Practical Measures to Prevent COVID-19, According to NEJM

In a podcast published by The New England Journal of Medicine (NEJM), Eric J. Rubin, MD, PhD, editor-in-chief for the journal, and Lindsey Baden, MD, MMSc, deputy editor of the journal, discussed practical measures that could help prevent the coronavirus disease 2019 (COVID-19).¹

First discussed was the difference in aerosol and surface stability of SARS-CoV-2, which has been linked to COVID-19, and SARS-CoV-1, the most closely related human coronavirus.² The comparison of the 2 viruses was published in a study in NEJM, which found that the stability of SARS-CoV-2 was similar to that of SARS-CoV-1.

The important difference in the 2 novel coronavirus strains, however, is that of high viral loads in the upper respiratory tract and the potential for persons infected with SARS-CoV-2 to shed and transmit the virus while asymptomatic. 

“Aerosols may not be the primary mode of transmission,” said Baden. “It seems more likely that droplets are important. And survival in droplets is less of an issue because droplets do not remain airborne for that long.” 

Both doctors concluded that, given the prevalence of droplets in this virus, the best way to avoid transmission is by cleaning surfaces. 

“Because SARS-CoV-2 is an enveloped virus, it has a lipid coat – it’s relatively easy to disrupt that, and as soon as that membrane is disrupted the virus is no longer infectious,” Rubin explained.

The greatest issue thus far, according to Baden, has been those who are potentially infectious but not symptomatic, as those individuals likely amplify the virus and shed it at very high levels. 

“The real driver, I think, is likely individuals who are infected, don’t necessarily know they’re infected, and then have close contact with others,” said Baden. “And that requires a different strategy than just cleaning the environment in terms of rapid ways to identify who’s potentially infectious, yet not symptomatic.” 

Given the prevalence of these asymptomatic individuals, the spread of the disease has been greatly affected by the burden of disease in various populations. And with a lack of PPE equipment and testing, these areas are not able to stop the spread of the virus effectively. 

In areas like New York City where the situation is becoming dire, Rubin suggested there is not a good answer at this point as to how facilities can limit the spread of disease; However, for areas that have not yet seen high numbers of patients with the virus, he recommends coming up with a plan and being prepared now. 

“In areas where we have a little bit more time to prepare, it’s extremely important to be thinking through the kinds of policies that you need to implement,” said Rubin. “Those will change, they will change on a likely daily basis as we learn more and as the availability of resources becomes better. But, if you are working at a hospital which has seen very little disease, you should be very prepared right now for what happens when the number of cases increase dramatically.” 

Though both stressed the importance of protecting patients and giving everyone access to healthcare, Rubin and Baden also indicated that a key part of that is protecting the healthcare workers who are caring for these patients.

“We don’t have a huge excess number of healthcare workers, and in fact, a number of people have been taken out of the system because either they’re being quarantined for exposure or because they have become ill themselves,” Rubin said. “And I think that we really need to take care of these people. They are putting themselves at risk and providing an important service that’s irreplaceable, so both from a practical and an ethical standpoint, we should be doing better.” 

References:

1. Rubin EJ, Baden LR, Morrissey S. Audio Interview: Practical Measures to Help Prevent Covid-19. N Engl J Med. doi:10.1056/NEJMe2006742.

2. Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. doi:10.1056/NEJMc2004973.