[Question #6759] Surprised nobody has asked yet

7 months ago
My apologies if this pathogen does not fit this forum. I read before in a prior post that both Drs EWH and HHH are researching Covid-19 and was hoping for insight. Trying to calibrate one’s fear and logic meters is a little difficult with this pandemic. But I trust the assessments of the 2 Drs. on this forum and the ability to give straight talk, even if the science and data are still evolving.

1) Is Covid-19 a meaningful risk with any intimate contact with new partners in the US, in particular WA, CA and NY, the most affected states? It seems asymptomatic people can spread this. It seems like this disease should be considered as much as STIs with a new partner.

2)  Overwhelmingly, the information points to immunocompromised people being at most risk. But then there is the young Dr. in China who first started talking about this who died. Is it reasonable to conclude at this point that for Immunocompetent people, the mortality risk is less than or perhaps much less than 1%? Also, should asymptomatic people in lower risk groups be overly cautious to not expose loved ones in higher risk groups? 

3) Some have said the majority of people will get this. Is that accurate?

4) I’ve been looking at the updated WHO data. I am thinking numbers out of South Korea where they have done more rigorous testing is encouraging with regard to deadliness of this disease, where mortality looks to be 0.7 to 0.8% compared to the WHO cited number of 3.4%. I understand that because we still haven’t gotten to an adequate sample size it is really hard to pin true mortality rate down. Will you be able to comment on your perspective on Covid mortality?

5) Any general advice at this point on how to approach this situation?

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Welcome to the forum. Thanks for your confidence in our services.

Indeed, yours is the first question on the forum about COVID-19 and SARS-nCoV-2, the formal name of the causative coronavirus. Before replying, Dr. Hook and I discussed the forum's approach. We will be happy to address issues related to sexual transmission and risks. However, we are discouraging other questions, i.e. more general ones about risks, symptoms, diagnosis or prevention. My replies below to questions 2-5 are very succinct. Among the many online resources, one of the best is CDC https://www.cdc.gov/coronavirus/2019-nCoV/index.html; and most academic medical centers and local and state health departments have excellent information and advice. As just one example, here's the link to information from my institution, the University of Washington -- which for obvious reasons (located in Seattle) has been at the forefront of evolving informaiton https://newsroom.uw.edu/postscript/coronavirus-updates-uw-medicine 

To your questions:

1) As you undoubtedly know, the main prevention strategy to reduce personal risk of COVID-19 and also help curtail spread in the community is called social distancing, i.e. limiting direct contact with other persons to the extent possible. Sex is the polar opposite of social distancing and I suspect carries just about the highest risk of nCoV transmission of all personal contacts. There are no data so far to prove this, but common sense indicates it's a high risk activity and that sex with multiple partners is especially high risk. (The same is true of other infections -- colds, flu, viral gastroenteritis. And in some parts of the world, serious infections like Ebola and Zika. All these can be viewed as "sexually transmissible" even though they are not classified as "sexually transmitted".) Presumably the mechanism of sexual transmission of COVID-19 is mostly through respiratory secretions (e.g. kissing, maybe oral sex) rather than intercourse -- but having sex (aside from masturbation and phone sex) is pretty much impossible without potential exposure to respiratory secretions and/or contaminated hands and fingers.

In summary, we would strongly recommend sexually active persons be very selective in their sexual partnerships, pay attention to partners' health, and limit new partnershps to the fewst possible. The lowest sexual risk of course will exist for mutually monogamous couples.

2,4) Your summary of mortality data is exactly consistent with my own. Almost certainly mortality risk is well under 1% for immunocompetent persons under age 60.

3) The most common estimates I have seen from public health and infectious diseases epidemiologists are 25-40% eventually infected. But this could change radically as the pandemic evolves; keep your antennae up for new information.

5) Follow the now standard advice about social distancing, frequent hand washing (or hand sanitizer), and keeping your hands away from your face. You'll have to seek out other resources for more detail.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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7 months ago
Thank you for your response, Dr. Handsfield. 

Certainly makes sense that any sexual activity with a new partner would be risky for coronavirus transmission, particularly as numbers of infected continue to increase in the community. I imagine if regions impose widespread quarantine (like SF Bay Area recently) it will undoubtedly change the logistics of new sexual partners meeting in the community. 

I have seen scattered reports of HIV antiviral drugs being helpful in isolated cases. I’m really surprised this isn’t getting more attention. Would you be able to share your perspective on HIV meds and covid and reliable resources to learn about this? If one finds oneself or a loved one infected with this virus, is it feasible to request HIV meds for it? 

If I may ask, as a healthcare provider, how has the outbreak  in the Seattle area affected your practice, your attention to your own health,  and your interaction with loved ones and friends? I am in the healthcare field but with relatively low direct patient contact, though there is still some and I am working in the hospital. I know there will be a lot of personal decisions ahead for me as to if and how I see loved ones. 

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Thank you for your interest, but as noted above, this forum is not a venue for discussion of COVID-19. Your question about treatment with HIV drugs is slightly relevant, so I'll just confirm what you apparently know. HIV and coronaviruses both are RNA viruses, which creates the potential for similar drugs being effective for both. So far, however, there are no scientific reports of their effectiveness. There are anecdotal reports of various drugs perhaps helping severely ill patients and others suggesting no effect. Controlled research will be needed and at least one such study is underway, using a drug called remdesivir (which never came to market for HIV treatment).

Best wishes and stay safe.
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