Coronavirus: Separating Fact From Fiction with Dr. Frank Esper

Podcast Transcript

Cassandra:  Hi, thanks for joining us. I'm your host Cassandra Holloway and you're listening to the Health Essentials podcast, brought to you by Cleveland Clinic. Today we're broadcasting virtually, as we are respecting the social distancing initiative that our hospital, as well as our community has set for us. We're joined virtually, by Dr. Frank Esper. Dr. Esper, thank you for taking the time out of your day to speak with us.

Dr. Esper:  It's very good to be here.

Cassandra:  Dr. Esper is a pediatric infectious disease specialist at Cleveland Clinic Children's, and today we're going to be talking about the 2019 novel coronavirus COVID-19. We're clearing up some myths about the virus that seem to be making the way around, especially on social media and we'll do our best to make sure we separate fact from fiction. Before we dive into all that, we want to remind our listeners that this is for informational purposes only and should not replace your own doctors’ advice. So Dr. Esper, there's a lot of information out there right now. Everywhere you look websites are putting out content, publishing articles, social media is crazy with all of these articles. What's your general advice about making sure you're looking at reliable information?

Dr. Esper:  Listen, the information is out there, it's all that we've been talking about for the last several months. I actually look forward to hearing some non coronavirus news. God help me, someday I'll be able to talk about salmonella again, and all these other germs that are out there. Right now, coronavirus is just inundating everywhere and anytime you turn on a TV or you go to a website. It's very difficult though because some of the information that you get may not be accurate or maybe someone's opinion but looks more like an official recommendation or based on science and that science may or may not have been real. The best thing to do though is generally not go to every source out there on the internet, but to really focus on several different sources that are really giving you the most up to date information.

Dr. Esper:  The first place that I generally would go would be Centers for Disease Control or the World Health Organization. Centers for Disease Control will tell you what's going on in the nation as a whole, and it basically is able to bring all the types of information all the different medical literature, scientific literature but then present it in a way that a lot of people can understand. That you don't have to understand the science but you can understand what they're trying to tell you and what it all means. The World Health Organization tells you what's going on in the world. The other place to really go is to your state health department. Ohio has a fantastic one, but a lot of states have very, very good information specific to your state. All of those really are giving very good information in ways that you can read.

Dr. Esper:  If you want some of the science and you say, "I want to see that study," go to a place like New England Journal of Medicine or JAMA because if you just go to there, they have a link where it just basically brings up all the papers that they have published on COVID-19. Then you can actually, if you have the ability to understand the science and maybe some of the methods that they're using but you could actually see the data. You can actually see the numbers, where it was from, how it was done, who did it, all that. So if you go to those types of sources, I think you'll get a very good understanding of what's going on and where we're going.

Cassandra:  Excellent incentive, just seeing something on Facebook that your aunt is posting about.

Dr. Esper:  Yeah, that's also one of the things, Facebook is a fantastic thing but I would say that most of Facebook, what you get is opinion and if you really want where peoples opinion and fact come together, that's going to be at places like Centers For Disease Control, the Ohio Department of Health, and it's also very important not just to check it once and then walkaway, you should check that two times a week at least, because the information's coming in so much, so fast and a lot of things that we said last week are no longer applying this week. That's one of the reasons why people can get so overwhelmed with all the information that's out there.

Cassandra:  Absolutely, yeah. It changes quickly. So let's dive into some of these statements and claims that we're hearing and get your expert opinion on them. So we keep hearing about lemon juice or lemon water, whether you're gargling with it or you're drinking it, it's said that viruses can't live in acidic environments. Is there any truth in lemon juice protecting you from COVID-19?

Dr. Esper:  There are many, many different viruses out there and some maybe much more susceptible to lemon than others, but this virus, we've actually done that study, they did a great study where it showed how well a virus can survive in outdoor... This particular virus, coronavirus, can survive in outdoor environments. One of which was based on the PH because that's what lemon juice is, it's just acidic fluid. Can the virus survive in acid? Unfortunately, the answer is yes. This virus was shown to be viable down to a PH of three. Which is about where lemon juice would be. That's straight lemon juice not diluted, anytime you dilute something, the PH will go right back up. So gargling with lemon juice and water, probably not going to be useful.

