When is this going to end? A Toronto doctor answers your COVID-19 questions

As self-distancing measures rise as a response to COVID-19, many of us have questions about how to best protect ourselves and deal with disruptions in daily life. 

Dr. Michael Gardam, an infectious disease specialist and the chief of staff at Humber River Hospital, is a veteran of the SARS epidemic and the 2009 H1N1 pandemic. He took your questions on CBC Radio's Metro Morning on Thursday. 

Do we know the actual number of cases?

Q: If people with mild to moderate flu-like symptoms are being asked to stay home and not get tested, how can we possibly have any idea what the actual number of COVID-19 cases are?

A: I think we've all been struggling with that question because I think the reality is the amount of testing that we're able to do in Canada, simply put, we can't test everybody with those symptoms. There's no specific treatment for COVID-19 and so the feeling has been if you are well enough to stay home and not go to the emergency department that's what you should do and basically self-isolate. 

I do realize that there are many people out there who are wondering if they have symptoms that could be this. And the reality is for many of us, we're not going to know. The amount of testing that we're doing over time is going to shift and it'll focus more on people who are being hospitalized or people going to the ICU. So unfortunately for many of us, we're not going to be able to know that information.

Why are test results taking so long?

Q: My friend had a regular flu and he went to the doctor because he might have symptoms of COVID-19. They tested him, and told him the results would be in 48 hours and it's been almost three days. He doesn't have the results yet. What's the usual time?

A: There's been a huge upswing in the number of tests being done in Ontario. Last I checked earlier this morning the time to get a result back is now getting close to five to seven days. The fact that he doesn't have a result yet, it likely means this sample is waiting in the queue to be tested. Now that some of the large hospital labs are up online in terms of doing their testing, I think we'll get through some of that backlog so hopefully this will improve over the next week or so.

Does no fever mean no infection?

Q: If you don't have a fever, can you still have COVID-19?

A: The reality is that there's a broad spectrum of symptoms with this ranging from no symptoms at all to being very sick. Certainly you don't need to have a fever to have this. I mean that's one of the biases in the way that we've been looking for people with cough and fever. You can imagine all cases that you know have a fever, we then diagnose with COVID-19 for example. But of course if we're not looking for people that don't have a fever, we don't know if those people have COVID-19. 

But we do know from the literature that definitely there's a wide range of symptoms, so not having a fever by no means rules it out. It could be as simple as a mild cold-like symptom with no fever — that actually could be COVID-19. We will learn more about this in the coming weeks.

Ibuprofen and COVID-19

Q: Should you take ibuprofen?

A: The general advice is no. Stick with Tylenol. Ibuprofen does interfere with part of your body's immune system with viral infections. It's recommended to stick with Tylenol.

Should I cancel my house cleaner?

Q: I'm 90 years old and I live alone. I'm healthy and I'm wondering if it's prudent to allow my cleaning lady to come in once a week while this is going on.

A: It all comes down to risk benefit. I certainly understand why you would want to have that service. I think it comes down to making sure your cleaning lady is well and not within two meters of you. So basically moving around rooms if at all possible while she's there. I mean the most prudent thing would be to say simply no. But I do understand it's a bit of a balance. And so if you are going to do that, stay away and make sure that your cleaning lady is feeling well before she comes into the house.

What about the towel I'm drying my hands on?

Q: I'm continually washing my hands. I'm wondering how often I should change the towel I'm drying them on.

A: If you can change it every day or so, that's fine. Obviously you can't change your towel every time you dry your hands. The nice thing about this particular virus is that it's not particularly hardy outside of the body. If you've washed your hands presumably the virus isn't on your hands and then you're drying your clean hands on a towel. I don't think you need to worry too much about the towel. If you're washing it regularly, that's fine. But the more important thing is that your hands were washed before you actually dried your hands on the towel.

Can my kids play with other kids?

Q: Is it safe to let my kids go and play outside on the street or in the park with other children that I know are not sick?

