CORONAVIRUS

Is that stuffy nose just allergies or coronavirus? FAQ with a UI expert

University of Iowa expert fields COVID-19 questions

Allergies.
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IOWA CITY — Information about COVID-19 and how to stay safe has evolved in recent days and weeks — as has Iowa’s response to the contagion, with Gov. Kim Reynolds recently rolling back restrictions in hopes of re-energizing the state’s economy.

Casinos, packing in hundreds to touch and retouch slot machines and other games, are back in action. Restaurants again are seating diners and taking reservations. Churches are filling pews for in-person services. And movie theaters have gotten the green light to restart their reels, so to speak.

With all the changes have come lots of questions — as Iowans scramble to adjust their practices and mind-set to a new normal. We took some of those questions and put them to University of Iowa Health Care Chief Medical Officer Theresa Brennan, who started off by acknowledging complexity around giving advice related to a novel coronavirus like COVID-19.

“This virus still is very young,” she said.

Q: The U.S. Centers for Disease Control and Prevention recently updated guidance on how COVID-19 spreads to emphasize it’s “mainly” passed from person to person via respiratory droplets emitted when an infected person coughs, sneezes or even talks. Given that, do people still 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.”

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.”

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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: Do you have any updated information about when or how long the virus can 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.”

COVID-19 and children

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.

“Kids may more commonly get eye symptoms,” she said. “They may have more pinkeye-type symptoms.”

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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: 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: 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.

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“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.”

Face shields vs. face masks

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.”

Q: Has it felt socially awkward?

A: “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.”

Is it allergies or coronavirus?

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.”

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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.

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.”

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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.”

Updates on coronavirus treatments

Q: Are COVID-19 patients hospitalized at UIHC still receiving plasma or Remdesivir — or both?

A: 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.”

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.”

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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.”

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.”

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?

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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.”

Comments: (319) 339-3158; vanessa.miller@thegazette.com

 

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Our most important Coronavirus coverage is free to the public.

If you believe local news is essential, especially during this crisis, please donate. Your contribution will support news resources to cover the impact of the pandemic on our local communities.

All donations are tax-deductible.