COVID-19

COVID-19

Have a question about COVID-19? We will ask the experts.

Send questions to tribdem@tribdem.com.

Note: Due to the volume of questions submitted, we will not be able to answer them all. Any questions of an urgent nature should be directed immediately to your primary care physician.

• • • • •

“How do I prepare my dad’s home for his return from the hospital after testing positive for the coronavirus? He is currently on ventilator and in ICU. Once he gets better and comes home, how do we as a family ensure his home, and specifically his bed, are safe to come home to? We are considering just buying him a new bed. Is that the best action to take?”

The answer:

I do not advise buying a new bed at this time. I recommend waiting until he improves and is transferred out of the ICU. Closer to discharge, Social Services will meet with you to discuss and arrange for all home care needs including possibly a hospital bed and home oxygen therapy if medically indicated. Home care needs may be covered by insurance depending upon his coverage.

My best wishes for your Dad’s quick and full recovery. 

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My stepdaughter and her three kids all tested negative using the nasal swab. I got tested as well and am negative. They are planning a visit here (they live two hours away), with an overnight stay. My grandkids want to hug me. What do you think?”

The answer:

It appears that you are all negative as of last week. If you have maintained social distance and have been practicing good hygiene, I’d suggest a hug.

Please keep an eye on the cases in your area and your stepdaughter’s area. If they have had spikes, it is important that all involved are following the social distancing recommendations.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“My husband and I became sick June 14. We both were tested June 15. Three days later, swab-testing showed he was positive and I was negative. But he only had fever and body aches as symptoms. I, on the other hand, had experienced every symptom – shortness of breath, loss of taste and smell, body aches, fever, headaches and stomach pain. Yet I was negative. We waited 11 days and retested. He is still positive and I am again negative. Could you maybe explain what in this crazy world is going on?”

The answer:

You didn’t mention if you and your husband still have symptoms and/or fever.

Your husband was infected with the SARS-CoV-2 virus (also known as COVID-19). If he has no symptoms or fever now, he is likely recovered.

One possible explanation for your husband’s repeat positive swab test is that he is shedding non-infectious or dead virus particles.

Since you had 2 negative swab tests 11 days apart, I believe you are not infected now with the COVID-19 virus. For you, I recommend a blood IgG antibody test for SARS-CoV-2 (COVID-19). If your IgG antibody test is positive, that would tell you were previously infected.

Finally, I also advise both of you to continue CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I recently spent nine days in Florida and practiced self-distancing as well as wearing a mask. I did have two airline flights, from Illinois to Florida and back, wearing a mask at all times. Upon my return, I was tested (nasal swab) and the results were negative. I’m in my eight day since returning. Am I still at risk of getting COVID-19 from my trip to Florida even if I tested negative the day after my return?’

The answer:

Florida is a hot spot for infection with SARS-CoV-2. COVID-19 cases in Florida for the week that you were there totaled 54,456.

Authorities there are confirming community spread. Since you were on an airplane, which is considered moderately high risk of exposure, and you were in a known COVID-19 hot spot, you should continue your self-isolation for 14 days.

Most cases of COVID-19 develop in days 5-7, but some people will develop symptoms as late as 21 days after exposure. If you develop symptoms, seek medical treatment.

The CDC recommends that further travel to areas of the country where COVID-19 cases are high should be on an as-needed basis only.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“I am a 65-year-old female. I was going to take swim lessons at the lake from an instructor who just told me her daughter works in radiology at a hospital and has had no symptoms. Neither she nor her daughter has been tested since March. Should I still take lessons?”

The answer:

Determining the level of risk associated with any activity has become forefront in our minds of late. When we are working to determine the level of risk that is associated with each activity, it is important to consider these things:

How close will you be to others? Six feet of personal space is best.

Will you be outside or inside? Outside is better to reduce your risk.

How many people will be involved in the activity? The less the numbers the better.

• Lower risk activities include: getting restaurant take-out; opening your mail; going camping; playing tennis.

• Moderately low risk activities include: grocery shopping while wearing a mask; going for a walk/run with a small group of people; waiting in a doctor’s office waiting room.

• Moderate risk activities include: going to a beach; shopping at a mall; swimming in a public pool; going to a backyard barbecue.

• Moderately high risk activities include: eating in a restaurant; playing basketball; playing football; traveling in a plane.

• High risk activities include: working out in a gym; going to a large event (music, sports, movie); going to a bar.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My sister just found out she has the virus. She is coughing, and can’t eat more than a couple of bites. What can she do to make herself comfortable?”

The answer:

She needs to contact her primary care physician as soon as possible for evaluation of her symptoms and further instructions. If she is getting worse and has shortness of breath, then take her to a hospital emergency department. It is important to remain hydrated and to avoid dehydration. She may also have pneumonia.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My son tested positive for COVID-19 six weeks ago. He no longer has symptoms, but his test has been positive every week after. Is this the pattern of all positive individuals? How many weeks are most people taking to get a negative result?”

The answer:

If your son had a genome (PCR) test for SARS-CoV-2 and it was positive, then he is still actively shedding the virus and should maintain his self-isolation. If your son had an antibody test, he could be positive for a few months.

Since he is still positive, I would recommend that he continues self-isolation. If you have further questions, please follow up with your primary care physician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Both my husband and I tested positive for COVID-19. Our boys did not, and they play baseball. Can the boys play this weekend if someone without COVID takes them? They have had no symptoms and have been isolated for seven days now.”

The answer:

Since you and your husband are in the same household as your boys, it is better that they also self-isolate.

SARS-CoV-2 is highly contagious and your sons could be in the incubation period now. 

This is the time when they have no symptoms but are still contagious. I would recommend that they remain isolated for 14 days and that you retest them once your symptoms have subsided.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“If you’ve taken the COVID-19 swab test and it was negative and you have no symptoms, do you still have to quarantine?”

The answer:

Many states have implemented rules for travel into their borders from places where COVID-19 cases are high. You may have to self-isolate for 14 days. I suggest you check local rules for where you are.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“I wanted to ask about my child who tested positive today for COVID-19. He is 10 and has shown no symptoms at all, but we were told that his friends he was hanging around with had tested positive so we went ahead and got him tested – as well as my wife and I. My wife and I both tested negative. How is it that this virus has been deemed very contagious but yet the two people that are around him all day that hug and kiss him, test negative? Is it possible we didn’t wait long enough to get tested?”

The answer:

I can understand your concern and confusion regarding your son’s positive test and your negative test. Without knowing which test you were given, I can only give you generalities. It is possible that your son is farther along in his infection than you and your wife.

SARS-CoV-2 is highly contagious. Even though you have tested negative, a member of your household has tested positive. I would recommend that you have your son use a separate bathroom and bedroom, that you wear a mask when interacting with your son, and that you monitor yourself and your family for symptoms or worsening conditions.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“I had given a friend a ride home and both where wearing masks. But I just found out they tested positive for COVID, but they just told me they had been feeling sick for over a week. Could I be infected now?”

The answer:

You were in close contact, but you were wearing a mask. If you don’t have any symptoms or fever, I doubt that you are infected. However since you were in close contact of a confirmed COVID-19 case, I do recommend that you get a swab test (molecular Polymerase Chain Reaction - PCR) now. I also advise you to continue CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • • 

“I have to go for an operation, so the doctor told me to get a COVID-19 test because they will need them at the hospital, so I did a swab test and am still waiting for results. My employer told me not to come to work if you tested for COVID-19. I don’t have symptoms, and I only did the test because I have the operation. What should I do?”

The answer:

It is standard procedure for hospitals to require a COVID-19 test before surgery. I would suggest that you speak to your employer and see what the policy is through the Human Resources department. It may be that you are not to come to work if you are positive.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • • 

“I just had a nephew pass away and doctors say all his symptoms point to COVID-19. He was tested, I believe, three times at the hospital and they were all negative results. So after he passed away the hospital transferred him to the medical examiner’s office to help determine if anything else could have caused his death as he was only 29 years old with no underlying condition that we knew of, plus he was very active in sports and took his health seriously. So my question is: Is it possible to be tested for COVID-19 multiple times with negative results and still have the virus?”

The answer:

I’m sorry to read of your young nephew’s passing. In my opinion, it is unlikely that an individual who recently tested negative three times in the hospital before his death was infected with SARS-CoV-2 (COVID-19 virus).

I believe the autopsy will probably give the answer.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My parents were both positive for COVID-19. My dad has been hospitalized after a month. My mom recently tested negative after a 14-day quarantine. I would like to go there and help my mom but I’m concerned about whether I could catch it due to the fact nothing has been sanitized inside the home. My mother has COPD, so she has not used any Lysol spray or wipes to clean anything she or my dad have touched. I want to go there but I have underlying conditions and have concerns?”

The answer:

I understand your concern. 

Studies have shown that SARS-CoV-2 can remain on surfaces for days. From your question it seems that your father is hospitalized and your mother has been at home for 14 days with no symptoms and a negative test. This would make your risk of contracting SARS-CoV-2 in their home low.

There are a few precautions you can take. You can wear a mask while in their home, and while cleaning you can wear gloves. Be sure to clean high-touch surfaces well and let the cleaning products dry on their own – don’t wipe them dry. Also, remember to wash your hands regularly.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I just found out my granddaughter has COVID-19 and I was around her 11 days ago. What do I do? I have chronic lymphocytic leukemia.”

The answer:

I definitely recommend that you get tested now with a swab test (molecular Polymerase Chain Reaction – PCR). The incubation period for the SARS-CoV-2 virus (also know as COVID-19) is estimated to be between two and 14 days, with a median of five to seven days. So now is a good time to be tested. If you don’t have any symptoms or fever, you’re probably not infected, however I can’t exclude it in view of your underlying chronic lymphocytic leukemia.

While you wait for your results, you should self-isolate to your home in a private room and use a private bathroom if possible. I also recommend that you continue good hand washing hygiene, wearing a mask and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • • 

“My husband was tested for COVID-19 at a free testing site in Beeville, Texas. He has no symptoms. He had to be tested because a person from his work tested positive. It’s been a week and a day and they still have not called or texted his results to him. That was how they told him he would get his results. They also told him it would be 24-48 hours to hear from them. So what do we do now?”

The answer:

It can be so worrisome to wait for test results. Many testing sites are experiencing delays in testing. I would follow up with your primary care physician to see if that office can get your results.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My sister was tested positive for COVID-19 via nasal swab on May 31. She had mild symptoms for less than 14 days and was retested via nasal swab on Day 17, and that test came back negative. She has had no more symptoms, except a small cough. Her job requested her to be retested to return to work and when she tested after Day 20 via swab, she was positive. Why would that happen?”

The answer:

There are several possible explanations.

The second nasal swab test (molecular Polymerase Chain Reaction – PCR) done on Day 17 was possibly a “false negative” due to an inadequate specimen.

The third swab (PCR) test done after Day 20 was positive. A study from the Korean Centers for Disease Control and Prevention studied 285 COVID-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved. The virus samples collected from them could not be grown in culture. One possible explanation is that the patients were shedding non-infectious or dead virus particles.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“If a family member was in contact with someone that had the virus and the family member's test was negative, does the family need to quarantine?”

The answer:

No.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“A coworker of mine tested positive for COVID-19. The person had been attending work for two weeks prior to the test, and had been feeling unwell, but did not tell anyone. After having mild symptoms myself for about four to five days, I got tested. My result came back as undetected. Since then, I have developed more symptoms, and have been feeling worse. 

“It has still only been about 10 days since the onset of my symptoms. My question is: What does an undetected result mean, since it was not negative or positive? Also, should I get retested, and if so how long should I wait before testing again?”

The answer:

I assume your test was a swab (molecular Polymerase Chain Reaction – PCR). The swab PCR test results that I receive are reported as POSITIVE for the SARS-CoV-2 virus (COVID-19), or NON-DETECTED (which is negative). Therefore, I believe your test result was negative.

The incubation period is the time between exposure to the virus and the onset of symptoms. The incubation period for the SARS-CoV-2 virus (also known as COVID-19) is estimated to be between two and 14 days, with a median of five to seven days.

