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Your coronavirus questions, answered: Medical experts respond to your COVID-19 concerns

Experts answer viewers’ COVID-19 questions, part 1
Despite constant corrections from health authorities, there are many myths and misinformation about COVID-19, creating widespread panic. Jeff Semple separates fact from fiction.

The coronavirus outbreak is sparking fear, confusion and plenty of questions. Who’s most at risk? Should I cancel my travel plans or avoid public gatherings? And what should I do if I develop symptoms associated with COVID-19?

Global News has been flooded with questions from readers, viewers and listeners. We’ve asked some of Canada’s top medical experts to respond to your coronavirus and COVID-19 concerns. Below, you’ll find the answers.

As the outbreak evolves, we’ll update this page with the latest answers and information. Send your questions to yourquestions@globalnews.ca.

If someone gets the virus and then recovers, can that person become infected again? Or are they immune?

Experts don’t think someone can catch this virus twice but at this point they’re not sure. “That has yet to be answered because we’re so early on in the outbreak,” says Vaisman.

“There were earlier reports of somebody testing initially positive, then negative and then positive again. Although this may have been due to the fact that the middle negative test was what we call a ‘false negative.’ It wasn’t an accurate test. But we don’t know the answer to that yet. Future research is going to be required.”

It’s possible, for example, that a patient’s immunity to COVID-19 could weaken if the virus mutates. Some viruses, such as influenza, mutate rapidly, which is why people continue catching the flu every year.

“Every year it’s a slightly different virus that we’re talking with,” says Jeff Kwong, a family physician and public-health professor at the University of Toronto. “And we don’t know enough yet about this new coronavirus, if it mutates as quickly as influenza.”

What happens after my 14-day isolation period is over? Can I go visit my grandkids?

“Now’s not the time to go and visit your other family members,” says Sumontra Chakrabarti, an infectious disease specialist with Mississauga Halton Healthline.

“We understand there has to be some essential things, like going to get groceries. Sometimes people have to go to certain types of doctor appointments. But,  if you’re going to go outside, what we recommend is that you keep yourself away, at least two metres, from everybody else.”

I self-isolated because I had symptoms consistent with COVID-19, but I’m no longer feeling symptoms. Am I still contagious?

“This is a very good question and it’s a research question,” says Dr. Ronald St. John, the former director-general of the Centre for Emergency Preparedness and Response at the Public Health Agency of Canada.

“There are some scattered reports of the virus being detected by molecular testing on people who are several days past being discharged from the hospital and who were deemed to be recovered.”

“It looks like that if you start from day one with symptoms, you’re contagious for about eight days,” says Sumontra Chakrabarti.

“One thing that’s important to note, though, is that in the mild cases, the symptoms only lasts for about five to seven days. So it’s possible, even when your symptoms go away, you could have some contagion for a couple of days after that.”

Is loss of smell a symptom of coronavirus, particularly in asymptomatic people?
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A team of leading ear, nose and throat doctors in the U.K. have warned that people experiencing the loss of smell or taste could be “hidden carriers” of the virus, capable of spreading it without realizing. They compiled data from a number of countries, including Germany and South Korea, that found a growing number of patients with little to no other symptoms aside from losing the sense of smell.
But a diminished sense of taste and smell can be symptomatic of a wide variety of illnesses, and isn’t definitive of COVID-19 at this point, according to Dr. Isaac Bogoch, an infectious disease specialist based out of Toronto General Hospital.
“I doubt this is a very specific feature of COVID-19. It might be a feature, but likely not a uniquely distinctive one compared to other infections,” he said.
Bogoch said it’s not unreasonable that people with the new coronavirus could see a decrease in their sense of smell, but said on the scale of symptom importance, it’s “minimal.”
“It’s a common symptom in many infections. It’s usually extremely mild,” he said. “If people truly have no other symptoms at all, I don’t think it would be wise to start rushing to testing centres.”
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Do we know anything about the consequences of the virus on pregnant women and on the fetus?

