COVID-19 Transmission Risks in Social Settings

Q: COVID-19 Transmission Risks in Social Settings

Dear Miss Ning Ning：<br>1. <br>The Wuhan pneumonia virus (COVID-19 virus) belongs to the second type of coronavirus (also known as β-coronavirus); it is an enveloped RNA virus with a large genome (26-32 kb) and is classified as a zoonotic virus. <br>Currently, the primary transmi

Transmission potential of Wuhan pneumonia?

Hello, doctor.
Last week I had a bit of a cold and went to see an ENT specialist.
I'm still taking medication.
The doctor said my lungs sounded fine, but I sometimes have a sore throat along with phlegm and nasal discharge, so I was prescribed antibiotics.
I really didn't want to go out for a meal, but today my family insisted on taking me out to eat to celebrate Mother's Day for my grandmother.
At the restaurant, there were four Japanese people sitting at a nearby table, and I was a bit worried they might be carriers.
They were serving food without wearing masks, which I think is the restaurant's fault.
I only wrote this in Chinese because I feel a bit scared seeing foreigners lately, even though they didn't seem to be coughing.
I also guessed they checked temperatures before entering the department store.
However, after eating, I noticed that the area near my right tonsil was still a bit painful, along with a runny nose.
My family said I was worrying too much and that it’s unlikely for me to get sick so quickly.
It’s probably just that my cold isn’t completely gone since I forgot to bring my evening medication and didn’t take it until I got home at 9 PM.

Doctor, what do you think is the likelihood of transmission in this situation? Even though we weren't at the same table, I still feel a bit concerned.
Is Taiwan really safe right now? Additionally, I sometimes suddenly feel like my breathing isn't smooth, but taking a deep breath usually helps.
This typically happens when I'm feeling very anxious.
I wonder if this difficulty in breathing is part of my symptoms, or if it’s just a psychological factor.
I heard from a classmate in Japan who tested positive that he experiences severe breathing difficulties and can barely move without getting short of breath.
I apologize for bothering you after your work hours.
Thank you.

Ning Ning, 20~29 year old female. Ask Date: 2020/05/22

Dr. Xiao Yongxun reply Family Medicine

Dear Miss Ning Ning:
1.
The Wuhan pneumonia virus (COVID-19 virus) belongs to the second type of coronavirus (also known as β-coronavirus); it is an enveloped RNA virus with a large genome (26-32 kb) and is classified as a zoonotic virus.
Currently, the primary transmission route is believed to be direct contact with infected secretions or droplet transmission.
The estimated incubation period is mostly between 1 to 14 days, with the most common duration being around 5 days.
2.
Regarding clinical symptoms, statistics from limited cases in our country indicate the following: fever (49%), cough (48%), throat symptoms (30%), fatigue (15%), headache (13%), muscle and joint pain (10%), sputum production (8%), respiratory symptoms (6%), chills (2%), nausea and vomiting (1%), nasal congestion (37%), pneumonia (7%), loss of smell and taste (6%), asymptomatic (5%), diarrhea (5%), and ocular symptoms (2%).
3.
Droplet transmission occurs at a distance of approximately 2 meters, and viruses remaining on surfaces can continue to spread through hugging, touching, etc.
Therefore, during this global pandemic, it is advisable to wear masks in enclosed spaces, crowded areas, public transportation, or when feeling unwell.
It is also recommended to wash hands frequently before rubbing eyes, picking the nose, preparing food, eating, or holding children.
4.
In our country, the index case of hospital-acquired infection from the Wuhan pneumonia virus (case 34) showed that virus was detected on surfaces in the patient's room, including bed rails, chairs, bedside tables, sinks, and toilets.
This indicates a significant risk of environmental contamination, or fomite transmission.
Professor Zhang Shangchun emphasizes the importance of hand hygiene.
Since such viruses can survive in the environment for an extended period, all inanimate objects in hospitals that may be contaminated with the coronavirus, including clothing and bed linens used by suspected infected patients, should be cleaned and disinfected with appropriate agents as a crucial part of infection control measures.
5.
Due to the overlap of symptoms between Wuhan pneumonia and common cold or influenza, it can be challenging to distinguish between them.
Therefore, clinical considerations must include any contact with confirmed cases, and sometimes a diagnosis may only be made when symptoms become pronounced or chest X-rays show abnormalities.
Based on your statement, the likelihood of contracting Wuhan pneumonia from those four Japanese individuals should be low.
Please pay attention to personal protective measures such as wearing masks and frequent handwashing, and maintain adequate sleep, a balanced diet, and regular exercise.
If you continue to feel unwell, you may discuss this with your ENT specialist or visit an infectious disease outpatient clinic at a regional hospital or higher.
6.
Regarding your statement, "sometimes I suddenly feel that my breathing is not smooth, but taking a deep breath makes it better, usually when I am very anxious," it is my personal speculation that this may be a temporary hyperventilation syndrome caused by anxiety or nervous personality traits; it often accompanies sensations of air hunger, numbness in the hands, dizziness, and limb stiffness.
However, it should not be attributed to pneumonia-related breathing difficulties; once pneumonia causes respiratory distress or failure, it is rare for symptoms to improve simply by taking a deep breath.
If you have further questions, please discuss them with your family physician or visit a pulmonology outpatient clinic at a regional hospital or higher.