It has been more than 10 days since the onset of your symptoms. Therefore, I recommend you get retested with a swab (PCR) now.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“One of my tenants tested positive for COVID twice, then 15 days later, had moved out of the house. What should I do?”

The answer:

 Clean and disinfect the house using CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“Suppose someone tested positive, recovered, and later tests showed the antibodies in their system but no further COVID-19.

“If that same person is later exposed to droplets or aerosols containing the virus, can that person inhale and then transmit the virus to someone else before their antibodies have a chance to kill the virus?”

The answer:

This is a good question.

Viruses need to be inside our cells in order to make copies of themselves. We inhale the virus, it attaches to our cells and then enters them by penetrating the cell membrane. Once inside, the virus will proceed to redirect the cell’s metabolic processes to make copies of the virus. This essentially makes the cell a virus factory.

If someone has been infected with SARS-CoV-2 and has recovered, then they have antibodies to the virus. Those antibodies will bind to the virus before it can enter the cell and prevent infection. It is nearly impossible for someone to inhale respiratory droplets and then transmit them to someone else. 

We have many levels of defense that prevent that from happening, mucus in our respiratory tract, histamine release (which causes sneezing and coughing), and the antibodies someone makes to a virus can be secreted into our nasal passages to stop the virus before it breeches our skin.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I live in New Jersey but will be traveling to North Carolina. New Jersey is currently requiring a 14-day quarantine for residents after they return from certain states, including North Carolina. If I get tested on the day I return, and the test is negative, is a full 14-day quarantine still necessary?”

The answer: 

Yes. You could have been exposed on your last day in North Carolina. On average symptoms present themselves five to seven days after exposure. However, some individuals are seeing symptoms as late as 19 days. I strongly recommend that you self-isolate for 14 days after travel.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My wife and I were exposed to my son two days before he manifested COVID-19 symptoms and tested positive. Eight days after the exposure, my wife tested and was negative, but I still didn’t get tested, although we live, eat and sleep together, is it possible that I might be positive while she is negative in eight days?”

The answer:

Yes it is possible that you are positive even if she is negative. It is best to self-isolate for 14 days from the time of exposure. If no symptoms present themselves, then you are likely not infected.

 – Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My cousin that we are supposed to be going on vacation with in two weeks tested positive for COVID. The only symptom he had was lack of taste that began more than two weeks ago. He has a retest five days before we are supposed to be leaving. If it is negative, is it OK to be around him? We will be staying in a house together, my wife is pregnant and we have a 2-year-old.” 

The answer:

If someone has tested positive for SARS-CoV-2 via PCR (genome) test, that person is considered to be actively infected and is likely shedding the virus.

Even though his symptoms are mild, he can still be shedding the virus. Until a PCR test is negative, it is wise to have him self-isolate (even with mild symptoms), because he is likely spreading the virus to others he comes in contact with.

His family should also be self-isolating to reduce the spread of the virus to the community, family and friends.

It is your choice as to whether you go on vacation with them, the risk assumption is high if he is PCR positive for SARS-CoV-2.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested negative for the COVID-19 antibodies, but my daughter who lives with me just informed me that someone she works with tested positive for coronavirus. Should I get a COVID-19 test?”

The answer:

If your daughter was a close contact (defined as being within six feet for a period of 10 minutes or longer) with an employee who tested positive, then I recommend both you and your daughter be tested (molecular Polymerase Chain Reaction – PCR swab test).

Your daughter’s exposure risk was higher if she was not wearing a mask. If you or your daughter develops any symptoms or fever, notify your primary care physician for instructions.

I also recommend that you both continue good hand washing hygiene, wear masks and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • • 

“I am staying with my daughter and son-in-law. 

“We took the COVID test. He tested positive and my daughter and I tested negative. He is self-isolating in part of the house. For how long do my daughter and I quarantine? When will I be able to get on a plane and fly back home?”

The answer:

Great job self-isolating after exposure.

Avoid interactions with the infected individual. 

Don’t share the same bathroom. Wear a mask in common areas of the home. Open the windows in the house, to avoid continual exposure.

The least amount of time you should spend in self-isolation is 14 days. Since you are in the same home, you could be exposed during your isolation. 

The safest course of action is to wait until your son-in-law has tested negative twice by PCR for SARS-CoV-2.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • • 

“How effective is a mask when the nose is not covered? It seems many prefer to wear their masks in this manner.”

The answer:

Masks are only effective if you cover both the nose and mouth. 

Wearing them in any other manner is ineffective.

By covering your mouth and nose, you are placing a barrier in between the world and any respiratory droplets that you are expelling via breathing.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“My daughter works in a dental office. Her manager tested positive for COVID. I saw my daughter last night, hugged her and talked to her for about 15 minutes. Am I now exposed as well?”

The answer:

Close contacts are people who have been within six feet for a period of 10 minutes or longer.

There are significant unknowns. I don’t know which test (Polymerase Chain Reaction – PCR swab or blood antibody) the manager had; if the manager was previously quarantined; if the manager had symptoms, fever or recovered; if the manager was contagious; and if your daughter was wearing a mask.

I recommend you and your daughter discuss screening for COVID-19 (PCR swab test) with your primary-care physician. I also advise continuing CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I tested positive on April 14 and 29, and indeterminate on May 14, and negative on May 26 and 30 and June 6. Now it’s June 29 and I’ve tested positive again. So am I still shedding the virus? Is that the reason I’m testing positive again?

The answer:

If the test you received was the PCR genome test, then you are shedding the virus. Please self-isolate for 14 days. If you are still symptomatic, I urge you to monitor your symptoms and seek medical treatment if your symptoms become severe.”

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

•  •  •  •  •

“Upon her return from Florida, my daughter tested positive for COVID on June 23. She has been quarantined since her return. When should my wife and I get tested for COVID? We would like to go Thursday. Should we wait until July 9?”

The answer:

I am assuming your daughter lives with you or that she visited you before she knew she was COVID-19 positive.

First, she should contact anyone she was in contact with and if she was on an airline, she should contact the carrier to inform them of her status. 

Contact tracing is incredibly important to prevent major community spread of the virus.

If you were exposed to her and have not developed symptoms, you may not need to be tested. You can self-quarantine for 14 days (avoid neighbors, crowds, etc.) and only get tested if you become symptomatic. If you feel that you want a test, I urge you to contact your physician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Is it possible to expose another person to coronavirus if you were positive but are now negative but a family member now has it? I tested negative after 43 days, plus had antibodies test done and I was positive for having antibodies.”

The answer:

An interesting question.

If you don’t have any symptoms or fever now, then I believe you are recovered and not contagious.

Your repeat swab test (molecular Polymerase Chain Reaction – PCR) was negative. You tested positive for antibodies (SARS-CoV-2 IgG) which is what I would expect because a positive SARS-CoV-2 IgG antibodies test tells if someone has been previously infected. IgG antibodies are detected in most patients 10 to 21 days (median 14 days) after symptoms of COVID-19.

I recommend that you continue good hand washing hygiene, wearing a mask and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • •

“If I test positive for COVID-19, would subsequent follow-up tests that are also positive be included in the daily report of new positive cases?”

The answer:

Each state is counting positive tests differently. If the state is counting cases, they are counting each person once.

In Pennsylvania, cases are counted as confirmed cases, probable cases, negative tests and deaths. 

New cases, however, can be antibody positive or genome positive.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“I am going to have surgery and I got tested for COVID-19. I have no symptoms other than a sinus infection that I’ve been dealing with for a while and postnasal drip. No chest congestion, very minimal cough. The test came back positive. Does not having any symptoms mean that I’m in the last stage of the virus, or is there a way to know in what phase of the disease I’m in – not because I felt sick, but because of the planned surgery?”

The answer:

I’m assuming that your positive test was a Polymerase Chain Reaction (PCR) swab test.

According to recent studies, approximately 40% to 45% of individuals infected with SARS-CoV-2 (COVID-19) may have no symptoms at the time of testing, and they may transmit the virus for 14 days or longer.

Therefore, inform your close contacts and advise them to quarantine at home for 14 days. 

This includes family members. Self-isolate in your home until these conditions are met:

1. It has been at least seven days since your symptoms first appeared.

2. It has been at least three days since you have not had a fever (without using fever reducing medications) and your respiratory symptoms are improving.

If your symptoms get worse, notify your primary care physician immediately. I also recommend continuing good hand washing hygiene, wearing a face mask and following other CDC recommendations.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My colleague tested negative but lives with his mother, who tested positive. I spent about an hour working with him. Are there any precautions I should take or am I OK to continue on?”

The answer:

If you and your colleague both have no symptoms or fever, I don’t have any specific instructions. However, I do recommend continuing good hand washing hygiene, wearing a face mask and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My employer had me take a COVID-19 test on Monday. We were scheduled to return to work on Friday. I got a phone call Wednesday from my HR department telling me that the laboratory that conducted my test needed more time on my test or had to re-do my test and can’t determine my results at this time. She told me I wouldn’t be put on the schedule until they hear back from them. She told me I can also go somewhere else that offers free testing if I wished, but I didn’t have to. She told me not to be nervous. I was told that they didn’t need me to give another sample and that they had enough. I am unsure why it came back abnormal or that it came back inconclusive. I am surprised because I have no symptoms. Why would the test come back this way?”

The answer: 

You didn’t mention whether your test was a Polymerase Chain Reaction (PCR) swab test, or a blood antibody test. It is important to know which test was done.

It’s possible that your test result was a “false positive.” 

However, recent studies suggested 40% to 45% of individuals infected with SARS-CoV-2 (COVID-19) may have no symptoms at the time of testing, and they may transmit the virus for 14 days or longer.

Therefore, I recommend that you discuss repeat testing and further instructions with your primary care physician.  

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have allergies, and I usually have a rough couple of weeks at the start of the yellow pollen season. I take my meds, but almost every year I end up with sinus infection which leads to fever, sneezing, sore throat and coughing, also aches and chills. I try to see my doctor ASAP to keep it from going full bloom. Well, I knew it was coming on, so I called the office to go in for the usual shots, antibiotics and zpak. I was told I couldn’t come to the office until I was tested for COVID-19. Why? I am 63, and I have worked in a hospital lab as a phlebotomist for more than 20 years. I know how to prevent contamination. I lived through SARS, several flu outbreaks, c-diff (C. Difficile Colitis), Mrsa.”

The answer:

First, thank you for your long service as a hospital phlebotomist. I’m sure you’re following appropriate hospital infectious disease precautions, as well as, department of health and CDC recommendations.

I recommend that you ask your physician this question. I don’t know what your physician’s office policies are for treating patients with respiratory symptoms during the COVID-19 pandemic.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I was tested for the antibodies for COVID-19 and was negative. Are my chances of getting COVID-19 higher than if I had tested positive?”

The answer:

An excellent question without an answer at this time.

Since the pandemic is only months old, there’s no data on long-term immune response. The immune response to COVID-19 is not fully understood, and definitive data on post infection immunity is lacking. It is not known for certain whether individuals infected with SARS-CoV-2 (COVID-19) who subsequently recover will be protected either fully or partially from future infection with SARS-CoV-2 or how long protective immunity may last.

Further research and the collection of patient data are needed. It remains to be determined whether a robust IgG response corresponds with immunity.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“My wife had COVID-19 as far back, we believe, as February with loss of taste, no smell and headaches. These symptoms were not known at that time and she was coughing a lot. We thought nothing of it, but maybe allergies or a cold. She then developed a fever in April, after the other symptoms subsided – fever for one week of 100 degrees-plus. 

“On May 4, she tested positive for the coronavirus. I had shown no symptoms through these four months and I tested negative for the coronavirus on May 4 as well. 

“We both had antibodies done on June 23, hers was positive and mine was negative. Should I be worried about catching the coronavirus? Should I get re-tested for the coronavirus?”

The answer:

If the question you are asking is if you should be concerned about your wife infecting you with SARS-CoV-2, the answer is no. It appears, from the information you have given, that your wife has recovered from COVID-19.