Dr. Esper:  Now for those people who actually have sore throats, gargling with hot water or lukewarm water with salt, it sometimes really helps heal a sore throat but I wouldn't use anything with acid in there like lemon juice or orange juice or anything like that because that usually irritates an already inflamed throat.

Cassandra:  Great advice. So the next one is, can mosquito bites spread COVID-19?

Dr. Esper:  There's a lot of bright spots. A, we don't have a lot of mosquito's in April thankfully, but B, this is not a blood-born infection. That's what mosquitoes transmit. Mosquitoes are basically biting someone, getting their blood and then going off and biting someone else and inserting that blood and then taking more, etcetera. That's how mosquitoes spread infections and so those infections have to be in the blood, things like malaria, things like West Nile, those can live in the blood.

Dr. Esper:  This virus, while they have shown that you can detect the virus for a very short amount of time in the blood, it is not something that's prevalent in the blood and that stays in there very long. So this is not one of the ways that this virus transmits. Also, the way it does transmit with all the coughing and all the sneezing and the close proximity to one another, it's so much more effective than mosquito transmission. Mosquito transmission's very, very slow, it takes a long time, I mean, you're waiting for a mosquito to fly from one person to another, as opposed to going to a crowded restaurant and a cough can spread it to a bunch of people at the same time. Respiratory transmission is much, much more transductant to infection than mosquito born transmission.

Cassandra:  Another important reason and reminder to practice social distancing, like we're supposed to be.

Dr. Esper:  Absolutely.

Cassandra:  So sticking with the blood theme. What about blood donations? Is it first safe to still donate blood right now? And second, is it true that you get tested for COVID-19, when you go in to donate?

Dr. Esper:  For those two questions it's still very important for us to donate blood. When you donate blood, you're actually donating a lot of things. You're donating the red blood cells, you're donating platelets, you're donating antibodies, there's a lot of things that we can get asthma, a lot of things that we can get from one person’s blood donation and all of these are very, very important to people who either have the infection or other people that don't have anything to do with this coronavirus. A person who gets into a car accident, car accidents are still happening. People who require chemotherapy for their cancer, the cancer didn't go away, they still need these types of blood products and unfortunately, we are in short supply.

Dr. Esper:  I can tell you that the Red Cross, and all the blood collection is still adhering to social distancing. So you're not seeing these beds lined up next to each other, they are very well spaced out. You will be asked about symptoms and signs of infection when you come in, and so in that case you will be screened verbally, to see if you have symptoms or you're someone who may have a viral infection and if you do, they may say, "Well you shouldn't donate blood today." But they will not do a blood test or a swab to see if you have the virus. We don't have enough of those tests out there and so they do not test when you donate blood with a swab in your nose or in your throat.

Cassandra:  It's great advice. I think we still need to have that reminder out there that people still need these donations. We still need people to donate blood.

Dr. Esper:  They are vitally important and they are in critical short supply. There's one thing that you could do to help other people out there, in addition to staying at home and addition to the social distancing, is to find out where they are donating blood and to help that way.

Cassandra:  Yes, absolutely. I think our listeners will appreciate having something they could help with for sure. So this next one I feel like was one of the first viral messages going around, it's the breath test. Is it true that if you can hold your breath for 10 seconds you don't have COVID-19?

Dr. Esper:  That's not true. Certainly this is a breathing virus. It comes in for the most part, by breathing, it's expelled with coughing, it's expelled with sneezing, and in the worst case scenarios, it causes pneumonia. So if you have a really, really bad pneumonia, you will have a hard time catching your breath and all that. By then, you'll have a whole bunch of other symptoms like fever and sweats, many times sore throats or body aches or something. It's actually fairly uncommon for people to just show up out of the blue with pneumonia, and so this breath holding test is no good way to say that you have this virus or that you're free of this virus. Just because you can hold your breath for 10 seconds, doesn't mean you can't catch the virus and it doesn't mean that you don't have the virus already. So no, that's a complete myth.

