CORONAVIRUS: UPDATED VISITOR RESTRICTIONS, INCREASED SAFETY MEASURES + COVID-19 TESTING.
The 2019 novel coronavirus, or COVID-19, is on everyone’s mind, with new developments emerging every day. Pediatric infectious disease specialist Frank Esper, MD, sits down to answer important questions about what we do and don’t yet know about the virus, and what everyone should be doing to protect themselves and others.

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COVID-19: What You Need to Know to Protect You + Your Family

Podcast Transcript

Deanna Pogorelc:  Hi, welcome and thanks for tuning into this Cleveland Clinic discussion on the 2019 novel coronavirus COVID-19. My name is Deanna Pogorelc and I'll be your host today. We know that these are uncertain times and that you all have a lot of questions about how this situation is evolving, and so with us today, we have Dr. Frank Esper and he's here to hopefully answer some of those questions for everyone.

Deanna Pogorelc:  Dr. Esper is a pediatric infectious disease specialist here at Cleveland Clinic Children's, and thanks so much for being here.

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

Deanna Pogorelc:  To our viewers, please remember, this is for informational purposes only and is not intended to replace your own physician's advice. So Dr. Esper, we know that this situation is changing fast and we're learning new things every day about this new coronavirus disease. So can you start by talking a little bit about what we know about what the virus does to our bodies?

Dr. Frank Esper:  We're still learning so much about what this coronavirus does. There is a lot of new information, not just news information that we're receiving, but there are numerous scientific reports and medical papers that are being published every day and that we are reviewing and we are finding out more about what this virus causes and what this virus can do. Right now though, our understanding is that this virus comes from a family of viruses, and the family of viruses are coronaviruses and they are, for the most part, cold viruses.

Dr. Frank Esper:  Unfortunately though, this is a new virus, just like the SARS virus, just like the MERS virus, it is just introduced into the humans and we have little to no immunity, and because of that we're getting a lot sicker from these new coronaviruses than we have been with all the other normal coronaviruses that usually causes a cold.

Dr. Frank Esper:  But for the most part, it's all respiratory. For the most part, it is all a problem of runny nose, cough, breathing problems. Unfortunately, this virus has a much higher incidence of causing pneumonia and that's where people are really getting into problems. That's where the older individuals are really finding a lot of problems. You get pneumonia, there's a strain on your heart. When you have pneumonia, obviously you're having also a hard time breathing. But in addition to that, then there's also this hyper inflammation.

Dr. Frank Esper:  Your body's immune system reacts so vigorously when this virus gets down into the lungs that the inflammation is also a big part of the severity of disinfection.

Deanna Pogorelc:  How is that different from something like the flu?

Dr. Frank Esper:  Influenza actually causes some of the very similar problems that we're experiencing with this coronavirus, but the flu is something we know. One of the things about the coronavirus is that we're still learning so much about it, but we've been studying influenza for decades and we know what to expect. Even with a pandemic, I don't think there was nearly as much uncertainty as we are dealing with this pandemic with the coronavirus. The influenza also can cause a bunch of upper nose stuff, so runny nose and the sniffles, but it also likes to go into the lungs.

Dr. Frank Esper:  It also really causes a lot of severe pneumonia. What we see with influenza that we don't see with coronavirus is that usually influenza opens the door to a second infection, usually a bacterial infection, and it's one of those things that a lot of people get their pneumonia shots to prevent. The coronaviruses causing all the problems by itself. It doesn't need help to cause all those severe infections and problems, whereas influenza is usually a bad virus, but also can partner with other germs.

Deanna Pogorelc:  Could you possibly have both at the same time?

Dr. Frank Esper:  We're still learning a lot about that. The first studies, we weren't seeing a lot of co-infections. That's where you actually confine to viruses at the same time like influenza and coronavirus, but we're seeing more and more studies that are just rolling out right now that maybe we can see more infections. It's still not clear, but we are changing our testing strategies based on all the information that's still coming in on a daily basis to whether or not, just because you have flu, could you also have this new coronavirus. We're talking about that right now.

