Mary Anne Jackson, M.D., dean of the University of Missouri-Kansas City School of Medicine, is an infectious disease expert. Also an alumna from the UMKC School of Medicine’s innovative six-year B.A./M.D. program, she served as one of six physicians statewide advising Missouri Governor Mike Parson about COVID-19, and was recently named senior advisor of public health in a five-member volunteer group on how Jackson County should spend its $122 million in CARES Act funding.
On numerous media appearances, Jackson has answered questions about evidence-based practices in dealing with the coronavirus pandemic. Here are just a few examples she’s dispelled of legend and lore about COVID-19:
1. A chiropractor has been publicizing an IV vitamin C product as a possible treatment for COVID-19. Anything to that?
Jackson: While there is biologic plausibility based on the hypothesis that when an individual suffers a severe infection, vitamin C which is necessary for cellular and tissue function, is depleted, there is no scientific evidence to support the use of vitamin C in the management of hospitalized COVID-19 patients. There is no data to support its use as prophylaxis that would be given in a chiropractor’s office.
One study registered at clinicaltrials.gov, will investigate the use of IV vitamin C in SARS-CoV-2 pneumonia patients in China using a randomized control trial protocol. The randomized control trial using a standard control group receiving placebo vs. the treatment group excludes bias and allows the outcome variable to be clear. This is especially important for COVID-19 where we know many cases spontaneously improve. There have been two recently published studies that are “open label” (no control group) to study the use of vitamin C in non-SARS-CoV-2 infections where individuals suffered from shock and acute respiratory distress syndrome. Neither showed clear evidence of benefit.
What is interesting is that anti-vaxxers appear to be circulating information on social media to drive the unproven messaging around vitamin C. For treatment of disease, trust a well-trained healthcare professional who practices evidence-based medicine and has extensive clinical experience.
2. Does heat kill the coronavirus? For example, the sun? A hot bath? Drinking hot water?
Jackson: There is no evidence of a benefit to flushing the virus from your system by drinking hot water or taking a hot bath. Drinking water will keep one hydrated and that is recommended for all.
The concept that heat can affect the virus is one worth discussing. The virus that causes COVID-19 is an enveloped virus, and enveloped viruses do generally demonstrate sensitivity to temperature and therefore may be more likely to appear or disappear during certain seasons related to temperature.
Research on other enveloped viruses suggests that this oily outer coat makes the viruses more susceptible to heat than those that do not have one. In colder conditions, the oily coat hardens into a rubber-like state, much like fat from cooked meat will harden as it cools, to protect the virus for longer when it is outside the body.
Many viruses wax and wane in seasons. Influenza typically arrives with the colder winter months. So does norovirus and RSV. Measles cases drop during the summer in temperate climates, and increase when schools are in session.
But we have no information about how the virus that causes COVID-19 will change with the seasons.
For one thing, pandemic viruses often don’t follow the same seasonal patterns seen in more normal outbreaks. Spanish flu, for example, peaked in the summer, while the typical seasonal flu peaks occur during the winter.
Even if COVID-19 does show some seasonal variability, it likely will persist to some degree and not totally disappear in the summer. A dip in cases will bring benefits, however. If it decreases in the summer, it is likely to re-emerge again in the fall. But there will be fewer susceptible individuals at that point, too, so potentially fewer cases-depending on how much of the population remains susceptible after the first wave.
3. If there has been a day of rain followed by sunshine, is playground equipment safe from COVID-19?
4. Jackson: As the weather warms, people will want to be outdoors and I’ve seen more people in our community outdoor walking and running in neighborhoods and in areas of parks and trails. It’s important to be outside to keep healthy, physically and mentally. And I especially like that I’ve seen families outside with their kids, who need to be active especially since they have no school and can’t be out with friends.
CDC and the World Health Organization (WHO) have been emphasizing that to control the COVID-19 epidemic, we must “flatten the curve” — that is, reduce the amount of transmission of the virus. We know that one proven way to accomplish this is by physical distancing — keeping six feet or more from other individuals and taking precautions to wash hands, refrain from being in enclosed spaces with other people, disinfect surfaces and other precautions to prevent the spread of the virus.
But do not take the kids to public playgrounds–you’ll find that all are cordoned off so that equipment can’t be accessed. Not only would open play areas encourage the kind of close contact we are trying to limit, but also, contaminated surfaces have been found to have detectable virus–including plastic and stainless steel. The duration that virus could exist on wood is not clearly known. There is no good evidence that following rain and with a day of sunshine, the playground is safe. There is no present guidance from CDC on how best to manage these spaces, including recommended cleaning and disinfection for outdoor equipment to prevent transmission of the coronavirus.