Cassandra:  Speaking of pneumonia, is it true that the pneumonia shot can protect you against COVID-19?

Dr. Esper:  That's a great question because the pneumonia shot can help you prevent against getting really sick with other types of viruses. For example, influenza, which we're finally coming out of the influenza season. Influenza can lead to second infections with other types of bacteria that the pneumonia shot prevents. Sometimes we say, "We want you to get your flu shot but also get your pneumonia shot because flu usually follows pneumonia." This coronavirus causes pneumonia all by itself. While many, many patients do get placed on antibiotics, there has not been a substantial number of studies out there that say that there's a lot of bacterial infections, in addition to the coronavirus. The coronavirus is bad enough on its own.

Dr. Esper:  It's still important for you to get the pneumonia shot. Those germs that are causing pneumonia are still out there, they aren't basically waiting on the sidelines for this coronavirus to finish its job, no. They're still out there so it's still important to talk to your doctor if you need a pneumonia shot, you should be getting the pneumonia shot. All children are getting the pneumonia shots on their schedule. Adults should be getting pneumonia shots on their schedule but the pneumonia shot doesn't do anything for this coronavirus.

Cassandra:  Gotcha. So moving on to the next claim here, it's about alcohol. Can we use Vodka as hand sanitizer?

Dr. Esper:  I'd rather use it as mouth sanitizer, it's pretty good. It can be true, there are a lot of different recipes out there that people have actually used alcohol to make their own hand sanitizer, especially when hand sanitizer is in short supply. And some of the distilleries are actually providing their alcohol for the makers, for hand sanitizer. You have to understand hand sanitizer, to be truly effective needs to be 70% alcohol by volume, in that particular construct. So usually it's a bunch of alcohol with a little gelatin there to give it a little bit more integrity. By itself, pouring alcohol on your hands is not necessarily any good and anything really needs to be at least 70%. There is vodka out there, I've heard some Russian vodka, that goes up to 95% or so but most of the vodka that you'll see, if it's a 20% or 30%, that won't really make good hand sanitizer at all.

Cassandra:  So let's talk about how long the virus can live on certain surfaces. Do we know the survival rates for certain surfaces?

Dr. Esper:  Yeah, there have been a lot of studies that are coming out telling us how long this virus can last on surfaces and the different types of surfaces. For the most part, it does not like to live on surfaces that have a lot of holes in it or microscopic little grooves and nooks and crannies. It likes something that's very, very smooth. For surfaces like steel or plastic, it can last several days on that surface. Smooth plastic, door knobs, things like that, it can last on there for a little while. Whereas, things like cardboard, you can imagine cardboard has all these little microscopic little holes in it. Fabric, it does not last very long in there, less than a day. Only measured based on hours.

Dr. Esper:  The problem though, and that's with a lot of these studies is that just because you have a virus that's on, let’s say, a door knob, doesn't necessarily mean that that's enough virus to actually then jump onto your skin and then from your skin into your lungs or into your nose to cause an infection. You have to figure out what's the infectious dose? And we do know that as soon as these viruses get out of a person from a cough, and let's say it lands on a table counter or a chair or something like that, it starts dying really quick. We may be able to find some viable virus after a few days, but that is 1000s of times less than what was deposited on that surface. As soon as it hits something that's just not alive and certainly not a human, it starts dying very, very quickly.

Dr. Esper:  So it's still very unclear as to whether or not, just because there is a viral particle that's on a door knob, means that you can actually get infected. It may not meet that threshold number of viral particles that's required to cause an infection. That's the whole infectious dose and that still has to be figured out.

