Dr. Trilla: “Life will undoubtedly go back to normal, but it would do us good to stop and reflect”
Dr. Antoni Trilla, Head of the Preventive Medicine and Epidemiology Unit at Hospital Clinic of Barcelona, volunteered to hold a videoconference with BBVA’s employees in order to answer some of the most frequently asked questions about coronavirus: Can someone who is asymptomatic transmit the virus? Can it be transmitted through contact with pets? How long will the preventive measures last? Is it dangerous to take ibuprofen if you have coronavirus? When will there be a vaccine? Hospital Clinic of Barcelona has compiled all the information available on COVID-19 and in a project undertaken together with the BBVA Foundation, has made it available in a dedicated portal, PortalCLÍNIC.
The rapid advance of the coronavirus pandemic is causing a lot of uncertainty and panic among communities. Information overload and fake news are contributing to the spread of myths that do very little to help ensure that the official recommendations receive the attention they should. To help tackle the dissemination of misinformation, Dr. Antoni Trilla, one of the country’s leading experts in the field, discussed the present situation and answered many of the questions posed above.
According to Dr. Trilla, we are in a critical phase in our response to the virus, a phase in which social distancing is the answer to slowing the spread of the virus. “The best way for us not to infect each other is to act as if each one of us is already infected and contagious. And, therefore, to make every effort not to infect others,” he explains. “This is the frame of mind that's needed to understand the reason for the strict measures: fundamentally, to reduce the number of new cases.”
Quarantine has proven to be the most effective tool: “It is very important in order to flatten the curve, reducing the number of new cases and protecting the health system from collapse.” Trilla does not believe it's possible to bring the entire country to a standstill, but if everyone follows the health officials’ recommendations, the health system will be able to bear the strain. He reckons that the quarantine phase will be extended “past the initial two weeks,” lasting through Easter in a best case scenario.
How to curb the spread of the virus
“The contagion period is normally calculated from the incubation period, which for most people is currently between five and seven days.” Someone with the virus could therefore be contagious for up to 14 days. The doctor cautions that the contagion period could last as long as 21 days, but for the vast majority it will be within 14 days.
The risk of contagion among people is greater when there are symptoms "although the viral load is already sufficiently high prior to the emergence of symptoms that an asymptomatic person can be contagious.” The doctor explains that the majority of new cases occur when the carrier is already showing symptoms: "The greater the symptoms, generally means the greater the viral load.”
This does not mean that people without symptoms cannot also be transmitters: “It's a small percentage, but it is true that a minority of carriers — probably between 5 and 7 percent — can transmit the virus before the onset of symptoms, especially in the 24-48 hours before symptoms emerge.” Asymptomatic carriers, however, represent a major problem because they increase the rate of infection, not knowing they are contagious. Consequently, preventative measures are essential.
The two main ways the virus is spread is through contact (generally hand to face) or breathing in droplets that may have been sneezed or coughed by a carrier. Consequently, it is best prevented by frequent hand washing and keeping a safe distance from other people. “The amount of time we wash our hands is especially important. We should scrub our hands at least 30 seconds: the fingers, between the fingers, and the palms in order to ensure an effective cleaning,” Trilla explains. “Moreover, because of their chemical properties, soap and water are ideal for removing the virus from our hands.” At this point,Trilla who is also a professor of public health at the University of Barcelona medical school, reiterates that the use of disposable gloves is not generally needed, “only in specific cases are gloves needed, for example when providing hands-on health care or handling food.”
"The best way to prevent the virus is spread is by frequent hand washing and keeping a safe distance from other people"
Regarding those people who are working directly with the public, the doctor explains that “exposure to the virus is not necessarily greater by virtue of being in contact with greater numbers of people, rather it depends on the distance and safety precautions that are followed.” These people should be especially vigilant with the recommendations: physical distance and regular hand washing.
"There is no risk of pet to human contagion," Trilla confirms, but he suggests following the same recommendations that apply to people. "There are things that we still do not know for certain about this disease, so following basic standards of care: washing your hands before and after touching your pets.”