Deanna Pogorelc:  The only way to know for sure that someone has the COVID-19 is to do the testing and get a formal positive on the test?

Dr. Frank Esper:  Yeah. The, the only way that we can tell if anybody has the coronavirus is to actually swab their nose or swab their throat or sometimes both, where we will actually test looking for the genetic fingerprints of this particular virus. The symptoms of coronavirus are the same symptoms as a lot of other viruses, including influenza. You just can't say, just because you have a fever, just because you have a sore throat, just because you have muscle aches or a cough, that could be any virus.

Dr. Frank Esper:  In order to figure out if you have the coronavirus, we have to do the coronavirus test. That being said, anybody who has those symptoms, especially in today and and these upcoming weeks, should be concerned about the possibility of coronavirus in addition to all the other viruses that are out there.

Deanna Pogorelc:  Then, how does the virus usually run its course in our bodies?

Dr. Frank Esper:  Again, one of the things that we're learning is, how long does this virus last? What we're seeing, and again, I will say that new information may completely tell me that I'm wrong by tomorrow, but what we have seen to this point is that for the first five days after you get infected, you, for the most part, don't have a lot of symptoms. Usually, your symptoms happen about five days or so after, and that we call the incubation period.

Dr. Frank Esper:  The virus is infected you and it's kind of revving up. Then you start getting symptoms around day a five, and then you can be symptomatic for about another, I don't know, five to seven days up to that point and then everything starts getting better. Or, around day five or about day seven, day eight, things can get a lot worse. When we're seeing people who go to really, really bad disease, people who get hospitalized are usually people who have been feeling, I got this virus for about a week, and then they start having troubles breathing.

Dr. Frank Esper:  It's really that second week of illness that we're really seeing and paying attention to people who we know have this virus to make sure that they're doing okay on day seven, day eight, day nine.

Deanna Pogorelc:  Just for clarification, can you explain the difference between coronavirus and COVID-19?

Dr. Frank Esper:  It's all about naming. Coronavirus is the virus itself. Remember, we changed this thing's name three times, right? The first one was the novel coronavirus and then it became COVID-19 and then it became the SARS2 coronavirus which causes COVID-19 disease. COVID-19 is the disease, the symptoms that are caused by the virus, SARS2 Corona virus. If you're confused at home, yeah, so be it. I wish I could make this a lot easier for you guys, but it's the SARS2 coronavirus. It's very closely related to the SARS virus that we had back in 2002/2003.

Dr. Frank Esper:  Honestly, also came from the same region. They both originated in China, probably both originated from similar bat coronaviruses that jumped from bats to humans, and that's what we're dealing with right now.

Deanna Pogorelc:  Okay. What about how it's spread? What do we know about that?

Dr. Frank Esper:  Well, again, spread, for the most part, we think that this is a respiratory, we know that this is a respiratory virus. So a lot of the spread, the majority of the spread is through the air. So, when people cough, when people sneeze, when people have that big cough, you could see the little phlegm, you can see the little droplets that are in the air, and they can hover in that air and then fall to the ground.

Dr. Frank Esper:  But if another person is within six feet of you, those droplets can make their way or be inhaled by another person or they can get onto their face or get onto the hands and then it gets into their mouths and into their system. Most of this is called aerosolized droplet transmission. Okay? Six feet. That's very different, and because people were thinking, oh my God, because these droplets go through the air, this must be airborne. Airborne transmission is a completely different beast. Airborne transmission is like when something gets aerosolized into a very micro particle, which then can float into the air and stay there for hours, even after the person has left the room, the infected person has left the room.

Dr. Frank Esper:  That's something like measles, that's something like tuberculosis. That is not something like this new SARS coronavirus. The second part though, and we're still figuring this out, is whether or not contact is also a way of transmission. We don't believe that ... it may be a way, but we don't think it is the major way that this virus goes from person to person and place to place. We're also identifying some of the virus in the stool, especially in younger kids, they may have a little more diarrhea.

Dr. Frank Esper:  It has also been cultured from the stool of infected patients, people who have diarrhea, but not a lot, and we're not sure that that is so much that it actually leads to further transmission, but we're still looking at that part.

