COVID-19 Frequently Asked Questions
Questions and Answers updated as of April 27, 2020
How long does the virus live on surfaces?
The virus is more stable on plastic and stainless-steel surfaces than on copper or cardboard. After 4 hours, there is no live virus detectable on copper surfaces, and virus lasted a few hours longer on cardboard. Live virus was detectable up to three days on plastic and stainless steel.
Is it true that there are two strains of this virus?
There are many coronaviruses – plural; there are seven different types and they have been around a long time. Some of them have caused severe outbreaks in the past and most of them are very mild. So, this new one, which has the scientific name SARS-CoV-2, or the clinical disease, as you know, named Coronavirus Infection Disease 2019 or COVID-19, are talking about the same virus. While there have been differences noted between SARS-CoV-2 isolated from different parts of the world, none of these mutations has significantly changed the disease caused by this virus.
Can animals carry and/or transfer the virus to humans?
The virus does not go from animals to humans in the same way it goes from human to human. Your dog cannot cough on you and give it to you. It could, however, potentially be on the fur or other areas of the animal from droplets.
Can someone be infected twice with it or does one become immune after they are infected and have recovered?
It’s a very new form of virus, the experience is just months long, so we don’t have the answer to all this question. The latest information based on the Chinese experience indicates that people cannot be re-infected twice in the same season. Obviously, we have no idea, just like with influenza whether you can get it again the following year and we have no idea how long immunity will last.
Can you be infected with COVID-19 WITHOUT having a fever?
Yes. We know that children are the most likely to have asymptomatic shedding or minimal symptoms. For adults – the older you get, the more likely you are to have symptoms. But the simple answer to the question is yes, it is possible to have COVID-19 infection without a significant fever.
As we know, many of the COVID-19 symptoms are similar to the flu. How are they treating COVID-19 and are antibiotics, prednisone and/or NSAIDs helpful or harmful?
There are treatments that are being used to treat the most severely affected patients. Most of these treatments are being used experimentally or off label as there is very little clinical data regarding the effectiveness of the drugs being tried. Plaquenil, also known as hydroxychloroquine, is a drug approved to treat a variety of rheumatologic conditions as well as malaria and some early reports suggested it might be an effective treatment for COVID-19. This has been widely disproved by subsequent studies. Various antivirals are being tried, including some anti-HIV cocktails; a combination cocktail has been used for a while starting in China. Gilead Sciences has an investigational drug that was developed for Ebola which is being studied but a recent study suggested it was not effetive. A variety of start-up companies are attempting to develop specific anti-COVID-19 therapies.
That’s just a window into how confusing this time is.
Questions about the use of common drugs like prednisone and NSAIDS are somewhat complicated. For the treatment of patients with exacerbations of their COPD, or flares of underlying lung disease, antibiotics and prednisone are the mainstay of treatment if someone isn’t improved by the increase of their inhalers. Our recommendation is that physicians and patients continue to treat the exacerbations as they normally would. But there’s some evidence that when patients become so ill with COVID-19 that they require hospitalization or admission to the ICU, giving high doses of steroids may cause increased mortality although the use of steroids in ICU patients with sepsis is still recommended. Similarly, the use of antibiotics in the sick patients is left in the discretion of the treater. Some people give broad spectrum antibiotics in the hopes of preventing or treating secondary infections with bacteria. Others argue against that.
The NSAID story (Non-steroidal anti-inflammatory drugs such as Advil, ibuprofen, Aleve, naproxen) is a complex one because a lot of publicity is centered around the fact that in France they’ve asked that patients and healthcare providers not use NSAIDs because of a small study which found that people who took NSAIDs to control their fever at higher doses had worse outcomes if they were admitted to the hospital. One problem with the study is that patients who are sicker and having a more difficult time controlling their fevers and body aches might be the ones who are more likely to be admitted to the hospital. Our recommendation is that people can take the minimal amount of non-steroidal anti-inflammatory drugs that they need to control their fever and body aches, which are a big component of COVID-19 infection. but should avoid taking more than the recommended doses.
Alpha-1 and COVID-19
Does Alpha-1 increase the likelihood of COVID-19 symptoms/complications? Does an Alpha-1 diagnosis put me in a high-risk category?
There is no evidence to base a definitive answer upon, but the expert opinion of our medical and scientific leadership at the Alpha-1 Foundation is that having Alpha-1 Antitrypsin Deficiency (Alpha-1), and especially having Alpha-1 with lung or liver disease, puts you into an increased risk category. But it likely increases the chance that symptoms will be more severe if an individual with Alpha-1 becomes infected.
Are Alpha-1 Carriers (MZs) who are asymptomatic at greater risk of symptoms or complications if they become infected with COVID-19?
We currently have no way to assess the risk to carriers of single abnormal gene for Alpha-1. There are estimated to be 23 million carriers of a single abnormal gene in the U.S. Unless those with infection are tested for Alpha-1, it can’t be yet be determined if there is an increased risk.
