some concern,” Brennan said. “And the most important thing I would say is when you’re bringing something into the house to make sure that you’re washing your hands after touching it.”
She also advised continuing to disinfect surfaces — particularly those like counters that might touch anything with potential to come in contact with your mouth.
Q: When or how long can the virus be transmitted?
A: “The last data I saw was somewhere between five and seven days from the time you’re exposed to the time that you have symptoms,” she said. “And we believe potentially you can transmit that a day or so before.”
Q: Regarding children, what symptoms should families watch for when it comes to both COVID-19 and the related multisystem inflammatory syndrome?
A: “Kids tend to have a little bit different symptomatology,” Brennan said, noting fevers, of course, are still something to flag.
But COVID-19-positive kids also have reported tummy issues, like nausea and diarrhea, along with generalized complaints, like irritability, particularly in very young kids.
“And actually we’re changing our guidelines on testing to include more gastrointestinal symptoms,” she said, noting kids can develop other generic viral symptoms like rashes and mouth sores.
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“Kids may more commonly get eye symptoms,” she said. “They may have more pinkeye-type symptoms.”
And while the disease seems to be less severe in kids, Brennan raised the possibility of overlooked pediatric cases.
“We’re still learning and it may be that we have actually, nationally and internationally, missed some of these kids that have more significant symptoms that weren’t really on our list in the beginning,” she said.
Q: So what is the way out of this? Are we just going to have to wait for a vaccine to establish some sense of normalcy again?
A: “I think ultimately the vaccine is the way to get back to normal,” Brennan said. “Most of us feel like it’s here until we have something definitive to protect people.”
COVID-19 and allergy season
Q: Now that this pandemic has dragged on into allergy season, a lot of Iowans are waking up with sore throats or developing congestion and other symptoms that also have been reported in COVID-19 patients. How can they tell the difference?
A: “It’s hard,” she said. “Many of these symptoms are pretty non-specific. And we went from influenza season, which is trailing off now, into allergy season, and the crossover is there.”
Brennan suggested people engage a health care provider if they have any doubts, but also pay attention to whether their symptoms feel familiar from seasons past.
“If you’re normally an allergy person, and these are usual allergy symptoms for you and you don’t have any other symptoms like fever, body aches — those are less common, really less common for allergy sufferers — then perhaps take an antihistamine and see if it gets better.”
But, she said, anyone who develops more of those viral-type symptoms — even if they could be tied to allergies — should have an evaluation.
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Q: If you have COVID-19 and you take allergy medicine, would you expect the symptoms to persist?
A: “We wouldn’t expect the medication to really have that much of an impact,” Brennan said. “And I’m talking about antihistamines that don’t have Tylenol or don’t have ibuprofen or don’t have any anti-inflammatory or pain component to them. They’re just purely the antihistamine.”
Q: Can allergies make COVID-19 symptoms worse, for those who’ve tested positive for the virus?
A: “I’m not sure that it would put them at higher risk of having more acute problems,” she said. “It could exacerbate the symptoms — they could feel worse, for sure.
“We also feel like people who have allergies — because of the changes in mucosa — could actually have an increased risk of having viral infections, and coronavirus could likely be one of those.”
Q: So are you saying people who are annually more susceptible to allergies might be more susceptible to contracting the coronavirus?
A: “No. I’m saying that people who are actively having allergy challenges — that are actively having nasal congestion and runny nose from the allergies that they have — because of the changes in the mucosa inside their nose and their mouth and their eyes, that could increase their risk of acquiring coronavirus.”
Q: When and where do I need to wear one?
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A: The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are hard to maintain, like at grocery stores.
Q: Who is my mask protecting — me or others?
A: “The mask is source protection,” Brennan said. “What that means is if I have COVID, and I have a mask on, that protects people I come in contact with. So if everyone wears a mask, then people who might be asymptomatic or pre-symptomatic or have minimal symptoms that don’t know that they have COVID will be protecting others by wearing the mask.”
Q: What can qualify as a “mask?”
A: There are a range of masks used in health care from the best, N95s, to surgical masks, which also are good. Those protect the people wearing them and others, Brennan said. But those should be conserved for health care workers, as they’re in short supply.
Homemade cloth masks are the kind the public is advised to use, and they offer some protection to the community, Brennan said.
Q: How should I wear a homemade mask?
A: “It should go under your chin to the bridge of your nose,” Brennan said. “And as far out on the sides of your face as it can. And likely better if it is a bit tighter than if it’s looser. So if you have one that you tie, it may be better than one that goes around your ears — depending on how well it fits.”
