March 12, 2020

By John Steinberg, MD, FASAM

Medical Director, The Bergand Group

At the Bergand Group, the health of our patients and of our staff is paramount. Therefore, we would like to provide up to date information regarding the current Corona Virus/COVID-19. Please note that information is accumulating rapidly and this information was based on what was known on 3-12-2020.

Q: What is a virus?

A: A virus is neither living nor non-living. It generally consists of some DNA or RNA and a few proteins that form a shell or a coat. The virus attaches to receptors on human cells, enters, and causes the human cell to make more copies of the virus which are released when the cell is killed by the reproducing virus.

Q: How is infection transmitted?

A: The primary means of transmission is by way of respiratory droplets. This explains the strategy of “social isolation” as the range of maximum infectivity is generally 3-6 feet. The virus can also be acquired from surfaces, by touch, and then by transferring it to mucous membrane surfaces such as the eyes, nose, or mouth. This is why the advice is given to not touch your face. It is not known with certainty how long the virus remains viable on surfaces. It could be as little as 30 minutes or it could be days. Frequent cleaning with either soap and water or other cleansers is advised.

Q: How contagious is it?

A: For an infectious disease to spread, it needs a population capable of getting infected.

For influenza: About 150,000,000 people are immunized each year- about 40-45% of the population. So, it’s hard for the virus to spread. Each person who gets influenza transmits it to an estimated 1.3 others.

For COVID-19: No one is immunized. The virus can spread rapidly. It is estimated that each COVID-19 infected person transmits the disease to 1.4 to 2.0 other persons.

Q: What is the illness like?

A: Most people get a relatively mild illness. Persons who are medically ill or elderly tend to have more severe disease. The most common symptoms are shortness of breath/trouble breathing, fever, and cough. (Influenza has muscle/body aches and headaches as typical symptoms along with cough and fever.) For some it can be a very severe illness. There is a number called “case fatality ratio.” For influenza, this is 0.1%. That means only 1 in 1000 persons who get influenza infection die from it. For COVID-19, it is hard to get an accurate number because we do not know exactly how many people are infected. Numbers range from a low of 0.5% to a CDC estimate at 2.3% to a WHO estimate of 4%. It is clearly a more severe illness than influenza with respect to its effects on populations. Most people will have few to mild symptoms. Those who do get sick, typically show symptoms around 5 to 10 days after exposure. The most common first symptom is shortness of breath or trouble breathing.

Q: Will all the cancellations going on stop the spread of the disease?

A: No. The goal is to slow the spread of disease so that the longer time course for the disease to run its course does not overwhelm our hospitals, health care facilities, and health professionals. The number of people with the disease will increase over time for the next few weeks to months.

Q: What should I do?

A: Don’t carry the disease to those who cannot tolerate it. If visiting elderly friends and relatives or persons with other severe illnesses, avoid shaking hands or close contact. Wash hands frequently. If you feel sick, do not go to work. If you think you have Corona Virus, contact the health department web site for up to date information on obtaining a test. Do not go directly to an ER or doctor’s office without calling first to determine the proper procedure to obtain testing. If you get the disease, remember, you will be able to transmit the disease within a few days after getting the virus, typically before you feel sick. Be careful for yourself and be careful for others.

Q: Do masks help?

A: Masks, unless fitted N-95 or equivalent, do not protect you from getting infected. The low cost, non-fitted masks that are most widely available are most useful in preventing those who are sick from infecting others. If you feel sick and you must go out, please consider wearing a mask.

Q: Should I continue with my treatment and 12-step groups?

A: This is a decision that each person and each group will have to make. Addiction, too, is a lethal disease. This is a very tough question that no one can answer for you. For now, if you feel well; if you have no known exposure to COVID-19; and if you have not traveled to a high prevalence area; our advice is to continue in treatment and in participation in various self-help groups. Please note that the advice given today may not be advisable in the near future.