Dr. Brian Labus, professor at the UNLV School of Public Health, checks the latest statistics on COVID-19, Wednesday, March 11, 2020.
Sunday, March 15, 2020 | 2 a.m.
The World Health Organization officially declared COVID-19 a pandemic last week, with more than 120,000 cases around the world. As new coronavirus cases spread around the globe, questions surrounding this new virus grow exponentially as well.
We asked Dr. Brian Labus of the UNLV School of Public Health questions about what you should know about the virus and how you should prepare for it.
Labus served as the Southern Nevada Health District’s senior epidemiologist for 15 years, where he was responsible for disease surveillance and outbreak investigation. There, he investigated everything that happened in the valley with illnesses such as norovirus, flu, foodborne disease, Legionnaires’ disease, hepatitis and dozens more. In 2008, Labus also led the investigation of the largest outbreak of health care-acquired hepatitis C in United State history.
Where do coronaviruses come from and how do they spread?
There are dozens of coronaviruses that infect mammals and birds. Only four of these regularly infect humans, and they are one of the causes of the common cold. Three more cause more serious disease in humans (SARS, MERS and COVID-19). Given the right circumstances, viruses can jump from animals to humans, and cause an outbreak like we are seeing now. The virus that causes COVID-19 probably originated in bats and infected an intermediate animal host, which infected humans.
Can the coronavirus spread through animal products imported overseas?
It isn’t spread by food, so that shouldn’t be a concern. We also haven’t seen the virus infecting animals. As for other products, the virus is thought to survive up to nine days under ideal conditions, so even if it was contaminated, the virus will be long dead by the time the products reach your store shelves.
Should I be worried about my pets contracting the virus?
No. Coronavirus does not infect cats or dogs.
Who is most vulnerable to the virus?
There are two things that make someone vulnerable to the virus: a weakened immune system and underlying health problems. Older people unfortunately face both of these issues. As people age, the immune system weakens. Also, chronic health problems occur more often as people get older. The highest death rates in China have been seen in people over 80, but people 50 and older had much higher death rates than people under 50.
Should I avoid the Strip or other heavily populated areas in Las Vegas?
At this time, coronavirus is not circulating widely in Nevada. We have identified a few cases, but those cases are not indicative of widespread community transmission. ... If you are in a very high-risk group — for example, you are 65 with a number of underlying health conditions and are on immunosuppressive drugs — you should probably consider those risks anytime you have close contact with groups of people, whether on the Strip or anywhere else in town.
Why do health experts advise people not to stock up on masks?
The particles that carry coronavirus are too small to be stopped by surgical or dust masks, so all they provide is a false sense of security. You need a special type of mask, called an N95, to provide any protection. They need to be fitted to your face, worn properly, and removed in a way that keeps you from infecting yourself. These masks are in short supply right now, even in hospitals. Stocking up on these masks makes it harder for medical providers treating patients with coronavirus to protect themselves.
Who is qualified to get tested?
A doctor has to have a reason to test you. First, you will have to have some sort of illness. A doctor won’t order a test just because you are anxious about being exposed. Second, there has to be a reason to test you. If you have traveled to a country with widespread transmission or have been exposed to someone known to have the disease, it would make sense to test you. Finally, doctors will typically try to eliminate other common causes of respiratory disease. Flu is still circulating widely in the community, so it would make sense to rule that out before considering coronavirus. If coronavirus starts to spread in our community, the way we look at risk starts to change and we will change our testing approach to go along with that.
Why are we so limited in our capacity to test for the virus?
It takes time to ensure that the test works correctly and to produce the kits. More test kits will be available as the test is rolled out to commercial laboratories all over the country, and testing bottlenecks will disappear.
Keep in mind that from the first reported case, it only took Chinese scientists a month to discover the virus. Once they found it, they created a test for it in two weeks. A month later, we can test for it in labs all over the country. It took twice as long just to identify SARS in 2003. The speed at which the laboratories have responded to this new virus is nothing short of incredible.
Do you think we’ll see cases slow down as the weather warms up?
It’s impossible to predict what is going to happen with a new virus. We don’t understand much about it, including how it will be affected by changes in the seasons.
Should I cancel my vacation plans?
There is no easy answer to this question. You have to make decisions based on your individual health, the place you are going, and the reason you plan to travel. ... Someone in their 70s with COPD and undergoing chemotherapy is obviously in a different risk group than a healthy 20-year-old. You would be willing to accept more risk if you are going to take care of an elderly family member having surgery than you would if you are going on a short vacation. ... You have to consider all those factors and make a decision with which you are comfortable.
If I am flying, how can I protect myself from getting infected?
Sitting close to strangers in a small space with recirculated air carries some risk in it, but that is risk we have always faced while flying. The recommendations for protecting yourself on a plane aren’t really any different than the recommendations for anywhere else. Wash your hands, use hand sanitizer, don’t touch your face, and wipe down surfaces you will be touching, like your tray table. The CDC instructs flight crews to identify sick passengers and keep them away from everyone else when possible, so you shouldn’t feel bad in saying something if your seatmate is coughing and sneezing all over you.
How likely is it that a city like Las Vegas could go into lockdown?