For those who live with someone who has been infected, “the recommendation is to keep a safe distance of between one and half to two meters (five to six and half feet) and try not to share any living spaces, dividing the space as if you live in different homes, so that you never overlap in the same space.” It is a difficult situation but it can be managed by establishing a shared schedule and, of course, by cleaning — with bleach if possible — the areas used by the virus carrier, Trilla advises.
Other tactics and tips
The virus can remain viable in the air and on smooth, non-porous surfaces for hours. It lasts less time on clothing and “washing clothes normally is adequate.” For other surfaces, Dr. Trilla suggests washing your hands before cleaning any other surface and wash them again after cleaning.
Touching money — notes and coins — has been a much discussed subject. “I wouldn't be too concerned about notes (bills), they don't particularly transmit the virus and washing your hands is sufficient,” but more attention should be paid to the use of credit and debit cards: “Credit/debit cards could be a source where the virus persists longer,” but their advantage is that, if they have contactless functionality, they don't have to exchange hands, so it is recommended to use them. Another controversial issue has been whether it is dangerous to take ibuprofen. He admits that we still don't have an answer to this question, given the large number of studies that make cases for and against. Given the uncertainty, “for the majority of people, there is an alternative: take paracetamol (acetaminophen) instead of an ibuprofen.”
The doctor says there is no call for panic with relation to online orders and packages. “Orders normally come in cardboard, which are porous surfaces, so there is no real risk,” he explains. Regardless, he says we should still follow basic hand washing hygiene before and after the delivery.”
How does the virus behave in the human body
One of the major symptoms of coronavirus is fever, even a low-grade fever. Although in 15-20 percent of the cases, there is no fever. “The other most common symptoms are a dry cough (non-phlegm producing), general malaise, a headache, and/or a sore throat.”
For groups at risk (the elderly, those with cardiovascular disease, chemotherapy treatments, diabetics, immunocompromised, etc.) the doctor explains that the measures described should be followed rigorously: “The precautions are the same as they are for the general population, but they should be more strictly followed with heightened diligence.”
The virus hits the elderly harder. This is the group with the greatest mortality rate. “For under thirty year-olds, the probability of dying is less than 0.3 percent, whereas for people over 80, it’s in the order of 12 to 16 percent,” Trilla points out.
With regard to pregnant women, Trilla confirms that they are not more susceptible to the virus than the rest of the population; neither does the evidence gathered to date confirm if the virus is transmitted to the fetus. "Currently there are no indications to suggest mothers should not breastfeed because the virus has not been detected in breast milk,” the doctor adds.
The future of coronavirus
At present everything seems to indicate that people who recover from being infected are immune. “We don't know for sure, but we believe this is the case. It would be a short-term immunity (half a year or a year).” If confirmed, it points to an important direction for the search for a vaccine: “If there is immunity, then there is solid hope for a vaccine.” Although this will take at least 12 to 18 months at best, following the established timelines for demonstrating vaccine safety and efficacy. "I think we will have a vaccine, but in all likelihood it won't be ready this season.”
The doctor also talked about virus mutations. He explained that “viruses always mutate, but mutations are normally small adaptations that aren't particularly important.” As the virus mutates it adapts to the human species: “It is in the virus’ interest to be easily transmitted and not to cause a serious illness. The common cold, for example. We catch it all the time, but it doesn't kill us.”
The near term future is uncertain, but Dr. Trilla is convinced that, for good or for bad, we’ll never be the same. “It will be hard to go back to life as normal after this pandemic. And to some extent, this is a good thing. What do I mean? Let's look at some of the things we're doing, things maybe we should keep doing. Remote working, telemedicine, fewer face-to-face meetings, hygiene that needed to improve, etc. Life will undoubtedly go back to normal, but it would do us good to stop and reflect.” What Trilla means is to accept this crisis as a warning that we need to shore up our healthcare systems. “This will help underscore that we have to invest in healthcare systems, in research, in technology and monitoring services to better track the path of contagion. This will not be the last epidemic. For the next one, the world needs to be better informed and more prepared.”
For more information, visit the special coronavirus PortalCLÍNIC.