Deanna Pogorelc:  You mentioned that there's a little bit of an incubation period, I think you said five days, so could somebody be infected and not know it and then potentially pass it on that way?

Dr. Frank Esper:  Well, you definitely can be infected and not know it. All right? We're seeing more and more people, especially children, especially young adults who are getting infected and don't even know that they were infected and clear the infection all by themselves and never knew that they were sick at all. It's still a small percentage. All right? It's definitely somewhere around less than 10. Early studies thought it was only 1%. It's getting a little bit higher.

Dr. Frank Esper:  We're seeing probably more and more in children. A small percentage of people will not develop any symptoms at all. In that incubation period, you don't have any symptoms and the virus is just kind of brewing. We do not know that you are infectious during that incubation period. You may not just have enough virus to cause an infection in another person. You have to reach a certain threshold. What that threshold is, is called the infectious dose, and we haven't figured out exactly what the infectious dose is, but most of the people who have been transmitting the infection to people in their families or people at work have been symptomatic.

Dr. Frank Esper:  So, we believe that you are most contagious when you're actually having the symptoms, and we feel like before you have the symptoms, you're probably not contagious at all or just very, very mildly contagious.

Deanna Pogorelc:  Okay, and are we all equally susceptible to getting this virus?

Dr. Frank Esper:  We are all equally ... This germ does not care who you are. Everybody can get sick and can get infected. However, the younger you are, the less likely we see the infection. We don't see a lot of infection in individuals under the age of 20 and in children. Great. Those individuals also don't seem to get nearly as sick as older individuals and that's great too. However, it doesn't mean you're off the hook. It's still, if you have a kid, if you're a kid or you have a child, they can still get infected with this infection.

Dr. Frank Esper:  We're also seeing that the younger adults, 20, 30s, 40-year olds have been shown that here in the United States to have more severe infections. You can still get really sick even if you're relatively young and in good health, you can still end up in the hospital, and very rarely, actually in the intensive care unit. Thankfully, death is extremely rare in the younger age groups. We're seeing the most severe infections, the most severe disease and the most deaths in people over the age of 65.

Deanna Pogorelc:  Okay. But there was some new research that came out about babies potentially being more susceptible than we had previously thought. What do you think about that.

Dr. Frank Esper:  Yeah, so that was a study that came out from China, about 2,000 children. Remember, China had 86 plus thousand cases, and they found 2,000 kids that were infected, and in those children, so this was a very small subset. They looked at all those children and said, how many of them were sick and which ones of them are sick based on by their age group. What we found though is that 90% of all children had mild or moderate or no disease at all. 90% didn't even require hospitalization. They didn't have any symptoms or they had such mild symptoms that they basically went home and got better on their own.

Dr. Frank Esper:  In the 10% that were hospitalized, in the 10% that did go onto severe disease or even critical disease, there was a higher proportion of small infants that were likely to have severe ... needing oxygen or critical where they needed some breathing help. However, the numbers were really small. There was only like seven children or seven infants that actually went critical out of 2000 children, out of 86,000 cases. You can imagine, we're talking about very, very small.

Dr. Frank Esper:  We are much more cautious about babies. Anytime any baby has this virus or any other virus, they're more likely to get hospitalized based on their age and based on any of their symptoms. When it comes to babies, we are very cautious and we have a tendency to bring them into the hospital and watch them very closely.

Deanna Pogorelc:  Sure. Okay. So let's talk about how we can prevent the transmission of this virus. What are some of the key points that you would say precautions people should be taking?

Dr. Frank Esper:  We've been saying from the get go that you should be washing your hands, and washing your hands is one of the best ways to prevent this virus and every other virus as well as every other germ from causing an infection. A lot of viruses do jump onto your hands, and once they get onto your hands, we have a tendency to scratch our nose or we put on our contacts or we move our glasses or we eat. This is the way they go from hands to mouth.

Dr. Frank Esper:  So washing your hands with something like soap and water, any soap and water, it doesn't have to be antibacterial soap. This is a virus anyways. It doesn't have to be an antibiotic soap or anything like that. Any soap is just fine, and if you don't have soap then we say go ahead and use those hand sanitizes which are around all over the place, although it's a bit hard to find these days in the stores, but any hand sanitizer that has 70% or so more of alcohol is also very, very good. But I also talked to you about it saying that this was more from coughing, right? This was more from all those droplets.