That does not mean that you are not at risk of acquiring SARS-CoV-2 from other sources. To add to this, research is showing that antibody protection is lasting three to six months. We do not know yet if reinfection is possible.

If you begin to show symptoms of COVID-19, monitor them and seek medical treatment if they become severe.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“I’ve been watching all the reports of new cases of COVID-19 in the U.S. with over a half-million tests being done daily now and about 25,000 positive results every day from these tests. My question is: Do these results mean that they are all sick or do the results mean in some or most cases that at one point they had it and have no symptoms and are not infectious to anyone anymore? Are we seeing higher numbers but only because they were previously infected or are these going to be active cases?”

The answer:

There are approximately 300,000 tests daily for COVID-19. 

Many public health officials are calling for 500,000 (on the low end) to tens of millions (on the higher end). The more we test, the better we will be able to respond to this pandemic. Testing allows science to determine how bad the problem is and how best to respond to it.

Testing is being done differently across the United States. Each state has put in place policies for how testing is being done there.

These tests come in two forms: viral genome tests (for active infections) and antibody tests (to look for an immune response to the virus and see if you previously had the infection). Depending on which test a person has gotten, they may be in an active infection (genome test) or they may have recovered from the infection (antibody).

Some important things to remember when looking at the testing data:

1. These data are assembled from many sources – private labs, state-run labs, hospitals.

2. Not all states are reporting at the same level. Some states are only reporting positive cases. 

This can lead to a skewed view of the results by not showing a comprehensive picture of the total testing being done. Some states are blending the testing data reporting genome positive tests with antibody positive tests, this is combining active infections (genome tests) with those that are recovered (IgG tests) and those in the early stages of recovery (IgM). Some states, particularly where meat packing industries are found, have set a threshold for reporting. They will not report cases unless 10% of the population from that plant has tested positive.

3. Positive tests in a state may not be indicative of total cases in that state, as some individuals are tested more than once.

4. Not all tests are being reported to the CDC. It can be difficult to determine the accurate picture of what is occurring with infections in the U.S. due to the lack of coordinated response in reporting. I would suggest looking at your state’s reporting and determine if officials there are reporting the type of positive case (genome vs antibody) along with the number of negative cases. This is the best way to see who is active, recovered and virus free.

This was a great question.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •  

“If you have been tested at your work place on a daily basis with temperature check and all the questions, and have been healthy, can you refuse to be swab-tested if health department demands it to be done?”

The answer:

I don’t know your place of employment.

However, the Wolf administration has issued a universal coronavirus testing order for nursing homes in Pennsylvania. 

The order requires all nursing homes to complete initial baseline testing no later than July 24. 

The Department of Health also issued updated testing guidance to all long-term care facilities, with a renewed focus on keeping COVID-19 out of the facility by testing all staff members and residents.

Your local health authorities have the latest information about COVID-19 testing in your area.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“My co-worker came to work with a fever. I wasn’t in the office when the person came in and was promptly sent home. My co-workers and I are currently divided into two teams – one team works one week and the other team works the other week. Should I be worried?”

The answer:

Fever can be a sign of many types of illnesses. If other symptoms were present – shortness of breath, coughing and loss of taste and smell – this would be more of an indication of COVID-19.

I would ask your workplace what the cleaning procedures are. If they are deep cleaning the area daily and your co-workers are practicing good hygiene, then you can better assess your risk.

It is important to remember that many illnesses cause fever, but the best way to prevent most infectious diseases is with good hygiene and proper hand washing.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My buddy’s ex-wife tested positive for COVID but refuses to quarantine. She is constantly over at my friend’s house and won’t leave him and their son alone. She even barges up in my friend’s house uninvited, knowing she’s positive. My friend told me that his son got his test results back and he’s negative and my friend already had a test done last week that came back negative. They don’t live in the same household, but she’s constantly driving by his house or stops by and just won’t leave him and his son alone and go home and self-quarantine. 

“She tested after him, so now he’s gotta go get retested because of her. But when they were leaving, she bent into the passenger window and gave their son a long hug – knowing that he just tested negative and knowing that she’s positive. Is there anything at all he can do to make her stop without getting a restraining order?”

The answer:

I would suggest that your friend and his former spouse work together to make a safety plan for COVID-19. It is always best to start with a dialogue about the problem.

If this is not possible or has been tried with no results, he can contact a lawyer and see what (if any) legal rights are afforded. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“Can my job require my dad’s negative test results for me to return to work? He does not work there but we live together.”

The answer:

Most employers have policies in place that cover what is required to return to work. I suggest that you contact your Human Resource Office and determine what their policy is.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My daughter’s son was exposed to someone with COVID and we have been around all of her family. He had the test but it’s not back yet. How long does it take to get it once he was exposed? My husband has no immune system. He is 89.”

The answer:

The incubation period is the time between exposure to the virus and the onset of symptoms. The incubation period for SARS-CoV-2 (also known as the COVID-19 virus) is estimated to be between two and 14 days, with a median of five to seven days (possibly longer in children).

According to recent studies, roughly 40% to 45% of individuals infected with SARS-CoV-2 may have no symptoms at the time of testing, and they can transmit the virus for 14 days or longer.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“I was COVID-19 positive after my quarantine of 14 days. I tested negative, but I’m confused what precautions I need to follow and am I free to move around my house and cook for myself. Do I need to repeat my test and after how many days?”

The answer:

Your history is that you were COVID-19 positive, then quarantined 14 days, and after which you tested negative.

You should self-isolate in your home until each of the following conditions are met:

1. It has been at least seven days since your symptoms first appeared and

2. It has been at least three days since you have not had a fever (without using fever-reducing medications) and your respiratory symptoms (cough, shortness of breath) are improving.

So after the above, and you have no symptoms of infection or fever, you should be safe. I do recommend continuing good hand washing hygiene, wearing a face mask and following other CDC recommendations. In my opinion, there is no need to repeat a Polymerase Chain Reaction (PCR) swab test.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I would like to know if a person has a spouse who tests positive but he or she tests negative, can the person testing negative still transmit the virus unintentionally through contact by touching of contaminated surfaces? Can that person then bring that into the work place?”

The answer:

If a person in your home has tested positive for SARS-CoV-2 (COVID-19), that individual should self-isolate and monitor his/her symptoms. If possible, have them use a separate bathroom and bedroom. If symptoms become severe, seek medical treatment. 

Others in your home should also stay home and wear masks when you enter common living areas.

While transmission is possible via fomites, inanimate object that can transmit disease (such as door knobs and tissues), that is not the main route of transmission. The best way to reduce the risk of this type of transmission is frequent cleaning of the high-contact surfaces and good hygiene practices.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am having surgery in a few days and have to have the swab test done. I think I had the virus in February and am wondering if I can pass the test. I am well and have no symptoms. Also, my dad had coronavirus this winter. Is it safe for me to travel out of town and see him this close to surgery? He is perfectly well now.”

The answer:

Chan Soon-Shiong Medical Center at Windber also requires pre-operative Polymerase Chain Reaction (PCR) swab testing for patient care and safety of operating room personnel. I suspect your PCR swab test will be negative since you feel well and have no symptoms. A blood test for COVID-19 IgG antibodies will be helpful to determine if you were infected with the SARS-CoV-2 (COVID-19) virus in February 2020.

I do not recommend traveling out of town this close to surgery because of the exposure risk. I do recommend continuing good hand washing hygiene, wearing a mask and following other CDC recommendations.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

 •  •  •  •  •

“My sister and her husband had developed symptoms on May 23. They were symptom-free as of June 19. They tested three times PCR. The first two times the results were borderline, the third time for my brother-in-law the result was positive and my sister was borderline. They don’t have any symptoms except they didn’t restore the sense of smell and taste completely. So what does that mean? To be positive while you are recovered and also are they infectious?”

The answer:

The nucleic acid amplification test is designed to look for active infections. It is possible that they are still infectious since symptoms are still present (loss of sense of smell and taste). If they want to rule out active infections, they can request an antibody test. In the meantime, please have them self-isolate to avoid spreading the virus.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

 •  •  •  •  •

“I had a COVID antibody test done just for the heck of it because I was already getting other blood drawn. The IgG was negative, but the IgM was positive. My doc deemed the whole test negative. Well, after I looked at my chart and discovered that the IgM was positive, I started researching online. I learned from your site (www.tribdem.com) and another site that if you test positive for the IgM one, then that means you are either currently infected or recently recovered from it. I called my doctor’s office and after informing them of the differences between the two antibody tests, they agreed to order a COVID-19 swab test. I won’t hear back for 24 to 48 hours. So, in the meantime I’m of course anxious about it. If I have it, I wonder if my husband and two kids do as well, and of course worry about every little symptom I may develop. So basically I guess my question is: If I had my blood drawn on a Tuesday and the test that I just got back last night shows I’m IgM positive but IgG negative, where would I most likely be at in the sickness phase? My only symptoms are a slightly stuffed up head and a little phlegm in my nose and in the back of my throat that I have had for the past few days. Just tonight I started getting a low-grade fever of 99.6. Would the worst be over or yet to come?”

The answer:

SARS-CoV-2 (COVID-19) antibodies include IgM and IgG. IgM is usually the first antibody produced by the immune system when a virus attacks. A positive IgM test indicates that you may have been infected and that your immune system has started responding to the virus. IgM detection with COVID-19 is a median five days (range three to six days). I agree with a Polymerase Chain Reaction (PCR) swab test. While you wait for your PCR result, you should:

• Quarantine and self-isolate to your home in a private room and use a private bathroom if possible.

• Whoever else lives in your home should also stay at home.

• Wear a mask when you enter general living areas. Interact with others as little as possible.

• All family members should wash hands regularly with soap and water.

• If you develop additional symptoms, or if your symptoms get worse, notify your physician.

Further instructions will depend on whether the PCR swab test is positive or negative.

Finally, I also recommend repeating the IgG blood antibody test in two to three weeks. IgG antibodies are detected in most patients 10 to 21 days (median 14 days) after symptoms of COVID-19 begin. IgG antibodies remain in the blood after the infection has passed.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

A reader of The Tribune-Democrat asked:

“I have been throwing my mask in the dryer on high heat for two or three minutes. Shouldn’t the heat kill any virus?”

The answer:

It is best to wash the masks in warm, soapy water, but if that isn’t possible the dryer on high heat for 10-15 minutes will suffice.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My question is: A person who tested positive and had coronavirus, can they still infect other people even after the 14 days and testing negative for the second test after they quarantined? I’m very concerned about that. Do scientists know if it could still be spread after the positive then negative test results? I have two small babies and I’m very worried. I’d appreciate an answer to this as I cannot find this on the internet anywhere.”

The answer:

We are unsure at this time about reinfection with SARS-CoV-2. A positive test after symptoms have ceased does not mean that the person is shedding virus that can be or is infectious.

Recent studies out of South Korea show that it is unlikely that persons who are testing positive for the virus via the genome test are not infectious. What the study suggests is that these patients have dead or non-infectious virus and that is what is being detected. Of course, more research is needed.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“Can a person who has tested negative still be carrying the virus and infect someone else?”

The answer:

There are two different types of tests for SARS-CoV-2, the virus that causes COVID-19. The genome test looks for viral RNA from a swab of the tested individual. The other type of test is an antibody test. This tests for an immune response to the virus in the form of antibodies being made by the body.

Tests are measured on two criteria, sensitivity (can the test detect small amounts of the viral genome or antibodies to the virus) and specificity (does the test detect only the virus and no other pathogen indicating there is no cross reactivity).

The FDA recently released determinations on how the tests are performing. These determinations had to make some assumptions due to the unknown prevalence of infection in the USA. They assumed a 95% confidence interval, meaning they are about 95% sure the tests will fall within the ranges they have set for detection. The results of these determinations show that the majority of the test available (14/16) are able to detect positive patients 90% of the time or greater (they are sensitive and specific).

No test is going to capture all positive individuals (false negatives happen) and tests also return false positives (individuals who are negative but test positive). As more testing is done, more data is gathered and the testing specificities and sensitivities can be adjusted accordingly.

