After Ranney posted a series of posts on Twitter on Sunday that many found to be extremely useful and informative, CNN interviewed the emergency room physician and associate professor of emergency medicine at Brown University.
Here's what she says we know and what we still don't know about Covid-19. The following interview, made via Twitter, has been slightly modified.
So we don't know how "exactly" how it actually spreads. How do we not know? Do we need more time to understand this? What does it take to understand all this information? To get a concrete idea of how it spreads / lasts on surfaces.There is conflicting information about the spread of the aerosol (such as measles) or droplets (such as the flu). There is also contradictory information on the lifespan of surfaces and their spread by human waste. Also, we don't know if cats can give it to us 🙂
Stupid question. What is the difference between the virus and the infectious virus?Honestly, we need some good laboratory studies! Merely observing that the virus is * there * does not mean that it is "infectious".
So, it's summer and we've seen some of the studies that have scientists / researchers sounding the alarm about HVAC / AC systems that can spread the virus. Is this something that we know for certain has spread the virus or is it also something that needs to be studied further?We can detect it ... but it may not make someone sick - it may be a dead virus.
Is that why it is so important not to be inside, in a confined space with a group of people?Great question. There are a number of studies showing that the air flow changes the modes of transmission inside a restaurant or building - but it is not certain that it spreads "through" the air conditioning system. Instead, it's probably due to the air blowing the droplets of virus (or aerosols) in some places.
It is important not to be in a confined space with a group of people because the virus is "blocked" if you are inside!
You also mentioned that we don't know the actual death rate from the virus. Why is that? And what will help us to determine it?Imagine that you spray something stinky in a closed box, compared to a spray outside ... you would feel it much longer and much more strongly, in a closed box, compared to the outside.
We still do not know how many people have been infected, due to delays in starting tests. Without knowing the denominator (the number of people infected), it is impossible to know the mortality rate (which is the number of people who died, divided by the number of people infected).
Do we know if there is a risk of spreading the virus through cigarette smoke / vapor or vapor?Importantly, the case fatality rate likely differs across populations. So, for example, it will certainly be higher for the elderly than for the young.
Do we just need more time to study the virus? Or is there also the problem that science just isn't there? Like we don't have the skills or knowledge to do certain things?Big question - I haven't seen any studies on this. We do know, however, that current smokers have a higher risk of serious illness and death.
It is not a lack of skills / knowledge - it is (a) time, and (b) funding to ensure it is done well.
So the time to do it is not something we can change. But the funding is! Is there more funding provided? Or should we put more into it? And how do universities / research institutions do research? How do they deal with social foreclosure / estrangement? Does this hinder research?In addition, much of the information currently published is published in the form of a "preprint" - which means that it has not yet been reviewed by other scientists. Which means we have to be more careful in how we read it - some (are) a little less reliable than others.
There is more funding provided ... but social isolation has made it more difficult, especially for clinical research. Most universities have temporarily interrupted or significantly reduced their research due to Covid-19 - due to the lack of PPE and concerns about the infection.
What is the danger of "preprinting"? Better yet, why should scientists examine it?And ... I would point out that research on a lot of other things influences Covid-19. It is therefore funding in general. For mental health, for cancer, for types of injuries - not JUST for Covid-19.
Peer review will therefore help to clarify which treatments seem to work and which seem to do more harm than good (i.e. antimalarial drugs). And that's another thing we don't know. That these drugs do more harm than good, right?Peer review detects unintentional errors, analytical problems and unsubstantiated conclusions. This generally results in stronger and more reliable publications.
We do not yet know exactly which drugs work and for whom.
And we also don't know how long people are infectious, and if they can be re-infected, right? And we don't really know the long-term effects that some people can have from the virus.There are very promising trials and promising basic scientific studies. It is essential for us to balance the potential risks with the potential benefits. ... good scientific trials help us do this.
Is there anything else we don't know that really stands out? Or don't you think you've gotten enough attention?Correct on both points. We do not think it is likely that people can be re-infected in the short term (eg 1-2 months) but we do not know in the longer term.
I think it's important to talk about the long-term consequences. We don't know what happens to you if you catch it and get better. We see early signs that it can damage your lungs and brain in the long run, but we just don't know.
