Health & Fitness
Coronavirus: Expert Offers Common-Sense Reasons Not To Panic
A dean at New York Medical College who's a former top official at the Centers for Disease Control gives Patch a reality check on COVID-19.
WESTCHESTER COUNTY, NY — With 22 cases of the new coronavirus now confirmed in New York — 18 of them in Westchester — Patch interviewed a local expert to talk about the realities and the facts, to ask about the balance between alertness and panic.
Actually, he's both local and national. Dr. Robert W. Amler is a dean at New York Medical College, heading the School of Health Sciences and Practice and vice president for government affairs at the campus in Valhalla. Formerly he was chief medical officer at the federal Centers for Disease Control and Prevention's Agency for Toxic Substances and Disease Registry.
"There are two sides to a story like this. There is both the alert side and the don't panic side," Dr. Amler said. "The question always is how can you alert people and also tell them not to panic at the same time? That is the nature of public emergencies like this. Even using the word 'emergency' stirs people up."
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Dr. Amler held a Q&A session with Patch Thursday.
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Patch: Many people are afraid. Should they be?
Dr. Amler: There's are several kinds of worries in these situations. There's always going to be the worry that something bad is going to happen to you. There's another: people begin to worry that "there's something I'm not doing, I'm not up to speed, I'm supposed to be doing this for my children, my loved ones, my friends...." Then there's the uncertainty of exactly what we're dealing with. That uncertainty, which is more common than not, creates more stress. And then there's a broad kind of worry. In the back of people's minds is "what if the experts don't really have this under control?" There are so many disaster movies that we see where the plot gets interesting because there's an even bigger conspiracy going on.
Patch: My child has a pediatrician’s appointment next week. Is the doctor's office safe?
Dr. Amler: Overall, the risk in this area and in the rest of the United States, even in California and Washington state, the risk to the public is still low, I would even say very low. Even if exposure occurs, even if infection occurs, for the vast majority of people the risk is still low.
We know that for most healthy people this is not a serious infection.
Patch: What about people who are at greater risk?
Dr. Amler: People at greater risk are at greater risk for all types of infections. They have already been forewarned to be careful about not catching the flu, not picking up other people's colds. If you recently had a procedure that restricts your immune response, you've already been cautioned about this.
Patch: Recipes for making your own hand sanitizer are going viral on social media. Is that a good idea?
Dr. Amler: On that, I honestly don't know. But last time I checked, soap is still plentiful. Soap and water is still much better than hand sanitizer. I would emphasize soap.
Patch: Readers are commenting that the quarantines seem a messy and unenforceable governmental response. Thoughts?
Dr. Amler: Though I have not managed this personally, I have read experiences of people self-quarantining, and the system has worked reasonably well.
When someone has had a credible exposure, such as recent travel to parts of the world where there are large numbers of cases, we ask them in good faith to restrict their activities to protect people, particularly their loved ones. The majority of people understand the problem.
It's not that onerous. You can still live at home for most cases and it's for a limited time.
It's not perfect — but look how long it has taken in the United States for the disease to begin spreading compared to places where it spread more rapidly. Self-quarantining has helped quite a bit.
Patch: Has the virus been spreading undiscovered throughout the country?
Dr. Amler: Certainly if you don't look for something at all you'll never find it. If you don't have an accurate test you won't find it as efficiently. However, the overall picture is that with literally thousands of cases in China in January, and thousands of travelers going back and forth between China and other parts of the world, we did not discover people getting sick.
They were not expecting the virus either, but they found it because large numbers of people were getting sick all over the place.
Patch: Could all the people in this country who are now sick with the flu really be sick with coronavirus?
Dr. Amler: For years we've had rampant flu infections throughout the United States. It's been our ability for many years to test for flu. We would have had large numbers of patients with negative flu tests. We have not.
Patch: I handed my keys with the customer bar code to a supermarket clerk, is that something I shouldn't do now?
Dr. Amler: Wipe it off from time to time and wash your hands.
Patch: Two local school districts closed their buildings and offices for two days for cleaning after two students were learned to have been possibly exposed. Another school district, at the epicenter of the Westchester outbreak, did not. What should schools be doing?
Dr. Amler: I would say each school is going to have to make institutional decisions based on what they know about their teachers, their students, the community they live in. In addition, they have to stay in compliance with the New York state Department of Education and the state Department of Health, from which guidelines have already gone out. Like in Westchester, they coordinate in Rockland with the health department, in Putnam with that health department.
These are executive decisions to be made depending on the nature of the exposure as interpreted by the health authority and what they feel they need to do practically for their community.
Cleaning the school is never a bad idea. Closing a facility because somebody who was there once might have been exposed — you need to work with the information you have.
Patch: Someone has an underlying condition. She worries will the coronavirus kill her?
Dr. Amler: She should communicate with the physician who takes care of her about her immune system and any precautions she should take. There's more flu going around than coronavirus. She needs to be closely aligned with her physician about any strategies. That's an individual situation.
Patch: Someone's booked on a river cruise in Europe. Should they cancel?
Dr. Amler: If they're going to go in the next couple of weeks they should look at the CDC website to check the status of the countries they're going to. They should look now and before leaving and see what the recommendation is for non-essential travel. They are going to want to consider how much more extensive the outbreak could get. If this is a summer cruise they might want to wait a while and see what develops. Some people are more averse to risk than others — they may feel they have other times they can go. It's an individual decision. I'm not telling people to immediately call up and cancel summer travel, because things might get better.
Patch: Can we compare coronavirus to SARS? SARS started in February 2003 and it was stopped by July 2003. Can we expect something like that?
Dr. Amler: Do you know how many people died in the United States from SARS? Zero. It was a much milder experience in the United States than in Canada. The SARs virus is related to COVID-19. We don't know will it follow a pattern like SARs or will it follow a pattern like flu. We will just have to wait and see.
Besides all the hand-washing, sanitation and keeping away from other people, which we would call non-pharmaceutical intervention — and which has a demonstrative impact — there are four things that must and are happening: better and more widely available testing, antiviral medication like Tamaflu, and a vaccine.
We have every reason to be confident that this disease will be managed.
That gets back to the original issue — alert versus panic. Right now the risk is low, and even if you're infected the risk is low.
Patch: What do you as a health professional worry about?
Dr. Amler: I don't worry. I simply hope that people will be careful and listen to what needs to be done. The non-pharmalogical steps are up to all of us and they're easy.
I hope that people continue to read Patch and learn what needs to be done. If they get the real story it can change the outcome for them.
Patch: Thanks for the plug! And the common sense.
The best way to prevent illness is to avoid being exposed to the virus, though the CDC recommends preventive actions to help avoid spreading respiratory diseases, such as:
- Avoid close contact with people who are sick
- Avoid touching your eyes, nose and mouth
- Stay home if sick
- Cover your cough or sneeze with a tissue and then throw the tissue away
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