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How to stay safe as Texas reopens: Dallas-area doctors answer your coronavirus questions

Dr. Mamta Jain and Dr. Erin Carlson make their suggestions for ‘the new normal.’

On Wednesday, May 20, The Dallas Morning News science writer Anna Kuchment spoke with two medical experts about the coronavirus and what North Texans need to know as the state reopens. The experts were Dr. Mamta Jain, professor of internal medicine at UT Southwestern Medical Center, who oversees COVID-19 clinical trials; and Erin Carlson, associate clinical professor and director of graduate public health programs at the University of Texas at Arlington’s College of Nursing and Health Innovation.

The conversation, held via conference call, was open to the public, and the panel took questions from readers submitted via email. To hear about upcoming calls, support The News by becoming a member.

Here’s a transcript of the conversation, which has been edited and condensed for space and clarity:

How does the coronavirus differ from the flu?

Anna Kuchment: “Dr. Jain, you’ve been treating COVID-19 patients since at least mid-March. Can you talk a little bit about how this disease is different from the flu and other more common respiratory illnesses that you’ve treated in the hospital?”

Dr. Mamta Jain, a professor of internal medicine at UT Southwestern Medical Center in Dallas.
Dr. Mamta Jain, a professor of internal medicine at UT Southwestern Medical Center in Dallas.(Brian Coats / UT Southwestern Medical Center)

Dr. Mamta Jain: “Well, in some ways, this is similar to flu in the sense that people get a cold, sore throat, fever. It’s a disease that’s transmitted by respiratory droplets, but it is much more infectious. Person to person spread is much more than what we see with influenza, and there are some unique symptoms that we don’t usually see with influenza, like loss of smell. We also, I think, are seeing much more complications of COVID-19, so those who get hospitalized, we see more severe inflammatory response in the lungs, and we’re seeing people develop thrombotic, or clots, blood clots, in their lungs and their legs, which we think may be related to the disease. Those are things that are different from influenza. We also, the mortality with this disease is higher than what we’ve seen with influenza.”

AK: “Thanks. Dr. Carlson, is there anything you would add to that?”

Dr. Erin Carlson: “Not much. I just want to remind everyone that we’re finding that COVID is transmitted more easily than the flu, as Dr. Jain mentioned. Now, we don’t know the details of that. We’re still working on the research for that, but that is a concern. The death rate’s 10 times that of influenza, about 1.3 percent for COVID compared to 0.1 percent for the flu, so those are the things, from the public health perspective, that we’re concerned about.”

AK: “And Dr. Jain, just one quick follow-up. We read a lot about how it’s the elderly and those with underlying conditions who are most at risk, but looking at statistics from Dallas County, it sounds like two-thirds of hospitalized patients are under age 65, and about half did not have any chronic health conditions. While it can disproportionately affect the elderly, people without underlying conditions are also at some risk. Is that right?”

Dr. Jain: “Absolutely. I don’t think that we should for a moment think that this is something that someone who’s young and healthy will not somehow get infected, because we have seen young, healthy people become infected and unfortunately, we’ve also seen them die. I think there’s a lot we still don’t know, and I don’t think anyone is immune to potentially being infected.”

What is the latest information on how the virus spreads?

AK: “In terms of how it’s transmitted, early on we were told that it’s mostly transmitted by high-touch surfaces. In other words, if someone who’s sick touches a doorknob and then you touch that doorknob afterward, that’s the main way that you can get sick. Now, it seems like it can be transmitted through the air as well. Dr. Carlson, can you talk a little bit more about how it’s passed from person to person?”

Erin Carlson, associate clinical professor and director of graduate public health programs at the University of Texas at Arlington's College of Nursing and Health Innovation.
Erin Carlson, associate clinical professor and director of graduate public health programs at the University of Texas at Arlington's College of Nursing and Health Innovation.(Lisa Torres)

Dr. Carlson: "Certainly. Yeah, so that’s correct. The CDC said this month that the main way the virus is currently thought to be spread is through respiratory droplets and airborne transmission, and I know this is a change from the information we originally received several months ago. To that, I just want to remind everyone that COVID-19 is a novel virus, so it is a new disease. We are all still learning how it spreads. While we are receiving different information now than when it began, that doesn’t mean that we are or did receive bad information. It just means that we’re receiving the best information known at that time. Back to the point with regard to transmission, the virus that causes COVID-19 likely spreads in a manner very similar to how any other respiratory infection spreads, whether it’s influenza or tuberculosis, and that is, it spreads primarily through airborne respiratory droplets. These are produced when an infected person coughs or sneezes or sings or talks or laughs. Every time we speak, many aerosolized droplets that are invisible to our eyes go into the air, and these droplets are then inhaled by people who are nearby, or they can land on a surface and then we tough that surface and touch our own eyes or nose or mouth with those drops.

“Something that’s interesting that just came out from the New England Journal of Medicine, they just published a study that talks about how long the virus stays in the air. This is providing some important information with regard to transmission, and this study found that COVID-19 can remain in aerosols, hung in the air for at least three hours. After one coughs or sneezes or even sings into the air, three hours later you can walk into that little cloud of aerosolized virus and you can so become infected, and it also lasts for several days on surfaces, according to the same study.”