If you’d like to see the FDA report, this website will give you the results of the determinations done thus far at https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“Will students have to wear masks to school this fall semester because of the coronavirus?”

The answer:

The Pennsylvania Department of Health along with the Centers for Disease Control and Prevention have given a list of preliminary guidelines that include health and safety plan considerations. Among those guidelines is the use of masks in Pre-K through 12th grades.

Each school will have to design its own health and safety plan and have it approved by the board of directors. Once that plan is approved by the directors, it must be sent to the Pennsylvania Department of Education and posted on the school’s website.

For more information on what Pennsylvania is recommending to the school districts, please navigate to this link: https://www.education.pa.gov/Schools/safeschools/emergencyplanning/COVID-19/SchoolReopeningGuidance/K12/Pages/default.aspx

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“I’m an RN. Thankfully, the pediatric population I care for is isolated. I only go to work and home. My husband gets groceries and other necessities and is diligent with wearing a face mask, wiping down all areas of the cart, etc. My daughter and granddaughter do not leave our home.

“One week ago my temperature was 99.9 and I was chilled to the bone, then a cough developed. Tested negative on May 30. Had virtual visit with my care providers on June 2 for increasingly productive cough, intermittent wheezing, increased fatigue. Was started on Albuterol inhaler, doxycycline and bromfed.

“My cough is very persistent, no relief to my chest heaviness.  Whenever I eat, drink, talk or move, coughing is triggered.

“Should I get tested again?”

The answer:

First, I thank you for your nursing care.

Regarding your question, your symptoms may or may not be related to coronavirus disease or other illness. I would repeat a molecular Polymerase Chain Reaction (PCR) swab test, and I also suggest a blood test for SARS-CoV-2 IgG antibodies to evaluate your immune response.

I’m concerned about your persistent cough and chest heaviness. Therefore, I also strongly recommend you contact your treating physician as soon as possible for further evaluation and treatment. You must continue good hand-washing hygiene and wearing a face mask.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

A reader of The Tribune-Democrat asked:

“I have heard that results of a COVID-19 test can also tell which day and which time exactly it enters the infected body. Is that true?”

The answer:

False. I’m not aware of such a test.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

A reader of The Tribune-Democrat asked:

“My daughter, who is a nurse, tested positive for COVID-19 on May 10. She stayed home from May 6 to May 23. She returned to work May 26. Is it safe for me, her 62-year-old mom, to take care of her baby?”

The answer:

An interesting question with unknowns.

First, I assume you and the baby have no symptoms or fever. 

Second, were you exposed to your daughter when she was sick and before or when she was quarantined?

I recommend you get a blood test for SARS-CoV-2 (COVID-19) IgG antibodies. In my opinion, it is probably safe for you to care for the baby. However I would wait for your antibody test result, and I recommend you ask the baby’s pediatrician if it is safe.

I also advise you to follow precautions including wearing a mask and good hand washing hygiene.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

A reader of The Tribune-Democrat asked:

“If you have been around someone with COVID-19 antibodies, do you have to quarantine?”

The answer:

SARS-CoV-2 (COVID-19) antibodies include IgM and IgG. IgM is usually the first antibody produced by the immune system when a virus attacks. A positive IgM test indicates that you may have been infected and that your immune system has started responding to the virus.

IgM detection with COVID-19 is a median five days (range three to six days). IgG antibodies are detected in most patients 10 to 21 days (median 14 days) after symptoms of COVID-19 begin. IgG antibodies remain in the blood after the infection has passed.

IgG antibodies also indicate that you may have had COVID-19 in the past, and these antibodies may protect you from future infection. It is unknown at this time how much protection antibodies might provide against reinfection.

If the individual had a positive IgM antibody test, I recommend a molecular Polymerase Chain Reaction (PCR) swab test and quarantine until the PCR test result is available.

If the individual had a positive IgG antibody test and symptoms – such as fever, cough and/or shortness of breath – 10 to 21 days ago, I also recommend a PCR swab test and quarantine until the PCR result is available.

If the individual has positive IgG antibodies, no recent symptoms and no fever, then no further testing is indicated and quarantine is not necessary.

In summary, it depends on which antibody was detected and if the individual had recent COVID-19 symptoms and/or fever.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If two relatives had coronavirus and are now negative, am I safe to be with them if I have not?”

The answer:

A recent study from the Korean Centers for Disease Control and Prevention tracked 285 COVID-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved, as indicated by a previous negative test result. The virus samples collected from them couldn’t be grown in culture, indicating the patients were shedding non-infectious or dead virus particles.

So once you recover, and you have no symptoms or fever, it’s safe to go out in public. However, I would recommend continuing to follow CDC precautions, including social distancing, good hand-washing hygiene, and wearing a face mask.

Since the pandemic was just recently declared on March 11, there is no data on long-term immune response.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“After much concentration with social distancing and staying at home I inadvertently drank from a soda my granddaughter had been drinking from. She is from a family of four with no apparent symptoms. I am 70 years old with Type 2 diabetes. Is there testing we should have done following this incident or any additional measures? I’m nervous that after all my efforts the past 2 1/2 months that I will contract the virus.”

The answer:

I congratulate you on all your efforts and safe practices. In my opinion, no testing is indicated unless you develop any symptoms or fever, and no additional measures are needed.

I believe your risk is very low concerning the one incident which you described, and I would not worry. I do recommend that you continue social distancing, good hand washing hygiene, and wearing a face mask. You’re doing a great job!

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My employer has required me to have two negative tests before returning to work. How long do I have to wait after my first negative test before I can get my second test?”

The answer:

The CDC has placed guidelines concerning returning to work after recovery from COVID-19. 

These guidelines state that an individual should have two consecutive negative results of an FDA-approved COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected greater than 24 hours apart.

Therefore, the least amount of time between testing that can occur is 25 hours.

It is important to point out that an individual must have two consecutive negative tests, and results for these tests can take several days to be returned to the individual.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“I am a personal trainer who has had an 89-year-old client request that I come to her home to train her. Besides being a trainer, I also have a part-time job at a regional airport near my home where I handle bags and check in passengers, as well as cleaning the plane. I am very careful when I work about wearing a mask, gloves, using social distancing and washing my hands. Is it safe for my client if I train her?”

The answer:

I’m glad that you are using personal protective equipment (PPE) and practicing good hand-washing hygiene. The question of risk exposure for an 89-year-old individual is not insignificant, even though you are taking appropriate precautions.

In the United States, the highest incidence of severe outcomes with COVID-19 were in patients older than 85. Therefore, visitors – other than caregivers – are not recommended.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I am 75 and have Post Polio Syndrome, chronic bronchitis and shingles. My husband is going back to work at an auto glass manufacturer. How can I isolate in my home? We also have three dogs. Could they carry the virus to me if he gets sick?”

The answer:

Self-isolate in a private room and use a private bathroom, if possible. Wear a mask when you enter general living areas. Follow other Pennsylvania Department of Health and CDC recommendations and precautions including good hand-washing hygiene and frequently clean with a sanitizer common surfaces you may both touch.

CDC is aware of a small number of pets worldwide, including cats and dogs, reported to be infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19. Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I have symptoms of COVID-19 and am scheduled to do my test this morning. It will take two days to get results. Is it safe to use my inhaler and nasal spray? And if my test is positive, is it safe to use my inhaler and nasal spray?”

The answer:

“I’m not aware of any inhaler and/or nasal spray contraindications with SARS-CoV-2 (COVID-19). I recommend that you follow-up with your primary care physician.”

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If the virus has a very short life in/on non-living environments, why is it so important to deep clean spaces that have been vacated for several months? 

Wouldn’t routine cleaning suffice before the space is occupied again?”

The answer:

Cleaning spaces that have been vacant for several months with a deep cleaning is a good idea in general. Many microbes could be present on these surfaces (Staphyloccous and Streptococcus species for example).

There have been news stories circulating that the CDC has changed their guidelines on how SARS CoV-2 spreads. This is untrue. The CDC merely placed the contaminated surfaces under a subcategory stating that the virus does not easily spread via contaminated surfaces. Both the old and new versions of the recommendations state that it is known that the virus can survive on contaminated surfaces for hours to days depending on the surface.

The best way to reduce risk of infection is to wash your hands regularly and clean surfaces with soap and water followed by a disinfectant.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband had COVID-19 symptoms, a sore throat, and because he is 63 years old, we wanted to check to see if he is OK. His results came back positive and he is on a 14-day quarantine. We have now all been tested in the family. So far my youngest daughter’s results came back negative. Should she move out to be safe?”

The answer:

I am assuming the test that all of you received was the genome test. If your husband was positive for the genome, that is indicative of an active infection. This means he is contagious. He needs to quarantine himself and limit the exposure to other family members. It is recommended that high-touch surfaces be cleaned multiple times a day as well.

It is prudent for your daughter (and any other family member who tested negative) to self-isolate in a separate part of the home. Since she is currently living in your home and your husband tested positive, there may have been exposure to SARS CoV-2 since the testing. Testing gives us a snapshot of what is occurring, and since you are all in the same household, there could have been exposure after testing.

If she has a place to go to for 14 days where she is not risking exposure to others, you may want to consider having her go there.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“If I pick up the virus from someone at noon, how soon do I start infecting others?”

The answer:

A small number of studies suggest that some people can be contagious during the incubation period, the time between exposure to the virus and the onset of symptoms. The incubation period for SARS-CoV-2 (also known as the COVID-19 virus) is estimated to be between two and 14 days, with a median of five to seven days (possibly longer in children). Greater than 95% of patients develop symptoms within 10-12 days of infection.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My ex and I have shared custody. She just called to say she’s in quarantine – waiting for COVID-19 test results. I have the children now, but she had them last week before her quarantine. 

Do we need to quarantine now until we hear her results? From a concerned father.”

The answer:

Yes, self-isolate to your home while you wait for her results. Whoever else lives in your home should also stay at home. Close contacts are people who have been within six feet of you for a period of 10 minutes or more. If you or the children develop symptoms, notify your health-care provider for instructions and testing. 

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“How can I keep COVID-19 from spreading in my home once I turn on my whole-house air conditioning? My husband works and I am doing my best to isolate him in his room and a bathroom across the hall.”

The answer:

There have been two studies that show the airborne droplets containing SARS-CoV2 can spread farther than six feet when the airflow in a room is increased (either from an air conditioner or a heating system). These systems often draw air in from a room and cool it, sending the cool air throughout the home and the heat outside. This type of system has the potential to circulate the virus in a home if someone is infected.

A study out of the University of Oregon together with the University of California-Davis says the best way to reduce the spread of the virus and still ventilate a room is to open a window. Opening a window in the home will reduce the possible virus concentration by increasing the concentration of air from the outside.

If you can’t open the window (allergies, asthma, 95-degree heat) and there is concern that someone in the home is infected (showing symptoms, asymptomatic or exposed), you could block the intake vent in the room(s) that individual is isolating in. 

Duct tape can cover the vent and help to reduce the spread of the virus through the home.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“Is there a COVID-19 test my 3-year-old grandson can take that would allow him to stay with us for a day or two if he tests negative? I am 71, and would do anything to see him again.”

The answer:

Molecular (Polymerase Chain Reaction – PCR) swab test detects RNA from SARS-CoV-2, also known as the COVID-19 virus. If the PCR is positive, the patient is considered infected with the COVID-19 virus and presumed to be contagious.

You mention testing your grandson, but also consider testing the grandparents as well. However, it is important to emphasize that a negative PCR does not exclude COVID-19. 

Also, realize that the mean incubation period for COVID-19 is five days, and the range can be two to 14 days. This means that a negative result does not rule out infection.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If a person’s antibody IgG and IgM came back positive, are they able to spread the virus because of the IGM result?”

The answer:

Testing shows us a snapshot of what is happening with a person and his/her course of disease. The two types of antibody tests are looking for a particular type of immune response.

When we are exposed to a pathogenic microbe, our immune system has two ways to defeat it.

The first is called the innate response. This response is encoded in our DNA as a human. 