Cassandra:  You mentioned that the virus likes smooth surfaces. What about mail, getting an envelope in the mail, would it be hanging out on your letter?

Dr. Esper:  Yeah. That's the concern. Again, letter, paper, very porus, doesn't really like that. When you're out in the elements, it also doesn't like to be out in the elements. Certainly, many of these viruses seem to circulate in cold weather. It has a little bit better chance to last longer in the cold weather than it does in the warmer weather. Even so, if it's not in another person, it doesn't do very well. These viruses are required to be inside a person in order for it to thrive, in order for it to live. How long it lasts, I think will be something we will be understanding a lot more as time goes on but am I worried about catching this virus from getting the mail in the morning? The answer is no. Certainly, people are looking at that but even if there were viral particles on there, again do you really have enough of those viral particles to cause a second infection? Probably not.

Cassandra:  Yeah, like you said, what is the infectious dose that would be required to get us sick? So you mentioned weather and I wanted to ask about obviously, it's spring right now and summer is quickly approaching. Do warmer temperatures, will they slow the spread of COVID-19?

Dr. Esper:  That remains to be seen. I don't think the summer is going to be some sort of silver bullet that's going to kill off this virus but I do think it's going to help. The virus is, and many of these viruses, this is an RNA virus. RNA is not very stable. It falls apart in heat, it falls apart with UV radiation. So as we see more and more of that because we're getting to the summer, the days are getting longer, the temperatures are getting higher, things can prevent that virus from lasting longer in the world, or even in your nose as you're breathing that warm, more humid air in. We have to understand though that just because you hit June, doesn't mean the virus goes away.

Dr. Esper:  If you look at it, we have plenty of cases in Florida. Florida's very hot, Florida's got some nice weather going on right now. We're seeing it in Australia, we're seeing it in South America, we're seeing it around the world but when you actually look at the entire map and you go to the World Health Organization, they will give you an entire world map. You will see that there is a lot more infections in the Northern Hemisphere than on the Southern Hemisphere. Is that because of testing? Maybe, but I also have a feeling that the Southern Hemisphere, which in this case they're coming out of their summer, is not as conducive to this virus as us, we're just coming out of winter. It very well may flop and so next thing you know, you're going to see a lot more infections as June, July and August come in, there's going to be in the Southern Hemisphere and less so in the Northern Hemisphere. By itself, we just can't wait this out in saying that the warm weather by itself is going to make this virus go away, it's all about social distancing right now.

Cassandra:  Absolutely, yeah. I want to talk a little bit about age here. Is it true that if you're young, teenagers, 20s, 30s, 40s, that you are immune to COVID-19 or if on the off chance that you do get it, that you'll be completely fine?

Dr. Esper:  It's not an immunity, just because you are under the age of 20, doesn't mean that you are immune to this virus. This virus can infect any age, and can cause really, really, sick disease in any age. However, those people who are younger are more resilient to the effects of this virus. The younger age groups don't seem to be infected as much and don't seem to get as sick as older age groups. That being said, we've seen plenty of young children who have gotten very, very sick and died from this virus. This is a virus, it can kill you if you let it, and don't let it, don't get infected. Everybody deserves to be safe and therefore, that's why we have to say, "Yeah, the schools have to be closed, everybody has to be safe." Whether you're a small child or an older adult.

Dr. Esper:  Even if you don't get sick, it doesn't mean that a younger person can't transmit it to someone who can get very sick because they're in an older age group. So we're all in this together but we are very thankful that children, young adults, don't get nearly as sick and certainly don't have the death rate that older individuals do. The most recent study from the Center For Disease Control, it's a few weeks old right now but when they looked at the first 4000 cases, they did see a substantial number of individuals between the ages of 24 and 44, actually accounted for a lot of the hospitalizations. So just because you're in your 20s, 30s and early 40s, doesn't mean that you're off the hook, you should still be very tuned into what's going on with this virus and how to protect yourself.

