Update: This AMA was hosted on January 30, 2020. Much has changed since then, please follow the current CDC guidelines if you have questions.
John Lednicky, a virologist and research professor of environmental and global health at the UF’s College of Public Health and Health Professions and the UF Emerging Pathogens Institute, hosted a Reddit Ask Me Anything.
During the two-hour session, he addressed a lot of popular questions about the coronavirus.
Here’s a recap of the questions and answers from the original AMA:
Q: What can be done to protect from coronavirus exposure? Are good handwashing techniques enough? Or do we need to invest in masks to be ready? Also, what’s the real lethality rate for it?
A: The best approach is to use well-established infection control practices. First and foremost, avoid being around people who have respiratory infections. Hand washing is important, but it should be done properly: running water for 20 seconds, soaping between fingers and the back of the hand, etc. This is because we can pick up viruses from contaminated surfaces and inoculate ourselves by touching our nose, eyes, perhaps our mouth. Coronaviruses can be spread through airborne routes…they can be present in large droplets that are formed when we cough, sneeze, talk, but they can also be associated with smaller particles that can stay airborne and thus inhaled. Coronaviruses can stay “viable” (infectious) on some environmental surfaces for up to a week, so hygiene is important as we can contact contaminated material in public places, especially if they are “high touch” surfaces such as doorknobs.
Q: How useful are the average available masks that the general population can get in pharmacy’s or hardware shops against infections diseases?
A: Great question. There are many different products on the market, some better than others. The best choice would be an N95 face mask. But the mask should be one that fits properly. If you can get a “fit test’ for an N95 mask, that would be great. Also important are proper don and doff of the mask. Some people put themselves at risk when they remove a mask, for example, by sticking ungloved fingers at the bridge of their nose and pushing those fingers downwards as they remove their mask, and that places potentially contaminated fingers close to the nose. This creates a situation where one could deposit fomites or other virus-contaminated particles close to the nose, and these might be inhaled. Stay away from flimsy face masks, especially those that look like a gauze or net, as they will not be protective. The better face masks, even if they are not N95 masks, will offer some protection from contaminated droplets. But don’t forget: consider wearing goggles also! Many respiratory viruses can infect you through contact with the surfaces of your eyes.
Q: So how at risk are we from catching this coronavirus from simply ordering things from China?
A: Probably nothing to worry about. But in biology, exceptions to the rule are common. For example, I would not be overly concerned about electronic gadgets from China. However, if someone were to tell me they had fresh-frozen bat or civet cat meat from Wuhan, and that they would prepare and cook that for me, that might raise some level of concern.
Q: How can you distinguish between symptoms of coronavirus vs symptoms of influenza?
A: To start, there are many different types of influenza viruses and the symptoms can vary depending on the virus and how healthy the person is. Therefore, it’s not really possible to distinguish coronavirus from influenza virus symptoms in many cases if at all. What’s exceptionally important is to confirm through laboratory tests. The symptoms of coronavirus infections also differ according to age and overall health.
Q: My question is how exactly does the virus lead to deadly symptoms of pneumonia etc.?
A: Exactly? We need more information. But basically, if the virus is truly similar to SARS CoV, what we know is this: The virus targets epithelial cells of the respiratory tract when it first causes an infection (other organ systems are affected subsequently). The danger is when our alveoli are infected. Alveoli are the site in our lower lungs where oxygen uptake occurs. If the alveoli are killed, that of course creates breathing difficulties. As the cells die, fluid from the bloodstream leaks into the lower lung area, and pneumonia results. With fluid present, bacteria and fungi can proliferate, and cause secondary infections, making the situation much worse.
Q: Is it true that once signs and symptoms occur, you are no longer contagious?
A: No! You remain contagious! And though this depends on the type of coronavirus, people with coronavirus infections can excrete infectious virus for weeks after the symptoms subside, not necessarily through coughing or sneezing but in their urine and stools.
Q: (Some) Media sources in Germany are arguing that it is foolish to worry about the Coronavirus because flu is just as infectious and has similar levels of lethality, but we don’t worry about flu. I assume this line of reasoning is flawed, but could you debunk it?