Additionally, she said, if you’re fashioning your own, use something that allows you to form it around your nose. And don’t keep touching it.
“When you put something on your face and you’re not used to having it on your face, humans have a tendency to touch it,” she said. “The purpose of the mask to be helpful, but if you’re touching it and then touching your eyes, and if you don’t be careful when you take it off, and you don’t launder it adequately …,” Brennan, said the mask can do more harm than good.
Q: Do I need to wear a mask outside?
A: “The purpose of masking is to do it when you’re with other people,” Brennan said. “So if you’re going outside and you know you’re going to be walking in a space where you’re going to encounter other people, it’s probably a good idea.”
If you’re in your own backyard and you’re not around anybody, “You could probably take the mask off.”
Q: With kids in many communities resuming activities and attending summer camps, how should they protect themselves? Should they wear masks? And how young is too young for a mask?
A: Emphasizing caretaker responsibilities first, Brennan stressed parents should up their cleaning practices and disinfect things “probably much more commonly than what’s happened before.”
“Social distancing is clearly a part of trying to keep this transmission low, and that’s really hard in kids because they get distracted and they play close to each other,” she said.
As for masking, kids should wear them — if they can.
“There are certain populations that probably shouldn’t wear a mask,” Brennan said. “Like kids under 2, or kids or adults who can’t — either from a thought standpoint or from a physical standpoint — remove the mask. Some kids probably shouldn’t be masked. But I think the recommendation from the CDC would be, and I would support, that masking is probably a good thing to do.”
Q: In looking at precautions community members should be taking, do you advocate for face shields over face masks?
A: “Our hospital epidemiologists actually advocated for that very early on, and that’s why we went to a universal face-shield practice here,” Brennan said. “Our epidemiologists — and I do, too — feel like a face shield offers a lot of protection, particularly when you’re considering a face shield vs. a cloth mask.
“Because remember, cloth masks are really source control. So if I have the virus and I wear the mask, I’m protecting you,” she said. “The face shield actually gives protection to the person wearing the shield. So I think face shields are a very good idea, and I am becoming someone who is going to wear my face shield in public.”
Wearing a face shield may seem strange at first, Brennan said.
“The first time I wore a shield, I did feel a little leery — because a lot of people had masks on, but nobody else had a shield on,” she said. “But I think people recognize that this is a reasonable and perhaps optimal alternative, and if people start wearing shields, it’s going to be less awkward.”
At home, work and out in public
Q: Do people need to “social distance” — and stay 6 feet from others — in their own homes, like with family members?
A: There is some risk to not doing so, Brennan said, even for those who aren’t going out.
“If you potentially have something delivered to your home, all surfaces have potential to carry the virus, depending on where they’ve been and who’s been around them,” she said. “But if you’re being very careful and not interacting with people and wiping down your groceries and doing all those careful things, then maybe not social distancing in your house.
“But if you’re going out into the public, there is potential for someone in the household to bring it in,” she said. “And then that spread could happen.”
Q: So do I have to keep up the frequent hand-washing in my home, even if no one is sick?
A: “I would say yes,” Brennan said. “Hand washing is a habit that people do, and it’s hard to turn habits on and off. And so if you want to have good habits when you’re in a public space, you probably should have those same habits everywhere.”
Plus, she said, if you or someone in your home is going out in public — or bringing things in from outside — “then hand hygiene, of course, is really important there, too.”
Q: How off limits are parks? Are just playgrounds a no-no?
A: “The emergency declaration from the governor was really aimed at two things,” Brennan said. “One is to stop having people aggregate.”
The other, she said, is to keep people from touching common surfaces, like playground equipment. But Brennan also stressed the importance of getting outside during this time for physical and mental health.
Note: As of June 1, most parks and playgrounds have reopened across the state, some with restrictions.
Q: Is it safe to pump gas?
A: “Anytime you’re touching a surface there’s some risk,” Brennan said. “And many people pump gas every day, so it is a surface that’s touched by a lot of people.”
That doesn’t mean you shouldn’t get gas, she said, but be aware — use hand sanitizer before and after, for example.
Q: How much more at-risk are “essential workers,” like those in groceries stores or public safety departments?
A: “We’re so thankful for them,” Brennan said. “Because if they weren’t there, we’d really be in a terrible bit of shape.”
