San Antonio Express-News (Sunday)
ALL YOU NEED TO KNOW ABOUT THE PANDEMIC.
Sleep and exercise are important. So is avoiding ‘treatments’ with bleach, other chemicals
Dr. Junda Woo has been medical director at the San Antonio Metropolitan Health Distric since 2015. She received a master’s in public health from the UT School of Public Health and trained as an OBGYN at Baylor College of Medicine in Houston.
We caught up with Dr. Woo to ask her a few questions about COVID-19: How it affects the human body, and how best to avoid it.
Can people do anything now to boost their health in a way that might help them to weather a future infection by the virus?
It’s the old standbys: Get enough sleep, eat well, exercise, take care of yourself. That will protect you from a lot of health conditions, and that includes this one. We know that not having enough sleep can weaken your immune system, and we know that exercise can improve your immune system. If I had to highlight two things, it would be those.
As the economy begins to reopen, more people are emerging from quarantine and returning to activities that might put them into contact with others who are infected by the virus. Can you differentiate between higherrisk and lower-risk activities? For instance, do casual interactions in outdoor settings have a lower risk of transmission than enclosed and crowded settings?
Absolutely. We think about time, we think about distance, and then what kind of exposure you have. The reason we talk about that 6-foot distance is that if you can just maintain that 6-foot
distance, that’s going to protect you more than a mask.
The two most important rules are: maintain a 6-foot distance from other people whether they seem sick or not, and don’t touch your face with unwashed hands And if you think about it, everything else that we talk about really grows out of those two.
People worry a lot about cleaning surfaces, and we don’t know if that’s because it’s something that feels more under our control. I’ve heard people say, ‘I touch my face without knowing it. I can’t help it.’ And it’s true because both of us touch our face 400 times a day without realizing it. But if you are able to not touch your face without washing your hands first, then it wouldn’t matter what you touched because you’ve already washed your hands. So those are the highest tips to follow.
Now, sometimes you’re not able to maintain a 6-foot distance. Well, that’s when you want to wear your mask and make sure that you’re not around anybody in a confined space for very long. In public health, when we call somebody who is sick to find out who their close contacts are, we ask, ‘Who were you within 6 feet of and was it for 10 minutes or more?’ So you can see why the 6-feet rule is so important.
And then there’s actually a range that goes from 10 minutes to 30 minutes. If you spend more than 30 minutes with somebody, regardless of how, you’re probably exposed if that person was symptomatic from COVID at the time. But there’s a range, and it also includes: ‘Were you face-toface? Was one person wearing a mask? Were you maybe side to side? What was happening? Was one person sneezing? Was one person singing?’ Those things also affect how dangerous an exposure is.
Is it known whether asymptomatic carriers of the virus are as infectious as those who have symptoms?
With the caveat that we still don’t know a lot, right now it is seeming to me like people who are pre-symptomatic — so in the 48 hours before you develop symptoms — it’s possible that those are the most infectious, followed by people who have symptoms, followed by people who are asymptomatic. But all of this knowledge could change next week. That’s just what I know today.
Can you recommend any home remedies or over-thecounter treatments for those who are infected by the virus but not yet sick enough to seek hospitalization?
So there’s not a treatment that we know of. We definitely don’t recommend — the FDA’s website has some specific remedies that they are worried about people using that are not recommended. It’s a solution that has bleach in it.
We should not be gargling with chemical solutions or using products that are not meant for use in humans. We don’t have anything like that, so it’s really going to be the same as if you had a cold or the flu, the things that you would take for your symptoms — so if you’re having pain to take Tylenol, or if you’re having a cough to take a cough medicine.
Patients have reported a long and unpredictable course of the disease, with apparent recoveries marred by sudden declines in health. When should someone who is infected seek medical attention?
The CDC says to seek emergency medical attention if you’re having trouble breathing, if you have persistent pain or pressure in your chest. If you are caring for somebody who’s sick and you’re not able to wake them up. If they seem bluish in their face or in their lips. Those are definitely reasons to call 911 and notify the operator that you are taking care of someone who may have or has COVID-19.
For things that are less severe than that, if you have the option of telemedicine, I would ask your own provider through a telemedicine appointment. And of course, we have federally qualified health clinics in town for people who don’t have insurance, and you don’t have to be a citizen to use the services.
What are some of the possible long-term medical conditions suffered by those who have “recovered” from the virus?
There can be lung problems, kidney problems and weakness of the heart muscle.
There are a lot of viral infections that can also infect the heart muscle, and we don’t know why some people are more affected than others. We’re finding that a number of people are needing to be on dialysis more than we initially expected with COVID-19, so that’s why the kidney might still be affected afterwards.
And then the lungs, again, we don’t know why there seem to be at least two main categories, two different ways that the lungs are affected. And one of those, it’s just harder to bounce back from. You may have heard that at the beginning we were putting a lot of people on ventilators, and you want to put them on early. Well, that’s still true. But there’s also some growing concern about, is the ventilator the right answer or is the ventilator maybe damaging lungs if people have an infection that’s making their lungs be very stiff. I’ll just stop there because I am not an ICU physician.
What are some of the most recent medical discoveries about the virus?
Last week, remdesivir did get FDA approval, so that’s promising.
Now we have a swab test that can be used at the point of care, and that should make it easier to control the virus because you can know more quickly who tests positive. It’s a 15-minute result. You can really trust the positive, but you can’t be sure of the negatives. There’s always a footnote. If it’s a negative, then the person is recommended to have another test if you have a high suspicion that you have the infection.
Scientists have come to believe that the virus harms not only the lungs, but also the blood vessels. Has this new understanding changed the way that doctors are treating those with the disease?
One of the things that more people are doing is using medicines that prevent or break up blood clots earlier in the disease to try to stop — it can’t stop the virus, but it can stop some of the bad effect of the virus.
Blood thinners, or there’s a separate category of medicine called clot busters that, if you already have a clot, then you need a different medicine from if you’re just trying to prevent clots. Blood thinners are for preventing clots. So both those categories of medicines. It may be because of the effect on blood vessels that we’re seeing so many more people need dialysis when they have COVID because of the fine blood vessels in the kidneys.