SATURDAy, MARCH 14 , 2020. THE WASHINGTON POST eZ re A
The coronavirus outbreak
BY JOEL ACHENBACHScientists studying the novel
coronavirus are quickly uncover-
ing features that allow it to infect
and sicken human beings. Every
virus has a signature way of
interacting with the world, and
this one — SARS-CoV-2, which
causes the disease covid-19 — is
well-equipped to create a historic
pandemic.
The coronavirus can be shed
by people even before they devel-
op symptoms. That pre-symp-
tomatic transmission has helped
it become a stealth contagion,
spreading through communities
before they know what hit them.
The coronavirus may take
many days — u p to 14 — b efore an
infection flares into symptoms,
and although most people recov-
er without a serious illness, this is
not a bug that comes and goes
quickly. A serious case of covid-
can last for weeks.
The virus lurks in the body
even after people feel better. A
new study in the Lancet, based on
research in China, found that the
median length of time the virus
remains in the respiratory tract
of a patient after symptoms begin
is 20 days. Among patients who
survived the disease, the virus
continued to be shed for between
eight and 37 days. (The study did
not reach any conclusions on
whether and to what extent this
persistence could lead to infec-
tions in other people.)
This coronavirus can establish
itself in the upper respiratory
tract, said Vincent Munster, chief
of the Virus Ecology Section of
Rocky Mountain Laboratories, a
facility in Hamilton, Mont., that
is part of the National Institute of
Allergy and Infectious Diseases.
That enables the virus to spread
more easily through coughing
and sneezing and stands in con-
trast to another coronavirus that
Munster’s laboratory has studied
— MERS, which tends to infect
cells in the lower respiratory
tract, he said. Though more lethal
than the new virus, MERS did not
spread as easily and did not
become a pandemic.
Munster and his colleagues
have been studying the novel
coronavirus under laboratory
conditions to better understand
its viability outside a host organ-
ism — in the air and on surfaces.
Those experiments found that
at least some coronavirus can
potentially remain viable — c apa-
ble of infecting a person — for up
to 24 hours on cardboard and up
to three days on plastic and
stainless steel.
When aerosolized into fine,
floating particles, the virus re-
mained viable for three hours. On
a copper surface, it was four
hours, the study found. The me-
dian length of viability for the
virus on stainless steel was
13 hours, and 16 hours on poly-
propylene, a common type of
plastic.
The new paper from Munster
and his team was posted on a
preprint site, and it has not yet
been published in a journal.The researchers used a nebu-
lizer to aerosolize the virus, but in
a natural environment, the virus
does not spread through aerosol
particles. Certain hospital treat-
ments can result in aerosolized
virus, but the main way the virus
has been spreading has been
through droplets — such as when
someone sneezes or coughs. Such
droplets can travel up to six feet.
As the coronavirus spreads,
the simple act of touching a
surface has become a delicate
matter of risk analysis. The world
is full of suspect surfaces. Is it
safe to touch an ATM screen? Or
the self-checkout at the grocery
store? A door handle? A package
that came in the mail?
The Centers for Disease Con-
trol and Prevention recommends
that people take steps to clean
and disinfect surfaces. But thedurability of some coronavirus
on a surface does not mean that it
remains just as infectious as the
hours go by. Most virus particles
degrade in a matter of minutes or
hours outside a living host, and
the quantity of infectious parti-
cles goes down exponentially
over time.
Although it is theoretically
possible for a person to become
infected a day or two after some-
one has deposited virus particles
(for example, by sneezing) on a
surface, it is much less likely than
in the first couple of hours after
the sneeze, said Munster.
“The risk of becoming infected
via these routes of transmission
reduces over time,” Munster said.
‘That window of becoming infect-
ed is highest in the first 10 min-
utes, or one hour or two hours.”
He addressed a commonlyvoiced concern: that a package in
the mail may be a vector for the
disease. He said that is very
unlikely, but added, “There’s nev-
er zero risk if the person w ho gave
you the package just sneezed on
that package one second ago.”