Cassandra:  Excellent. I like your point about if you are younger and you do have these symptoms, even if you're asymptomatic, you could still transfer to older people who will have a harder time with it. I think it's just another important reminder of social distancing, everyone's sacrificing right now, for sure.

Dr. Esper:  We're starting to really appreciate how much asymptomatic patients are. In some studies, anywhere between 15 to 20% of people don't have any symptoms whatsoever, which is great for that person but it doesn't necessarily mean that they can't spread. So we're seeing some really good studies that are now really coming out, that are being published that says that this virus can spread a few days before you can even develop symptoms. It may be that some of the people who never develop symptoms can still spread the virus. So it's again, very important that we all stay tuned, looking for all that good information that's from the CDC and World Health Organization, or your state department of health, to figure out exactly what you're supposed to be doing to keep yourself safe, as well as everybody else around you.

Cassandra:  So Dr. Esper, is it true that ibuprofen makes COVID-19 worse, or that we shouldn't be treating symptoms with ibuprofen because it's more dangerous?

Dr. Esper:  Yeah, that's been a topic of discussion for the last month or so. Someone from I believe it was from France, that suggested that we shouldn't be using... I think it was the health foreign minister for France, that said in a tweet, "We shouldn't be using ibuprofen," but did not give us any data to back that up. Nor have we seen any studies to this point that suggest that we shouldn't be using ibuprofen. People should still feel very safe about using ibuprofen if they have a fever, if they have body aches, and at this point in time, we do not believe it causes any worse infection or worse disease.

Dr. Esper:  The coronavirus can cause bad disease by itself, whether you have ibuprofen on or not. What we do know is, certain individuals who have other medical problems should not take the ibuprofen. If you have kidney disease, you may not want to take the ibuprofen, not because of the coronavirus, just because it may cause problems with your kidneys. So talk to your doctor as to whether or not ibuprofen is okay for you but from this coronavirus standpoint, as the data is right now, it's okay to use ibuprofen, Advil, motrin, all that stuff.

Cassandra:  So I want to talk a little bit about testing. People that are having symptoms of coronavirus, who are talking to their doctor, and maybe they don't qualify for testing. Maybe they're not in these high-risk age groups or groups in general and they're really frustrated about that. Can you talk a little bit about just the reasoning behind it or give advice for why the testing isn't available to certain people?

Dr. Esper:  I think when it comes down to it, when we actually go back, we will get through this, and we go back and look back at what were some of our successes and what were some of our shortcomings, certainly, the ability of testing is going to be one of the shortcomings for this particular health crisis. We wish we had more tests out there. We wish we could test everybody who wanted to be tested, or just everybody in general so we could tell you who does and who doesn't have this infection. It would make isolation and controlling this virus so much easier, but we can't. At the beginning it was who can do the test? Then it was about who has enough machines to do the test? Now we're running out of swabs to actually swab somebody's nose or swab someone's throat. A lot of this has led to limitations and so we had to be very, very deliberate as to who we test and why we're testing them.

Dr. Esper:  If you're having symptoms, if you're having fever, if you're having a cough, that's certainly something I would say, "Yeah, I would like to offer you a test." For those people who are 60 and above, that's absolutely what we're doing, here at the Cleveland Clinic, or if you're sick enough that you're getting admitted to the hospital, we're absolutely going to be testing you. Or if you're a healthcare provider, and you're infected, you could be spreading it to a whole bunch of other people, you certainly will be tested if you're having any symptoms. But for those people who are not having symptoms, or those people who are just at home, they're doing fine, they're just on the couch. They're probably not going to get tested at this point in time.

Dr. Esper:  Now that leads to a question, will you ever know? The answer is there will be a blood test eventually, and we're talking about that right now. There will be a blood test to see whether or not you ever had the infection, whether or not you were ever exposed to the infection and we could do that with blood tests but that's going to be way in the future when we have the ability to do that. Right now, not everybody is going to be able to get tested but we are increasing the number of tests that we do each and every week and we will eventually get to the point where yes, we can offer you a test for everybody that wants to do it but we're just not there right now.