A: Half yes and half no. In terms of them going outside and running around, I think that's a great idea. I don't think that we need to lock ourselves indoors at this time, provided people are feeling well they can go outside and do whatever they want to do with the exception that you shouldn't be around other people. 

In terms of going to playgrounds and having kids congregate and run around together, I would say no you can't do that. So getting outside is a wonderful idea but they need to stay away from other people just like all of us do.

Asthma and COVID-19

Q: I have asthma and have asthma medication. I'm fine right now, but how is the care different if one does end up going to the hospital? Could I just be taking care of myself here if I got COVID-19?

A: It all depends how you're feeling. People with asthma can get worse asthma when they get a viral infection. 

You know your body pretty well. If you're able to manage this at home, you manage it at home. If you feel like you're really short of breath and your puffers are not working, then that would be the right time for you to go to the emergency department or to another health care provider to be seen and potentially given other medication. 

How can I build up my immune system?

Q: My question is for someone who has pre-diabetes and rheumatoid arthritis. What would you suggest to build the immune system and keep it strong?

A: It really comes down to basic things like getting enough rest and getting enough sleep. There's really nothing specific that you can do to boost your immune system. It's really for people who have weakened immune systems, like you were mentioning rheumatoid arthritis. Some people are on biologic medications which can weaken your immune system. It really comes down to trying to rest as much as you can but also avoiding other people. The best way to deal with the coronavirus is not to get infected with it in the first place.

How can Uber drivers protect themselves?

Q: I'm an Uber driver and I was faced with a situation where a rider came into my car and he said that he had just arrived from the U.S. and the government had asked him to quarantine himself. I have kids and I need to go to Wal-Mart to get provisions. What can I do to report such cases because, even if I deny him the ride he's going to call another driver and he's going to probably not say that he's come from the U.S. So is there a help line or some number where I can do something about this?

A: I've heard similar questions from people who say you know where we're supposed to be social distancing yet I see you know crowds of people in the park. Right now, Canada's approach to this has been voluntary. They're asking everybody to do the right thing.

But I do not believe they have the ability to actually police it at this point. But there may be more to come. It may very well be that a week from now the rules change again and governments start to become much more aggressive in terms of how they are dealing with people. 

Right now, I'm not aware that there's a particular number that you could call to help with that.

When will it end?

Q: I'm hearing so many crazy theories about how this virus got started. Can you tell me what your opinion is? And also do you have any guesses when this is going to end?

A: In terms of how it got started, it's very clearly an animal virus that jumped into humans and that's happened before. We have many viruses in the past that have done things like that. This is just the latest one that has done that. All of the conspiracy theories that this was a virus in a research lab in China have all been thoroughly disproven. 

This is what viruses do. They occasionally jump species, and when they jump species they can be quite bad in the new species because none of us have any immunity to it. 

In terms of when this is going to end, I would love to know the answer to that question. What we're doing in Canada is going to go on for weeks while we see what our surge numbers are like in hospitals and whether hospitals are able to handle the surge. 

We should know in a week or two whether what we're doing right now is having an impact on those numbers. I believe it will have an impact on those numbers. But in terms of how long this goes on for after the next couple of months, nobody knows. There's lots of wishful thinking out there that it may just die down in the summer. That would be lovely. 

I'm not sure that's actually true. We'll find out when we get there. And then in terms of how long it lasts after the summer, it's very much dependent on what proportion of the population has been infected with this. 

So if it's still only a small percentage of the population that had it then presumably this can keep going and this could be something we're dealing with for months and months. You know the big hope at this point is as soon as we get a vaccine that will definitely start to dramatically slow this down. So we really don't know. 

We look at what's happened in China and it's incredibly impressive how their cases have dropped. Nobody knows what's going to happen in China over the next few weeks, whether this might start to bump up again or whether it's done.

These are all things that we're actively looking into and, you know, the one thing I tell myself every morning when I get up, we're one day closer to figuring out what the heck is going on and we're one day closer to eventually getting a vaccine.