Are Alpha-1 Carriers (MZs) with diagnosed lung disease at greater risk of symptoms or complications if they become infected with COVID-19?
All individuals with underlying lung disease, whether MZ or MM (normal), have an increased risk of more serious disease if they get COVID-19 infection.
I am a healthcare provider working in a hospital and I have Alpha-1. Currently I do not have known liver or lung disease. Are there any additional precautions I should take?
Currently, we think that your routine personal protection equipment and your hospital guidelines are the way to go. At present, we don’t think that additional precautions are necessary. Take the usual precautions according to your hospital’s guidelines regarding putting on your personal protection equipment and protecting yourself from droplets or aerosols. It is important to note that protective equipment is in short supply in some parts of the country at the time of this writing and healthcare providers are becoming an ever-growing population among infected individuals.
Should an Alpha wear a facemask in public or around a spouse/family member who still has to go to work?
Yes, if available.
What if I’m admitted to the hospital and I have Alpha-1 Antitrypsin Deficiency?
If you routinely receive augmentation therapy infusions for Alpha-1 lung disease, we feel strongly that every effort should be made to include your weekly infusions of augmentation therapy as part of the medications you’re receiving in the hospital, particularly if you’re in the intensive care unit.
Augmentation Therapy & Infusions
Can the virus be in Augmentation Therapy?
The Plasma Protein Therapeutics Association (PPTA) has come out with several statements confirming that the virus that causes COVID-19 cannot be passed on through plasma product infusions because the virus is very large and is lipophilic, which means it has fat in the membrane that surrounds it, and those two characteristics of the virus make it considerably easier to remove by the procedures that plasma fractionators use to remove viruses. In addition, even whole blood is felt not to be a transmitter of COVID-19.
Do you anticipate a shortage of infusion products as people stay away from donation centers?
We have been in contact with all the plasma product producing companies and they say they have not seen a dramatic reduction in the number of donors. At the moment, the plasma product supplies are as usual, but it’s certainly important to evaluate this into the future. We will stay on top of this and continue to encourage plasma donations to continue, and let the community know if there are any changes in the supply.
We’ll be working with the community to try to develop a program where they will be able to tell their story for donors to be able to hear that and understand the importance of plasma donations, particularly during this time period.
If I currently receive my infusions in the hospital or at an infusion center, should I continue going to the hospital and take my chances with COVID-19, or skip my infusions and isolate myself at home? What about going to the hospital for routine testing or clinic visits?
In general, the principle here is that your job now is to stay healthy and to stay safe, and your health maintenance is to avoid exposing yourself to other people. So physical distancing, or social distancing, means that if you have a regular visit to your doctor coming up, you should not be going in person. Many clinics have telemedicine options now that Alphas can use with their regular doctor. Please call in to your clinics, ask if telemedicine options are available. It’s not unreasonable to cancel your routine health visit, do not go to your regularly scheduled PFT, or labs. All these services are closed in many healthcare facilities anyway.
Most infusion centers have gone one of three ways: 1) There are centers that have closed down their infusion center. 2) there are a couple of institutions that have set up tents outside the hospital for the infusions, although that’s rare. 3) Many infusion centers have chosen to take extra special precautions to prevent COVID-19 transmission through enhanced cleaning and disinfection and provision of separate entrances to the facility so that you’re not moving through the areas where potentially infected patients and staff might be. It becomes a question of what’s the risk and what’s the benefit. The benefit, we presume, has to do with the anti-inflammatory effects and protective effects of augmentation therapy on your lungs. It’s logical that there would be benefit but it is unproven at this time. The risk is increased exposure to the virus that causes COVID-19 in the hospital setting.
Patients also have questions about the risk of receiving home infusions by an infusion nurse. Home infusion nurses are, by definition, going home to home visiting various patients, some of whom who may have COVID-19 infection. Therefore, infusion nurses should wear a mask if they are coming to your home. The small group of Alpha-1 patients who are self-infusing augmentation therapy have the best equation of risk and benefit, because the risks can be really minimized if you’re doing self-infusion, but it’s tough to learn self-infusion if you wanted to consider that on your own and on the spur of the moment. That is something that should be discussed with your physician and training arranged, if possible.
If I decide to continue my infusions, no matter what the setting, what about taking a double dose every two weeks to minimize my exposure to the healthcare setting?
That is an option. Again, we think you’ll need to discuss this with your physician. Your physician would need to write such an order for you to get a double dose every two weeks or even a triple dose every three weeks. Receiving a double dose every two weeks or a triple dose every three weeks is not as effective as weekly infusions. You’re probably left with less protection during the several days just prior to the next infusion. But it’s definitely better than missing an infusion on that second or third week and reduces your exposure to the healthcare system.
Has anyone looked into getting Medicare to cover home infusions so that we don't have to go to infusion centers?
Please find the link to the press release here.