Dr. Frank Esper:  So, by covering your cough, if you do happen to be coughing into your sleeve, then you're less likely to spray those droplets onto other people or into a particular area that someone can breathe in. Therefore, it is best for you to always cover your cough if you are coughing, but also staying home if you're sick. One of the reasons that we talked about social isolation, but definitely we talk about if you're sick, you want to stay home and away from people until you get better. The vast majority of people, 80 plus percent get better on their own.

Dr. Frank Esper:  Your immune system is better than any medication antiviral that I have. A lot of times your immune system is more than enough to take care of it. But it is something that is important that we don't spread this virus, and that by spreading this virus through your coughing by staying at home and by washing your hands as three of the biggest things that you could do to prevent the infection both in yourself as well as in your family and in your community.

Deanna Pogorelc:  Yeah. Can we talk a little bit more about social distancing? I know that's something that's top of mind for people right now. Do we know that this is a technique that actually does work to help prevent the spread of disease?

Dr. Frank Esper:  We actually do. All our information on social distancing comes from the plagues of the past. The big one was the pandemic flu, the Spanish flu in 1918. Where we actually see that, if people stay apart from one another, they can't spread the influenza. Honestly, this isn't some novel thing that we just came up. People in the thousands of years of evolution, we've been social distancing ourselves more when someone is sick. It's something that's innate to us.

Dr. Frank Esper:  But the thing is is that society now is bringing this all together, and that's one of the reasons why it's very tough to socially distance yourself. Also, as our society has grown over these last a hundred years, and especially after the last 25, 30 years, we're becoming much more interconnected. In fact, we are actually, from an early age, we are trying to show connectivity, connections, socialization. We are social creatures. So, social distancing is actually very, very difficult for us, but it does work.

Dr. Frank Esper:  It does help prevent the spread of this infection. It's one of the best things that we can do right now in addition to taking care of yourself, isolating yourself if you're sick, washing your hands, but staying apart from one another is one of the ways that we prevent this virus from doing what it wants. What it wants to do is it infects you, it makes a million copies of itself and then it tries to get out from you to some other person and ping pong from person to person to go place to place. If we separate ourselves, then anybody who is infected cannot infect someone else and it basically stops right there.

Deanna Pogorelc:  Okay. I know some people are probably wondering how far we have to take this. Can we still go to the grocery store? Can we still invite someone over for dinner? What are your thoughts on that?

Dr. Frank Esper:  That depends on what's going on in the community and that's one of the things that just changes day after day. Here in Ohio, we are not at the point where you say, you can't invite a person over, but every person that you do invite over is a risk. And so you have to understand that and you have to make a decision for yourself and for your family as to what is the risk over these next several weeks. Whereas in California where they're trying to say hunker down in a place. They want nobody to go from place to place. Just to stay home.

Dr. Frank Esper:  That being said, you still need to go to the grocery store. You do still need to go to the gas station, and healthcare workers still need to come to work and there's firemen, policemen, there's essential people that have to work. In that context, we are trying to provide them the best, safest environment with again, focusing on washing your hands, making sure we screen people to say, "Are you sick? If so go home." Things like that.

Deanna Pogorelc:  What are hospitals and healthcare facilities doing to prepare and to deal with this illness and then also preventing the spread.

Dr. Frank Esper:  Hospitals have been fighting off infection for quite some time and we're actually pretty good at it, but infections are also very good at spreading. It is a battle that we have been waging against numerous different germs, numerous different viruses or bacteria. This virus is a new one and so we're still learning about it. Right now, the best thing that we can do in in the hospital, and we've taken this in multiple different layers.

Dr. Frank Esper:  The first thing we do is we make sure that everybody's on board, and from the get-go, especially here at the Cleveland Clinic from the top down, everybody has been on the same page that they have opened up every door, they have been answering every call. They have opened their wallets saying what you need, you get. it has been very, very impressive to this point.