“We don’t know yet about the effect of the virus on the fetus or on the pregnant woman,” says infectious disease expert Alon Vaisman. “But so far, the evidence has been very reassuring that there hasn’t been transmission from mom to baby.” 

COVID-19 has had remarkably little impact on babies and children, but they can become infected. A newborn baby in London reportedly tested positive for coronavirus just minutes after birth. The child’s mother had been admitted to hospital days earlier with suspected pneumonia. It’s not known whether the child contracted the disease in the womb or was infected during birth.

Vaisman says a pregnant woman’s weakened immune system and regular check-ups may put them at a higher risk of being exposed to the virus. “When it comes to pregnant women, these (medical) appointments are absolutely necessary to make sure everything’s OK. The only thing we could recommend is to avoid contact with people as much within reason.”
How will COVID-19 respond to the warmer spring/summer weather we are fast-approaching? 
Seasonal influenza thrives in the northern hemisphere during the winter and then tapers off in the warmer spring and summer months. But experts aren’t sure whether COVID-19 will follow a similar pattern.
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“Nobody has any idea what the spread of this virus is going to do when it gets warmer,” says Michael Gardam, Chief of Staff at Humber River Hospital. “There have been some theories that perhaps it will behave like influenza. However, given the spread of this around the world, in many parts of the world that are warmer than here, I think we need to put that whole ‘it’s all going to go away in the summer’ thing to rest.”
Countries in the middle of summer, such as Australia and Brazil, reported dozens of cases of COVID-19. Singapore, where it’s hot and humid most of the year, has confirmed more than 100 cases.
“I think it’s very likely we’re going to continue to see spread over the summer. Now, might the spread slow down a bit? Maybe. But it’s going to be very hard to measure that.”

Should governments close schools to slow the spread of the virus?

School closures, such as the Ontario Government’s decision to cancel classes for elementary and high school students until April 6, can cause significant disruption. But health experts note that temporarily closing classrooms has proved to be one of the most effective tools in curtailing a contagion. 

“There’s certainly evidence from other respiratory viruses that children are a big incubator of this. And they’re also the ones that are very good at spreading it to other people,” says Michael Gardam, Chief of Staff at Humber River Hospital.

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“Based on that evidence, I think most places have thought about closing schools.”

Parents won’t be surprised to hear that children are considered “super spreaders” of respiratory illnesses. But that may prove particularly true in the case of COVID-19, because the vast majority of children’s symptoms thus far have been mild and, as a result, more difficult to detect.

The WHO reported in February that 2.4 per cent of COVID-19 cases involved children and just 0.2 per cent were children who became critically ill.

What should I do if I develop symptoms consistent with COVID-19?

Symptoms of the new coronavirus include a fever, dry cough, fatigue and shortness of breath. But if you develop these symptoms, it’s still unlikely that you’re infected with COVID-19.

“It’s important to recognize that, right now, we’re in respiratory virus season. The symptoms of COVID-19 will be similar to all the symptoms that you’d experience from other respiratory viruses,” explains Alon Vaisman, an infectious disease expert with the University Health Network in Toronto.

“The highest risk individuals are those who’ve travelled recently or been exposed to somebody who is confirmed to be infected.”

READ MORE: Coronavirus: How to protect yourself

Vaisman notes that most hospitals and community centres in Canada are still only testing those who have recently travelled abroad or had direct exposure to someone diagnosed with COVID-19.

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“If you’re experiencing respiratory symptoms or fever, you’re most likely explanation is not COVID-19. However, the likelihood of that will change depending on what happens in Canada and whether we start seeing increases in community transmission.”

What are the chances of dying from COVID-19?

We still don’t know exactly how deadly this disease is. Globally, about 3.4 per cent of reported COVID-19 cases have died, according to the World Health Organisation’s briefing on March 3. But the actual mortality rate may be much lower.