AK: “Dr. Jain, is there anything you’d like to add to that?”

Dr. Jain: “No. I mean, I think the respiratory transmission is the main thing, and to try to minimize risk of transmission is the reason why the CDC has been recommending universal masks in public places.”

Besides remdesivir, what other treatment options are on the way?

In this March 2020 photo provided by Gilead Sciences, a vial of the investigational drug remdesivir is visually inspected at a Gilead manufacturing site in the United States. Given through an IV, the medication is designed to interfere with an enzyme that reproduces viral genetic material. (Gilead Sciences via AP)
In this March 2020 photo provided by Gilead Sciences, a vial of the investigational drug remdesivir is visually inspected at a Gilead manufacturing site in the United States. Given through an IV, the medication is designed to interfere with an enzyme that reproduces viral genetic material. (Gilead Sciences via AP)(Associated Press / AP)

AK: “Dr. Jain, you oversee clinical trials at UT Southwestern. As we’ve reported in the news, the antiviral drug remdesivir recently received emergency use authorization from the FDA because it has been shown to shorten the length of time that a person is ill. The drawbacks of that drug include that it can only be administered by IV in a hospital setting, and it doesn’t work for everyone. Can you talk about what other treatments are on the horizon?”

Dr. Jain: “Sure. We are looking at anti-inflammatory drugs such as sarilumab. We are going to be doing a study that is actually going to look at the concept of, do you just give an antiviral, versus giving an antiviral plus something that is an anti-inflammatory? We’re also going to be doing a trial with some novel molecules that are, again, working on the cytokine storm, so basically, what happens early on in infection, you have the virus, but as the virus attacks the lungs, then your immune system starts to try to fight that virus and sometimes that immune response goes haywire. A lot of the drugs that are coming out or are being examined is trying to work on that immune response, and try to reduce it or tamp down on it so that it doesn’t cause more damage to the lungs.

“There’s also convalescent plasma that’s being used, that’s potentially providing antibodies. There’s also being developed, monoclonal antibodies. Those trials are not up and running, but those are things that are being developed by companies, so we’ll see. I think there is, I can tell you that there is robust development of drugs currently, to try to fight this virus, not just from an antiviral perspective but from an anti-inflammatory perspective, and also other complications that the virus may cause, like blood clots. All of these mechanisms are being examined and explored.”

What about hydroxychloroquine, zinc and vitamin D?

President Donald Trump speaks at a reelection rally in Bossier City, Louisiana on Thursday, Nov. 14, 2019. (Ryan Michalesko/The Dallas Morning News)
President Donald Trump speaks at a reelection rally in Bossier City, Louisiana on Thursday, Nov. 14, 2019. (Ryan Michalesko/The Dallas Morning News)(Ryan Michalesko / Staff Photographer)

AK: “We learned this week that President Trump has been taking a combination of hydroxychloroquine and zinc in an effort to protect himself from COVID-19. Is this something that other people should consider? Should other people talk to their doctors about getting a prescription for hydroxychloroquine, Dr. Jain?”

Dr. Jain: "I think I would be cautious. Hydroxychloroquine, as a treatment, we don't have the data yet. There are trials ongoing currently. There is some data suggesting that there may be risks, especially high doses of hydroxychloroquine. There was a study from Brazil that they stopped one of the arms because of cardiac toxicity. There is concern that hydroxychloroquine really doesn't work in patients with more severe illness, but what it appears that you're referring to is more of a prevention strategy, with giving hydroxychloroquine when you don't have an infection. Would it prevent you from getting an infection? We don't know the answer to that.

“In fact, at UT Southwestern, we are participating in a clinical trial called the HERO study, which is a study being conducted in academic centers around the country. It’s for healthcare workers. It’s a registry and then a trial. All healthcare workers can get into the registry, and then those who are at higher risk -- your EMTs or your emergency room doctors and nurses, and your ICU nurses and doctors and respiratory techs, just the people that are on the front line -- they can, if they meet certain criteria, participate in a clinical trial in which they would get hydroxychloroquine versus placebo for a month. What they’re trying to see is, does this drug really protect them from becoming infected? I think that’s something that is important for us to learn. We just don’t have the answer yet.”

AK: “Dr. Carlson, I believe you have actually taken hydroxychloroquine in the past, so what would you say about taking that drug as an effort to prevent COVID-19?”

Dr. Carlson: "I just want to offer the patient perspective, and also speak on behalf of those who have autoimmune diseases and do take that medication for therapeutic means, for treatment. First of all, I just want... I’m concerned that there will be some kind of run on this medication because of people trying to get it prescribed prophylactically to prevent COVID-19. If that happens, that medication will be in short supply, and the people who rely on this medication to function won’t be able to do that, and won’t be able to have their meds. People with lupus, people with rheumatoid arthritis, people with Sjogren’s disease, those are the three autoimmune diseases where some patients are on hydroxychloroquine to manage their disease. A lot of the meds, a lot of the hydroxychloroquine, comes out of China, and we’re already seeing some supply problems with meds coming out of China, so we would not want to further compromise any kind of supply from this drug for those who need it.