Although she doesn’t have exact numbers, Brennan said those who can avoid interacting with others and touching common surfaces have “much lower risk.”
“Anyone who is encountering someone in the public, given that it is pretty widely spread in community transmission now, they have some risk.”
Q: Am I going to get it no matter what?
A: “I don’t think that’s true,” Brennan said. “It is out there in the community, but you can do a lot of things to keep yourself safe. And if you really practice those things, I think you can keep yourself safe.”
Q: As restaurants and bars reopen — albeit with limitations and restrictions — do you have new thoughts or opinions about the risks of visiting them?
A: “Someone considering going to a restaurant should consider the risk and the benefit,” Brennan said. “So perhaps calling a restaurant ahead of time to ask them what they’re doing.”
She advised patrons go to establishments they know and feel comfortable visiting.
“If one feels like it’s important and necessary to go to a sit-down restaurant, then making sure that the tables are spaced appropriately so that people can be social distanced,” Brennan said, adding diners should make sure staffers delivering the food are wearing masks.
“It’s important for the economy to open up,” she said. “But if you have to do it, we as the individuals who are then going out into the community, we have to do it appropriately.”
Q: How effective are ventilators at helping hospitalized COVID-19 patients?
A: “Ventilators are used when patients can’t adequately get oxygen into their blood by themselves or can’t get rid of the byproducts that we make that we blow off when we breathe,” Brennan said. “And when a patient isn’t able to do that, ventilators are lifesaving.”
But, she said, this virus attacks not only the lungs but the heart — risking multi-organ failure, including the kidneys.
“So ventilators really are successful in treating the breathing part of the disease,” she said. But “there are times when ventilators become inadequate, and then there’s not a lot of great options.”
Q: For treatment, are COVID-19 patients hospitalized at UIHC receiving plasma or Remdesivir — or both?
A: UIHC has used plasma from recovered COVID-19 patients to help those currently hospitalized with the disease. Mercy Iowa City has also joined a national COVID-19 treatment study on convalescent plasma.
Regarding plasma, Brennan said, “We’re offering it to all patients."
“Patients would have a choice of whether they want to receive it or not,” she said. “And our numbers have gone up. Our donor numbers have gone up as well.”
UIHC was part of an international clinical trial to use Remdesivir, an anti-viral medication, and was allowed to administer the drug to patients without formal federal approval before many other hospitals could.
Now that Remdesivir has achieved federal approval and no longer is limited to research trials, Brennan said, UIHC providers “have the ability to offer both of them and speak to the potential opportunities.”
Q: How effective have those treatments been for COVID-19 patients?
A: Brennan prefaced her comments by noting cause and effect can be hard to determine when you have a limited number of patients, who may have recovered without a specific treatment.
“It’s a little hard to make any firm assessments,” she said. “What I can tell you is our outcomes have been quite good. And better than we would have expected, given national and international data that we’ve had.
“That could be related to the treatment,” she said. “It could also be related to our home treatment team and how we’re proactively trying to keep these patients healthy.”
Q: What are things COVID-19 patients recovering at home can do to hurry their healing?
A: “The most important thing that we’re finding with them is really they need to maintain good hydration,” she said. “The patients that don’t are the ones that are getting admitted.”
Many COVID-19 patients have experienced a bad taste and lack of smell, making it difficult to eat or drink. And while eating is important, Brennan said, “Probably much more important is that they continue to drink and to get good fluids in — whether that is water or Gatorade or some electrolyte drink — just continuing to replenish.”
Q: How is the university using antibody testing? Is it offering it to the broader community?
A: “We have the antibody testing,” Brennan said. “It is available clinically for physicians to determine whether it would benefit the care of the patient.”
The university also is pursuing possible research trials involving use of the antibody.
“But we’re not broadly testing any individual population from a clinical standpoint.”
Q: Is there even evidence having the antibodies is beneficial?
A: Brennan said that while not all antibodies are as beneficial as others, some can be neutralizing — “meaning that they help neutralize the virus.” Experts don’t yet know exactly helpful COVID-19 antibodies can be, Brennan said.
“We believe there are neutralizing antibodies because that’s the way the convalescent plasma works,” she said. “But we don’t know if someone who has had COVID-19, whether those antibodies give long-term immunity or short-term.”
Additional Resident Resources
Q: What additional resources are available to area residents?
A: The Gazette, in coordination with the City of Cedar Rapids has created a community resource page for residents. Resources listed include workforce, mental health and many others in a directory format.
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