It is nearly the same for all of us (with minor differences). This response causes inflammation. It is non-specific and only reacts to each pathogen based on its particular type. 

For example, all bacteria are treated the same. It cannot distinguish Streptococcus pyogenes from Staphylococcus aureus. It doesn’t distinguish an adenovirus from the Ebola virus.

Most of the time, this innate response kills the invading microbe. When it doesn’t, that is when we see symptoms of a disease. 

When the innate response can’t destroy all of the microbes, then we see the adaptive response.

The adaptive response is specific. This response is different in every individual. 

We have a complex immune genetic system to take gene segments and piece them together to create an entirely new gene. It’s called somatic recombination. Our germline DNA is pieced together to give us a new never before seen gene to fight a specific pathogen. 

That gene is then turned into a protein and made into an antibody for the specific pathogen.

The first antibody made when fighting that response is IgM. If this is found in a test, it indicates the person is in the early stages of the specific response to the virus. IgG is made later, about 14 days into the infection, in the specific response – and is often the antibody that allows our immune response to remember the infection (it is made for a few months to years after an infection).

If a person tests positive for IgG, that would suggest the individual was infected sometime in the past. If he or she is symptomatic, the person would still be able to transmit the SARS CoV-2 to others, but in most cases the IgG test would be positive after the disease has run its course.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“If a person had COVID-19 in the past, let’s say in February, and takes the test again in May, is the test going to show negative? In other words you could have had coronavirus in the past and it would test negative now? 

“So, the only way to find out if you had it in the past would be the antibody test, correct?”

The answer:

Great questions, and it all comes back to testing and more frequent testing. There’s some very recent positive data out of South Korea which I’ll discuss below.

Your questions refer to the different types of tests. One test is the molecular swab (Polymerase Chain Reaction – PCR), which detects genetic RNA from SARS-CoV-2, also known as the COVID-19 virus. The other test is a blood IgG antibody, which determines if someone was previously infected, or was recently exposed to the virus 10-21 days ago.

If you had COVID-19 infection in February, the PCR swab test would probably be negative now, and the blood IgG antibody test would probably be positive (indicating prior infection). Recent data out of South Korea suggest that if the repeat PCR swab test is positive, that may be detecting dead virus, rather than indicating reinfection. And the positive IgG antibodies may provide some protection.

Because the pandemic is only a few months old, there is no data on long-term immune response.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“When older adults fly, can they get tested upon arrival so they don’t need to be secluded for 14 days?”

The answer:

The tests that are available on the market are antibody tests and SARS CoV-2 genome tests.

The antibody tests show if a person is having an adaptive or specific response to the virus; the genome test is indicative of an active infection, as viral RNA is present. These tests, particularly the genome test, give a snapshot of what is happening on that day.

Individuals who are exposed to SARS CoV-2 won’t show symptoms for five to seven days, on average. A test upon landing would not be sufficient to say that the individual is not in the incubation period of COVID-19.

The person could have been exposed to the virus on the plane. This is why the 14-day quarantine is recommended.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband and I tested positive in March, then after two weeks, we had no symptoms. We got retested last week and are both positive. Why would this happen?”

The answer:

An excellent question that has relevant implications.

I assume the tests were molecular PCR (Polymerase Chain Reaction), which detects genetic RNA from the COVID-19 virus. If you and your husband don’t have any symptoms or fever, this implies both are now asymptomatic carriers. It is not known how long you will remain a carrier without symptoms, and that may depend in part how long protective immunity will last.

I recommend you and your husband consider blood tests for IgG antibodies to SARS-CoV-2. 

It is unknown if both are still contagious, and that’s why it’s important to wear face masks in public and continue social distancing. While the evidence on reinfection is evolving, current data and experience from previous viruses without substantial seasonal mutation do not support this hypothesis.

Because the COVID-19 pandemic is only a few months old, there is no data on long-term immune response. It is also controversial when asymptomatic carriers may return back to work. I recommend both of you follow up with your primary care physician, and if necessary, consult an infectious disease specialist.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have read that scientists are working on testing community spread by testing water from the sewer. 

Would it be possible to develop individual urine tests (akin to pregnancy testing) that could inform a person positive or negative for the virus on a daily basis?”

The answer:

To my knowledge, there are only two kinds of tests for SARS CoV 2, a genomic RNA test and an antibody test. The RNA test is looking for viral genetic material in patients and the antibody test is looking for the presence of an immune response to the virus.

SARS CoV 2 has been detected in feces of infected patients, but it is not clear whether that virus is infectious. In addition, waste water has been shown to contain the virus, but standard municipal sanitation practices or use of a septic tank has been shown to inactivate the virus.

Urine contains waste products from the human body that can be dissolved in water. Hormones, sugar, vitamins and certain proteins can be found in urine. RNA and DNA can be found in urine as well. 

Urine tests, such as those you mention in your question, require a high concentration of the substance to be in the urine.

A recent study out of China was able to detect SARS CoV 2 in urine of one patient out of 17 with confirmed disease. Other peer reviewed studies were unable to find viral RNA in urine. These studies used a technique called RT-PCR to detect the viral RNA. This technique amplifies minutely small quantities of viral RNA and brings the concentration up to detectable levels.

Who knows what the future holds? That is the beauty of science. But at present, we do not have the ability to detect the minuscule amount of viral RNA in urine without amplifying it first.

•  •  •  •  •

“I am a cashier at Walmart. I had something similar to COVID-19 in December, however no breathing problems. Am I safe to visit my 2-week-old grandson? I shower, wash my hair and wear clean clothes and wash my hands when visiting. I also work daily, sanitize frequently and wash my hands every chance I can. I also wear a mask when working and visiting. Am I putting my grandson in danger?”

The answer:

Social distancing is hard and it must be truly difficult when a new family member is born.

When we are first born and until we are about a year old, our immune systems are immature. The responses we build to microbes takes time and the littlest among us have not been around long enough to have the same responses that adults or even older children do. This makes infants more susceptible to infections.

In a recent study out of China, of more than 2,100 children with suspected or confirmed COVID-19 in between late December and early February showed that about 11% of infants had severe or critical illness. Children in other age groups had lower rates of severe or critical illness (about 7% for children ages 1 to 5, 4% for ages 6 to 10, 4% for ages 11 to 15).

Other studies are showing an inflammatory illness that may be linked to COVID-19. This response that is seen in children is severe and rare. It has to deal with an immune response that leads to a cytokine storm. Our innate response, the one we are born with, has the ability to make our blood vessels leaky in order to let white blood cells into our tissues where the infection is. It does this by releasing cytokines, proteins that allow the immune system to communicate with cells and tissue of the body. This response is usually localized, but in some children it becomes systemic causing the blood vessels all over the body to be leaky; this results in severe symptoms such as organ failure and shock.

From your question, it appears that you are doing things to reduce your risk of infection. If you feel that you had COVID-19 in December, I urge you to request an antibody test. This could help determine if you did have COVID-19.

With respect to visiting your newborn grandson, I support respecting the community directed stay-at-home orders. He is still developing his immune system and is in a risk group because of his age. You and your family can speak with the child’s pediatrician to see what the case counts are in your area and then determine what level of risk is acceptable to you as a family.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“Can you be a carrier of COVID-19 and not have any symptoms – as in you’re immune to the virus but still carry and spread the virus?”

The answer:

Yes, there are asymptomatic carriers, however no one can truly determine the impact of asymptomatic cases on spread until there’s more testing.

Can these people who are completely asymptomatic, who never develop any symptoms, transmit the infection? That’s still an open question, and no one knows for sure. Experts say these carriers without symptoms make it even more important for people to wear face masks in public.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I was really sick with upper respiratory turned into bronchitis turned to pneumonia in late December to middle of February. Is it possible I had COVID? Would an antibody test still show antibodies if I did? I had almost all the symptoms.”

The answer:

When did SARS CoV-2 emerge? 

That is one of the big questions of 2020.

Science uses a method called the molecular clock to determine when new pathogens emerge. 

SARS CoV-2 is an RNA virus. It uses an enzyme to copy itself called RNA dependent RNA polymerase. This enzyme is sloppy in its copying. The rate of mistakes it makes is able to be tracked.

Using this technology, scientists at the Imperial College of London collaborated with the World Health Organization to determine that SARS CoV-2 emerged between Nov. 6 and Dec. 13 in Wuhan, China. Couple the new respiratory virus with the ability to be anywhere in the world in 24 hours and ...

Testing can help sort out whether a person has recovered from COVID-19. The test that will determine if a person has had an immune response to the infection is the antibody test. IgG antibodies are present in a person after she or he has had an infection that resulted in an adaptive (specific) immune response.

If you are curious about your status, you can seek out an IgG antibody test. The more data that can be acquired about positive cases, in any stage, will help answer the question of when. It is possible, however, that we will never know when it emerged.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am wondering how it could be possible to see my significant other during the coronavirus pandemic. We live separately, and I have been quarantined while he has continued to do basic things such as grocery shop and goes to work two times per week, always following recommended precautions. We are wondering if he were to do a PCR test for coronavirus RNA combined with an IgG and IgM antibody test, could this provide a sufficient picture upon which to base a decision to see one another, or not? “

The answer:

Social distancing is so hard! All of us have someone we want to see.

In public health there is something called risk reduction. It refers to using strategies that minimize the risk or harm certain human behaviors come with – for example, wearing a bicycle helmet when riding a bike. If you wear a helmet, you are less likely to have a traumatic brain injury if you wreck. You still ride the bike, just in a safer way.

With SARS CoV-2, becoming more lax on your social distancing is not the same as wearing a bicycle helmet when riding a bike. SARS CoV-2 is spread via airborne droplets by people who may not know they are sick yet. Even people who are practicing social distancing may not know they have been exposed because they could have come in contact with people who don’t know they are infected yet.

Testing can help. The test for genomic RNA of SARS CoV-2 will let a person know if he or she is actively infected at that time. The antibody tests would show that you are in the first stages of an adaptive immune response (IgM) or that you are in the later stages or recovered from COVID-19 (IgG). 

However, this is only a snapshot of the infection risk. It only says that at the time of the test, the individual is SARS CoV-2 free. If that individual goes out in the community the next day, he or she could be exposed to someone with the virus and become infected.

Until we have more testing, two-thirds of our population recovered, or a treatment is found, it is best to keep socially distant.

As always the risk assumption is yours; however, the recommendation is to maintain social distance. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Are drug users, especially intravenous, more likely to spread COVID-19 or other viruses and diseases than non-drug users?”

The answer:

SARS CoV-2 is spread via respiratory droplets. Anyone can spread the infection if they have symptoms and we are seeing studies that show asymptomatic transmission in about 35% of individuals (recent studies from the New England Journal of Medicine).

Now is a good time to remind everyone that human behavior contributes to the spread of any infectious disease. When we consider COVID-19, we can reduce the spread by wearing a mask in public, washing our hands, and maintaining social distance.

Injection drug users are at a greater risk for blood-borne pathogens, such as Hepatitis and HIV, as well as having a greater risk for sepsis, a bacterial infection in the blood. As for other drug users, according to the National Institute of Allergy and Infectious Diseases, because SARS CoV-2 attacks the lungs it could be a serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health.

In short, anything that decreases lung functioning can lead to more severe COVID-19 disease.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am a nanny and was asked to enter the family’s home wearing a mask. I assumed they (mom, dad and 41/2-year-old) would also be wearing masks. They did not. I wear one to protect them and vice-versa, correct?”

The answer:

There are no formal guidelines on what should be done in this situation. Childcare is a necessity for many families, even if they are working from home. In this situation, I would recommend that you all (mom, dad, child and nanny) keep each other apprised of your health situation. Have a discussion about your exposures and risk factors for SARS CoV-2 (for example, do you live in a home with an essential worker) be truthful about each other’s movement (or lack there of) in the community. If you are nannying for another family, be sure to inform all parties involved.

After this conversation, decide together on a safety plan that makes everyone comfortable.

For example, everyone has their temperature taken daily before work starts. If symptoms become apparent, all are notified.