“Most of those numbers are coming from Hubei Province, where they were overwhelmed with this. And so their mortality rate is artificially high,” says Michael Gardam, Chief of Staff at Humber River Hospital.

Because symptoms can be mild and many cases are likely going undiagnosed, experts believe the real mortality (or death) rate is closer to one per cent. South Korea, for example, rolled out a mass public testing programme, with as many as 10,000 new tests conducted per day. The mortality rate there has remained below one per cent.

Italy has seen a mortality rate closer to five per cent, but it also has the oldest population in Europe, with about a quarter of its residents aged 65 or older.

Who is most at risk?

“The older you are, the more likely you are to have a rougher course with this infection,” says infectious disease expert Isaac Bogoch.

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In Italy, for example, the average age of those who have died was 81, according to Italy’s national health institute on March 5. And many of the victims had preexisting health conditions.

‘Focus on what we truly have control over’: Psychologist talks mental health and coronavirus
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In China, the official mortality rate was 14.8 per cent in people 80 or older, compared with an overall national mortality rate of 2.3 per cent.

“So it certainly can take its toll on older people. Now, if someone is 80-years-old and they get this infection, is it certain that they are going to die? Of course not. It’s a risk factor.”

Are children at risk?

Children can become infected with COVID-19 but appear to carry a much lower risk of developing severe symptoms. Fewer than one per cent of confirmed cases in China were nine years or younger and there were no reported deaths.

“It is a bit of a mystery. I don’t think we fully understand why that is the case,” says Vaisman.

“It’s a respiratory infection and people with the most vulnerable lungs tend to be the very youngest and the very oldest. So it is mysterious as to why very young people are not affected the same way that we would see with other viruses.”

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While unexplained, it’s also not unusual: children fare better at managing many other infectious diseases, such as chickenpox and SARS (severe acute respiratory syndrome).

That said, health officials remain concerned about the potential for children to spread the coronavirus to others, particularly since their symptoms are typically mild and cases can go undiagnosed. “They’re considered a real threat to others because they’re sick, but not that sick. And they can spread it to other people,” says Gardam.

What if I have an underlying medical condition or weakened immune system?

The answer depends, of course, on the severity of a person’s existing health issue. “Not all underlying medical conditions are created equal,” says Bogoch.

“If someone has mild asthma, they may have a bit of a rougher course with this infection, though likely not. But if someone has, for example, really hard-to-manage COPD (chronic obstructive pulmonary disease), this infection can certainly cause some damage.”

Other underlying conditions associated with severe cases of COVID-19 have included high blood pressure or hypertension, diabetes and cardiovascular disease.

We have a spring break trip scheduled to California. At what point would you consider cancelling it?

If you’re wondering whether to cancel travel plans, health officials say your first stop should be the Government of Canada’s travel advisory webpage. Be sure to check the advisories for both your destination and any stopover locations along the way.

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The website currently recommends avoiding all travel on cruise ships, for example. Vaisman says seniors or those with underlying health conditions might want to reconsider any trip outside the country, including to the United States. “Really think about whether that travel is necessary because they are considered ‘at-risk’.”

READ MORE: How many Canadians have coronavirus? Total number of confirmed cases by region

“If you go out and travel somewhere, even if it’s the United States and you become unwell, how’s that going to affect your family? How’s it going to affect your job? How’s it going to affect your colleagues at work? Because if you do require quarantine, it’s going to have a pretty significant effect on the quality of your life and the people close to you.”

Gardam says he’s personally decided to cancel all travel plans outside of Canada for the foreseeable future. “We’re seeing people’s vacations getting screwed up. I don’t want my vacations screwed up. I have no interest in travelling to someplace and then finding out I have to be in quarantine, or the place I’m staying has been put in lockdown, or my flights have been cancelled or whatever else. I don’t want to deal with that.”