“The other thing I want to address is the safety of this drug, and that is the safety with regard to kind of this attitude of, it’s like popping Tylenol or Benadryl to prevent a condition, and it’s not. This is a dangerous drug. Meaning, it has significant side effects. It has significant rates for toxicity. When patients take this drug, it’s not because you just take it with a carefree attitude. You take it because it’s your only option to calm a very furious disease and be able to function. Chemotherapy is safe too, but would you choose to take that if you didn’t have cancer? There are certain things that have a significant toxicity and risk, that you only choose to take because you have no other options, because that’s the only drug that will work. I want people to understand the risk that’s involved. When people are on this drug, they are under extremely close supervision by their rheumatologist. Blood draws are taken very frequently to monitor for liver toxicity, and you become really good friends with your eye doctor because you’re constantly being monitored for any vision problems. This can result in a loss of vision, a permanent loss of vision. This can result in liver damage, so this is a very serious drug. Please do not be cavalier in considering this drug.”

AK: “President Trump is also taking zinc. What about supplements like zinc, or vitamin D?”

Harish Kothari, medical technician, uses a pipette to fill test tubes with serum and a reagent which will be mixed to determine the levels of Vitamin D in a person's blood, July 10, 2012.
Harish Kothari, medical technician, uses a pipette to fill test tubes with serum and a reagent which will be mixed to determine the levels of Vitamin D in a person's blood, July 10, 2012.

Dr. Carlson: "With regard to zinc, not that I’m aware of, but I’ll definitely want to bounce that to Dr. Jain for her thoughts. Zinc is just really something that, I know some people believe in it for colds, and yes, the cold is a type of coronavirus, but not this one. As far as vitamin D, my knowledge, I’ve been actually looking up some clinical data on that recently because my doctor advised me that it can help reduce the severity of symptoms if you do get COVID. What studies have found is, I think, over 40% percent of the people who ended up with very severe symptoms, hospitalized for COVID, were vitamin D-deficient. Now, we don’t know if that is just because a significant proportion of the population is vitamin D deficient in general, or if there’s actually some type of true association there. That’s what we’re looking at with vitamin D, is my understanding, but again, I’d like to see what Dr. Jain says about either of these.

Dr. Jain: "Yeah, so I think with the zinc supplement, I’m not aware of any data with SARS-CoV-2, which is the virus that causes COVID-19. The data, there have been trials with zinc lozenges for the common cold, and one of the viruses that can cause the common cold is coronavirus. About 30 to 40 percent of common colds can be caused by coronavirus, but that’s a different virus than the SARS-CoV-2. Yes, there is some data suggesting that zinc may help with some of the symptoms of the common cold, but there is not, as far as I can tell, any data that zinc helps with SARS-CoV-2.

“In terms of vitamin D, I think, again, the data is all retrospective analysis, and because there’s a large proportion of the population that has low vitamin D levels, it’s hard to tell if there’s a real association between low vitamin D levels and poor outcomes. I think this is going to be something that would have to really be examined in a more rigorous fashion, to be able to tell. I don’t think right now we have any clear-cut evidence to support the use of either one.”

When will we have a significant treatment or vaccine for the virus?

FILE - In this March 16, 2020, file photo, Neal Browning receives a shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, at the Kaiser Permanente Washington Health Research Institute in Seattle. The vaccine by Cambridge, Massachusetts-based Moderna Inc., generated antibodies similar to those seen in people who have recovered from COVID-19 in a study of volunteers who were given either a low or medium dose. (AP Photo/Ted S. Warren, File)
FILE - In this March 16, 2020, file photo, Neal Browning receives a shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, at the Kaiser Permanente Washington Health Research Institute in Seattle. The vaccine by Cambridge, Massachusetts-based Moderna Inc., generated antibodies similar to those seen in people who have recovered from COVID-19 in a study of volunteers who were given either a low or medium dose. (AP Photo/Ted S. Warren, File)(Ted S. Warren)

AK: “When might we have a treatment or a vaccine that can make a significant impact on this illness? Dr. Jain, I’ll ask you first.”

Dr. Jain: "In terms of treatments, remdesivir is an antiviral drug, but it was developed for Ebola. It’s not specifically developed for SARS-CoV-2, so I think it will take some time for scientists to develop a new molecule that would be specific for SARS-CoV-2. I have no idea how long that will take, but we have at least something right now, and I think there’s still more drug discovery, and there are people looking at repurposing, looking at drugs that we’ve used for other things and seeing if it may have activity for SARS-CoV-2.

“In terms of a vaccine, there is a lot of interest and a lot of focus and attention on developing a vaccine, because I think that’s very important. How long it will take before we have something is hard to say. Even after you have a vaccine, a candidate vaccine that works, you still have to then get the manufacturing and everything like that, and this is not a virus that just affects the US. This is a global virus, so I mean, everyone in the world would want this vaccine. Just producing it for a global population is going to require many companies. Looking back at HIV, we’re 30 years into the HIV epidemic and we still do not have a vaccine for HIV. Several different vaccines have been examined. They looked very promising in primate or in animal models, in monkey models, and then we took it to clinical trials and it just didn’t work. I think we just have to wait and see, but the thing that gives me hope is that there’s so much focus and there are so many companies working on it, that hopefully there will be a breakthrough.”

AK: “Thanks. Dr. Carlson, is there anything you’d like to add to that?”