Cassandra:  So in Ohio, we are estimated to peak in mid-May, and I know previously it was mid-April, and there's probably a lot of frustration around that, for those who are practicing social distancing, working from home, or who may be not able to work right now. Can you explain a little bit about our prediction models for COVID-19 and why they may be changing at this point?

Dr. Esper:  This is all about people making their best estimates, they're writing their predictions out and a lot of this is very, very complicated calculus, where they're writing everything down on a piece of paper and they're putting out, "This is when we expect things to happen." But if you remember last year, on paper the Browns were supposed to go to the Super Bowl, well that didn't happen. You have to understand that these are just predictions and these predictions are only as good as the assumptions that are made when you do these predictions. Sometimes, this virus has been throwing curve-balls, ever since it started, it's going to do what it does.

Dr. Esper:  What we can say is that we do expect that the next few weeks are going to be worse than the last few weeks. We expect these next several weeks coming up, two to three, may lead to the highest number of cases. But what we can also say is that because what we have done here in Ohio, and certainly here in Cuyahoga County, in North East, Ohio all that. Everybody here's really been all in on social distancing. The governor has been extremely aggressive on social distancing and everybody has really followed his lead and the lead of our state health department and it's directive. And because of that we have definitely seen some suggestions that things are doing a heck of a lot better here than in other places where either the population hasn't or their governors have not really pushed on the social distancing.

Dr. Esper:  What you will find is that because we did things so well, we may actually have to deal with the circulation a little bit longer because we're preventing this virus from moving from place to place, it's going to go very, very slowly, it's having trouble. And because it's going very slowly, a peak is going to be a lot longer off. Whereas you look in places where there's a huge burst of infection, and uncontrolled infection, exponential spread of infection, places like Italy, and what seems to be going on in New York. They're going to peak earlier because everybody gets infected all at once but that's what we're trying to avoid.

Dr. Esper:  Just because you see so many people get infected so quickly, and their peak happens but by the time it's all done it's scorched earth, everybody got infected and they all got infected at the same time. Which is what we are trying to not happen here, where the whole health system, the police system, the fire department, the electrical workers, they all get sick at the same time and all the systems fall apart. That's what we're doing so we are doing our job and we're succeeding but that comes at a cost and that cost is that the peak may be a little bit later than what we want but it isn't going to be nearly as high that it's going to cause us a lot of problems.

Cassandra:  I'm curious, so we possibly will not see the peak in mid-May, will it be pushed out even longer if we keep doing the social distancing and doing what we're doing?

Dr. Esper:  I think it's going to happen late April, early May, that's my prediction for whatever it's worth. I do think as I said before, the summer is not a magic bullet but it is yet another influencer against this virus. So I have a feeling that what we're going to see is a substantial downturn in the virus. Hopefully, in conjunction with the social distancing we're going to see a really big lull, if not all go away entirely. That seems like a long time from now but I do expect that between those two things, we're going to see a substantial decrease in late May, early June and hopefully throughout the summer. And then the question is, does it come back? That's another podcast for another time.

Cassandra:  Absolutely. What would be your advice to people about grocery shopping? So I know that we're still allowed to go to the store, go to the grocery for our essential items. What advice would you give to people when they do have to go out and make a grocery shopping trip?

Dr. Esper:  You have to go, right? To protect yourself from this virus, you're supposed to isolate yourself as much as possible but also to live. You have to eat so you need to go to the grocery store, you need to go to get those items that you need for you and your family.

Dr. Esper:  The best thing to do is really try to minimize the amount of trips that you go to the store. To really focus on what you need for the next week, and if you can do it once a week rather than two to three times a week, or every day. You certainly don't want to do that because every time you go into a store, that's an enclosed space and that enclosed space can really aid in the transmission of this particular virus. So going there once a week is much better and also it's generally, if it's only one person rather than a group, I know that we all want to get out, I know that the kids are just anxious to do something, anything, even grocery shopping. Before, I had to pull them out of the house in order to go grocery shopping, now they're just, "Please get me out of here." The answer is usually to have one person that goes and does the shopping and then comes back with the groceries rather than a group, and try to do it less often as feasible.

