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Q&A with Dr. Megan Srinivas on COVID-19

-Megan Srinivas

The Messenger recently interviewed Dr. Megan Srinivas via telephone about the spread of COVID-19. Srinivas is an infectious disease and internal medicine physician at the Community Health Center of Fort Dodge. Here are her responses to our questions:

What do you see as the biggest misconception surrounding the outbreak of COVID-19?

“That changes on a day-by-day basis and changes based on who you talk to. There are people who initially didn’t think we had it in Iowa because we weren’t testing. And that’s a huge misconception. Without testing, you can’t tell whether we have something or not. Viruses know no borders and this is a perfect example of that, regardless of the fact that we weren’t in the initial wave of the infection. We are just a few weeks behind. The virus will travel throughout the country because humans travel throughout the country. Any contact you have with anybody else is a potential risk of transmission. That’s why we are seeing the numbers starting to climb in Iowa right now.”

Can you describe the range in symptoms that a person with the novel coronavirus might experience and when would be the appropriate time to contact your health care provider?

“What’s extremely common is we are seeing a lot of cough, some people will have fevers. About 50% of people will have fevers. And then we are also seeing difficulty breathing. It could start out as simple shortness of breath, but could progress to something much more. About 10% of people are having GI symptoms, meaning diarrhea, nausea and sometimes stomach cramping. We are also seeing people starting out with congestion. Some started out with nasal congestion and kind of that runny nose phenomenon and then it evolved into the cough and shortness of breath. We are seeing it manifest in different ways. With mild symptoms, I would go ahead and call your health care provider to get on their radar. More likely than not they are going to say, ‘monitor your symptoms at home and give us a call back as things progress.’ But it’s never a bad idea to check in, especially because every person’s situation and personal health conditions are different. So it’s never a bad idea to check in with your health provider if you think you have symptoms consistent with COVID-19.”

Testing seems to be a confusing part of the COVID-19 equation. Can you explain which people should and should not be tested? If people can harbor the virus without showing symptoms, why shouldn’t they be tested? Why shouldn’t most people just be tested?

“That’s one of the things from the infectious disease and public health world — we have been pushing to expand our availability of test kits so we can test everybody. That’s the best way to get on top of it and open up the economy slowly and ensure we are still keeping the spread and the transmission in control. Unfortunately, right now in the nation, we just don’t have enough test kits available. It’s just they don’t exist. Once that’s available, doing that widespread testing is critical to get on top of the illness. Right now we don’t have enough tests to test everyone with mild symptoms. Once we get more broad-based testing, I imagine that the CDC guidelines will be widened so we can start to capture more of a picture of everybody who is infected.”

How should people handle trips to the grocery store and cleaning certain items when returning from the store?

“Try to limit how often you go to not more than once a week. Planning ahead and trying to get all the groceries you need on one trip. Also when you go to the store, make sure it isn’t a family trip. Only have one person from the household go. The less people that we have in the grocery store, the less likelihood that people are coming in close contact with each other. Trying to ensure you don’t have to take the family with you is important. The great thing with some of our grocery stores here is they offer online ordering with free pickup and that’s one way to really minimize having to go into the grocery store and expose yourself and others. When we bring it home, we have a counter space that we already cleaned off and wipe down cartons and containers with Clorox wipes as we put it away. Then we wipe down that counter space where we unpacked the groceries. Just to try to minimize any chance that we are bringing the infection home to our household. The virus is easily killed with household disinfectant. Just using simple things like Clorox wipes and washing hands with soap and water after handling any outside materials, is enough to get on top of slowing that virus.”

How should people handle dating at this time? What is the difference between a married couple kissing and two people who just want to meet?

“Luckily we have things like FaceTime or Zoom or Skype or virtual hangouts. The key is we are trying to prevent different households from getting together because if one person in a household is dating someone else in another household, having those two people interact, if one of them carries the virus then they are going to take that virus back and expose the rest of their household. And that’s how we have transmission increase and occur. So while it’s not the most fun, dating should be done with physical distancing at this time. Just to protect everyone in your own household. With married couples, if you are living together you are going to be exposed to each other. The way you can try to minimize spreading from one another is wiping down doorknobs, etc. as often as you can. In all likelihood, if it’s in your household, most likely everyone in the household is getting exposed.”

There is concern that this virus could re-emerge in the fall? Is that possible? And is it possible that we would follow similar steps with the closing of businesses and public facilities?

“There’s definitely a possibility that this could re-emerge in the fall. One of the things with this virus is it’s not necessarily the summer heat that’s going to kill this virus or slow it down, it’s the UV radiation that will slow it down from the sun. The UV light is stronger in the summer and we often do see viruses like this hit a wall over the summer and re-emerge in the fall.

One thing we can hopefully have in place by the fall, is a really robust testing system. So we have enough test kits to test anyone with mild symptoms. When we can institute that type of testing and utilize it to direct our public health intervention, it makes the necessity of having to shut down completely, less needed. The hope is by then we will have enough testing in place and can do more prevention than a complete shutdown like we are now.”

What has Iowa done right to this point in handling the pandemic and what should the state have done or do differently going forward?

“We definitely shut down our schools quickly, which was great. We shut down bars and restaurants for dine-in services before St. Patrick’s Day to try and reduce the number of interactions and the spread of the virus. We have seen places where parades and parties continued despite having the virus, had a lot higher transmission. That was definitely a good decision on our state’s part. What we do need to do going forward though is really enforce social distancing a lot more strictly. Having clear messaging saying that everyone needs to stay at home, not just those who have symptoms, but everyone staying home is a priority. Having an in-home order come from the state is important in ensuring that at the local level we can enforce social distancing practices. It empowers our local authorities to do so. Going forward that’s what we need to aim to do.”

What’s your best advice for the Fort Dodge community during this challenging time?

“It’s a very stressful time. And social distancing doesn’t mean we are emotionally distancing, it just means physically we can’t be in the same spaces as the people we care about and support. Emotionally, we can. We can still call somebody every day. You can still FaceTime or Skype with people to share your stresses, share your emotions and still share laughter and good times. Don’t forget to do those things that make you you and make you feel human. When we are all trying to watch out for our community and our neighbors, we are going to get on top of this. But we also need to remember to take care of ourselves and our needs during this time and be there for each other.”

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