Dr. Carlson: "Like Dr. Jain said, there’s so much focus on it. Everyone’s working together on it, and so from the global health perspective, this is an extraordinary endeavor. The Gates Foundation, for instance, is working with governments all over the world, and so that’s really promising. There are also 115 different vaccine opportunities in the pipeline right now. Researchers are saying about eight to 10 of those look pretty promising, so there’s hope. I just want to remind everybody that there’s hope.

There’s also something novel that’s happening with this particular vaccine that I don’t think we’ve really seen before. Normally, when you’re doing vaccine development, you go through the trial phases of the vaccine, and then you get the vaccine that works, and now you have to think about how you are going to ramp up the production of that vaccine. Then, how are you going to distribute it? It’s no small matter to distribute a vaccine, certainly worldwide, when you think about the refrigeration, the transportation, everything that has to happen. Something interesting that’s happening right now is that in parallel to vaccine development, they’re already starting to develop the infrastructure, the facilities, globally, that would be able to then produce the vaccine and distribute the vaccine. They’re identifying facilities right now, globally, that could help do that. That’s some pretty promising work."

Does our current level of testing make it safe to reopen Texas?

A driver weaves through cones that direct motorists between stations at a Dallas County drive-thru COVID-19 testing center in a parking lot outside American Airlines Center on Thursday, April 9, 2020, in Dallas.  (Smiley N. Pool/The Dallas Morning News)
A driver weaves through cones that direct motorists between stations at a Dallas County drive-thru COVID-19 testing center in a parking lot outside American Airlines Center on Thursday, April 9, 2020, in Dallas. (Smiley N. Pool/The Dallas Morning News)(Smiley N. Pool / Staff Photographer)

AK: “Dr. Carlson, in response to COVID-19, Texas has really ramped up testing and contact tracing significantly. Are we, at the county level or at the state level, where we need to be to prevent a new surge of cases as the state reopens?”

Dr. Carlson: "Well, we’re not quite there yet, to be able to prevent a new surge of cases. That’s a bit concerning, because health policy pundits have said it is politically untenable for most politicians to be able to go back to restrictions once they’ve lifted them. We get one chance to lift restrictions well, at the right time and in the right way, to prevent a resurgence. So, it’s possible that we can have a new surge of cases, but there are some things we can do about that. We can follow scientific guidance. We can stay at home, and we need some more accurate testing.

"With regard to the scientific guidance, the latest data show that the country’s cases and deaths have plateaued, so that’s good news in that we’re not necessarily rising at a sharp rate. They have also not significantly decreased. We were originally given the guidance that there needs to be a two-week downward trend before we can safely re-open. This was guidance from Dr. Deborah Birx and Dr. Anthony Fauci and the CDC, and that hasn’t yet happened in Texas or in any of the states that have re-opened.

A sample COVID-19 test kit lays on a table at the bioterrorism laboratory, which is part of the CDCÕs Laboratory Response Network, at the Dallas County Health and Human Services building in Dallas on Monday, April 7, 2020. (Lynda M. Gonzalez/The Dallas Morning News)
A sample COVID-19 test kit lays on a table at the bioterrorism laboratory, which is part of the CDCÕs Laboratory Response Network, at the Dallas County Health and Human Services building in Dallas on Monday, April 7, 2020. (Lynda M. Gonzalez/The Dallas Morning News)(Lynda M. Gonzalez / Staff Photographer)

"Back to this piece of what we do about it, then. We can stay at home as much as possible. That doesn’t mean that we become hermits. We can do some of the things that have re-opened. Some data that supports that is the University of Washington’s Institute for Health Metrics and Evaluation. They’ve created the models that we’re all following and that have been in the media, and they estimate that under current conditions, according to how we are currently re-opening, between 350,0000 and 1.2 million deaths will occur in the US by the end of 2020. That is a jump from the original estimate of about 63,000 deaths by August 4th, when we were under shelter in place conditions, so we can see the difference in the projected cases and deaths when we lift those and then we have more interaction.

“The final thing we really need to think about is more accurate tests. Now, we keep talking about the need for more testing, but we need to focus on accurate testing as well. The Food and Drug Administration, they just issued an alert last week that the ID NOW rapid test for COVID-19 is actually producing an alarming number of false negatives. That’s a very common rapid test that’s used, it’s a popular rapid test. Also, there’s a respected internal medicine journal, The Annals of Internal Medicine, for our health folks on the call. They published a study just last week that found that testing accuracy really vacillates over the course of the disease. They showed, in their study, that one in three tests gave a false negative on the day symptoms appeared, but one in five tests gave a false negative three days into symptoms, and that two-thirds of tests showed a false negative two weeks into symptoms. Testing accuracy is really imperative if we’re going to get a handle on this and prevent a resurgence.”

AK: “Dr. Jain, have you encountered problems with the accuracy of COVID-19 tests? What should patients do about that?”

Dr. Jain: “Yes, we have had providers question the accuracy of the tests, and what we advise them is that if you suspect that the clinical symptoms are consistent with COVID-19, so we have learned many of the people that come into the hospital are going to have abnormal findings on their chest x-ray, something that looks like viral pneumonia. They’re going to have abnormal liver function tests. If they have those type of things and the test is negative, assume that your clinical suspicion is correct and repeat the tests. Yes. We are also seeing that some of these tests are not producing, are not completely as accurate as we had thought they were.”