Maybe you have certain rooms that are for family only in the home, maybe you and the child remain in one area of the home.

Through working together as a unit, you can be sure to address all concerns and come to an agreement in which everyone feels safe.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“The news keeps saying people under 18 rarely transmit the disease. However, what evidence is this based on? I read that children under 18 don’t get the disease, or very mildly and don’t transmit. But how many children have had the disease? How many children under 18 have actually been tested? If we do not have facts on children under 18 how can we say that they rarely get it and they do not transmit it?”

The answer:

We don’t have all the facts yet on how COVID-19 affects different populations, or know how many people have had the virus. And this is especially true with children.

It seems that children may not have symptoms that are severe, but we do know they get the virus. There have been a few cases (not locally) where kids are intubated, and respirators were used for children. Children can still pass the virus to their older family members who can have much more severe symptoms.

Everyone, including children, should follow the recommended precautions to prevent the spread of the virus.

– Dr. Uchenna Okereke, infectious disease specialist, Conemaugh Physician Group.

• • • • •

“Is it safe for my young children to visit grandparents? We have not left the house since March 12, aside from work. My husband and I are both health care workers. Grandma has also been self-isolating at home. Now that some restrictions are being lifted, we were wondering if family visits are OK. My 2-year-old misses his grandparents terribly.”

The answer:

Social distancing is hard on our mental health. It can be even harder for young children. My students and I created a toolkit that contains some information on how to talk to your child about COVID-19. Here is the link: www.johnstown.pitt.edu/coronavirus-toolkit.

As of now, our region, the southwestern portion of Pennsylvania, is under stay-at-home orders. This is to decrease our exposure to other individuals. We do this because of the R0 – the number of how infectious a virus is. If the average R0 in the population is greater than 1, the infection will spread exponentially. If R0 is less than 1, the infection will spread out be it slowly, and it will eventually die out. For SARS CoV-2 that number is 2.5-3. This means that one infected individual can infect up to 3 others.

If a person is expressing symptoms of COVID-19, we know to stay socially distant; however, studies have shown that asymptomatic transmission is occurring. This means that some individuals could be spreading the virus and appear to be healthy, making it difficult for anyone to know if they have been exposed or not.

The choice is, of course, yours. 

But the recommendation is to maintain social distancing in our area.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown 

•  •  •  •  •

“Do current COVID-19 tests tell you what stage of the disease you’re in? Two family members were tested, with someone going to their home and drawing blood. The next day, one of them was told they were at the acute stage of the virus and that the other was at the end stage of COVID. I have not heard that kind of testing before and am concerned they are being scammed. 

“I have only heard positive, negative results; or positive or negative for the antibodies. Why these different tests?” 

The answer:

Molecular testing identifies people with the virus, and an antibody test can tell whether someone has been previously infected.

Qualitative real-time reverse transcriptase Polymerase Chain Reaction (PCR) nasopharyngeal swab is either positive or negative. If positive, this indicates that RNA from the virus was detected, and that the patient is considered infected with the virus and presumed to be contagious.

There are several types of COVID-19 antibody blood tests. 

One is a blood finger prick IgG/IgM Rapid Test which takes 10-15 minutes for the results and are either negative or positive (a colored line appears, just as a pregnancy test). The IgM test line is usually positive (colored) four days after becoming infected with the virus, but “false negatives” can occur if within less than four days, because the incubation period is estimated to be between 1-14 days. 

IgG antibodies are usually detected (colored line) 7-21 days after symptoms develop, and this test also identifies if someone has been previously infected. 

IgG testing can also be done on a lab machine – which requires a tube of blood, and takes approximately 45 minutes to 1 hour. The results are reported as positive or negative based upon a cutoff numerical result.

Therefore, a positive IgM antibody test result indicates early COVID-19 disease, and IgG indicates a later phase, or someone who has been previously infected. Antibody testing has received Emergency Use Authorization (EUA) from the FDA. Antibody testing is being reviewed by the FDA, and final FDA approval is pending.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •  

“What is the possibility of getting virus from meat with the problems the packing plants are having?”

The answer:

SARS CoV-2 is transmitted by respiratory droplets. While there are many reports of workers at meat packing plants getting sick with COVID-19, there are no reports of transmission via food.

It is good to remember that SARS CoV-2 is able to be viable on plastic for a few days. It is good to follow hygiene practices to prevent the spread: wipe your packages down and wash your hands after putting your groceries away.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My wife is returning to the United States from Warsaw, Poland. She is taking a train from Warsaw across the Polish/German border to Frankfort, Germany, directly to its airport. She is an American citizen with a valid passport, a plane ticket, and has submitted all required forms to the Polish government and U.S. Consulate in Warsaw and Berlin.

“When she arrives at her hub U.S. airport, she will be screened at Washington Dulles, and after screening is advised (not ordered) to self-quarantine upon her arrival at her ultimate destination, Indianapolis, Indiana. Is there an appropriate location where she should go for 14 days to self-quarantine alone? I assume she cannot go to our residence where our family, children and me, are already in self-quarantine.

“Finally, if I can arrange for her to be tested for the COVID-19 virus either serologically (finger-prick testing) and/or nasal swab testing, and the results are negative for the coronavirus, is it then prudent for her to come to her family at our residence and self-quarantine with us?”

The answer:

Ideally, she should self-quarantine (self-isolate) in a private apartment. If a private residence is not available and she wants to stay with her family, then she should self-isolate in a private room (basement or other private portion of the residence), and use a private bathroom if possible. 

Whoever else lives in your home should also stay at home.

If she tests negative, she still needs to self-quarantine/self-isolate for 14 days in a private room and use a private bathroom, because the incubation period for the virus is estimated to be between one and 14 days. After 14 days, if she has had no known exposure to a confirmed case, and she remains asymptomatic, she can stop the self-quarantine.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I wanted to pass out roses on Mother’s Day. Can you get COVID-19 by someone holding the stem that has COVID-19 or will it not affect flowers?”

The answer:

We know that SARS-CoV-2 is viable on many surfaces for a few hours to a few days. However, plants are not one of the surfaces that have been tested.

Since the virus is spread via respiratory droplets, it is more likely that someone with COVID-19 would transmit the infection when they coughed near you, not from touching the flower.

As with anything we touch, it is good to practice hand hygiene and avoid touching your face until you have washed your hands. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My 90-year-old mother lives with me. She recently had a fall and was sent to a nursing home rehabilitation facility. While there, she tested positive for the virus without symptoms. When she does get to return home, should I be tested due to my suppressed immune system? I have most of the symptoms listed for COVID, but have not been tested.”

The answer:

Since you have symptoms, a history of immune suppression, and a known exposure to a confirmed case (your mother), I recommend that you get a PCR (Polymerase Chain Reaction) nasopharyngeal swab test – which detects RNA from COVID-19.

This test will require a physician’s order. If this test is positive, the patient is considered infected with the virus and presumed to be contagious.

You should self-isolate in your home while you wait for your result. What you subsequently should do depends on whether your PCR test is positive or negative. I recommend you follow up with your primary care physician.

I would also consider a blood test, which detects IgG antibodies to the protein of SARS-CoV-2.

This antibody blood test is being reviewed by the FDA.

It is not known for certain whether individuals infected with COVID-19 and who subsequently recover will be protected, either fully or partially, from future infection with COVID-19, or how long protective immunity may last.

Concerning when your mother can return home, that depends on her condition and progress at the rehab facility. I suggest you ask her physician there.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My cat has tested positive for the coronavirus. I have no symptoms and haven’t been tested. I informed my employer and after working most of my shift he sent me home stating I have to get tested and I need to have my vet send over my cat’s records. Can they do that?”

The answer:

Cats get the intestinal form of coronavirus that can cause diarrhea. They also so get feline infectious peritonitis (FIP), which is also a coronavirus that is deadly to cats. This is not COVID-19 and is not zoonotic to humans.

So when you said the cat was tested, do you mean tested and positive for coronavirus or COVID-19? If your cat is positive for intestinal corona or even FIP, then there is no risk of infection to humans. If it is COVID-19, which I highly doubt, it is a reportable disease to health officials.

According to the CDC guidelines, there is no need to get tested if you do not display any of the symptoms they mention – such as coughing and fever. Finally, until now, there is no scientific evidence of transmitting COVID-19 from animals to humans. More important, corona virus in cats (intestinal form) does not equal COVID-19 at all.

– Dr. Fayez Assad, medical director, Johnstown Veterinary Associates

•  •  •  •  •

“Should we assume the opening up to the green phase will be months away from now? When do you expect large gatherings such as wedding receptions, concerts, etc., to be allowed again?”

The answer:

The reopening of Pennsylvania, and our region specifically, to the green phase is going to be decided by case data. As it stands now, a region must have 50 new cases or fewer in a 14-day period to move to the yellow phase. The green phase will follow that – when we see a sharp decline in cases.

The decision to move through the phases is going to depend on data. That data is dependent on accurate testing and contact tracing of individuals who are infected. The Pennsylvania Department of Health is working to collect the most accurate data with Carnegie Mellon University.

An important thing to point out here is a number we call the R0. 

This indicates the contagiousness of an infectious disease. For COVID-19, this number is between 2.5 and 3.0. That means that one infected person will transmit the disease to as many as three people. To move to the green phase from the yellow phase is going to require people to follow the rules. 

If the public observes the rules – wearing a mask when out in public, aggressively washing their hands, and avoiding gatherings of 25 or greater – then we can move through the yellow phase more quickly.

In short, we are in this for the long haul. Viruses such as SARS CoV 2 don’t go away. We must either have a vaccine to prevent the disease or have two-thirds of the nation recovered from the illness. I implore everyone to urge officials to make more testing available, to aid public health officials when asked for information, and to limit your exposure to others (until one of the above occurs).

Together is the only way we can decrease our time apart.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

"I had severe symptoms in March, was hospitalized and tested. The test came back positive on March 16. My husband had mild symptoms, but he wasn’t hospitalized nor tested. As an essential worker, I had to be re-tested in order to go back to work, so on April 23 my husband and I got tested. I was negative and he was positive. Now what do we do?"

The answer:

The CDC recommends two strategies for returning to work. One is a test-based strategy that states you should have two consecutive negative molecular (genome) tests in which the swabbing has been done greater than 24 hours apart. The other is a non-testing based strategy where you must be fever free for 3 days and be at least 7 days removed from when symptoms started.

The CDC also recommends that an individual with a laboratory confirmed case who is asymptomatic should wait 10 days before returning to work.

This situation is in the in-between. You are negative, but your husband is positive. If we take the guidelines and adapt them to your situation, it may be prudent for you to wait the 10 days before returning to work. At the very least, it is prudent to be sure your husband is fever free for 3 days and that it has been 7 days since his symptoms started before you return to work.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“Can coronavirus testing be done anonymously, similar to STD testing?”

The answer:

At this time, all COVID-19 testing requires an order from a health care provider, and the specimen must be collected by someone trained to do it, such as a nurse. The ordering physician shares the test results with the patient. So it is not a fully anonymous process, currently. 

But health care providers work diligently to protect your personal health information, so you can feel confident getting a test if it is recommended.

– Emily Korns, director of marketing communications, Conemaugh Health System 

• • • • • 

“I am a 67-year-old woman, active and in good health. I rent my basement to a traveling nurse who is working at a local ER. She has already had one COVID-19 scare and was quarantined until her results came in – thankfully negative. “However, she could of course become positive at any time. Should I be concerned?”

The answer:

If this nurse is compliant with Department of Health and CDC recommendations including personal protective equipment, proper hand washing hygiene, and if she is following hospital ER infection protocols, the risks to others including yourself should be minimal.

You have already established separate living areas if the nurse is in your basement. Practice social distancing and good hand washing, and frequently clean surfaces you may both touch. I also recommend you both wear face masks when in the same area of the house.

Finally, we should all be thankful for nurses and all health care personnel for their care.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • •

“I am hearing more and more that this virus causes clotting in the body – causing strokes and organ failure due to bodies being riddled with clots. But we can’t take NSAIDs (nonsteroidal anti-inflammatory drugs) such as Ibuprofen, which have been known to thin the blood and prevent clotting. What can we do to prevent the clotting aspect of this virus?”