Implementing a large-scale quarantine is not a decision to be taken lightly. It would cause a serious disruption in the lives of everyone in Southern Nevada, and probably have impacts that we feel as individuals and as a community for years to come. This is why it is not the automatic first step taken in responding to an outbreak. It also has to be done for the right reasons and done in the right way. If it is the only way to protect our community, it is something that we would have no choice but to do. If we have other options, we would consider those first before we do something so drastic. What we ultimately decide to do depends on how disease spreads in Southern Nevada. A community lockdown may be something we have to consider at some point, but we have no way of predicting what will happen. Let’s hope we don’t get to that point, and in the meantime take reasonable public health steps along the way to keep us from getting there.
How prepared do you think Clark County is to handle a pandemic?
The challenge is always the uncertainty of an unfolding situation like this, but I think Clark County is as prepared as it can be. We have dealt with outbreaks and other public health threats before. The many agencies that are involved in a response work well together and regularly train for this sort of thing. Given the challenges we have successfully faced as a community, I think we hold our own against any other big city in the world.
How does the response to COVID-19 compare with other past global pandemics, such as H1N1 in 2009?
The early response we are seeing reminds me a lot of what happened in 2009. That is mostly because every public health response is built upon the previous one. We are using things we learned about public communication, testing and surveillance to make our response better this time. The public response is similar as well, with a lot of fear and anxiety driving decisions like stockpiling essential supplies. I don’t expect human behavior to change from outbreak to outbreak, but I do expect us to get better in our response to disease.
Do you think social media has played a role in how most of the public has responded to the illness?
Of course. For better or worse, that is how we communicate now. We have instant access to information from reputable and not-so-reputable sources. The challenge is to sort through all of that information and decide what is true. That is a difficult task, even for disease experts. For some people, that access to information has been calming. For others, it is increased their anxiety.
What lessons can we use from global pandemics that have happened in history?
Our entire public health system is built upon what we have learned in past outbreaks. We have refined our disease surveillance, our investigation process, the way we talk to the public, and what our health care system needs to be successful in responding to disease. Most importantly, we have learned to work together to solve these problems. Outbreaks don’t respect borders, so we have learned to work together as an international public health community.
What else can I do to protect myself?
The recommendations we have are the less-than-satisfying basic public health steps of washing your hands and limiting your exposure to other people. Everyone wants a vaccine, a pill, or some novel step they can take, but these basic things go a long way to protect your health. You can also think about what you will need to do if there are some disruptions in your life, such as a school or daycare closure, having to work from home, or having to help an ill family member. The time to prepare for those things is now, not when they are happening.
Should I still get my flu shot?
Flu stays with us through the spring, so it’s not too late to get a flu shot. While we are likely past the peak for this year, it can still provide protection against a disease that has stepped out of the spotlight but continues to infect — and kill — people nationwide.
Is there any estimate on when this will all be over?
Disease modeling is useful to evaluate how a disease may be spreading and how different control measures are likely to affect that spread, but they are not very good at predicting what is going to happen. We don’t understand the virus well enough, we don’t understand the exact conditions that exist in each community, and we can’t model the hundreds or thousands of interactions people have each day. It would be nice to be able to make an estimate of when it will be over, but we can’t even predict what is going to happen tomorrow.
We’ve heard the World Health Organization praise countries like China and South Korea on their responses to COVID-19 and containment measures. What can we learn from these countries as far as social distancing policies?
We’ve shown that social distancing can work to help control an outbreak. It’s challenging to look at specific actions because social distancing is based entirely on changing how we interact day-to-day with each other. Each community is different, so what works will be different.
There is a lot of worry about shortages of medical staff and equipment, as we saw in China and Italy. The New York Times even reported that some medical workers in China used raincoats and garbage bags when they didn’t have enough medical supplies. Do you see a similar scenario playing out in the United States? Particularly in Clark County?
We have had a little time to prepare because of these outbreaks in other places. However, our health care system has a lot of just-in-time delivery of critical items, which can easily be disrupted when demand spikes and everyone is clamoring for those same scarce supplies. That is a challenge in any emergency.It all depends on how the disease spreads in our community.
Do you think U.S. response (i.e. canceling travel, public sporting events) is appropriate? Is it over the top or should we be doing more?
It’s probably a little of both. Every community is unique, so their response has to be what is best locally no matter what everyone else is doing. The same response that is over the top for one community might be perfect for another one and not enough in a third.
Do we know how long the virus can live on a surface?
We are trying to understand that, but we don't know for sure yet. Looking at other coronavirus, we can make some educated estimates. Viruses like SARS can live for up to nine days given the right conditions.
Could the reason why COVID-19 seems to have a much higher mortality rate be because we heaven't built of an immunity to it yet? Whereas with seasonal flu strains, we've been able to build up an immunity to it over the years.
The death rates reported tend to be misleading. Early in an outbreak, or when the disease first reaches a new city, it is easiest to identify the sickest people. It's not so easy to find people with really mild illness that blends into the background of the other diseases circulating in the community, like flu. So when we calculate death rates, they tend to better represent the death rates in hospitalized patients than the community as a whole. That explains a lot of the high numbers right now. The other thing to consider is that viruses are all different. There are a few coronaviruses that circulate all the time and cause the common cold. They don't kill anyone. Coronaviruses like SARS and MERS had much higher death rates (about 10% for SARS and over 30% for MERS).
Is there anything you think is missing from the overall public discourse on COVID-19 you'd like to note?
With sports being cancelled, watching the case report numbers seems to have given us something to do. If you don't know what those numbers mean, they tell a misleading story. Just because you watched ten seconds of a football game and saw your team score does not mean that they are going to score touchdowns every ten seconds. Seeing the case counts increase from 5 to 10 in one day does not mean the outbreak is doubling every day.