AK: “And what about antibody tests? We’ve received a few questions from readers who suspect that they may have had COVID-19 before tests were available or maybe before they met the criteria for testing. Should you go out and get an antibody test? How accurate are those?”

A motorists talks with staff at the drive-through coronavirus testing site at American Airlines Center in downtown Dallas on Saturday.
A motorists talks with staff at the drive-through coronavirus testing site at American Airlines Center in downtown Dallas on Saturday.(Ashley Landis / Staff Photographer)

Dr. Jain: "Usually, antibodies emerge two to three weeks after you’ve had symptoms. The issue has been, in mid-March, the FDA had relaxed its criteria for allowing companies to make the antibody testing available. That led to a lot of different companies coming to the marketplace. Unfortunately, there were also companies that had not validated their tests. More recently, the FDA has clamped down on that and has made more rigorous requirements, so I think you have to be careful about where you’re getting these tests done. I would try to make sure you try to get it from a reputable lab. The Roche antibody test, I’ve read that has a fairly high sensitivity and specificity. There are probably other ones, but I think there has been some question about some of the tests, so I think you need to be careful.

“What does the test mean? The test is helpful to tell you that you have had the infection. You have antibodies now, so you at some point maybe you had a mild case that you thought was a cold, or maybe you were asymptomatic and you recovered. But the antibody test does not tell you that you’re not going to get infected again. We need to make sure that people understand that right now. We don’t know if having antibodies is protective of getting re-infected. That data is not out, and if you have antibodies, how long are you protected? The CDC is conducting studies to understand how much of, what proportion of the population has been exposed, and that’s why they’re doing these antibody tests, but on a personal level, it doesn’t necessarily mean that if you have antibodies now you can go into a public place and not be at risk. We just don’t know that yet.”

Caller submitted questions

Cecilia Collins-Bratton (right) and Harper Trull jump on a playground following the opening ceremony for Pacific Plaza in downtown Dallas on Monday, Oct. 14, 2019. The plaza is the first of four new green spaces that will open by the end of 2022 with help from the nonprofit, Parks for Downtown Dallas. (Lynda M. Gonzalez/The Dallas Morning News)
Cecilia Collins-Bratton (right) and Harper Trull jump on a playground following the opening ceremony for Pacific Plaza in downtown Dallas on Monday, Oct. 14, 2019. The plaza is the first of four new green spaces that will open by the end of 2022 with help from the nonprofit, Parks for Downtown Dallas. (Lynda M. Gonzalez/The Dallas Morning News)(Lynda M. Gonzalez / Staff Photographer)

What can people who are over the age of 75 with no health issues actually do safely as of today?

Dr. Carlson: "Sure. I think that's a great question, and I think that everyone should be asking that question, not only folks who are 75 or older. I think that everyone needs to think, "What can I safely do?" The actions of everyone, regardless of their age or underlying health conditions, impacts how safely someone who is 75 or older, or someone with underlying health conditions can be out doing things. Part of whether or not you can really go out and do things depends on how responsibly other folks are acting, and so I think that there's a risk-reward. We have to think about this risk-reward ratio in everything we do right now.

The U.S. Navy Blue Angels fly over the downtown Dallas skyline on Wednesday, May 6, 2020.
The U.S. Navy Blue Angels fly over the downtown Dallas skyline on Wednesday, May 6, 2020. (Smiley N. Pool / Staff Photographer)

"Nothing’s really safe for anyone, okay? It’s that, is it worth the risk? Going to the grocery store is a risk. It’s worth it. I need food to eat, right? Going to work might be a risk, but obviously you need to work. You need a paycheck. You have to think, “Is this worth the risk?”

"I think that there’s a lot of socialization we can actually do, but we can do it safely. Last week, the first time I really left my own bubble, I went to see a friend and we sat outside in her backyard, safely distanced, but facing each other. We sat about six, seven feet away from each other. We caught up, we sat there for several hours. It was really nice. Perfectly safe. Anything you can do outdoors is good. Being in confined, small rooms with people, breathing, is not good. Try to be outside as much as you can. People’s backyards is really a great place to gather, so you can still have that socialization and camaraderie. That’s one thing.

"I think if you do go to any businesses, then be sure to wear your mask and go to places where you see other people wearing masks. Now, if you need to go to a place where not many people are wearing masks, which I think a lot of us are seeing nowadays, then I would strongly recommend for those folks who have their own underlying health conditions or are older in age, that you wear the closest you can get to an N-95 mask. I realize not many of us have N-95 masks right now if we’re not in healthcare and we need to save those for healthcare workers, but we can get pretty close.

People gather at Winfrey Point at White Rock Lake after the The U.S. Navy Blue Angels fly over of Dallas on Wednesday, May 6, 2020.  The appearance of the Navy flight demonstration squadron is part of nationwide series of flyovers called America Strong to honor healthcare workers, first responders and other essential frontline workers during the COVID-19 pandemic.
People gather at Winfrey Point at White Rock Lake after the The U.S. Navy Blue Angels fly over of Dallas on Wednesday, May 6, 2020. The appearance of the Navy flight demonstration squadron is part of nationwide series of flyovers called America Strong to honor healthcare workers, first responders and other essential frontline workers during the COVID-19 pandemic.(Smiley N. Pool / Staff Photographer)

"What that does for you is, even if somebody else isn’t wearing a mask, you are still, you still have a high level of protection, because the general masks we see, those are to protect our germs from getting to somebody else but they don’t necessarily prevent somebody else’s germs from getting to us, so the only way it works is if everyone’s wearing their mask.

