Coronavirus Q&A with UConn Health

Medical Expert: Vaccine by Start of School is "Best-Case Scenario"

As scientists and medical experts seek answers to the COVID-19 conundrum, Dr. Kevin Dieckhaus — chief of the Division of Infectious Diseases at UConn Health — answered the following Q&A from Today Magazine on key medical and scientific issues related to the coronavirus and COVID-19.

1A. The CDC's general guidelines say hands can be washed effectively with cold or warm water (and soap) — is cold water effective against the coronavirus?

The more important issue is washing with any water regardless of temperature, and using soap to physically remove the virus from surfaces. • Editor’s Note — Complementary counsel from the CDC advises washing hands with “clean, running water (warm or cold)”

1B. If an alcohol-based hand sanitizer isn't available, is utilizing hydrogen peroxide to wash hands just as effective against the coronavirus and other germs?

Hydrogen peroxide is generally sold as a 3% solution. It can be diluted to a 0.5% solution for washing services, and should remain on the surface for a minute to provide disinfection for COVID-19. Repeated use of undiluted hydrogen peroxide on skin can lead to skin irritation.

2. There has been conflicting information about whether ibuprofen makes COVID-19 worse — should people with COVID-19 avoid ibuprofen?

Ibuprofen and other nonsteroidal anti-inflammatory drugs may increase the level of ACE2 on cell surfaces, which is the receptor to which SARS-CoV-2 binds. So there is a theoretical concern of more susceptibility to COVID-19 if one takes ibuprofen which may thereby increase the number of receptors on susceptible cells. This has not been borne out in any clinical trial. Nevertheless, given these concerns, the preferred antipyretic agent in the setting of COVID-19 is acetaminophen. • Editor’s Note — Dictionary definition of “antipyretic”: “used to prevent or reduce fever” • SARS-CoV-2: official name of novel coronavirus

3A. According to reports, facemasks don't protect the wearer but can prevent infected people

(who don't know they're infected) from spreading the virus — is this accurate?

This is accurate. Masking prevents the person who has COVID-19 and is without symptoms from dispersing the virus to surrounding air and surfaces.

3B. When everyone is wearing a facemask in public, is it possible for the coronavirus to spread through the air?

Masking would severely limit the airborne transmission. Coronavirus may still be transmitted by its presence on surfaces.

4. Is September — i.e., the start of the school year — a realistic time to expect a vaccine to be available?

Vaccine development for COVID-19 has been on an accelerated path. Predictions of a vaccine available in September would be a "best-case scenario." If an effective vaccine is developed in this short time frame, scale up would take additional time.

5. The CDC says that most people with COVID-19 "have mild illness and are able to recover at home without medical care" — and established science indicates that after people are infected with a virus, they develop antibodies and therefore immunity ... given this, is it counterintuitively advantageous for the general population (all those not at-risk) to catch this coronavirus so they won't get sick with COVID-19 again?

This is the argument for "herd immunity,” which would suggest that if a large percentage of the population were to acquire COVID-19, those who survive would then be immune, decreasing the disease prevalence. The societal cost to this strategy would be millions of infections, and depending on the ultimate mortality rate of infection, perhaps many millions of lives lost.

6A. Given the science of virus immunity, could continued statewide stay-at-home mandates actually extend the duration of the coronavirus crisis?

"Flattening the curve" is the reason for stay-at-home mandates. This allows for a reduced peak in the number of cases but does potentially extend the duration of the epidemic. Reducing the peak is important to avoid overwhelming a finite healthcare infrastructure, and prevents associated mortality from inability to treat otherwise treatable patients. Broadening the curve over time, even with an identical number of patients, would be more manageable for our current healthcare system and lead to reduced morbidity and mortality overall. • Editor’s Note — Dictionary definition of “morbidity”: “the condition of being diseased” and “the rate of disease in a population”

6B. In other words, once society opens up again, all uninfected people can still get sick from the virus — so as long as at-risk populations self-quarantine, is it actually beneficial to end stay-at-home mandates, given the science of virus immunity?

See above (5 and 6A). The plan for stay-at-home orders and social distancing is to reduce the prevalence of COVID-19 and thereby reduce morbidity and mortality until such time as more definitive treatments and/or preventive measures such as a vaccine are available.

7. As long as we as a society protect at-risk vulnerable populations — offer at-risk-only store hours, encourage or urge at-risk people to self-quarantine, wear facemasks when near at-risk citizens, etc. — is the best approach for the start of next school year to reopen schools and businesses and allow society to operate more normally?

Maintaining quarantine and social isolation, so long as we do not have effective therapy or preventive measures to combat COVID-19, remain the only effective measure to reduce the burden of this pandemic. This strategy comes at a substantial cost in terms of the economy and society. Identifying the right balance between public health and societal needs will be a real challenge going forward until such time as effective treatments or prevention such as a vaccine are available. The question of reopening strategies will need to be made by our elected leaders, balancing public health, the economy and functions of our society. +

Special to Today Magazine

UConn Health is based in Farmington and has other Farmington Valley locations in Avon, Canton and Simsbury (and other locations statewide)