People with respiratory diseases such as asthma and COPD are at greater risk of complications from viral infections such as influenza and COVID-19. Understandably, the recent outbreak of COVID-19 has caused great concern among both health care professionals and patients, so we think it is important to make sure everyone is educated about this pathogen.

What makes COVID-19 different

Human coronaviruses are nothing new - these viruses have caused mild upper and lower respiratory symptoms during brief infections for a long time. COVID-19 is different in that it originated in bats, and for reasons that are not clear, it made the jump to humans in the Wuhan province of China in late 2019. It was determined in December 2019 that these infections were due to a coronavirus, and the RNA of this virus was sequenced by mid-January 2020 so that we better knew with what we are dealing.

COVID-19 seems to cause respiratory symptoms in humans that are somewhat similar to those caused by influenza viruses. Unlike influenza, which can be lethal in children and especially infants, COVID-19 seems to cause only mild symptoms in children under 15. This seems like a good thing (at least for the children!). However, the downside is that children might be mistaken for simply "having a cold" and may unwittingly infect adults. Additionally, the risk of severe complications in adults, while still low, may be a bit higher than with influenza. Best estimates thus far are that the mortality rate with COVID-19 is about 1.5%, comparable to the influenza pandemic of 1918. But it also appears that once we understand this better, the mortality rate might be a bit lower, more comparable to the H1N1 outbreak in 2009.

People have been concerned about similarities between COVID-19 and the outbreaks of SARS and MERS in recent memory. Those fears are somewhat misplaced. The main differences are that while those viruses were more lethal and did result in higher mortality rates, they were a lot harder to transmit. So while these viruses had a higher mortality rate than COVID-19, it was a lot harder to get infected. Due to the lower mortality, we do not expect COVID-19 to be anywhere near as devastating as these other viruses were.

It remains true that influenza kills far more people each year than what we've seen with COVID-19. Still, it is challenging to understand how dangerous this new virus really may be. Since we only recently developed a way to test for this new virus and haven't yet been able to do widespread testing, we test only people who are significantly ill and who we therefore think may have this infection. Thus, we likely are underestimating the total number of people infected with the virus, which means the fatality rate may actually be overestimated.

The best response is prevention

Update March 17th: Check out our information page for patients if you have an appointment at one of our offices.

Prevention strategies consist mostly of avoiding infection. Vaccines are under development, but it takes time to develop a vaccine and then make sure that it is both safe and effective before distributing it worldwide. Conservative estimates are that it will likely take a year. The development of an effective vaccine is complicated by the fact that like influenza, COVID-19 seems to mutate as it passes from one person to another, so the development of an effective vaccine will be challenging. It also remains to be seen whether COVID-19 backs off during the summer, as influenza does. More importantly for vaccine development, we will need to be watching very carefully for whether the most common strains significantly mutate from one year to the next. Influenza viruses do this, which is why the flu vaccine needs to be slightly different every year.

In the meantime, virus experts worldwide all agree on the following strategy for preventing infection with COVID-19 and other viruses: WASH YOUR HANDS

By far, the most common means of virus transmission is from contact with the virus on surfaces and moving the virus to the mucus membranes of the eyes, nose, and mouth with the hands. Masks are not shown to be effective - most people are not trained on how to use masks effectively, and most people seem to wear them in a way that doesn't protect them at all. Further, the current panic-buying of masks puts health care workers - who really do need them and know how to use them effectively - at risk of not having access to them. Preventing coming in contact with viruses on surfaces continues to be far more effective than wearing a mask.

Like most viruses, a big problem with COVID-19 is that infected people start to be able to transmit the virus even before they have symptoms. So simply avoiding symptomatic people isn't enough - we need to be protecting ourselves all the time since we really can't know if we're being exposed to people who are infected.

The main points for prevention of COVID-19 transmission include:

• Wash your hands with plain soap and water frequently, and for 20-30 seconds at a time. This remains the best way to limit the transmission of COVID-19 and all other respiratory viruses.
• Please don't buy and try to use masks. They're not going to help.
• Manage your secretions. If you're sneezing or coughing, do it into your elbow to limit the spread of virus-containing droplets, and to make sure you don't spread them on your hands.
• Don't shake hands. Greet people without making contact such as a wave or a bow.
• Alcohol-based hand sanitizers are also effective against viruses and should be used when washing hands with soap and water isn't available or practical.
• Don't go to work or school if you're ill, especially if you have a fever. You can spread the disease even before you have symptoms, but by the time you think you're infected, you should certainly prevent exposure to others until your symptoms go away.

COVID-19 in patients with asthma or COPD

Particularly relevant to the patients of AASC, the best strategy for people with underlying respiratory conditions such as asthma or COPD is to make sure that these diseases are well controlled. Other human coronaviruses are known to trigger asthma attacks, and it is expected that COVID-19 will be no different - people with respiratory problems who get infected will be at greater risk of having more severe problems with their breathing. Be sure to keep your regular followup appointments to review how well your disease is controlled. If you are having any problems with your breathing, make sure to come in to get it checked out, so we can adjust your treatment if necessary to ensure that we're maintaining optimal control. This is the best way to minimize complications in the event you get infected with COVID-19.

In summary, there is no question that the current outbreak of COVID-19 carries with it a substantial risk of significant complications, but panic is not the answer. Making sure that we take effective, reasonable steps to prevent infection and that any underlying conditions such as asthma or COPD are optimally controlled will prove to be the best strategy to make sure we all effectively weather this storm.