After Ranney took to Twitter on Sunday with a series of posts on the subject that many thought were very helpful and informative, CNN interviewed the emergency physician and Brown University associate professor of emergency medicine.
Here’s what she says we know, and what we still don’t know, about Covid-19. The following interview, conducted via Twitter, had been easily edited.
So we don’t know how “exactly” how it really spreads. How do we not know? Do we need more time to figure it out??
There is conflicting information about whether it is aerosol spread (like measles) or drop (like flu). Also contradictory information about how long it lives on surfaces and whether it spreads with human waste. We also don̵
What is needed to find out all that information? To get a concrete idea of how it is transferred / lasts on surfaces.
Honestly, we need some more good laboratory studies! Just observing that the virus is * there * does not mean that it is ‘contagious’.
Stupid question. What is the difference between the virus that is there and that it is contagious?
We may discover it … but it may not get anyone sick – it can be a dead virus.
So it’s summer and we’ve seen some of the studies that have scientists / researchers sounding the alarm about HVAC / AC systems potentially spreading the virus. Is it something we know for sure has spread the virus or is it also something that needs to be studied more?
Great question. There are a number of studies that show that airflow changes the transmission pattern in a restaurant or building – but it may not spread “through” the AC system. Instead, it is probably because air blows the virus droplets (or aerosols) to some places.
Is that why it is so important not to be in a confined space with a group of people?
It is important not to be in a confined space with a group of people because the virus “gets stuck” if you are inside!
Imagine spraying something dirty in a closed box, compared to spraying it outside … you would smell it much longer, and much stronger, in the closed box, compared to the outside.
You also mentioned that we do not know the true mortality rate of the virus. Why is it like that? And what can help us decide that?
We still do not know how many people have been infected due to delays in running the test. Without knowing the denominator (the number of infected persons) it is impossible to know the death (which is the number of people who die, divided by the number of infected).
It is important that deaths vary for different populations. So, for example, it will surely be higher for the elderly than for the young.
Do we know if there is any risk of the virus spreading with cigarette or gun smoke / steam?
Big question – I haven’t seen any studies on it. However, we know that current smokers are at higher risk of serious illness and death.
Do we just need more time to study the virus? Or is it also the question that science is just not there? As if we don’t have the skills or knowledge to do certain things?
It is not a lack of skills / knowledge – it is (a) time and (b) funding to make sure it is done well.
Many of the things that are published right now are published as an “oppression” – which means that it has not been reviewed by other researchers yet. Which means we need to be more careful in how we read it – some (are) a little less reliable than others.
So time to get it done is not something we can change. But funding is! Is there more funding? Or do you need to spend more on it? And how do universities / research institutions research things. How do they handle lockdown / social distancing? Does it inhibit research?
There is more funding … but social distancing has made it tougher, especially for clinical research. Most universities temporarily stopped or drastically reduced their research due to Covid-19 – due to a lack of PPE and concerns about infection.
And … I want to highlight that research on many other things affects Covid-19. So it’s about financing in general. For mental health, for cancer, for injury patterns – not just for Covid-19.
What is the danger of “oppression?” Put better, why do researchers have to review it?
Peer review examines unintentional mistakes, problems with analyzes and unsubstantiated conclusions. This generally results in stronger and more reliable publications.
So peer review will help clear the air about what treatments seem to work and which seem to do more harm than good (ie anti-malaria drugs). And that’s another thing we don’t know. If these drugs do more harm than good, right?
We do not yet fully know which drugs work and for whom.
There are some very promising studies and there are some promising basic science studies. It is important for us to balance potential risk with potential benefit. … good scientific studies help us do that.
And we also don’t know how long people are contagious, and if they can be re-infected, right? And we don’t really know the long-term effects that some people can get from the virus.
Right on both bills. We do not think that people are likely to be re-infected in the short term (eg 1-2 months) but we do not know about the longer term.
Is there anything else we don’t know that really stands out for you? Or do you think you have not received enough attention?
I think it is important to talk about the long-term consequences. We don’t know what will happen to you if you catch it and get better. We see some early signs that it could damage your lungs and brains in the long run, but we just don’t know.
What we know about Covid-19
We know the genome of the virus. Why is it important?
Because it helps us (a) identify if / when it mutates, (b) track its spread (c) identify treatments and vaccines (because we focus on specific targets on the virus.)