Cassandra:  I'm assuming, probably avoid peak store times? Probably again, try to separate yourself.

Dr. Esper:  Yeah, you do want to avoid peak store times but I have no idea when peak store times are because everybody's been told not to go during peak store times, so everybody is showing up early in the morning and everybody's showing up late at night, and those are now the peaks. So I'm not sure exactly what the peak store time is anymore, but certainly and as well as everybody is home so even throughout the day you can find... It's usually best, I don't really try to say, "This is the time you should go." Everybody's a little different, every store is a little different. There's certainly when you're at the store, try to avoid the contact and making sure that everybody keeps themselves a safe distance apart.

Dr. Esper:  I was at the store about three, four days ago and everybody really was. There were people who were very conscious of, "Oh, someone's coming down the aisle, I'll wait here and then we'll move." And I think that's the best way to play it.

Cassandra:  Absolutely. So when we are coming home from the grocery with our items, should we be sanitizing everything that we bring home? Maybe out on the deck before we bring it in or before we put it in the car even?

Dr. Esper:  That's a great question and it has not really been well answered. At this point in time, I've not seen any good science that says, that we are getting infected from the items that we're bringing home from a grocery store. That being said, there is absolutely no problem wiping off a box of cardboard or a plastic bag full of noodles or something like that. That's fine. You should certainly though, feel very good about the food that's within a carton, or the food that's within a package. That's safe. The question is, does the package itself have any of these viral particles? Go back to the point where we said, even if there were, is there really enough to cause infection? Probably not.

Dr. Esper:  When it comes to things like produce, it's always been our recommendation that you wash it off. It's always been our recommendation that you rinse off the produce with cold water. You don't need to sanitize it, you definitely do not want to use disinfectants on an apple or things that you're about to eat. Washing that off with cold water has always been a good recommendation, not just for this virus but for all the other different types of germs that are out there. So I definitely would encourage that.

Cassandra:  I want to talk a little bit about being outside. Going outside to exercise, we've been told that's okay, walking the dog is okay. What recommendations do you have for people who are going to go outside?

Dr. Esper:  Generally when you do go outside, again just like when you go to the store, you try to keep your distance from everybody. Unfortunately, really going outside is all we've got right now. Every store is closed, all the movie theaters are closed, there's nothing for us to do and so everybody's going to the parks, and going to the trails. When I went to one, I was so surprised at how many people, the cars were lined up and down the road, every parking lot was full. It was almost like at an amusement park where you had to wait in line to get on a trail. It was pretty funny and it was great to see people. There's something to be said that when we're all squirreled away in our houses, there's something nice to actually see that there are other people that are out there, doing normal things like walking a dog, or jogging, or just taking a baby for a stroll.

Dr. Esper:  You still need to maintain your distance and some places where there's a lot higher incidents, they were talking about closing down parks, just because there were too many people, in too small of an acreage. Thankfully, at least around here that is not the case. It is a great opportunity for you to get outside, it's very healthy for you, it's very healthy for your family and you could stay together as a family but you should stay away from other families. So if you want to walk with neighbors, you've got to stay apart from them. Everybody that's living in the same household, absolutely, you can stay in close proximity because that's how you're living. You still for the best way to keep yourself safe, you still need to keep some distance between yourselves and other people who are outdoors as well.

Cassandra:  Sure. I wanted to ask you, I'm a runner, and this has come through my mind a couple of times when I've been out and I know the recommendation is to stay six feet apart from the person. When you're running and huffing and puffing, and there's wind all around. I'm curious if, do we need to, especially as a runner, go out of our way to avoid other people on the sidewalk? Does the wind carry the virus from me to the person a little bit ahead of me on the sidewalk?

