Loren Miller is a physician researcher at the Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center. His specialty is infectious diseases. The Journal spoke with him shortly after Los Angeles County declared a state of emergency. At the time, there were seven known COVID-19 cases in the county. As of press time, that number had doubled. Miller emphasized that this is a fluid situation. Speak to your health care provider for the most up- to-date guidance.
Jewish Journal: What are you doing differently, if anything?
Loren Miller: Probably the most important lesson is [to] keep your hands below your neck. With these viruses, you don’t know who’s contagious. Anything you touch, any surface you touch, could be contaminated with all sorts of viruses: cold viruses that cause colds and flus, bacteria, coronavirus. We know that the way you acquire these — one of the most common ways — is that your hands touch a contaminated surface and then you touch what we call your mucous membranes, which would be your eyes, nose or mouth. We know that people commonly, inadvertently, touch these parts of their bodies all the time. If you get used to keeping your hands below your neck, you can avoid touching those and acquiring all sorts of viruses, including COVID-19.
I should point out that COVID-19 is a coronavirus. We know other coronaviruses can probably live for several days on inanimate objects like tabletops, or keyboards, or you name it. So just because you don’t think anybody was around in the last few hours, doesn’t mean they can’t be contaminated.
If I really need to do something — rub my eye or eat with my hands or something like that — I’ll just wash my hands beforehand or use alcohol hand rub (hand sanitizer) because both of those things are good at killing germs.
JJ: How likely are we to see something in Los Angeles like what has happened in Italy?
LM: It’s hard to say. It could be anything from something like the SARS epidemic, where it seemed to get controlled. But I don’t think it’s unfeasible at all that it gets into the community and spreads from person to person. Right now in L.A., we don’t have any community transmission. Those people who got it were exposed during their travel. But all it takes is one person who doesn’t know that they have it. So there is a huge potential that it could spread in the community. We’ve got to remain super vigilant.
JJ: Let’s say you’re a healthy adult and you wake up tomorrow with a fever and you’re not feeling well. Should you make an appointment with your doctor?
LM: This is one of the other things that changes dramatically. A week ago, it would be, you don’t have to do anything unless you’re exposed to someone from Wuhan, China, or Italy or Korea or Japan or Iran. It’s a really hard thing because the health department literally puts out notices at least daily. That’s why I’m almost a little reluctant to [answer] because a week ago they’d be like, just stay at home. Also, a week ago they didn’t have the capacity to test. It was limited. It’s better this week but still limited. It’ll be better probably in the subsequent weeks.
The best thing to do is to contact your provider or an urgent care and get advice. Don’t go there; just call and ask what should be done. Whatever advice I tell you today could change. Places like urgent care, emergency departments, clinics, they will be following the advice of local county health departments and what to do with people with these symptoms, and that’s going to evolve over time.
JJ: Some people may be thinking now is not the time to go to the doctor or the hospital.
LM: That is probably wise advice. Today, there is no known risk of community spread in the Los Angeles area, so the risk would be very, very low. Things could be different tomorrow, and I wouldn’t be surprised, for example, if elective things like mammograms or Pap smears or annual checkups, those things they’d say, “Hey, you know what? We’re just not giving them now at all.”
JJ: If you have an elderly relative, are there any additional precautions that you would advise?
LM: The first thing that should be done whether there is COVID-19 or not circulating, if you’re sick with cold-like symptoms, you should stay away from them if it’s at all possible because you could transmit it. Many older people have other medical conditions that weaken their immune system. That small cold or flu that aren’t COVID-19 could cause serious symptoms in persons with immune-impaired immune systems. It’s [best] to really avoid them until you’re recovered, until your symptoms are all gone. Sometimes it’s impossible. You are the caretaker. If there’s no way you can get some help from people who don’t show symptoms, do really good hand hygiene before you have contact with them.
