Questions and Answers on the spread of COVID-19

Elaine Sugden

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An 80 year old friend asked Dr Elaine Sugden ( a retired consultant oncologist) a number of questions about the spread of COVID-19. She checked the latest information from various sources. 

1.  How likely is it that a person without any symptoms could infect others with Covid-19? 

Very. A person who has the virus is infectious 2-3 days before showing symptoms, at the peak of ‘infectivity’ just after symptoms start and then gradually less so for up to 10 days or more; usually a few days after the end of symptoms.


2.  How is coronavirus mainly spread from one person to another? 

I don’t know which is more important but spread is either directly (coughing/sneezing) or by touching contaminated surfaces - which is where the hand-washing routine comes in.


3.  What is the likely outcome for someone who is infected by the novel coronavirus?    

A child?   

The majority have either no or only very mild symptoms.  As with adults there is a significant risk for children with underlying health conditions to be very poorly. In a recent study in the USA, 80% of children needing intensive care had underlying health conditions.

A healthy adult? 

good

a healthy old person? 

less good but still reasonable. As we age our immune system is less good (the reason cancers increase with age).

The more usual ‘underlying conditions’ which increase vulnerability are: diseases which affect the lungs, heart, kidneys, liver, nervous system, diabetes; serious obesity; pregnancy; those having chemotherapy and some sorts of radiotherapy for cancer.


4.  What proportion of people who are infected with Covid-19 require treatment or Intensive Care in hospital?  

We don’t know for the UK because in general we don’t know who has had the disease (most of those in the community with symptoms were not tested).  In China it was recorded that about 1 in 5 over 80yrs and 1 in 100 under 30's needed to be hospitalised.


5.  What is the rate of success of such hospital treatments?

Half of those in intensive care survive but only one in three of those needing ventilation (this explains the medics clapping when someone is able to leave intensive care)

Not all go into intensive care because they are known to be already very frail and medical experience has shown that they will not survive the ordeal. For the same reason, and so that they can die at home, it can also be also better for the frail not to go into hospital.

The care home situation has been serious - the hospitals were emptied of all who were ready for discharge to make room for Covid patients. Some of the elderly returning to care homes were infected (? known or unknown - they were not tested). The care homes didn’t know these residents were infected and anyway often didn’t have enough personal protective equipment and so the other residents, far from being shielded as was intended, were an opportunity for the virus to spread unchecked.

Sadly of course this also exposed the staff to the virus and some of them and/or members of their families have died as well as many care home residents.