Q&A: How to Stay Healthy in a Philadelphia Coronavirus Outbreak

Shoppers are stockpiling supplies all across the region. L to R: The shelves at a Walmart in Marlton, NJ (Photo by Maria Lewis); the hand soap stock at a CVS in Center City, Philadelphia (Photo by Ernest Owens); and, the shelves at a Giant Supermarket in Flourtown, PA (Photo by Heather Gray)

As of Monday morning, Pennsylvania and New Jersey are each claiming six presumptive positive cases of coronavirus disease 2019, also known as COVID-19. Pennsylvania reports one case in Delaware County, four in Montgomery County and one in Wayne County. In New Jersey, one of the cases is in Cherry Hill. On Friday, Mayor Jim Kenney announced that the city is “fortunate there are no confirmed cases of COVID-19 coronavirus in Philadelphia as of now” but noted that the city is prepared and wants all residents to take “proper precautions.”

To understand exactly what it means for Philadelphians to take proper precautions, we talked to Pablo Teba, an infectious disease specialist at Penn Medicine, a professor of medicine at the University of Pennsylvania, and an adjunct professor at the Wistar Institute. The Wistar Institute is collaborating with Inovio Pharmaceuticals to develop a vaccine for COVID-19. Tebas’s biggest piece of advice on how to stay healthy amid an outbreak? Use common sense.

Philly Mag: As the city tests for potential cases, what’s the best thing Philadelphians can do to get ready?
Tebas: I think you have to use common sense and try to prevent getting infected. When there are only a few cases in an area, I think quarantine works. You should stay home for 14 days if you’ve been exposed to a case or if you have symptoms, and isolate yourself from others.

But when there are more cases in the community, it’s important to avoid large groups of people. This might not be the time to go to a basketball game or a meeting where there are going to be hundreds of people. Try to limit your probability of contacting other people who might be sick.

We know that masks aren’t that protective if you’re not sick. Try to avoid interacting with people who are sick, and then make sure you wash your hands or use Purell or some other alcohol frequently. Try to avoid touching your face, because that’s the way the virus is being transmitted — by touching infected patients and then touching your face.

Here in the United States, we’ve seen other cities start by announcing testing of the virus and then go on to have an outbreak and deaths. The number of cases nationwide has surpassed 500, with 22 deaths as of Monday morning. Knowing that, should Philadelphians be worried?
The problem with the epidemic is that for most people, particularly young people, this is going to be fine. It’s going to be a bad cold. About 95 percent of the people who get infected will most likely be okay.

The problem is that five percent of infected patients are going to have serious illness. And for those cases, you need to have access to a good hospital, access to oxygen and ventilators. Five percent of a lot of people is still a lot of people. If there are 40,000 cases, then five percent is 2,000 cases. The health system can get saturated very quickly if you have a very high spike in cases. So the key is to decrease the rate of transmission. If the hospital gets overwhelmed with the number of cases, you’re going to start having some problems. That’s when you might start to run out of ICU beds or ventilators, and that’s when the epidemic becomes really scary.

If the cases are sporadic, here and there, our health system can absorb them. The problem is when there are too many cases and the health system can’t absorb them. So if you feel sick but you’re not very sick, the last thing you want to do is to go to the hospital, because you’re going to put yourself and others at risk. If you’re infected but not sick and short of breath, the best thing is to self-quarantine. Stay home and isolate yourself. And eventually, I think entities like the city health department will look for ways to test people for the virus at home.

There are some reports that children and newborns aren’t as susceptible to the virus as adults or elderly people. Knowing that, why have some cities chosen to close down schools?
I think young people do get the virus. It’s clear from data in China that young people are getting the virus, but they tend to have fewer symptoms. They might even be asymptomatic, but they are spreading the virus. They might not have very severe cases of the disease, but because you aren’t experiencing symptoms and aren’t stuck in bed or in a hospital to recover, you can transmit the virus to a lot more people. Children can be in contact with grandparents, and those elderly patients are then the ones that get really sick. So that’s why the children might be sort of a reservoir of patients who don’t have symptoms but can transmit the virus to others. That’s why some cities are electing to shut down schools.

How does this compare to other recent outbreaks of disease we’ve seen, like SARS, MERS or Ebola? Why does this one seem so much harder to contain? What makes this virus so much more contagious?
It seems like this virus is more contagious than the others because it can survive in the environment for several hours. The number of individuals who are sick with the virus is more than what we saw with those other outbreaks. Ebola is more lethal, but because people are so sick and bedridden, they don’t transmit as easily. A lot of people with the coronavirus are basically fine and don’t really show symptoms, but they can transmit it to a lot of people very quickly. It’s very infectious, and that’s what makes this virus different from other epidemics — there are more cases of transmission of the virus than there were in other epidemics.