Another thing if you’re sick is covering your cough. One of the easiest ways is what I call the vampire move. You put your elbow over your face. The back of your elbow is facing outward. And you cough into the crease of your elbow so you’re not spreading your germs. A lot of people recommend coughing or sneezing into tissue. Again, I would do good hand hygiene after that because sometimes your hands get contaminated after coughing or sneezing into your hand.
No one washes their hands long enough. The CDC and other experts recommend 20 seconds with soap and water. That is a long time. That’s why I’m a fan — when available — of the alcohol hand rubs. It’s much quicker and it actually kills germs better than soap and water.
JJ: You’ve got concert tickets. Do you go?
LM: The easy answer is if you’re sick, don’t go. The hard answer is, again, things change so fast. Right now, we’re not aware of any community spread in the Los Angeles area, so the risk seems to be extremely low as of today.
JJ: But the people who are quarantined, they had to have come through airports, etc.?
LM: That brings up a really important thing. Here are the two most important things about how germs are spread. People cough and sneeze into their hands and don’t clean them, or they cough onto a tabletop or doorknob, something like that. Then you touch it and you touch your eyes or your nose or your mouth. The other way is if someone else coughs directly on you. A cough goes about 3 feet. That’s as far as the germs will travel. You’d have to be within 3 feet of somebody and that would have to hit your eye, your nose, your mouth, or hit your hands, some part of your body that then you touch. In some ways, this coronavirus, if someone’s in front of you coughing, if someone is traveling and coughing and walking through the terminal, unless they’re coughing on you, you’re very unlikely to get it. Again, it’s the inanimate objects that worry me a lot.
That said, the problem is, there are places that are crowded: a standing-only concert, [or] you go to an airport and you’re queued up to get on a plane. If you’re in a social situation where you can keep your distance, that’s probably a lot safer than a very crowded venue. Supermarkets, you could argue, you’re usually not that close to people, but you are in line. There are other germs like tuberculosis and measles that can waft in the air. You can be far away from somebody and still acquire it. Coronavirus does not act like that. That’s the key thing.
If it was me — I’ve got a concert ticket for later this month — I don’t know if I’ll go because it’s standing room only at the Hollywood Palladium. I don’t think I want to go to that venue. I can’t control the people around me very well. I can’t control my distance. Again, I don’t know what the epidemic will be like then, too.
JJ: Why is getting a flu shot being recommended as part of combatting the spread of COVID-19?
LM: They’re really unrelated. It’s good to get your flu shot if you haven’t. People are worried about COVID-19 for all the right reasons. They want to keep themselves healthy and protect themselves and their loved ones from disease. If you worry about those things, you should also worry about the flu because the flu probably kills in the order of 20,000-40,000 people a year. Even if you’re young and healthy, it doesn’t mean that you can’t transmit it to someone who’s vulnerable. It’s a great protection for you and your loved ones.
JJ: What about travel?
LM: If someone is going to San Francisco and has to be in the airport, again, as of today, the risk is very, very low. Stay tuned to news outlets because it can change very quickly, and keep to the basics, which I mentioned. Keep your hands below your neck. Do good hand hygiene. You may want to limit nonessential travel, but the risk currently is very, very low.
JJ: I assume we have no idea how long this is going to last.
LM: That’s correct. It wouldn’t surprise me if this lasts a long time.
JJ: Why do you say that?
LM: Because it just takes some level of undiscovered community transmission to spread things relatively quickly before it can be contained, so it has the potential to get out of control. Do I think it will? I just don’t know. Again, it could go the way of SARS and it gets contained within a limited period of time. It could also become something that spreads in communities all over the nation. It’s just so hard to predict.
JJ: Is there some reason to think this is the new normal?
LM: I think the potential for new viruses to leap from animals to humans, like this coronavirus, has probably increased. As our human population increases, we have increased travel. We’re all so interconnected all over the globe. As travel becomes increasingly affordable, we’re going to be at increased risk for this. I don’t know if it’s the new normal, but it wouldn’t be surprising if these events happen with increasing frequency in the future.
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