Bottom line: Avoid the playground (and play dates) for kids while you are social distancing unless it is the playground in your own backyard for your family.
4. Should you consider deliberately exposing yourself to inoculate yourself?
Jackson: In the past, some parents participated in “chickenpox parties” to intentionally expose their unvaccinated children to a child with chickenpox in hopes that they would get the disease. CDC strongly recommends against hosting or participating in these events because serious complications and even death can follow infection and one cannot predict how severe the disease will be.
Now the same bad idea has emerged related to COVID-19. On March 24, it was announced that an individual in Kentucky tested positive for the novel coronavirus after they attended a “coronavirus party” for people in their 20s.
Young people are less at risk of developing serious complications of COVID-19, the disease caused by the novel coronavirus, but they may still require hospitalization for serious symptoms. And even someone who only contracts a mild case of the disease can spread it to vulnerable people.
We need to wait for the vaccine–and until then continue social distancing.
5. Can livestock pass COVID-19 on through our food supply?
Jackson: There are some food products that can be contaminated and pose a risk for transmission to humans–like E coli, norovirus and hepatitis A. That is why there is emphasis on food preparation safety in general.
The bacteria and viruses that are transmitted by food products are those that cause gastrointestinal infection. SARS-CoV-2 is a respiratory virus and there is no known foodborne risk for transmission.
There is no evidence that livestock or any other food product in the U.S. is a vector for transmission of the virus, and there is no evidence of human or animal food or food packaging to be associated with disease transmission.
There is no risk of food product recalls, and the U.S. food supply is safe.
6. Will drinking lots of water wash the virus down to your stomach where it will be killed by stomach acid? What about drinking bleach? Can you ward off the virus by eating food with higher PH level?
Jackson: Washing the virus down the esophagus will not reduce the risk of coronavirus and the virus is resistant to the diluted acid in the stomach
Gargling with water or with an antiseptic solution, compared to doing neither, did reduce reports of respiratory symptoms in a study from Japan. However, the findings don’t necessarily apply to COVID-19 – and it’s dangerous to assume that they do.
The main risk is from breathing in tiny droplets containing thousands of viral particles after an infected person coughs or sneezes within 6 feet from you.
The overwhelming evidence suggests that the best approach remains avoiding unnecessary social contact and washing your hands. So, put down the water and pick up the soap instead.
Drinking bleach is not a cure and is dangerous–it can result in vomiting, diarrhea and liver failure. Some bleach-based cleaners, however, are helpful for keeping surfaces virus-free.
7. Pets cannot spread the coronavirus, can they?
Jackson: This virus is thought to have jumped from animals to humans, but there is no evidence that it is spreading among pets or from cats and dogs to their owners. Cats have been infected, both at the zoo and in homes-but there is no evidence that cat to human transmission is a significant concern. There was one instance in Hong Kong where a dog tested positive, but the dog was well, and it was thought contaminated by secretions from the infected pet owner.
The CDC suggests letting family members without symptoms take on pet care and recommends that people with symptoms should avoid close contact such as “petting, snuggling, being kissed or licked, and sharing food.”
When you care for your pets, wash your hands before and after handling and feeding.
8. Does ibuprofen make COVID-19 symptoms worse?
Jackson: I first heard of the ibuprofen alert after a report from the French health minister, Olivier Veran, identified that it could be a factor in worsening the infection based on anecdotal reports from physicians treating patients in that country. Then there was a letter that was published in the British medical journal The Lancet Respiratory Medicine where it was hypothesized that ibuprofen could make it easier for the new coronavirus, SARS-CoV-2, to enter cells. The theory is that ibuprofen could increase the levels of ACE2, which is a protein that the coronavirus uses to enter cells and might therefore increase the risk of serious infection. However, there is no evidence that ibuprofen raises ACE2 levels.
The National Institute of Allergy and Infectious Diseases says more research is needed, but right now, there is “no evidence that ibuprofen increases the risk of serious complications or of acquiring the virus that causes COVID-19.”
There are reasons in general to avoid ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) because they are known to have gastrointestinal, kidney and cardiovascular side effects, which may be especially dangerous in very ill or elderly patients or in those with preexisting conditions.
9. Does putting petroleum jelly in your nose prevent the virus from getting into pores? Will rinsing your nose with saline prevent the virus?
Jackson: In the face of the COVID-19 coronavirus outbreak, it’s natural that we’re looking for ways to stay healthy. Washing your hands and practicing social distancing are two proven pieces of advice that are more important than ever.