A: It is not foolish to worry about the new coronavirus in that we don’t really know what the outcome will be regarding how the virus spreads worldwide and whether a ‘pandemic’ will occur. But influenza viruses affect people every year, and depending on the year, 50000 or more people die in the US due to influenza virus infections. And note that ebola is a deadly disease, but in the US, we ‘don’t worry” about it because the virus that causes that disease has not become established here. The issue regarding ‘not to worry’ boils down to fear of the unknown.
Q: Statistically speaking (just a guess would be fine), if a healthy adult got the coronavirus, what are the odds of pneumonia and death? How about for a child/senior?
A: Not a simple question. Depends on many variables. With SARS and MERS CoVs, for example, most of those severely impacted or dead had/have underlying health issues, such as diabetes, etc. They tend to be people older than about 50 years of age. For the new virus, more information is needed. My understanding is that most of those that have died of the new coronavirus are also people in the older age group (50 and above) with underlying health conditions.
Coronavirus vs. SARS
Q: Many media outlets are comparing the nCoV to SARS – How genetically related are these two viruses? Is it erroneous to compare the two epidemics?
A: Many people are scrambling to provide an answer about how closely related the viruses are. An early study indicated about 70%. But that may be at the genetic level, and different nucleotide sequences can encode the same amino acid sequence. In any case, many experts say this new virus was actually a progenitor of SARS CoV (ie, it was teh virus that evolved into SARS CoV). Lessons learned from the SARS epidemic are being applied to understanding the new epidemic, but your question regarding “erroneous” is hard to answer because there is not enough information available yet. Moreover, the situation in China was very different back when the SARS outbreak occurred. For one, people are traveling a lot more now. And the Chinese are expert in infection control procedures based on their previous experience. The problem is transparency in communication may be sub-optimal, so we have to wait and see how the situation changes over the next few days.
Q: SARS blew over. This one doesn’t have me worried. How will we know when it’s time to actually take it seriously and get scared?
A: One has to stay tuned to current developments; the CDC and WHO post information daily and if you are in the USA, refer to the CDC posts. Internationally, the situation differs depending on where you are. We should always ‘respect’ the situation ‘by taking it seriously’. But not to panic. So common sense approaches regarding infection control are a good idea. In Gainesville, Florida, there are many people ill with respiratory infections. The flu, respiratory syncytial virus, etc. That is typical for this time of the year. So residents here should not panic when they encounter sneezing and coughing folks at this time, as there have been NO confirmed cases of Wuhan coronavirus in Florida to start with. But stay tuned to what the public health folks are saying in the USA. Florida is a choice vacation destination for many internationals, so there is always the possibility of the virus showing up in this state.
Coronavirus Vaccinations and Cures
Q: There are already talks of producing a vaccine. How soon could we reasonably expect to see one?
A: There are many different approaches to making a vaccine. Success depends on good science, luck, and having enough funds to produce the vaccine, show it is safe, and prove it works. How long will that take? Hard to say!
Q: Could you estimate how long the development of a cure for the coronavirus may need? What are the key variables that influence the timespan needed for development?
A: Considering there is really no “proven” antiviral against SARS CoV, this should be a wake-up call for government agencies that they need to fund research in this area. [The virus came and went before a PROVEN antiviral was developed]. A vaccine would take another year or so to produce and test, so this is another area that needs research funding. The major issues are that the laboratory studies are expensive to set up, and proving the remedies (antiviral medication or vaccine) are SAFE and effective requires testing.
Q: What is the current priority: a vaccine or a cure?
A: Both are priorities. There are many antiviral agents that are being tested. Scientists are now scrambling to produce both.
Q: One theory is that the coronavirus was created in a lab in Wuhan as a bioweapon and it accidentally got out. Is there any credibility to this theory?