The answer:

In our cases locally, we have not yet seen the severe clotting described by the reader, or deaths attributed to clots or pulmonary embolism, but we recognize this is a complication. 

Most likely, this level of clotting is due to sepsis brought on by a very severe form of the infection. In the hospital, patients may be prescribed a medication, such as heparin to avoid clotting. For the average patient at home with a mild or moderate case of COVID, anti-clotting therapy doesn’t seem to be indicated.

If you have a personal history or family history of blood clots, this is important information to share with your primary care physician or your emergency care provider. With COVID-19 or any condition where you may be inactive due to illness, it’s a good idea to try to move around a bit to keep blood flowing, even if it’s just getting up to walk around the couch.”

– Dr. Uchenna Okereke, infectious disease specialist, Conemaugh Physician Group.

• • • • •

“I’m a 50-year-old male with severe asthma and hypertension. Both diseases are well controlled with medications. I realize that I have two high risk factors for COVID-19 complications if I became infected. However, I never get sick. Given that I have a strong immune system, does that make me any less likely of becoming infected with COVID-19?”

The answer:

It is important that your asthma and hypertension are both well controlled, and that you have a good immune system. Patients that are immunosuppressed or immunocompromised are at a higher risk of infection and complications.

However, there are other important contributing factors including behavior (contact length and frequency), virulence of the virus and environment (crowding, poor air quality and pollution). Therefore, immune status is not the only determining factor whether or not you become infected with COVID-19.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I’m 67 and was diagnosed with the virus about two weeks ago. I’m quarantined and have shortness of breath, but have been to emergency room twice and all tests are good. How long does it take for symptoms to subside?”

The answer:

There are no specific answers for duration of illness or exact recovery time, and each patient is different. Those with milder symptoms may recover in 7-10 days. Others with more moderate or severe symptoms may take 3 to 4 weeks.

I also read medical reports of patients who were hospitalized with significant complications and were subsequently discharged, but were still not completely recovered at 10 weeks or longer.

I certainly hope that your symptoms resolve soon, and it is very important that you follow up with your treating physician.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“Does spraying the soles of my shoes with bleach without wiping kill the coronavirus instantly, or does It take some time? Is there a better way to clean them to prevent the virus from spreading into the house?”

The answer:

COVID-19 is spread via respiratory droplets and anything that those droplets get on. The term for this is fomite transmission.

Research has shown that the virus can survive on surfaces for a few hours to a few days, depending on the surface. A disinfectant such as bleach will destroy the virus. You may spray with a bleach solution (1/3 cup of bleach per gallon of water) or use a household disinfectant spray (such as Lysol) and allow the shoes to dry. This can take a few minutes.

Another option that can be done is to wipe the shoes down with a hydrogen peroxide wipe (it only takes 30 seconds for these wipes to kill). Lastly, you may use a 70% alcohol-based solution to wipe the shoes down and allow them to dry (this can take up to a minute).

If you are worried about bringing the virus into the house, you may want to spray the shoes outside your home and bring them in after the 30-180 seconds has passed. That’s what I do!

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“If someone is asymptomatic yet positive for COVID-19, how long would they be considered contagious?”

The answer:

Great question.

If you test positive:

• Notify your close contacts and let them know they should quarantine at home for 14 days. This includes your family members.

• Self-isolate in your home until each of the following conditions are met:

1. It has been at least 7 days since your symptoms first appeared, AND

2. It has been at least 3 days since you have not had a fever (without using fever-reducing medications) and your respiratory symptoms (cough, shortness of breath) are improving.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“We have all these stories of how many caught the coronavirus and how many deaths have been recorded, but not one single number on people who have recovered from it. Is there an accurate estimate of COVID-19 recoveries in Pennsylvania?”

The answer:

An accurate figure does not exist. They may start collecting hospital discharges, but since only 10% of all confirmed COVID-19 cases end up in the hospital, it doesn’t mean that much. They aren’t really “recovered” when they are sent home anyway.

If someone gets a positive test, stays home while the illness runs its course and returns to the self-distancing world, that person is not being checked or reported as recovered. Not to mention hundreds, probably, who get mild symptom but are just being told to stay home, and then recover without even testing. They aren’t even showing up on the daily positive report.

– Randy Griffith, health care reporter, The Tribune-Democrat

•  •  •  •  • 

“Should we be concerned, as we soon turn on our air conditioning, about airborne spread of coronavirus?”

Answer:

COVID-19, SARS-CoV-2, is droplet transmission. The airborne droplets travel through the air and can make it about six feet. When you add an air conditioner, you are adding strong airflow into the equation. This would allow the airborne droplets to travel farther.

If you are using the air conditioner in your home and no one in your household is sick, then you don’t need to worry about transmission. What can be of concern is, if social distancing is lessened and you are in a public building with air conditioning with a symptomatic (or asymptomatic) COVID-19 patient, the six-foot rule may not help. The air flow from the air conditioner would allow the droplets to transfer farther than the average of six feet.

Reference: Lu J, Gu J, Li K, Xu C, Su W, Lai Z, et al. COVID-19 outbreak associated with air conditioning in restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020 Jul [4/15/20]. https://doi.org/10.3201/eid2607.200764

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

"What if my car inspection is due? Is there a grace period? I really don't want to take my car to a shop right now."

The answer:

For driver licenses, photo ID cards and learner's permits scheduled to expire from March 16, 2020 through April 30, 2020, the expiration date is now extended until May 31, 2020.

– Pennsylvania Department of Transportation website (https://www.penndot.gov/pages/coronavirus.aspx).

• • • • •

"When in a risky area (such as a store), you might encounter someone within the 6-foot recommendation who is sneezing, coughing or simply asking for your help, and you could feel compromised and at risk.

"Would more personal immediate actions reduce the COVID-19 risk, aside from the obvious of keeping your mouth closed or wearing a mask or goggles?

"Although unorthodox to some, would blowing your nose (carrying tissues) and/or blinking your eyes, despite no real need to, mitigate being infected if the virus is airborne – followed by a thorough washing of your hands, mouth, nose and eyes (area or drops) when possible?"

The answer:

An excellent and practical question.

The Centers for Disease Control and Prevention recommends “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain” – grocery stores and pharmacies, and especially in areas of significant community-based transmission.

The right way to wear a face covering or mask is to cover your entire nose and mouth, which means that the face mask should be tight-fitting underneath your chin. It will be less effective if you remove it from your face when you’re in a crowded store, such as to speak to someone.

An important takeaway from the CDC’s message is that covering your face when you leave the house must not replace thoroughly washing your hands. 

It’s also worth emphasizing that sewing your own face mask may not prevent you from acquiring the coronavirus in a high-risk situation, such as lingering in crowded places.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

"Can I catch COVID-19 from my cat or my dog?"

The answer:

There have been some studies that are looking into whether domesticated cats and dogs can get SARS-CoV2. These results indicated SARS-CoV2 could replicate in cats and that SARS-CoV2 could be transmitted via respiratory droplets between cats, though it appears that it is not highly contagious between cats.

They also show that dogs are not really susceptible to the infection.

These studies show that cats can catch it from you, but none have shown that cats can transmit the virus to humans. That work has not been done, so the answers is we don't know yet.

The best approach right now for cat owners is to keep their indoor cats inside and their outdoor cats outside.

For more information check out this article in Nature: www.nature.com/articles/d41586-020-00984-8. It is a good summary of the work that has been done so far.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown

• • • • •

“I would like to know if it’s normal for a person to experience symptoms (day 1) and feel better over the next few days, only to experience those same symptoms on day 10-11 that were far worse.”

The answer:

Another excellent question.

Patients may have a mild common cold-like illness and/or an uncomplicated upper respiratory viral infection with symptoms such as fever, fatigue, cough, muscle pain, sore throat, shortness of breath, nasal congestion or headache. Rarely, patients may initially have diarrhea, nausea and vomiting.

The above symptoms may improve, or progress in 7-10 days to a severe viral pneumonia leading to acute respiratory distress depending upon the immune status of the patient, age, and other chronic underlying medical conditions.

– David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

"With summer and warmer weather coming soon, can the coronavirus be spread by mosquitos?"

The answer:

I can understand your concern – my goodness, what would we do it this were true!

Infectious disease transmission types are two basic categories: Direct (person to person) and indirect (which involves an intermediate carrier). Indirect transmission can come from fomites (inanimate objects that transmit disease), vehicles (food and water) or vectors (living things that transmit disease).

COVID-19 (SARS-CoV 2) is spread by airborne droplets, a form of direct transmission. That means it is spread by coughing, sneezing and talking. There are all kinds of modes of transmission – ways that infectious diseases spread – but this one is only airborne droplets.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown

• • • • •

"We have scheduled a Bahamas trip in September with Carnival Cruise Lines. They have not canceled yet. Is it OK to keep this vacation or should we cancel?"

The answer:

"Cruise lines all have different policies. Generally, people are waiting (to cancel)."

– Epic Journeys

For more information, contact your travel agent. For information specific to Carnival Cruise Lines, visit: www.carnival.com

• • • • •

“I work in a nursing home as a certified nursing assistant. If one of the residents goes to the hospital and tests positive, does our upper management have the right to not disclose this information to employees.”

The answer:

There is no requirement from either CMS (Centers for Medicare & Medicaid Services) or the Pennsylvania Department of Health that nursing homes or hospitals are required to inform employees of confirmed cases. But we do expect facilities to take steps to protect the health and safety of residents and share information with those who may be affected.

– Pennsylvania Department of Health

•  •  •  •  •

“I am a registered nurse and I want to know how long is a surgical mask, fabric mask or N95 mask effective?

“I do home care and can work one-on-one with one patient for up to eight hours a day in their home, or visit up to four patients in one day and am provided with surgical masks.

“In searching for an answer, I came across an article in the International Journal of Infection Control, 2013, that suggested that face masks are no longer effective beyond two hours of use!

“What renders them ineffective? Is it the moisture that accumulates? If so, could I recycle the surgical mask I wear with the same patient after it dries? My employer is unable to provide enough masks for me to change the mask every hour (changing every two hours doesn’t make sense if it’s rendered ineffective by two hours!).

“I share custody of my children (ages 11 and 14) with my ex, and my husband shares custody of his children (ages 13, 16 and 18) with his ex, so we have five children coming and going between homes and being exposed to their other parents and step-parents (but no other children) in their other homes. My step-kids’ mom is a social worker and continues to work in-person with people in the public.

“As an RN doing in-home visits and infusion therapy for medically-vulnerable patients, I fear that I have too much external exposure outside of my control to maintain a low-risk of being exposed, becoming a carrier, and therefore infecting the vulnerable population I care for.

“My fear is that I will need to choose between my husband and me being able to see our children and my continued work as a nurse in the community. What advice can you offer?”

The answers:

Excellent and interesting questions.

I’m not aware of any evidence-based data that states face masks are ineffective after two hours. In my opinion, if the patient contacts are not high risk for COVID-19, and/or not confirmed COVID-19 positive, a surgical face mask may be used the entire day, unless the mask becomes soiled. If the face mask becomes soiled, then it should be changed immediately.

A healthcare worker administering an aerosol treatment must wear a N95 mask – and a surgical mask on top of the N95. The surgical mask must be properly disposed of after the treatment. The N95 mask may be reused by the same healthcare worker that day if not soiled.

Regarding your living and working situation, your concerns are understandable. You can mitigate risks by limiting in-home visits to only those patients that are absolutely necessary, and not routine visits. You also need to follow strict Pa. Department of Health and CDC guidelines by frequent hand washing before and after each patient encounter, wearing gloves and a face mask as described above, and washing your hands when you return home.

Social distancing is very difficult with children; however, you can limit other outside family contact exposures. It’s impossible for healthcare workers (myself included) who are treating patients in the home, in doctors’ offices or at the hospital to eliminate all patient contact or exposure. This is the profession we chose.