“If you don’t have an N-95 mask, something very similar is to insert a HEPA filter into your cloth mask. Just like we have for our air conditioner. There is a study out of University of Nebraska Medical Center with a respected environmental infectious disease researcher showing that a HEPA filter is really similar to an N-95 mask and offers over 90% protection from the outside aerosolized particles coming in. If you cut that out from the paper, and you can actually order them now, and put that into your own fabric mask, now you have really good protection and it allows you to go to the store safely, and go to the salon more safely, and do a lot of things. Just protect yourself when you’re doing it. There are ways to do that.”

My son is playing baseball this summer. How do you suggest we keep him safe while on the field and in the dugout?

Dr. Jain: “Oh. Again, I would just suggest masks, and using hand sanitizer, making sure your hands, washing your hands after the practice and in between. I mean, there probably is a risk whenever you’re around other people, and so if you can wear a mask, I think that at least tries to reduce some of that risk.”

Dr. Carlson: "With regard to athleticism, athletic events, again it goes back to that risk-reward. Is it worth the risk? It might be. I’m not saying it’s not. We just have to think about that. Something you need to think about when you’re weighing that risk-reward of participating in these activities is, even though children are unlikely to have severe symptoms, the child can contract the disease and then spread it to others. Think about if your child who’s practicing contracts the disease, is there somebody in your life who’s at serious risk, to whom that disease could be passed from your child? Is there anybody in your household who has an underlying health condition, or are there grandparents or folks who are older age who could contract the disease?

“In terms of reducing the risk, we can try not to share bats, that would be really important. Don’t share equipment, and if it’s a softball or T-ball type of practice, don’t share mitts. Try to have everybody use their own, that would be really helpful. I know we’re still going to be touching the ball, but wipe that down every so often, and wash hands every so often throughout the practice, and that could help mitigate some of it. You’re good, because you’re outside, so that’s a really good part of it too.”

Is it safe to have a cleaning person come to the house if she wears a mask and gloves while working?

Dr. Jain: “I’ve thought about that myself. I feel like I need to have someone come to my house and clean, and I think it’s the same thing Dr. Carlson was talking about, the risk-reward. I think if someone came that you knew, and they wore a mask and they washed their hands and they cleaned, I think that’s reasonable to do. I think if you maintain your distance from them, that would be a reasonable thing. I mean, I think we have to recognize that this is going to be with us for a while, and we’re going to have to make adjustments to how we live. Maybe moving forward, anyone coming to our homes to do things are going to need to wash their hands and wear a mask, and that’s how things are going to have to work.”

Is it safe for the elderly to receive a haircut right now?

Dr. Jain: “My sons are just dying to get a haircut, and my husband also, and so I told them that if they need to get a haircut, they have to make sure that wherever they go, that the person that’s cutting their hair is wearing a mask. They have to wear a mask. The person that’s cutting their hair also has to have washed their hands and to wear gloves. Even if they’re wearing gloves, I would want them to sanitize it before they’re cutting their hair, and those things need to be in place before I’d feel comfortable having them go there. Assuming that the place that they’re going to, that the shop management is making sure that the employees there have their temperature checked and they’re not working if they’re having a fever or anything like that.”

How soon may the elderly, one of us with lifelong asthma, the other with rheumatoid arthritis, go to a restaurant without feeling intimations of mortality?

Dr. Carlson: "I really appreciate that question, as someone who has both asthma and rheumatoid arthritis. I appreciate the precaution that you’re taking and your concern. While I’m a bit younger, I have similar concerns. I keep thinking back to a quote that Dallas County Judge Clay Jenkins said. He said, in reference to the reopening, “Just because you can do something doesn’t mean you should do it.” He also said, as did Mayor Johnson, that the personal behaviors in which each individual chooses to engage impact the larger community.

Bartender Tara Dieringer says,  places gloves on while cleaning the bar at RM 12:20 Bistro, as the staff prepares to open the restaurant, Monday, May 18, 2020 in Dallas. Ben Torres/Special Contributor
Bartender Tara Dieringer says, places gloves on while cleaning the bar at RM 12:20 Bistro, as the staff prepares to open the restaurant, Monday, May 18, 2020 in Dallas. Ben Torres/Special Contributor(Ben Torres / Special Contributor)

"Now, I would be a little bit cautious about going to the restaurant. Again, risk-reward. It might be something you really miss and really want to do and that gives you a lot of joy. That’s something that’s important, that weights into the equation. Keep in mind that this situation we’re in is temporary. It’s not going to be forever, so while we’re going through this, maybe think, “Okay, I really love this favorite restaurant that I frequented. I’m going to start doing carry-out from there a couple times a week.” Maybe go into your backyard and invite friends over, and everybody eat, safely distanced, outside, from the restaurant that you all used to enjoy together. That’s another way to do it, so just think about carry-out versus the risk of actually going and sitting in the restaurant.

