University experts tackle multiple questions surrounding the coronavirus

A nurse holds a swabs and test tube kit to test people for COVID-19, the disease that is caused by the new coronavirus. Photo: Associated Press
By Janette Neuwahl Tannen

A nurse holds a swabs and test tube kit to test people for COVID-19, the disease that is caused by the new coronavirus. Photo: Associated Press

University experts tackle multiple questions surrounding the coronavirus

By Janette Neuwahl Tannen
Professor Jose Szapocznik, a public health expert, as well as Dr. Jose G. Castro, an infectious disease physician, are immersed in research and clinical practice to treat those affected by the coronavirus.

The rising threat of COVID-19 is impacting many people every day in South Florida. While the number of cases in Miami-Dade was four on Friday, it rose to 23 by Monday night. And in Broward County, a total of 43 cases have been confirmed as of Monday night.

Florida Gov. Ron DeSantis announced during a Tuesday morning news conference that all bars and nightclubs in the state would close at 5 p.m. Tuesday for a period of 30 days. Restaurants in the Sunshine State can only operate at half capacity.

University of Miami public health experts Dr. Jose G. Castro, professor of clinical medicine in the division of infectious disease at the Miller School of Medicine, and Jose Szapocznik, professor and chair emeritus of the Department of Public Health Sciences at the Miller School of Medicine, help to separate the falsehoods from the facts. They share insights about the evolving COVID-19 outbreak, explain how the virus is spreading, and explore the philosophy behind efforts to curb the pandemic in the United States. Szapocznik studies the impact of the environment on health outcomes and the impact of family members on each other. He is also the director of the Center for Family Studies.

What are the symptoms people are experiencing who have been diagnosed with COVID-19?

Castro: The symptoms are like those of the flu—fever, cough, shortness of breath, and muscle pain. What we do know from other institutions and other countries is that a majority of patients will have a mild to moderate form of the virus. That would be fever and cough, just like a flu. It’s enough to stay home unless you become short of breath, or unless you are immune-suppressed—that could put you at risk for a more severe disease. As you become older, the chances of becoming sicker increase.

If you are experiencing mild symptoms, what should you do?

Castro: Currently, there are not a lot of tests available. So, if you have mild symptoms, it’s better to talk to your doctor, who can advise you if you should go to an emergency room or urgent care center. Some doctors’ offices may want you to come in. But it’s probably better just to talk over the phone with your provider, rather than going to a place where people may truly have the infection while you could just have a cold.

How can you find out if you have COVID-19?

Castro: So far, we have been testing through the Miami-Dade County Health Department, and we are told more tests will become available soon through commercial testing.

Szapocznik: Right now, because there’s such a scarcity of testing in the country, only people with severe symptoms are being tested. For example, they must have a high fever, usually over 101.5, as well as shortness of breath and severe coughing. However, the only way to know if you truly have COVID-19 is by being tested.

If diagnosed, what’s the best course of action to protect yourself and your family, as well as others around you?

Castro: The recommendation if you’re not very sick is to self-isolate in a room in your house until the symptoms resolve, and keep in contact with your doctor. If you have a mild disease, you don’t want to go to hospital; because so far, there’s no specific treatment for this and then you are spreading the virus.

You should be ok after several days. On the other hand, if you have specific conditions like diabetes, hypertension, or a weakened immune system, as you talk with your doctor, you may be advised to go to a hospital. But I don’t think the advice for anyone is to rush to the hospital.

Szapocznik: Older people need to be careful, and everybody who lives with an older person must be just as careful as the older person because they can bring the virus inside the home. So, it’s a family responsibility to keep people healthy and that’s a huge sacrifice. It’s difficult to explain to young adults and teens that they must sacrifice themselves for the sake of older people who are home.

How exactly do they test for COVID-19? How long does it take to get a result?

Castro: The way it’s been working is you go to an institution, like a hospital. A health care worker takes a nose swab and sends the sample to the county health department. Then, they notify you if you have coronavirus. Right now, it takes a few days to get a result. Soon, it may be that commercial labs will be doing the tests with a faster turnaround. Scientists are working on a rapid test that takes a few hours. That’s what we are working toward. But right now, there’s no rapid test for COVID-19 in the United States.

How long is someone contagious if they have COVID-19?

Castro: We don’t know exactly. What we do know is that just before they develop symptoms, people are most contagious. And, that eventually decreases.

Two weeks is the usual incubation period; so, it may take up to two weeks to develop symptoms after encountering someone who has coronavirus. Then, you need to wait until symptoms subside to be around others again. 

Does having a flu shot help?

Castro: In general, the flu shot stimulates your immune system, but we don’t have proof of it helping prevent coronavirus. But with the ongoing flu season, people can get sick and die from the flu, too, so getting a flu shot is recommended.

What about the pneumonia vaccine?

Castro: This vaccine exists but it’s not specifically for COVID-19. When people get viral pneumonia from COVID-19, they can get bacteria in their lungs as a result of it, therefore they can get bacterial pneumonia. So, it’s possible that a person could get double pneumonia. However, this vaccine is only typically recommended for people who are 65 and older or have chronic diseases.

Can people get infected with COVID-19 more than once?

Castro: We aren’t sure. In my opinion, probably not, but it’s still unclear.

How long do you think it will take before we get a handle on things and see a slowdown of transmission in the United States?

Castro: I’m not sure. The best we can do is to practice social distancing, avoid large gatherings, always wash our hands, and avoid interactions. That will help. I’ve seen good measures like closing schools and universities, as well as companies trying to get employees to work from home. If you can do that, it is going to help. 

Why do you think this virus is primarily affecting older men, and is less common in women and kids?
Szapocznik: There are a number of reasons. It’s generally known that men die much earlier than women. On average, men don’t take care of their health as well as women. Also, when women have symptoms, they seek help much faster and earlier than men, in general. Men are also more likely to have been smokers than women, so their lungs may be more compromised.

Do you anticipate that may change in the U.S.?

Szapocznik: It will probably infect men and women equally if they are exposed. I don’t think the virus has a preference. It may be that women have fewer underlying conditions, or seek help earlier, or both. Symptoms are usually mild in children.

Many people are likely to get restless being isolated for weeks. Do you have any suggestions for how to encourage younger people to stay in isolation or practice social distancing?

Szapocznik: Families need to sit around a table or living room and talk together about how they can prevent against getting infected. The only way younger adults are likely to collaborate is if they are made participants in the decision-making process of “how we are going to protect ourselves and our family.” A conversation may need to be framed around “How are we all going to protect grandfather, the most vulnerable person in our family?” In a participatory process, young people are involved in deciding as a family how to protect themselves and their family. You have to create the context in which that young person can have the freedom to make decisions to protect grandfather because they love him.