During a CNN town hall pro-
gram on the coronavirus Thurs-
day night, Anthony S. Fauci, the
longtime director of the NIAID,
addressed the issue of packages:
“I think if you start thinking
about money and mail a nd things
like that, you can almost sort of
immobilize yourself, which I
don’t think is a good idea.”
A virus is a peculiar object that
is inert and arguably not truly
alive outside a host. Only when it
invades a cell and hijacks its
machinery can the virus begin to
replicate.
Outside, on an inanimate sur-face, the virus will gradually lose
the ability to be an infectious
agent. It may dry out, for exam-
ple. It can degrade when exposed
to ultraviolet radiation from the
sun. A person sneezing on a
surface may deposit many thou-
sands of virus particles, and some
may remain viable for days. Still,
the likelihood of a person who
comes into contact with the rem-
nants of that sneeze goes down
over time, because most infec-
tions are the result of a large viral
load.
“The more exposed you get to
more virus, the higher the likeli-
hood it is that you get infected,”
Munster said.
That w as echoed by Gary Whit-
taker, an infectious disease ex-
pert at Cornell University, who
said that typically it takes “an
army of viruses going in” t o break
through the natural defenses of a
human being, which include mu-
cus that lines airways.
“We’re talking about thou-
sands or tens of thousands of
particles to infect an animal or a
person,” Whittaker said.
The U.S. strategy for slowing
the spread of the coronavirus is
currently focused on social dis-
tancing, in recognition of the fact
that human beings are vectors of
covid-19. Simultaneously, people
in the United States have been
urged by the CDC to clean and
disinfect surfaces in their homes.
The CDC has put forth guidance
on how to blend a disinfectant
solution f rom bleach — f ive table-
spoons (1/3 cup) of bleach per
gallon of water (and never mix
bleach with ammonia or any
other cleanser).
Amid these precautions, peo-
ple should understand that sur-
faces that contain the virus —
known to scientists as fomites —
are not the major drivers of this
pandemic. Covid-19 is primarily
spread through direct person-to-
person contact.
“It may be possible that a
person can get COVID-19 by
touching a surface or object that
has the virus on it and then
touching their own mouth, nose,
or possibly their eyes, but this is
not thought to be the main way
the virus spreads,” the CDC says.
[email protected]Person-to-person spread is more likely than via surfaces
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Workers in protective suits disinfect and clean a bus station on Friday in Bogota, Colombia. Most coronavirus particles on a surface
degrade in a matter of minutes or hours outside a living host, and the quantity of infectious particles goes down exponentially over time.BY AMY GOLDSTEINIn his prime-time speech, Pres-
ident Trump announced Wednes-
day night that health insurers
had pledged to eliminate “all
co-payments for coronavirus
treatments” and “extend insur-
ance coverage to those treat-
ments.”
T hat is not exactly correct. A
broad swath of the nation’s pri-
vate health insurers has agreed to
waive the charges for a coronavi-
rus test for their members. But
they have not committed to cover
the cost of care for those sickened
by the virus.
And while there is no specific
treatment for the rapidly spread-
ing infections, insurers have not
expanded coverage for anyone,
including the more seriously ill
who need hospitalization. Almost
all private health plans include
hospital coverage, with patients
in different plans left to pay
different amounts of the bill, and
that arrangement is intact in the
era of covid-19, the disease caused
by the virus.
“We haven’t agreed to waive
out-of-pocket costs for treat-
ment,” said Kristine Grow, a
spokeswoman for America’s
Health Insurance Plans, the in-
dustry’s main trade group.
The president’s misstatements
reflect confusion about the patch-
work response to efforts to ensure
that Americans’ inability to af-
ford testing is not a hurdle — a
critical matter when knowing
who has the virus is crucial to
slowing its spread. Those mis-
statements were repeated Thurs-
day morning by the director of
the Centers for Disease Control
and Prevention testifying on Cap-
itol Hill.