Dr. Frank Esper:  The other thing that we've been doing though is we've been setting together different stages, different tiers of protections for our healthcare workers and for our patients. As we've seen more and more spread in the community, we have been going to different and higher and higher tiers of protection for our caregivers. Most recently, we've been talking about restricting visitors to the hospital and it came into this staged way, but we are at a point where we want to restrict people from coming in because every time someone comes in that's a potential risk.

Dr. Frank Esper:  And we want to minimize the risk to our patients. We are making sure that we are screening all our employees, asking them every day. We're now even taking their temperatures every time they come to work to make sure that they are not sick, that we are giving everybody the equipment that they need in order to prevent illness in them. And we are testing them if they have symptoms, we are testing employees to make sure that they are not infected with this virus and then spreading it to patients or other employees. So, we've been very aggressive about that.

Deanna Pogorelc:  You mentioned testing. I know initially in terms of just public testing, there was some concern about supply and I'm curious if that's still an issue just in terms of testing people who are symptomatic and inappropriate for testing.

Dr. Frank Esper:  It's still an issue. That's no secret. Testing across the United States has been very difficult to get online and to get moving Cleveland Clinic because .... exactly because from the top down, the leadership that we've had was one of the first institutions to be able to offer testing onsite. We have certainly surpassed a lot of other institutions and a lot of even state laboratories across the nation, and we'd been working very closely with all the other hospital systems to make sure that, because we all know we're all in the ship together guys.

Dr. Frank Esper:  We're all working against this virus and making sure that we get their testing centers up. The drive through testing center is only about a week old right now had had a few speed bumps but we are actually getting through that. I'm working through that. The testing, we're still at least 500 samples are able to be screened today and we are working diligently to increase their capacity and we want to get two more to a thousand, maybe even higher to whatever our institution needs.

Deanna Pogorelc:  So if someone develops a cough or fever or some of these flu symptoms, what's the first or what are the next steps that they should be doing?

Dr. Frank Esper:  Well, if someone develops a symptom, the first thing they should do is, you know, not go to work if they're an adult and they do work, not go to school. Well, you don't have to worry about that, the schools are closed. Basically, keep to yourself and make sure that you don't expose anybody else within your household or within your community. If you're having these types of symptoms and you feel like you need to get and talk to your doctor, then you should call them first. All right? Talking to a physician over the phone or the nurse practitioner or any of the screening people will be able to help you figure out whether you need to be seen or more likely whether we could do a virtual appointment.

Dr. Frank Esper:  Just because you're sick and just because we don't want to spread the infection doesn't mean you don't get to see a doctor. We have substantially increased our capabilities with virtual appointments. A lot of times all we need is to basically see you and talk to you and figure out what the problems are. If you are having problems breathing, if you are struggling to get your breathing, to catch your breath, or you're having heart palpitations, things like that, then you need to get to the emergency department or you need to call for emergency services because some things just can't wait.

Dr. Frank Esper:  While we are all talking about coronavirus, coronavirus, coronavirus, there's all the other normal things that are happening all every, day and that normal people get sick without even a coronavirus being involved. If they need to be seen then they will be seen.

Deanna Pogorelc:  In your mind, as an expert in this field of infectious disease, what are some of the big unanswered questions about the coronavirus that would really help you all get a better grasp on this?

Dr. Frank Esper:  There's a lot of things we still don't know about this coronavirus. One of the biggest questions, at least, especially in my mind, is why are the younger age groups so spared not only from bad disease but also from even getting infected to begin with. There's a lot of thoughts on that, whether it has to do with preexisting immunity because kids get so many more viruses than adults or is it because of their response to this infection is different than the adult response, or are the receptors and children's somehow different than the receptors of adults?

Dr. Frank Esper:  You're going to see a lot of movement on those types of questions because that may give us a clue as to how to prevent this stuff going forward as well as what to target when we're talking about vaccines, when we're talking about antiviral medications, that's going to be one big thing that we're going to see. The second thing is also about the transmission. We said, we believe that this is mostly through cough. What is the component of people who are asymptomatic, as you brought up so good, can they spread, and if so, how often?