Early reports said that the U.S. should be more worried about the flu than the coronavirus. Is that still the case?
Well, in terms of raw numbers, yes, you should be concerned about the flu. The flu has killed thousands of people this year in the United States. But it’s a different concern. Flu is preventable. The flu vaccine isn’t great, but it reduces your chances of getting the flu by 60 percent, so you should be vaccinated for the flu.

This coronavirus epidemic is concerning because of how transmittable it is and also because of the severity of some cases. The proportion of people who are going to get a severe disease is higher for the coronavirus than for the flu. But if you look from outside, and you look at the global health problem and the number of people that die, more people have died from the flu than have died from the coronavirus this year. You have to be concerned about both. You still need to be concerned about the flu. There are still a lot of cases of the flu in the community.

But taking commonsense measures might help with both viruses. Avoid crowded places, clean your hands, avoid touching your face. If you’re sick, use a mask to avoid transmission to others, but don’t use a mask if you’re not sick. That, I think, will help fight the epidemic. Because what the city doesn’t want, what nobody in the U.S. wants, is a very high spike in cases that might become overwhelming.

What’s the best thing we can do to help our older friends and family, who are at much higher risk of dying or suffering a serious respiratory illness as a result of infection?
People who are immuno-suppressed need to prevent their exposure to others. They should try to avoid public transportation and take other measures like that. People who are immuno-suppressed — they should be careful. If you have friends or family or a neighbor who’s older and can’t go to the grocery store or needs to use public transportation to get there, it would be kind of you, if you’re younger, to offer to get the groceries for that person and make sure they have enough food and water.

Check on your neighbors, and try to help others who might be immuno-suppressed and might not have help at home from anybody. Maybe they don’t know how to order food online or have their groceries delivered to their homes. So help your neighbors, especially the ones who are immuno-suppressed or are at higher risk of coronavirus infection for whatever reason.

If you’re infected with the virus, what’s the best thing you can do? Is recovery similar to the flu, where you pretty much have to wait it out in bed while your immune system does its job? Or should you take more precautionary measures to ensure the virus doesn’t turn into a serious respiratory illness?
If you’re a proven case of the coronavirus, you have to follow the instructions of public health officials. At the present time, the recommendation is to keep people in isolation for 14 days. And then they have to document that you’re not shedding the virus. So if you have the virus, you’re going to have to go home and stay home and figure out what to do with your family and everybody else that you’re going to be in contact with. If you have been in contact with somebody with coronavirus but you aren’t sick enough to need help in terms of oxygen and all of that, then the best thing you can do is stay home and prevent passing the virus to others. But if you’re severely sick, you have to go to the hospital.

Some of the lifestyle adjustments that are being recommended in the presence of the virus, like limiting public transportation usage, staying home when you’re sick, etc., aren’t really feasible for people who can’t afford to miss work or don’t have a car. How can these people protect themselves against the virus?
Be careful with surfaces that can be contaminated. Wash your hands. People can use Purell or some alcohol to wash their hands. Avoid touching your face. Be very conscious of where your hands are. And for people who are sick, try to stay away from other people who might be sick. Use common sense, and try to avoid contact.

Some experts have recommended that in addition to stocking up on food and basic medicine to deal with symptoms and preparing to rest if we’re infected, we should all pre-order our prescription medications. Why is that? Will there be shortages of drugs that have nothing to do with the coronavirus?
People are worried about the drug supply because a lot of drugs are manufactured in China, so some people have concerns about the supply chain. I don’t think we’re at that point. I was at Costco last weekend because I needed to buy a couple of things, and it looked like a zoo. Everybody was buying everything. I don’t think we’re at that point yet. It’s a big country, and I don’t think the supply chain is going to be compromised, but people tend to overreact. Have some food supplies, yes. But for people who are older or immunosuppressed, make sure you have enough food to last for one or two weeks. Buy hand sanitizer, and make sure you have enough of that. But I don’t think people need to act like this is the end of the world. It’s not the end of the world. Use common sense. Buy supplies, but don’t overdo it.

Do we have any idea if there’s a light at the end of the tunnel? How long can an outbreak like this last? Will it ever be containable?
When we look at China, we see that the number of cases is going down now after about two months or 10 weeks since the first cases appeared. It will be hard to know exactly how long it will last. There are several vaccines in development that might be solutions down the road, but it’s going to take time. There are drugs being tested as we speak as treatments for the virus, and they look promising. If this is like other epidemics, it’s going to be two or three months before it starts flattening out and going away, maybe — at least, that’s what we’re seeing in China so far. But I don’t think we have enough information to know how long it will last.