A: Those who engage in bioweapons work do so in very highly secured laboratories and work under exacting rules. It would be kinda silly if this was an accidental release or purposely done, as this would be a state targeting its own people. But one can never fully know state (government) secrets. I think a better likelihood is that the virus was from some animal sold for food at the live animal market. It is a zoonotic virus. For example, this virus and SARS CoV are highly related to various bat viruses, and at the live food market in Wuhan, bats and animals that might consume them (civet cat? badger?) if a sick bat was grounded are sold for food. The animals are caged and crowded and maintained in unhygienic conditions, creating conditions where urine, fecal material, and so on containing this and other viruses get deposited onto surfaces or are aerosolized. It is possible then to self-inoculate with ‘fomites’ or breathe in particles containing the virus.
Q: Hi John! Does airline travel really exponentially increase your chances of coming into contact with the virus? And if so, what precautions should someone take if they are about to be going on a flight?
A: Good question, depends on where you’re going! About the only thing you can do is make sure you’re not touching a lot of things and touching your facial area. A mask and possibly goggles could help, too.
Q: Have you actually interacted with samples of the coronavirus or is this all theorycrafting?
A: Samples of the new coronavirus have not been made available to most American laboratories yet. I have not worked with the new coronavirus. But, my lab routinely works with human and animal coronaviruses, and I have worked with SARS coronavirus.
Q: Based on sequence alone, how well can you model or predict (virus) virulence, transmission from host to another and stability outside host ?
A: Profound question that would take days to answer! Bottom line is sequence information gives clues but does NOT answer the question about virulence. Clue because if a new virus is similar to a known virulent virus, the first assumption is both new and old virus may be equally virulent. But that has to be tested/proven through medical observation, and laboratory tests. For transmission from host to another host, epidemiology studies are required, and aerobiology studies also. The latter are technically difficult to do (look up review articles from my laboratory group about that), and some animal modeling must also be done. If the virus originated from an animal, surveillance tests must be performed, and the virus isolated from the animal. determining stability outside the host requires laboratory tests. In my laboratory, we take pure preparations of a virus, deposit those on test surfaces, and determine how long the virus stays infectious under controlled humidity, light, and temperature conditions over an observation period that may be one month long.
Q: How can one determine how fast a virus mutates? Does that depend on the virus type or do the mutations occur at random? How come certain viruses are more contagious than others I’m very interested in microbiology myself and seeing this AMA made me very excited. I hope I can call myself a virologist someday.
A: In general, RNA viruses mutate faster than DNA viruses, and that is because their polymerases (enzymes that replicate their genomes) tend to be ‘error prone’. That is an evolutionary advantage to the virus in the sense that by mutating constantly, antibodies to previous versions of the virus are not able to prevent spread of the virus (ie, the virus would likely go extinct if enough hosts had antibodies the virus). There are many ways viruses are transmitted. All things kept equal, the viruses that are easiest to transmit human to human are those that have mutated (‘Adapted’) to attach to and enter human cells. That also affects ‘contagion’. Those that are easily transmitted through airborne routes are easiest to transmit. Virology is an interesting field. Hope you can call yourself a virologist someday!
Q: I have studied Biology only till high school, and don’t have much understanding of Biological experiments. I know its complicated, but can you ELI5 [explain like I’m 5 years old] how genetic analysis is performed? Like what kind of experiments do you do? How are they done? I have always been curious about what is done in advanced Biology labs.
A: Genetic analyses are performed through various “nucleotide sequence” analyses methods. This would take lots of biochemistry and other deep science to explain. But basically, if you have a pure form of the virus, you can extract its genetic material, and through biochemical methods, determine the genetic code (sequence). To those who understand it (geneticists, etc.) is like looking at a computer program’s code. Once you have the code, bioinformatics specialists use sophisticated computer programs to determine how closely related the virus is to other known viruses. The Wuhan coronavirus, for example, is closely related to SARS coronavirus. From that, we start developing hypotheses about how the virus might cause disease, and where it came from (based on what we already learned from SARS CoV studies). But then we have to prove our hypotheses through research!
Q: What’s your favorite part of the research you do? What’s been your favorite finding in your career?
A: The favorite part of my career is that there is something new everyday. Everyday brings a new challenge. My favorite finding changes everyday, but my most recent favorite is finding three new viruses affecting Florida animals. I also like that we were able to find Madariaga virus and Keystone virus in humans. We were the first lab in the world to do so.