We know the genome of the virus. Why is it important?What we know about Covid-19
You mentioned in your Twitter feed that we know how to fight this. If we get more tests, do better contact tracking that isolates and identifies exposed and sick people, and get better PPE, we don't have that much social distance. Why is that?Because it helps us to (a) identify if / when it mutates, (b) track its spread (c) identify treatments and vaccines (because we focus on specific targets on the virus.)
Do we know that people in parks / beaches are immune to the virus? People who do not wear masks at the beach but who can be a social distancing, they are fine and are not in a high risk situation?We must distance ourselves socially to prevent transmission. We are currently trying to distance ourselves from * almost everyone * because we don't know who could be contagious. But if we know exactly who is sick and if these people remain isolated from others, then the rest of us can go about their business without worrying.
So if we know who is sick and they are not part of the general population / do not interact with others, we can release social distance ... close families / groups of friends can get together , within reasonable limits?Re: being in the parks / at the beach - there is a risk gradient. Being outdoors is less risky than being indoors because the virus wears off. It is * possible * to be infected if you are downwind of a sick person, but it is unlikely. (Coming back to my analogy above about a strong smell. If you're on the beach and someone is spraying a perfume, you won't smell it at all, or you might smell it for a very short time. If you are in a closed room, you will feel it for a while).
And we know what constitutes "high risk" exposure.Correct! BUT it is important to also have random tests on asymptomatic people - because (a) people can be infectious before having symptoms, and (b) current data suggests that 1/3 of people never have symptoms (but can still be infectious)
But how do you prevent high-risk exposures from reckless people? Or people who just don't know they have it?High risk exposure = indoors, close together. The closer you are to a sick person, the more likely you are to be infected. We can't yet say "2 feet" or "6 feet" or "12 feet" is adequate indoors - the current recommendations are 6 feet but there is some debate about it.
Big question about careless people. This is where consistent, high quality public health messages are important. We must (1) make it easier for people to stay at home in the event of illness (make sure they have food, sick leave, etc.), (2) create STANDARDS to stay home (for example, people feel that their friends and family should * stay * at home.)
So we know that the virus affects people differently because of their socio-economic status. But it also affects certain ethnic groups more. What is the science and the facts that tell us how it affects them differently and why?Some may also add (3) impose seclusion by checking people daily, and perhaps even imposing fines if they break the isolation. It is more extreme but it is sometimes necessary.
We know that minorities and people of lower socio-economic status are disproportionately more likely to become infected and die. Current evidence suggests that this is due to structural inequalities - for example, because minorities have fewer jobs that allow them to work from home - NOT because of genetic differences. It may also reflect well-established differences in access to high quality health care. We are still trying to understand the exact reasons, but these observations are similar to trends, for example, in maternal mortality among blacks compared to whites.
So we talked about what we know about Covid-19. But what do you want people to know about it, in addition to everything we just talked about? What do people need to know about it broadly?What you should remember from Covid-19
In a broader sense, I want people to know a few things.
First, they knew how quickly and how ardently scientists worked to improve our scientific knowledge of the virus. People have literally worked around the clock to try to define the virus, identify potential therapeutic and vaccine targets, define modes of transmission and create new ways to keep us safe. But good science takes time.
Second, it's okay for us to express uncertainty in science - to be honest that we don't know things, and sometimes even change what we say. It is part of the scientific process. Good scientists will be honest about what they do and don't know, and will be honest when they are wrong. It is not to be political or to be suspicious.
Third, even if it is a new virus, there are very standard public health measures that help reduce the transmission of infectious diseases. It is about testing, tracing, isolating and protecting. When we say that these works - they are based on more than a century of evidence.
So we may not have a cure for the virus, but we know how to beat it. And it's thanks to standard public health measures.Fourth, good public health helps support a strong economy. Few doctors, scientists and public health professionals would describe Covid-19 as a situation or a situation. There are great ways to * reopen * and * protect us all. We insist on PPE, tests and follow-up of contacts in order to restart the economy. There are also great ways to support our communities while recognizing that the world has changed.
Well ... I wouldn't say how to "beat him". I would say "how to reduce its impact". This virus will not go away, and all those who claim to "defeat" it are spirits. Instead, we want to "contain it." We know how to help our society stay as healthy and safe as possible. while we work simultaneously to improve our knowledge of prevention and treatment.
We are in a new normal. Standard public health measures work to protect us from a new wave and allow us to return to work :).