You mentioned in your Twitter thread that we know how to fight this. If we get more tests, contact tracking better which isolates and identifies vulnerable and sick people and gets better PPE, we do not need as much social distance. Why is it like that?
We need social distance to prevent transmission. We are currently trying to distance social from * almost everyone * because we do not know who can be contagious. But if we know exactly who is sick, and if these people remain isolated from others, the rest of us can do our business without worrying.
Do we know that people out in parks / at the beach are safe from getting the virus? People who don’t wear masks on the beach but who can be social distance, are they okay and not in a high risk situation?
Re: being in parks / on the beach – there is a gradient of risk. Being outdoors is less likely than being indoors, as the virus spreads. It is * possible * to be infected if you are headwind from someone who is sick, but it is unlikely. (I come back to my analogy above about a strong odor. If you are on the beach and someone is spraying a perfume, you do not smell it at all, or maybe it smells for a very small time. But if you are in a closed room, the smell you for a while).
So if we know who is sick, and they are not in the population / interact with others, can we relax social distance … close families / groups of friends can gather, within reason?
Correctly! BUT, it is important to also have random tests of asymptomatic people – because (a) people can be contagious before they have symptoms, and (b) current data indicates that 1/3 of people do not ever get symptoms (but can still be infectious) )
And we know what constitutes “high risk” exposure.
High-risk exposure = inside, close to each other. The longer you are close to someone who is sick, the higher the chance of getting infected. We can’t yet say “2 feet” or “6 feet” or “12 feet” is enough inside – current recommendations are 6 feet but we are debating it.
But how do we prevent high-risk exposures from careless people? Or people who just don’t know they have it?
Big question about sloppy people. This is where consistent, high-quality public health messages are important. We must (1) make it easy for people to stay at home if they are sick (make sure they have food, make sure they have sick leave, etc.), (2) create NORMS that they will stay at home (e.g. people feel they are * expected * of their friends and family to stay home.)
Some may also add (3) to effect isolation by checking people daily, and may even be fined if they break the isolation. This is more extreme but is sometimes needed.
So we know that the virus affects people differently because of their socio-economic status. But it also affects some ethnic groups more. What is the science and facts that tell us how it affects them differently, and why?
We know that minorities and people with lower socio-economic status are disproportionately more likely to become infected and die. Current data suggests that this is due to structural inequalities – for example, because minorities less often have jobs that allow them to work from home – NOT because of genetic differences. This may also reflect well-established differences in access to high quality care. We are still trying to find out the exact causes, but these observations are similar to patterns in, for example, motherhood among blacks against whites.
What you need to remember about Covid-19
So we’ve talked about what we know about Covid-19. But what do you wish people knew about it, in addition to everything we just talked about? What do people need to know about it in a wider sense?
In a broader sense, I wish people knew some things.
First, they knew how fast and hard researchers worked to try to improve our scientific knowledge of the virus. Humans have literally worked around the clock to try to define the virus, identify potential therapeutic targets and vaccine targets, define transmission patterns, and create new ways to keep us all safe. But good science takes time.
Secondly, it is normal for us to express uncertainty in science – to be honest that we do not know things and sometimes even change what we say. It is part of the scientific process. Good researchers will be honest about what they do and do not know and will be honest when they are wrong. It’s not about being political or being cagey.
Third, although this is a new virus, there are very standardized public health measures that work to reduce the transmission of infectious diseases. These are tests, tracking, insulation and protection. When we say that these work – it is based on over a century of evidence.
Fourth, good public health helps support a strong economy. Few doctors, researchers and public health professionals would describe Covid-19 as an either / or situation. There are great ways to * both * open * and * keep us all safe. We require PPE, testing and contact tracking to restart the economy. There are also great ways to support our communities while realizing that the world has changed.
So we may not have a cure for the virus, but we know how to beat it. And it is through ordinary public health measures.
Well … I wouldn’t say how to beat it. I would say “how to reduce the impact.” This virus will not go away, and anyone who claims they will “defeat it” will be glib. Instead, we want to “contain it.” We know how to help our society to be as healthy and safe as possible. while at the same time we are working to improve our knowledge of both prevention and treatment.
We are in a new normal. Common public health measures work to protect us from a new force and let us go back to work :).