– David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  • 

“Why do the experts say that this week and next week will be the worst for COVID-19? I understand the virus is out of control, but how do they know what is to come in the next two weeks? What makes these weeks different?”

The answer:

The next two weeks are going to see more cases of SARS CoV2, COVID-19. This is because more testing is being done nationally.

Another thing to consider is the disease course. The incubation period, where an infected individual is asymptomatic, can be up to 14 days with an average time of 4.5 days. The symptomatic phase is about 14 days. 

Mild symptoms last for about five days with severe disease to follow on days 5 through 8. 

Some patients, about 20%, have some type of respiratory distress that may require hospitalization and this can last from days 8 to 12.

If we take all of these things together (more testing and the number of sick people from two weeks ago), it is quite possible that we will see a great number of new cases and a higher death toll in the coming weeks.

It is so very important to keep social distancing in place; it is our best defense at flattening this curve of new infections and slowing the spread of SARS-CoV2.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

•  •  •  •  •

“A vaccine for COVID-19 might be available in 12 months. How helpful will it be if this coronavirus mutates by then, as the flu does yearly?”

The answer:

This is a great question. SARS-CoV2 or COVID-19 is definitely mutating. The question is whether that mutation will happen in a part of the virus that effects transmissibility or disease course (symptom severity).

Coronaviruses have an ability that Influenza doesn’t, they proofread their genomes before they package it into a new virus. This means that SARS-CoV2 mutates at 1/3 to 1/2 the rate of Influenza.

Variants may happen with this virus, but with the slow rate of change individuals will be protected for years after acquiring the infection or getting vaccinated. This is different from the months of protection seen with influenza.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

A New Jersey-based reader of The Tribune-Democrat asked:

“My daughter and her entire family of five have been extremely ill with all of the symptoms of this virus including temperatures as high as 104. My daughter, an X-ray tech, and her husband, a first responder, were tested at separate times and separate sites and to our surprise, the results were negative. My daughter was also tested for influenza which was negative. Is there another virus going around that mimics COVID? Should their results be trusted? Have there been false negative results?”

The answer:

All excellent questions.

With rapid influenza tests, there can be 20-30% “false negative” results. Therefore, if you believe an individual has acute influenza, and a negative rapid flu test, you should still treat for flu.

There are other viruses going around including adenovirus, parainfluenza, and RSV (respiratory Syncytial virus). There is a viral panel test that a physician may order which tests for these other viruses.

Regarding COVID-19 testing, the PCR (Polymerase Chain Reaction) which detects RNA from the COVID-19 virus is very accurate, but a negative result does not rule out the possibility of COVID-19 based on the timing of the exposure and the incubation period of the virus.

So a negative result should not be used as the solo basis for patient management decisions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

"My family (husband, myself, 3-year-old and 18-month-old) has quarantined for the past week and a half. We have a livestock feed business at our house that we continue to operate, but we have one or two customers at any given time and have been following the 6-foot rule, along with disinfecting twice a day. We have only done grocery pick up and drive-thru for a couple lunches just to get out of the house. My mom and sister have been quarantining at a different location for the same amount of time, following basically the same guidelines. If all of us quarantine for two weeks with absolutely no symptoms, would we be safe to then only have contact with my mom and sister? I realize you can’t predict with 100% certainty, but your thoughts would be greatly appreciated."

The answer:

Although risk may be minimal if the relatives are local, there’s still risk and kids are not good at understanding social distancing. Children especially don’t practice good hygiene, and exposing them to older adults could be risky for both.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

"When you report about the cases of the coronavirus, why don't you name the town or city for the confirmed cases?"

The answer:

At Conemaugh Health System we understand how concerned the community is about the spread of COVID-19. And, as healthcare providers, we are obligated by law to protect the privacy of all of our patients. We will not, and cannot, share identifying information about our patients without consent.

We do share our patient data in real time with the Pennsylvania Department of Health (and in turn, the CDC). This includes test results, symptoms, diagnosis, and demographic information related to COVID19 or any other infectious disease. These public health experts are responsible for mapping the spread of disease and interpreting the data, and they do a great job of it.

It may seem important in today's environment to know details about those infected in the community – their age, where they work, their address – so you can determine your risk of exposure. However, this can have the unintended consequences of causing panic and singling people out as targets for unwelcome attention.

The public health message will be the same whether someone lives in your neighborhood or not – stay physically distant, wash your hands, don't touch your face, disinfect surfaces and watch for symptoms. The best advice right now might be to behave as if everyone has COVID-19, rather than trying to determine who does or doesn't.

– Emily Korns, director of marketing and communications, Conemaugh Health System

Health institutions must adhere to federal privacy guidelines as stipulated in the Health Insurance Portability and Accountability Act (HIPAA):

"The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections."

– U.S. Department of Health & Human Services (HHS.gov)

• • • • •

"I have rheumatoid arthritis. Am I considered high risk for contracting COVID-19?"

The answer:

The short answer is yes. Autoimmune disorders that are a result of inflammatory conditions put the individual at a greater risk for all types of infectious diseases.

With RA specifically, individuals can be on immunosuppressive drugs. This can subdue the non-specific immune response to viruses. Science doesn’t know if you are at a greater risk of contracting the virus, but you are at a greater risk of severe symptoms if you do.

For more information on inflammatory autoimmune disorders and COVID-19, I suggest you check out this website: www.creakyjoints.org.

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

•  •  •  •  •

"Can you contract the influenza virus unknowingly, and then contract COVID-19 virus with diagnosed known symptoms detection at or around the same time? And if so, would your risk of life be greater having both and to what extent? Also, would the flu show up when tested for COVID virus, or would it go undetected?"

The answer:

Influenza symptoms are fever, chills, muscle aches, cough and tiredness. These symptoms come on quickly; you can wake up feeling fine and six hours later be sick.

Symptoms of COVID-19 are fever, dry cough and shortness of breath, which is consistent with the viral pneumonia it causes. COVID-19 is a slower onset, the illness ramps up over a period of days. In fact, you can divide the slow onset into three stages: 1. asymptotic incubation period, where the virus may or may not be detectable; 2. non-severe symptomatic period, where you can detect the virus and; 3. severe respiratory symptomatic stage, with high virus levels in the body.

It would be unlikely that you would unknowingly have influenza. It is possible to have both infections, it is just unlikely.

Since both viruses infect the lungs, in different cell types, that presents a greater risk to your health and life.

Some tests for COVID-19 use a nasal swab or oral swab and compare the genetic material captured on the swab with the genetic code of COVID-19.

There is a new test that was just approved by the FDA that will be using a clumping reaction, like what is done for strep throat. This test is quicker and produces results in 15 minutes or less. Since these test are specific for COVID-19, they would not be able to show infection with influenza. A test specific for influenza would be needed to determine infection.

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

• • • • •

"For other, and possibly this, coronavirus, does the route of transmission affect symptoms? Is it possible that the lungs could be spared if a person contracted the virus via the eye or digestive tract instead of through the air?"

The answer:

Viruses are specific to a certain cell type. Think of it like the key for your front door only one key will open that door, that key is specific to your door. Viruses are like the key. If the right lock isn’t present on the cell, the virus can’t get in.

So when we think about route of transmission, the virus is transmitted in the way that will best get it to the cell that it wishes to infect. For COVID-19, its specific cells are found in the part of the lungs called the alveoli; these cells help with gas exchange. So if you come in contact with the virus, it will seek out the specific lung cells to infect. If it gets in your eye, the ears, nose and throat are connected and the virus could get to the lungs. If it comes in via the digestive tract, it is harder for the virus to get to your lungs.

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

•  •  •  •  •

"Is anyone identifying persons who had contact with the COVID-19 infected? These contacts should be self-quarantined."

The answer:

"We identify those who were exposed, use the Pa. Department of Health Risk Assessment, and follow Pa Department of Health guidelines and recommendations.

"Regarding self quarantine: Yes, and again based upon the Pa. Department of Health risk assessment and following Pa. Department of Health guidelines and recommendations."

– Dr. David Csikos, Chief Medical Officer, Chan Soon-Shiong Medical Center at Windber.

The Pennsylvania Department of Health website can be found at health.pa.gov.

On this topic, the DOH says:

• Isolation separates sick people with a contagious disease from people who are not sick. Isolation is usually voluntary, but in an emergency, officials have the authority to isolate people who are sick.

• Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. Quarantined people may or may not become sick; but separating them from those who were never exposed helps prevent the spread of the disease. Quarantine can be voluntary, but in an emergency, officials have the authority to quarantine people who have been exposed to an infectious disease.

• • • • •

"If someone gets the virus and recovers, is that person immune from the virus and probably won't get it again?"

The answer:

The Los Angeles Times reports that China has seen more than 100 cases of individuals being released from hospitals and later testing positive for the coronavirus a second time. A man, 36, died five days after being declared virus-free and discharged. 

Keiji Fukuda, director of Hong Kong University’s School of Public Health, said the likely reasons are testing errors and patients leaving hospitals too soon.

“If you get an infection, your immune system is revved up against that virus,” Fukuda said. “To get reinfected again when you’re in that situation would be quite unusual unless your immune system was not functioning right.”

– Los Angeles Times reports

 • • • • •

"If someone has traveled to a known hot spot for COVID-19 in a state such as California or Washington or out of the country, how are other employees and clients protected if an employee refuses to do a self-quarantine after travel and/or contact with potential COVID-19 risk factors and continues to come in contact with people at the workplace?"

The answer:

The Occupational Safety and Health Administration (OSHA) recently published Guidance on Preparing Workplaces for COVID-19, outlining steps employers can take to help protect their workforce. OSHA has divided workplaces and work operations into four risk zones, according to the likelihood of employees’ occupational exposure during a pandemic. These different classifications can inform employers on how to treat their workplace during this pandemic.

Employers have a duty to provide a safe workplace to all employees, this includes exposure to COVID-19 in the workplace. Employers should be understandably concerned about providing a safe environment for their employees and, as such, may ask employees about the areas they have recently traveled to and if they may have had any exposure to COVID-19.

If an employer concludes that an employee may pose a health threat to other employees, the employer can require that the employee stay home for the duration of the COVID-19 incubation period, which has generally been assigned as 14 days. They can also ask employees to seek medical attention and/or get tested for COVID-19, but cannot require them to do so. The employer also has no obligation to report a suspected or confirmed case of COVID-19 to the local, state, or federal health departments. Only healthcare providers that receive confirmation of a positive test are mandatory reporters.

In short, the employer cannot require the employee to self-isolate, but must take steps to protect other employees from any potential exposure, including sending the potentially infected employee home.

Here is a link to some more helpful information that was recently published by my law firm: https://www.muslaw.com/covid-19-update-mitigation-of-employment-law-risks/

– Katelin Montgomery, associate attorney with the law firm Meyer, Unkovic and Scott LLP, in Pittsburgh.

• • • • •

“Can a person have coronavirus and flu virus simultaneously?”

The answer:

“It is possible to get two infections at the same time. For example, you can have a common cold, from a virus, and that can lead to a bacterial infection in the sinuses. Yes, you can get the flu and COVID-19 at the same time. It is recommended that if you haven’t gotten your flu shot yet that you do so now. It won’t protect you from COVID-19, but it will keep you from getting the flu.

“Symptoms are similar for both illnesses with the major difference being that COVID-19 causes shortness of breath due to the viral pneumonia.”

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

“When older adults fly, can they get tested upon arrival so they don’t need to be secluded for 14 days?”

The answer:

The tests that are available on the market are antibody tests and SARS CoV-2 genome tests.

The antibody tests show if a person is having an adaptive or specific response to the virus; the genome test is indicative of an active infection, as viral RNA is present. These tests, particularly the genome test, give a snapshot of what is happening on that day.

Individuals who are exposed to SARS CoV-2 won’t show symptoms for five to seven days, on average. A test upon landing would not be sufficient to say that the individual is not in the incubation period of COVID-19. 

The person could have been exposed to the virus on the plane. This is why the 14-day quarantine is recommended.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

Have a question about coronavirus, also known as COVID-19? Send questions to tribdem@tribdem.com.