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COVID-19: How Did We Get Here? Where Are We Headed?

 

COVID-19 Doctors

COVID-19: How Did We Get Here? Where Are We Headed?

As the world grapples with this pandemic, our understanding of it is changing rapidly. This can be seen even in the names we use.

Let’s be precise:
On February 11, the virus was officially named “Severe Acute Respiratory Syndrome Coronavirus 2”, or “SARS-CoV-2,” because it is related to the coronavirus that caused the SARS outbreak of 2003 in Asia.

Since SARS was so deadly, using that name in Asia might cause communications issues and unnecessary panic. So, the World Health Organization (WHO) uses the terms “the virus responsible for COVID-19” or “the COVID-19 virus” when communicating with the public.

The disease itself is formerly referred to as COVID-19. The press tends to use “Coronavirus” and “COVID-19” interchangeably. In the healthcare environment, however, it pays to be accurate.

The typical contagion routes have changed.
Previously, the primary sources of infection were person-to-person contact, and in NYC that meant being in a direct chain of contact with a traveler from China or from one of several European or Middle Eastern hot spots. Contact tracing in cases like these was a fairly simple, linear problem—Patient A to Patient B, etc.

A typical example is the direct spread of infection from one nursing home to another by health care workers working in both places while asymptomatic but infectious. Later those same asymptomatic workers transmitted the virus to their family members who were factory or meatpacking industry employees, resulting in the disease emerging in both locations.

Spring—and other things—are in the air.
In the months that followed the initial outbreak, people in major US cities began becoming ill from environmental exposure alone. Simply being in the same space as sick people seemed to be enough to contract the virus once it became widespread. Purely airborne transmission, rather than contact with surface contamination, appears to be the primary source. In fact, based on a statistically significant testing project involving 3000 people, nearly a quarter of New York City dwellers have developed antibodies to the coronavirus—meaning they were exposed, even if they didn’t show symptoms—and may have been “silent spreaders” of the disease.

In one carefully studied case, one sick person dining in a restaurant in China infected nine other people, and the pattern of infection was directly linked to the air conditioning system’s air distribution pattern. It’s clear that the coronavirus was simply blown around the room, causing indirect exposure. And in Mount Vernon, Washington, a single infected singer at choir practice caused 52 cases! They had practiced limited physical contact but not strictly observed social distancing and no one wore masks. In this case, the act of singing was a perfect means of airborne spreading of the virus, rapidly and with devastating results.

Lately other patient cases have arisen that seem to defy the defensive measures taken. Non-obvious transmission routes have emerged, or are suspected, as indicated where people who have practiced careful isolation have still become ill:

  • Shoes, clothing and personal accessories may be contaminated with the virus, and they may track the virus from surfaces contaminated by cough droplets into otherwise protected spaces.
  • Pets are another possible source. Dogs have shown exposure to the virus, but none have been symptomatic; while cats, including large zoo animals such as lions and tigers, have actually contracted the disease. It is being investigated whether pets with outside access may be a source for contamination of homes with the virus.
  • While young, healthy adults and children are far less likely to have serious complications from a COVID-19 infection, it is not clear whether their rates of infection are lower than adults. It’s clear that children with underlying conditions such as such as immunodeficiency, obesity, diabetes, seizure disorders, asthma and other chronic lung disorders are at greater risk of complications than was previously believed. So, schools, daycare and playgrounds must be considered as serious hazards for virus transmission—especially as adults go back to work and children spend more time in these places.

Although many areas have shown steady declines in infection, there is a serious concern that the strong demand for isolation easing—including the reopening of businesses, beaches and houses of worship—and growing resistance to social distancing and responsible use of masks among some of the population may result in a widespread second wave of infection this summer.

It is likely that visitors from “reopened” regions in the United States may become the primary source of new infections as the disease progresses. In fact, one expert predicts this outbreak may linger for up to three years.

Our facility has put in place strict measures to protect our patients and staff. Read more here.

Next Month: Updated guidance tailored for patients, their caregivers and families in the field. Stay tuned!