Reply Date: 2020/05/22

More Info

Understanding COVID-19 transmission risks in social settings is crucial, especially in light of the ongoing pandemic. Your concerns about dining out while experiencing cold symptoms are valid, and it's important to approach this situation with both caution and knowledge.

Firstly, regarding the risk of transmission from the individuals you encountered at the restaurant, it's essential to understand that COVID-19 spreads primarily through respiratory droplets when an infected person coughs, sneezes, talks, or breathes. While being in close proximity to others, especially indoors, can increase the risk of transmission, several factors can influence this risk:
1. Distance: You mentioned that you were not at the same table as the individuals you were concerned about. Maintaining a distance of at least six feet from others significantly reduces the likelihood of transmission. If you were seated at a different table and did not interact closely with them, your risk of infection is lower.

2. Mask Usage: The absence of masks among those dining can increase the risk of transmission, especially if they are asymptomatic carriers of the virus. However, if they were not coughing or showing symptoms, the risk remains lower than if they were exhibiting respiratory symptoms.

3. Ventilation: Restaurants with good ventilation systems can help disperse viral particles in the air, further reducing the risk of transmission. If the restaurant was well-ventilated, this would also contribute to a lower risk.

4. Personal Health: Since you are currently experiencing symptoms of a cold, it’s wise to be cautious. While your symptoms may be due to a common cold or another non-COVID illness, it’s still important to monitor your health closely. If you develop new symptoms such as a persistent cough, fever, or loss of taste or smell, consider getting tested for COVID-19.

Regarding your throat discomfort and nasal symptoms, these could indeed be related to your ongoing cold rather than a new infection. It’s common for respiratory infections to linger and cause throat irritation and nasal congestion. However, if your symptoms worsen or you develop new ones, it would be prudent to consult a healthcare professional.

As for the sensation of breathlessness you mentioned, this can often be linked to anxiety, especially in stressful situations. Anxiety can lead to hyperventilation, which may cause temporary feelings of breathlessness. If you find that deep breathing helps alleviate this sensation, it’s likely a response to anxiety rather than a direct symptom of a respiratory illness. However, if you experience persistent or severe breathlessness, it’s important to seek medical attention to rule out any underlying conditions.

In summary, while your concerns about potential exposure to COVID-19 are understandable, the risk of transmission in your described scenario appears to be low, especially if you maintained distance and the individuals were not exhibiting symptoms. Continue to monitor your health, practice good hygiene, and consider wearing a mask in crowded or enclosed spaces to further reduce your risk. If your symptoms persist or worsen, don’t hesitate to reach out to a healthcare provider for further evaluation and guidance.

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