I have tickets to a basketball game. Should I cancel those plans and avoid large crowds?

Health experts are stressing the importance of avoiding large gatherings as an effective means of curtailing the outbreak. “When you increase the likelihood of transmission by having people close together, then you’re potentially going to run into trouble, especially you’re talking about things that are non-essential, like parades or concerts,” says Vaisman. “All it takes is a few individuals who have the virus. All of a sudden you have a few transmission events and then the virus just kind of explodes from there.”

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The coronavirus is understood to have a “reproductive number” between two and 2.5, meaning each sick person is infecting at least two other people. “So that’s enough to say it’s quick exponential growth,” says Jeffrey Rosenthal, a professor of statistical sciences at the University of Toronto. “There’s definitely the potential for there to be a lot more cases because it is quite contagious.”

Coronavirus searches trend on Twitter as experts recommend sticking to credible sources
Coronavirus searches trend on Twitter as experts recommend sticking to credible sources

The majority of cases are mild, which has helped to fuel the spread. “That may be why this outbreak has become so severe,” says Bogoch. “Many people who are mildly symptomatic are well enough to leave the house, well enough to travel and therefore transmit to other people. And that perhaps is one of the biggest contributors to this problem.”

Canada’s Minister of Health Patty Hajdu said on March 11 that the government anticipates between 30 and 70 per cent of Canada’s population will contract the virus.

Are people contagious before their symptoms appear? How long do symptoms last?

Once someone contracts COVID-19, it typically takes around four or five days before they start showing symptoms. But they can be contagious before that.

“People will probably shed (or spread) the virus for about a day or so before they feel sick,” says Bogoch. “That’s common with all viruses.”

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“If you’re an otherwise healthy person, you may find the illness passes after a few days. Although people who are unwell, for example, or who have (underlying health conditions) like diabetes or heart disease, or the elderly, will have a much worse outcome and may experience more severe side effects, such that on around ‘Day 7’ they may require admission to hospital.”

Do masks protect against the virus?

Yes and no. If you’re sick, a surgical mask can help prevent you from spreading the virus to others. But if you’re not sick, it’s unlikely to offer much protection.

“Walking around the city wearing a mask intermittently? There’s no evidence to say that that’s going to help you,” says Gardam.

“You’d have to be wearing that mask 24/7 to not potentially get infected and never touch it and move it around. And you probably shouldn’t eat either, because you’ve got to take it off when you do that. And you should have eye protection as well. So a mask on its own, it really doesn’t make any sense.”

Do the pneumonia vaccine or the flu shot protect against the virus?

The flu shot and the pneumonia (or pneumococcal) vaccine, which is a routine immunization for infants and people 65 and older, won’t protect against COVID-19. But they can help patients avoid contracting those illnesses as a result of weakened immune system from COVID-19. In severe cases, the novel coronvirus may cause pneumonia and lead to respiratory failure.

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Should governments close schools to slow the spread of the virus?

School closures, such as the Ontario Government’s decision to cancel classes for elementary and high school students until April 6, can cause significant disruption. But health experts note that temperately closing classrooms has proved to be one of the most effective tools in curtailing a contagion. 

“There’s certainly evidence from other respiratory viruses that children are a big incubator of this. And they’re also the ones that are very good at spreading it to other people,” says Michael Gardam, Chief of Staff at Humber River Hospital. 

Parents won’t be surprised to hear that children are considered “super spreaders” of respiratory illnesses. But that may prove particularly true in the case of COVID-19, because the majority of children’s symptoms thus far have been very mild and, as a result, more difficult to detect.

“So based on that evidence, I think most places have thought about closing schools,” Gardam says. 

The WHO reported in February that 2.4 per cent of COVID-19 cases involved children and just 0.2 per cent were children who became critically ill.

Do you have questions about the coronavirus? We’ll find the answers. E-mail your COVID-19 questions to yourquestions@globalnews.ca.