Until very recently, when only
the CDC and then public health
labs could perform the test, the
government paid for the test it-
self, but not for the expense, say,
of going to an emergency room to
get tested.
The scenario is more compli-
cated now that private testing
companies have started to get
involved. One of the largest,
Quest Diagnostics, said M onday
that doctors and other health-
care providers could order the
test.
“We anticipate we will have
performed several thousands of
tests for patients by the end of the
week... and expect to perform
tens of thousands of tests within
the next weeks,” the company
said in a statement.
The people at greatest risk of
finding a coronavirus test unaf-
fordable are the 27 million unin-
sured Americans. And some of
them may be especially vulnera-
ble to infection, working in low-
wage jobs such as f ood service
that come without health bene-
fits and exposure to the public.
No one is keeping complete
tabs on how many people are
getting tested across the country,
so there is no information on how
many of them lack health cover-
age.
Quest said in its statement that
it had not finalized a price for
those who are uninsured. “We
have not yet finalized our unin-
sured patient price,” a dding, “Our
goal is to enable broad access.”
A spokeswoman for another
major company, LabCorp, said
the company has been providing
its test to doctors for the past
week and testing specimens since
last Friday. The spokeswoman,
Pattie Kushner, said the company
expects the federal government
will probably p ay $51 per test for
Medicare patients, but she did
not say what the price would be
for uninsured customers.
People covered by most private
insurance companies may see a
test price on their benefits expla-
nations, but they will not actually
have to pay anything for the
service. One by one in recent
days, each of the nation’s major
insurance companies issued pub-
lic guarantees that they will cover
the costs, and a group of industry
leaders renewed this promise
during a meeting T uesday with
Vice President Pence.
It is less clear whether testing
costs are being covered by a
relatively small slice of the indus-
try that Trump administration
health officials have been pro-
moting: short-term health plans,
as well as health plans sold to
groups of individuals and associ-
ations. Both types are inexpen-
sive because they offer skimpy
benefits.
On Thursday, the Internal Rev-
enue Service issued a notice that
private health plans with highdeductibles — increasingly com-
mon across the country — can
eliminate those deductibles for
services related to the coronavi-
rus without risking their tax sta-
tus. The IRS notice said this refers
to both testing and treatment.
The government’s largest pub-
lic insurance programs, Medicare
and Medicaid, are also covering
the cost of testing, and federal
health officials have recently
been publicizing that fact.
At a congressional hearing
Thursday, Robert Redfield, the
CDC’s director, further muddled
the administration’s message
about paying for services related
to the new virus.
At one point during the House
Oversight and Reform Commit-
tee hearing, Rep. Ayanna Pressley
(D-Mass.) asked Redfield, “Will
the cost of testing be covered?”
He r eplied, “Cost of testing will be
covered.”
“A nd what about treatment?”
Pressley asked. Again, Redfield
replied, “Cost of treatment will be
covered,” even though neither
private nor public insurers have
said they will pay the entire cost
of care related to the virus.
Later during the hearing, Rep.
Katie Porter (D-Calif.) reminded
Redfield that she and House col-
leagues had asked him last week
to use CDC authority to p rovide
for testing and treatment at no
cost, regardless of whether pa-
tients are insured.
“Will you commit to invoking
that and to provide testing for
every American?”
He r epeatedly declined to com-
mit, saying that the CDC is collab-
orating with the Department of
Health and Human Services to
“operationalize” their response.
Porter persisted. “You can
make that commitment now,” she
said, demanding a response. “My
answer is yes,” Redfield finally
replied.
B ut as the hearing was ending,
Redfield took that back, saying
the administration “is currently
examining all avenues” for the
uninsured to afford tests and
treatment. In the meantime, he
recommended that people go to
community health centers.
[email protected]lena H. sun contributed to this
report.Most insurers will waive costs for
tests, but not sick visits or treatment
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