Summa Health's infectious disease specialist Dr. Thomas File offers the latest updates on COVID-19

Posted September 21, 2020 by Thomas M File, Jr., MD

We’ve learned a lot about the novel coronavirus (COVID-19) in the past six to eight months since the virus infiltrated our lives and bodies. We now know much more about how it’s spread, symptoms to watch for and how to treat some of them, as well as successful ways to protect ourselves from transmission. 

But, there’s still a long road ahead. There are many unknowns about the virus, including immunity and long-term effects. Summa Health sits down with our chairman of the Infectious Disease Division and Co-Director of the hospital’s Antimicrobial Stewardship Program Dr. Thomas File to get the latest updates on what we need to know about COVID-19. 

What do we now know about the virus today?

We’ve learned COVID-19 is much more highly transmissible (or contagious) than other seasonal respiratory viruses. 

We also know there are many people who are asymptomatic, but yet they can still spread the virus. In fact, some studies suggest that up to 40 percent of patients infected with COVID-19 have no significant symptoms, but yet can still spread it. 

I think that’s a very unique aspect of this virus. Asymptomatic patients make it very difficult to contain it. Now, you almost have to assume that anybody is positive because they may not have symptoms. 

We’re also learning more about the symptoms. Earlier in this pandemic, we focused primarily on respiratory symptoms: cough, fever and shortness of breath. Now we know that there’s a variety of other symptoms associated with this infection, such as headache, chills, muscle cramps, body aches, loss of smell and taste, gastrointestinal symptoms and a variety of rashes. We’ve found that it does not just affect the lungs. It can affect other organs, as well, including the heart, brain and kidneys, which is very distressing.

What I’m most concerned about is the potential long-term effects from COVID-19. We’ve only been following it for about six to eight months, but patients who have had pneumonia can have persistent lung or even heart effects. In fact, there was a study out of Germany that showed many of the patients they studied, the majority of whom experienced mild symptoms, had some sort of heart damage when evaluated 2-3 months after their illness.  It will be important to learn how long these effects last as patients are followed longer.

What is the incubation time for COVID-19?

After exposure, we know the median time for a patient to develop symptoms is about five days. However, it can go anywhere from about two to 14 days. 

It appears the best time to test asymptomatic patients is about five to seven days after exposure. That assumes they have an established time when they were exposed. 

Is COVID-19 testing important to help stop the spread?

Testing is really important to try to control this pandemic. Testing allows us to identify patients early and potentially contact trace to help reduce the spread. 

We certainly test all patients who are symptomatic and coming into our hospital. With our in-house testing service, the present turnaround time for accurate testing is within hours. We’re looking to add other tests to shorten the turnaround time. 

We also have made arrangements for drive-through testing, particularly for ambulatory patients with symptoms compatible with COVID-19 and for patients about to undergo surgical procedures or at-risk aerosol-generating procedures. It’s important for us to know as we may have to delay their surgery not only to protect our staff, but also because studies have suggested asymptomatic infected patients may not do as well post surgery. 

How are you treating COVID-19 patients?

Our Covid-19 medical team is using the antiviral medication Remdesivir quite frequently in our patients who require admission to the hospital. We now know Remdesivir benefits patients who are at least sick enough to come to the hospital and require supplemental oxygen. It doesn’t necessarily mean they need to be intubated or require a ventilator, but they have lower levels of oxygen.

We also know that steroids are beneficial for patients who have developed more severe complications and require intubation, especially those in the Intensive Care Unit. One randomized clinical trial showed that indeed steroids actually reduce mortality. 

Clinical results such as this and compelling information that is coming out every day tell us how best to use these interventions to reduce the impact on patients.

Now that we’re heading into flu season, many people are wondering if they should get vaccinated. Is that something you recommend?

Getting the flu vaccine is extremely important this year because there is great concern that a co-infection of influenza and COVID-19 can be associated with an even more severe disease. Getting the flu vaccine will hopefully reduce that possibility.

Are wearing masks, social distancing and hand washing the keys to protecting ourselves? 

Yes, these safety measures are critical. Until we have a vaccine, these measures are the best defense we have against the virus — most specifically masks. I can’t emphasize strong enough the need to wear masks. We’re getting more and more compelling information on the benefits of masks and how they reduce transmission.

Even cloth masks can reduce the amount of air droplets that go from one person, who may be asymptomatic, to anther person. So, masks are extremely important and really do help reduce the transmission.

Social distancing is also really important, in addition to good hand hygiene. We’ve seen the most likely source of much of the cases over the summer was caused by a lot of people congregating in gatherings or in bars. So, if you’re in close proximity to others, particularly if you’re not wearing a mask, then there’s going to be a risk of transmission.

We all have a responsibility to try to reduce the spread of COVID-19 to our loved ones, our colleagues and beyond. The data is clear these safety measures work, so it’s important for us to follow them. It’s our best defense against something that none of us, including myself, an infectious disease specialist, have ever lived through in this country.

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