A dry nose can make one more vulnerable to viruses and certainly is an irritant for those who suffer allergies. A water-based product can help. Using saline or saltwater nose rinses will not prevent the virus, but in certain people with asthma for instance, who also have nasal and sinus symptoms, a saltwater nasal wash, or nasal irrigation, can help reduce nasal symptoms that can aggravate asthma.
According to National Jewish Health, a nasal wash:
- Cleans mucus from the nose, so medication can be more effective
- Cleans allergens and irritants from the nose, reducing their impact
- Cleans bacteria and viruses from the nose, decreasing infections
- Decreases swelling in the nose and increases airflow
But do not use tap water for the nasal wash. Do not use well water. Only use distilled or sterilized water for nasal rinses. And follow the CDC water preparation guidelines for proper preparation.
Avoid petroleum jelly in the nose–it can be inhaled and cause lung injury called lipid pneumonia. Don’t use antibiotic ointment either–that type of ointment does not fight viruses.
10. Can kids die from COVID-19?
Jackson: While children have been generally spared from COVID-19, pediatric cases requiring intensive care have occurred within our state and there are rare child deaths. The burden of disease is far less for children than influenza though.
A new syndrome, recently described, called Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C is an inflammatory response with organ dysfunction, thought to be triggered by prior exposure to SARS CoV-2. On May 14, 2020, the Centers for Disease Control issued a health advisory, to alert providers to this condition, which has now been identified in at least 19 different states and Washington DC. Parents should report to their pediatric provider if their child develops fevers especially associated with a rash. While the prognosis is good, children have suffered shock and required intensive care–the syndrome is extremely rare and we are still learning more about it.
11. If you can hold your breath for 10 seconds, does that mean you don’t have the virus?
Jackson: It is true that those with serious lung disease of many types, such as emphysema, may not be able to hold their breath for 10 seconds.
Many respiratory viral infections make it difficult to hold your breath because the airway is irritated. The inability to do so does not identify those who have COVID-19.
This false claim was first attributed to someone at Stanford University Medicine–and the spokesperson at Stanford denies it came from them, and on March 12, they posted on social media that this was misinformation.
The only way to know if one is infected by SARS-CoV-2 is by testing secretions obtained by a swab placed in the nose/throat and having the specimen tested in a laboratory.
12. Is cupping a treatment for COVID-19?
Jackson: Cupping is a process whereby the skin is bruised using a suction cup over the skin, and is used in traditional Chinese medicine for a variety of ailments. It is being studied in a Chinese population convalescing from COVID-19, but there is no evidence that it is beneficial at this point.
13. Is proning a treatment for COVID-19?
Jackson: There is no specific treatment for COVID-19 and we currently rely on supportive intensive care including oxygen, IV fluids andmechanical ventilation. Of specific therapies targeting SARS-CoV-2, none have been adequately studied, but there are some encouraging reports. Prone positioning of those with respiratory failure, meaning having the patient on a ventilator lay face down, was shown in a small study to result in better lung function with better oxygen levels and this treatment is being incorporated into care now.
Other therapies which are being examined include the use of hydroxychloroquine, an antimalarial drug which was shown to inhibit virus in a small study when paired with an antibiotic called azithromycin. We now know that there is no data to support its efficacy and individuals accessing chloroquine products and suffering life-threatening toxicity.
There are a couple broad-spectrum antiviral agents (one used in Ebola called remdesivir) that are being studied. Remdesivir is an intravenous drug used for those with serious COVID who require hospitalization and treated patients have shown a shortened course of disease.
Drugs that modify an inflammatory over-response seen in COVID-19 appear promising. These agents inhibit IL-6, an immune modifier, and are also being studied in severe cases of COVID-19.
14. Even though COVID is here to stay, at least for the next six months to a year, is it okay for me to go out into the community now? Can I go to the doctor for my routine care?
Jackson: We have successfully flattened the curve here in Kansas City, but COVID is continuing to circulate. The chance that you’ll be exposed to SARS CoV-2, is related to three factors:
- what activity you are involved in
- your proximity to others
- the duration of exposure
Risk is greatest for indoor exposure where individuals are in close quarters with a large group of people. After a choir practice that took place in Washington on March 17, 2020, among 122 choir members, 87% of the group became infected from one infected member–it appears the act of singing amplified the spread of the virus. In contrast, if one is outdoors for a limited time, and can socially distance from others, the risk is very low.
In terms of going back to your doctor for routine appointments, every provider in our community is prepared to care for patients even while the virus is still circulating. It is especially important that infants and children visit their pediatrician and get their immunizations on time. Many pediatricians are asking parents to call on arrival to the office, and the provider will text when the office is ready to place the patient directly into an examination room. We don’t want a measles outbreak in our community while we’re still tackling COVID!