Dr. Esper:  I think while there may not be an exact science, the six foot rule pretty much applies for everybody in every situation. A lot of times, when you talk about the way the virus wants to spread, it usually spreads by somebody coughing. It usually spreads by somebody sneezing, and basically what they are doing, they are expelling these little small droplets that can then go quite far, usually six feet is the max. When you're running, you may be breathing hard but you're not really getting that type of force out that's going to be able to expel something so far away. So I wouldn't be too worried, I think the six foot rule will still apply whether you're running, jogging, or what-have-you.

Cassandra:  Good. That's great advice. So the last thing I want to talk to you here is about prevention. I think it's safe to say a lot of us have heard the messaging around what we can do to help protect ourselves and to help stop the spread of COVID-19 but I think it always is worth repeating. How can we protect ourselves? How can we stop the spread or prevent the spread from getting worse?

Dr. Esper:  We're doing everything there is. Around the United States everybody is doing something a little bit different, every state is a little bit different. Whether it's in what they're restricting or when they start restricting it. Certainly the social distancing is one of the best things that we have seen to prevent the spread from going further. Like I said, this virus cannot live outside the body. So unless you give it a way out, for it to find someone else, it's going to die off, it's going to be a dead end. So if you happen to be infected the best thing that you can do to prevent this from spreading is to minimize who comes in that you could actually infect. And that's where the whole, people are wearing masks when they're working with patients who are ill because that prevents that virus from causing an infection.

Dr. Esper:  These viruses, all of them including this coronavirus, they have a similar way of doing things. They are hit and run. They infect you, they've got five to six days to make millions and millions of virus babies, and then they get those virus babies out to somebody else. That is what they want to do. Make a note though, at no point in time does a virus really want to kill a person. It doesn't need to kill you, it just needs you to cause a lot of virus babies to come out and then spread it to someone else. Whether you live or die doesn't make a difference to the virus. Honestly, the most successful viruses are actually the ones who let you be a little less sick so that you still go to work, you still go to school, you still go to the grocery store. You don't feel that bad, you think, "Oh, it's just a bad cold." And that's why we don't even care about the cold viruses.

Dr. Esper:  This one obviously can cause people to get very, very sick but one of the reasons why its spread so well is that the substantial number of people aren't so sick, and that's how they were able to spread it before we realized what was going on. In order to prevent this virus from spreading, the best thing you can do is right now, if you're sick, you stay home. If for the people who aren't sick, to make sure that they don't get in contact with other people who could be sick, and a lot of people could be sick and they don't even know it. So it's always good to think that everybody is a possible person who could be infected. That's not to say to shun everybody, this virus is not some sort of pariah or anything like that, it's just this is what the virus does. But to also make sure that you keep a safe distance and you wave happily to your neighbors and you wave happily to all the kids that are on the bikes as they go up and down the street. That's absolutely okay.

Dr. Esper:  That's one of the best things that we can do right now. Then also, the best thing to do is to stay on top of all the recommendations that are coming out from the Centers of Disease Control, that are coming out from your state department of health and the World Health Organization. Remember to just keep using those sites to tell you how to stay safe and what's going on in the world and any new recommendations that you're able to follow.

Cassandra:  That's wonderful advice to end with. Thank you Dr. Esper for taking the time to share such great advice and information with us. I know so many listeners will find what you have to say really valuable today.

Dr. Esper:  Yeah, happy to do it Cassandra. Thank you.

Cassandra:  For the latest news about COVID-19, visit clevelandclinic.org/coronavirus. If you want to listen to more Health Essentials podcasts, featuring experts at Cleveland Clinic. Subscribe wherever you get your podcast from or visit clevelandclinic.org/hepodcasts. And don't forget follow us on Facebook, Twitter and Instagram at clevelandclinic, all one word, to stay up-to-date on the latest health news and information about coronavirus, as well as your own health and wellness. Thanks again for listening, take care of yourself and stay safe.