Dr. Frank Esper:  That's going to be something that's probably going to be very, very ... we're going to probably find that out fairly quickly over the next few weeks. Certainly, anybody who is infected, whether they have symptoms or not, it needs to stay home. All right? Anybody who is infected, whether they're coughing or whether they don't have any symptoms, needs to prevent and isolate. I'm sorry, it's not isolation, we call it ... No, it is isolation. Isolation, if you have infection, you have to stay home.

Dr. Frank Esper:  If you think you have the infection or you are exposed, we call that quarantine. They're basically the same thing. You stay away from people for a little while. The other things that we're going to find out right now is about medication. We're learning a lot about treatment. You're going to see more treatments before you see the vaccines, and vaccines are in the future, but they take a lot of time because we're building a vaccine from the ground up. With a lot of the medications that we're testing right now are actually medications that we had even before this outbreak happened.

Dr. Frank Esper:  Because we saw SARS, we saw MERS, and we said, "Hey, we need something just in case another bad coronavirus happens, and that's why we have some of these medications ready to go and they were the first to be used in China as well as here in the United States. We should expect some information as to whether or not these medications are working in the upcoming weeks.

Deanna Pogorelc:  Yeah. So do you have any indication of if or when we can expect things to start getting better?

Dr. Frank Esper:  No, but it will. It really depends, and it's not so much, will it get better, it is when it will get better. It's not just here in Cleveland. Every different city, every different state is its own little mini area of infection and that some places are very, very active right now. New York, Seattle, California. Some places are not very active right now, the entire Midwest. All right? Ohio has been doing a really, really good job to this point as well. Different places have instituted different countermeasures, the social distancing, the closing of schools, things like that at different times, and so that may affect where the peaks happen, but every place is going to have its own little mini peak.

Dr. Frank Esper:  Just because, let's say Ohio is doing fine right now, if other places around the United States get really, really bad, it may spill over to where we are. So, we always have to be diligent that we have to watch the whole country as a whole and the world as a whole to see when this virus is going to go away. If you think about what happened in China, and I'm using this just as an example, I can't say. If it started in December and they're only now not seeing new cases, I believe they're not reporting any new cases, you're probably talking several months.

Deanna Pogorelc:  Okay. As we wrap up here, is there anything we haven't covered yet that you really would like to leave our viewers with?

Dr. Frank Esper:  I think the biggest thing that we haven't covered, the main thing though is that the virus ... it's still very important for us to tell you that the virus does not cause very severe symptoms in the majority of people, because one of the issues about this, and I think it's coming from all the social distancing and all the interruptions in our lives, all the schools being down, all the restaurants being closed. There's nothing on sports. I don't know how ESPN is doing anything right now.

Dr. Frank Esper:  This is a big disruption in our lives, but it has led to a huge amount of anxiety. It's palpable. How skittish and how anxious we are about this virus and about what the future holds. It is still very important to know that the virus, by itself, for each and every person is still very mild in the majority of individuals and that we need to make sure that if you are someone who is over the age of 65 and if you are someone who is at risk, if you have high blood pressure, if you have heart problems, lung problems, diabetes, those things, they need to be extra, extra cautious.

Dr. Frank Esper:  But everybody, we are in this boat together, everybody needs to be cautious. There is nobody who is safe from this virus and no one should think that they are safe just because they're young or just because they're healthy. Even if you don't get sick, you might pass it on to someone who does and not even know it, or just have such mild symptoms and that you are able to keep working or keep playing. Don't do that. Listen to the medical directors, listen to the Ohio department of health and all the state health departments listening to the CDC and the WHO.

Dr. Frank Esper:  Get your good information from those sites. The Internet's full of a lot of things that can somehow send you astray, so make sure you're getting good information, and the website on the Ohio coronavirus site as well as for the Centers for Disease Control is really, really good.

Deanna Pogorelc:  Great. Well, thank you so much for being here and taking all those questions, and thank you to everyone for watching. For the latest updates from the Cleveland Clinic related to COVID-19, visit clevelandclinic.org/coronavirus. Thanks, and take care.

 

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