COVID-19: Dispelling common misinformation

One of the most insidious difficulties with the COVID-19 pandemic is that the information keeps changing—and changing rapidly. What makes this especially dangerous is that what we think we know about the disease has a direct impact on our social and hygiene practices and, therefore, our health. With updated data and new understandings of the respiratory illness coming to light daily, misinformation abounds. Delayed news coverage and disagreements among health experts have cast shadows of doubt on the veracity of information related to COVID-19. 

While knowledge of the disease is still evolving—making it difficult to distinguish fact from fiction—it is imperative to stop the spread of half-truths and misinformation. With this in mind, here is recent information that has either proven to be true or been dispelled. 

CLAIM: COVID-19 is just like the flu

VERDICT: False

Anthony Fauci, MD, director, National Institute of Allergy and Infectious Diseases (NIAID), debunked certain COVID-19 myths in an interview with media personality Lilly Singh. A big misperception—even among physicians—is that COVID-19 is akin to the seasonal flu.

“[COVID-19] is [not] like the seasonal flu. It transmits much more rapidly,” Dr. Fauci explained. “The mortality of the seasonal flu that you and I experience every season is about 0.1%—the mortality of [COVID-19] is about 1%, which means it’s 10 times more lethal. In seasonal flu, we have never seen hospital rooms—hospital intensive care units—overrun: where you run out of beds and you run out of ventilators. We’ve seen that all over the world. We’re seeing it in Europe[and] we’re seeing it in New York City.”

CLAIM: Most people are not asymptomatic carriers

VERDICT: Inconclusive

“There are a number of people out there who are without symptoms,” Dr. Fauci told Singh. “Those are the ones that you’re concerned that they’re going to inadvertently pass the infection on to someone else. What percentage of the totality of the coronavirus infection is asymptomatic? We don’t know. We don’t think it’s a vast, large percentage; we think it’s relatively small. But, I say that with some trepidation because we haven’t looked at it in an orderly way.” 

Although Dr. Fauci believes the number of asymptomatic carriers to be relatively small, new data are prompting the CDC to reconsider their guidelines on the use of face masks. 

“One of the [pieces of] information that we have pretty much confirmed now is that a significant number of individuals that are infected actually remain asymptomatic. That may be as many as 25%. That's important, because now you have individuals that may not have any symptoms that can contribute to transmission, and we have learned that in fact they do contribute to transmission,” said virologist Robert Redfield, MD, director of the CDC, in an interview with NPR.

CLAIM: The virus lives on certain fomites

VERDICT: True

Viruses can live on inanimate objects for variable periods of time, Dr. Fauci told Singh. SARS-CoV-2, the virus that causes COVID-19, survives “better on hard surfaces like stainless steel [and] certain types of plastic,” he said. “It does less well on cloth and corrugated [cardboard],” he added. The virus can live on some surfaces for up to 3 days, according to recent research. Dr. Fauci recommends routinely sanitizing frequently touched points of contact and objects like doorknobs and credit cards.

CLAIM: The virus is airborne

VERDICT: Inconclusive

When Singh asked whether the virus is airborne, Dr. Fauci noted that the term airborne “means different things to different people.”

He continued: “When something is airborne, that’s misleading. It’s what’s really called aerosol, which means that when the virus comes out of your respiratory tree, it’s in a droplet that’s so small that it doesn’t just drop to the ground. It can hang around for a period of time. Several minutes—usually no more than that.”

Essentially, with airborne transmission, very small droplets of the virus are aerosolized when an infected individual sneezes or coughs, and can linger in the air. 

Although Dr. Fauci says that SARS-CoV-2 may only remain in the air for a few minutes—suggesting that the risk of transmission in this mode is minuscule—other experts disagree. For instance, in a much publicized study, scientists from the NIAID, Princeton University, University of California-Los Angeles, and the CDC detected SARS-Cov-2 for up to 3 hours in aerosols. 

However, “The experimental aerosols used in labs are smaller than what comes out of a cough or sneeze, so they remain in the air at face-level longer than heavier particles would in nature,” explained Carolyn E. Machamer, PhD, professor of cell biology at Johns Hopkins University School of Medicine.

And then there’s the World Health Organization, which can’t seem to decide one way or the other. 

“In a scientific brief posted to its website on 27 March, the World Health Organization said that there is not sufficient evidence to suggest that SARS-CoV-2 is airborne, except in a handful of medical contexts, such as when intubating an infected patient,” according to a recent article in Nature. 

Although the organization claims there isn’t enough evidence that the virus is airborne, it still recommends “airborne precautions for circumstances and settings in which aerosol-generating procedures and support treatment are performed, according to risk assessment.”

CLAIM: Only the elderly and immunocompromised die from the disease

VERDICT: False

This myth is probably the biggest one floating in the ether. Although it’s true that mostly older people are infected and subsequently die from COVID-19, young and otherwise healthy people are at risk, too. 

Per the CDC, identifiable risk factors include being elderly (aged 65 or older), living in a nursing home or long-term care facility, being immunocompromised, having serious heart disease, having asthma, having diabetes, having chronic kidney disease, having liver disease, or being severely obese. 

Results from a retrospective study out of China identified factors associated with COVID-19 infection in a cohort of 191 patients, of whom 54 died and 137 were discharged. Per the researchers, 48% of patients had comorbid disorders, 30% of patients had hypertension, 19% had diabetes, and 8% had coronary artery disease. Furthermore, older patients had increased odds of in-hospital death.

Yet, first-hand accounts from specialists contradict the myth that COVID-19 is a disease that only affects the elderly and the ill.

“For those of us in the trenches, it has never been just about the elderly,” reflected Hassan Bencheqroun, MD, an intensivist at Desert Regional Medical Center in Palm Springs, CA, and an assistant professor at the University of California Riverside School of Medicine. “That’s just what people want to believe.”

Dr. Bencheqroun noted that 90% of COVID-19 deaths occur in those older than age 60. But, these statistics could quickly become dated. “If you read an article from 2 days ago, it’s like it’s already 20 years old,” he said of the rapid turnover of information.

To keep up to date, Dr. Bencheqroun has been listening to webinars by pulmonologists and intensivists from the Wuhan province of China, as well as reading reports dispatched from Italy and France. “Every expert from the Wuhan province says that young people do die from this. It’s not just the elderly, immunocompromised, or cardiovascular patients. [Younger and otherwise healthy] patients may not make up 80% to 90% of deaths, but they do make up a non-negligible percentage of deaths,” he explained.

When pressed for what he thinks increases the risk of infection, Dr. Bencheqroun provided some thoughts. “I’m somebody who likes to disseminate academically sound information. Susceptibility to COVID-19 might be influenced by genetics. The mortality is different in different countries. How come rates of infection are lower in Germany than in Italy or France? Is it social distancing? Is it because 90% of Italians infected are over 60 years old and have cardiovascular [disease] and other comorbidities? Or, does it have something to do with ethnic distribution around the world? Personally, I can’t speculate one way or the other, and we will find out more as we move forward.”