"Another thing I want to remind everyone of is that restaurants are re-opening because of economic pressures, not because it is safe to re-open from a public health perspective, and public health officials have said this. If containing COVID-19 was the only focus, and we had no economic pressures, and we lived in a utopian society where money grew on trees, we would not even consider re-opening according to what is best for public health and safety right now. However, we live in reality, and that reality has led our policy-makers to make a careful and important decision to re-open, so we can continue to patronize local businesses in a variety of safe manners, support our local economy. But let’s find ways to do that without taking unnecessary risks.

Social Distancing decals inform customers where to stand inside the newly opened McDonald's restaurant at the Preston Oaks shopping center in Dallas, May 13, 2020. The McDonald's is opened for the first time since the October 2019 tornado that destroyed it. Ben Torres/Special Contributor
Social Distancing decals inform customers where to stand inside the newly opened McDonald's restaurant at the Preston Oaks shopping center in Dallas, May 13, 2020. The McDonald's is opened for the first time since the October 2019 tornado that destroyed it. Ben Torres/Special Contributor(Ben Torres / Special Contributor)

"If you really want to go to that restaurant and stay as safe as possible, there are some things you can look out for. First of all, is there a reservation system? That is, is there some kind of system to make sure the restaurant is within the recommended 25 percent capacity and then 50% percent capacity? I would like to see all the servers wearing masks, because they should be, and if they’re not it shows a lack of attention to the state guidelines by the restaurant managers. I would look, are the tables spaced apart? Will there be at least one table’s distance between you and another diner? I would, say, bring my own wipes and wipe down the chair arms, the table, the salt and pepper shakers, and even the glasses. If you’re really concerned, I would even say, bring your own straw to use in the glass. They have those re-usable straws, so that’s another option, because yes, there are things that gather on the top of the glass where we sip from. It depends on, how extreme do you want to be? How careful do you want to be?

"Recognize also that the restaurant experience is going to be different. We shouldn’t expect it to be the same, and maybe that will damper our desire to go. Or not. The server is not going to come to your table as often as before COVID-19. The manager probably won’t be around to ask how your meal was. There’s going to be pared-down person-to-person interaction.

“Also, we have to finally remember that one of the reasons we eat out is to socialize with others. We go out to dinner with people from other households. So, if you think that’s a safe option, or if you really want to see somebody else, then you might want to think about going into somebody’s backyard or eating outside, safely spaced away from the other diners.”

How can we stay safe if we are thinking about traveling over the summer?

Dr. Carlson: "I’m always happy to talk about travel. I love this question because my greatest love, next to my husband, is travel. That’s one thing that I think some of us really miss. The public health person in me really wants to say this is a great time to be into camping or to get into camping, but for those of us who are rooted in reality and really miss more traditional travel, there is some good news here, I think. The US Travel Association, in accordance with CDC re-opening guidelines, published some very extensive guidelines for the travel industry this month. They’re pretty good. I encourage anyone to check those out, and I’m going to post a link in my Instagram bio as well, for anyone interested. My Instagram is public_health_prof. But, anyway, under those guidelines we’ll see some more touchless features at the places to which we travel. We’re going to see touchless features for ticketing and check-in, and what I mean by touchless is we’re going to do things from our phones rather than have this common tablet we’re all touching. We’re going to see more and more of that.

A man wearing a face mask walk past the otherwise empty security lines at Dallas Love Field on Tuesday, April 14, 2020, in Dallas.  (Smiley N. Pool/The Dallas Morning News)
A man wearing a face mask walk past the otherwise empty security lines at Dallas Love Field on Tuesday, April 14, 2020, in Dallas. (Smiley N. Pool/The Dallas Morning News)(Smiley N. Pool / Staff Photographer)

"There will be masks required in some places, and there will be measures set up for physical distancing at these kinds of attractions that we visit. There’s not going to be any more crowds at museums or theme parks. They’re also going to be temperature and symptom checking for the employees at those types of tourist attractions. Now, some things that we can do this summer that are maybe less risky, is, we can go on short domestic roadtrips. We won’t have international travel for a while. There will be some challenges to airline schedules, but we can go for a roadtrip. We can go to places that organically offer social distancing, like outdoor national monuments, national parks, those kinds of things. Think about how you’re going to get there, though. Think about wearing a mask when you stop at gas stations along the way. Think about bringing as much food with you as possible. Think about driving through for your food so you’re limiting the time sitting in restaurants. Make sure that you have ways to wash your hands.

"Then, the other good news is with regard to lodging. There’s going to be some big changes for lodging. AirBnB has already said that they’re mandating a 24-hour vacancy period between guests, so that way, any of that virus that is hanging in the air is going to be gone by the time that guest gets there, so that’s good. What hotels are doing is they’re starting to use, some have already started to use hospital-grade disinfectants, and they’re employing technology. There’s a thing called electrostatic spraying, and it’s not new. It’s been around forever, but what it does is it’s this technique where you use an electric charge to make sure that the disinfectant is applied to a surface in a way that fully covers it. They’re starting to do this in hotel rooms, so that’s pretty good news. I think we’re going to see much safer opportunities for travel. That doesn’t mean to not bring your own wipes and wipe down all surfaces in the room, just to be safe, and to also ask, when you make the hotel reservation, to be in a room that nobody has occupied in the day prior to your arrival.

Langdon Gund, a student at Texas Tech University studying for his doctorate in audiology at the School of Health Professions, has multiple rows to himself on a Southwest Airlines flight from Dallas Love Field to Houston Hobby on Friday, March 20, 2020.  The 737-700, configured to accommodate 143 passengers carried fewer than 50 for the flight, including passengers from a cancelled previous flight to Houston.
Langdon Gund, a student at Texas Tech University studying for his doctorate in audiology at the School of Health Professions, has multiple rows to himself on a Southwest Airlines flight from Dallas Love Field to Houston Hobby on Friday, March 20, 2020. The 737-700, configured to accommodate 143 passengers carried fewer than 50 for the flight, including passengers from a cancelled previous flight to Houston. (Smiley N. Pool / Staff Photographer)

“So, there’s hope for travel. Again, this is temporary. There is going to be a lot of pent-up demand for travel. We’ll get to go all of the places we want to go in the future, so if you don’t feel completely safe, then let’s just do what we need to do to keep the world safe for now, if that’s an option.”

Dr. Jain: “I love to travel, but is it safe to travel? Actually, during the lockdown, there were so few people traveling at that time, I think it was actually really safe, but now more people are traveling on airplanes and that’s a little bit more worrisome. I think, for me personally, I think about, well, if we go somewhere as a family, we’re going to have the same issues of, well, do we go to restaurants? Just the practicality of trying to go on vacation seems quite cumbersome right now, and so we’re kind of rethinking all of those things. Trying to fly commercially, I would say that, think about the risk-benefit. If you really, really need to fly, if there’s a real urgency, then obviously you can take precautions, wear masks, sanitize your hands and those type of things. If you don’t need to fly, I would not. Again, I hope we will in the next year or year and a half or so, have a vaccine, and once we have something that can protect us, then things will be very different.”

Closing remarks

Dr. Jain: "I think I would just tell your readers that obviously, as Dr. Carlson had mentioned, we need to open up economically. People need to get a paycheck. Our economy needs to go back, but we need to be safe and careful in how we do this. We need to think about what we’re doing, and be cautious. If you need to go in a public area, be cognizant that there are other people who may be at risk. Wear a mask. If for some reason, if you are one of these asymptomatic carriers, you at least are not infecting someone else. I think we need to take care of everyone and be cognizant that we’re not living in isolation. When we go in public we need to be careful.

Dallas County Judge Clay Jenkins displays an improvised clothe face mask made with a bandana and hair ties as he addresses members of the media regarding the new coronavirus pandemic on Wednesday, April 8, 2020 at the Dallas County Emergency Operations Center in Dallas. (Ryan Michalesko/Staff Photographer)
Dallas County Judge Clay Jenkins displays an improvised clothe face mask made with a bandana and hair ties as he addresses members of the media regarding the new coronavirus pandemic on Wednesday, April 8, 2020 at the Dallas County Emergency Operations Center in Dallas. (Ryan Michalesko/Staff Photographer)(Ryan Michalesko / Staff Photographer)

Dr. Carlson: "I saw a great quote by Dallas County Judge Clay Jenkins. Actually, on the front page of The Dallas Morning News today, and it said, “It is important for each of us to focus now on not only on what is legal, but also what is safe, and on the recommendations of public health experts.” I think that’s a really good thing to keep in mind. What we do as individuals, how we choose to behave, it affects others in really important ways, and if we take an unnecessary risk, that could actually really have a serious impact on somebody else, somebody you don’t even know, but that leaves them and their family in a serious situation. We have to always be cognizant in public health of how what we do affects others and affects the greater good.

"Finally, just a couple of kind of utilitarian pieces for our listeners that I found helpful, and I hope it helps them as well. I’m getting a lot of questions from friends about masks, because I know we’re seeing all kinds of masks out there right now, and I’m getting questions like, “What kind of mask is really safe if we don’t have an N-95?” There’s great research right now. I encourage you to Google two pieces of research. There’s a researcher at University of Nebraska Medical Center who’s done a great mask study, that found the information about the HEPA filter and that shows the risk reduction associated with each kind of fabric out of which we make a mask. Then also, Wake Forest has some great research on masks.

“Then finally, the other questions that I hear a lot of people asking is, since we don’t have access to Clorox wipes right now, and typical disinfectants, people are asking about your natural products and other things. Does this work, or that work? There’s a list on the EPA website. It’s called the N list. You can Google it, and every single ingredient that’s considered an active ingredient in anything sold as a disinfectant out there is on that list. It checks whether or not it works against COVID-19, and how long it needs to sit on the surface before it does disinfect against COVID-19, so, just a couple of helpful tips. Thank you so much for the opportunity to be on this panel today, to Anna and everyone at The Dallas Morning News. I really appreciate it. It’s been a lot of fun.”

Find the latest news on Coronavirus from The Dallas Morning News here.

Anna Kuchment. Anna Kuchment covers science for The Dallas Morning News and for Scientific American, where she is a contributing editor. She previously worked as a senior editor at Scientific American and as a staff reporter, writer and editor at Newsweek magazine. She holds a Master of Science degree from the Columbia University Graduate School of Journalism.

akuchment@dallasnews.com @akuchment
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