Covid-19 Update Aggie Physician

1,284,496 Views | 3660 Replies | Last: 2 yr ago by tamc91
Reveille
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dutch15 said:

Reveille,

I posted previously, but not sure you saw it. How did China keep there numbers so low (relatively speaking)? Also, they are allowing people to go back to work because cases are on the decline, so how do they keep from having a relapse?




Not sure how much in trust the China numbers considering how they hide the disease from us at first. Not to mention now that the world doesn't want to trade with them because of this they have a financial incentive to say things are better. So i take thier numbers with a grain of salt. But being a communist country they have much stricter isolation protocols then we do.

Don't want this to get political so will end it there.
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Reveille
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12thmandy said:

What are the recommendations for those of us with infants? I can't stay at home because I have a job that will likely not be able to close. If I'm exposed I'm afraid I'll easily pass it to my infant. Is there anything I should be doing other than the obvious washing my hands etc. to help keep her safe? Also, my mom (in her late 60s) usually watches her while I'm at work. Should I be thinking of another plan for that?


Practice good reverse isolation techniques. When you get home change clothes and shower. Try not to breath or cough of them. In your case you can consider a mask if you are worried.

The guys news is this virus does not seem to affect kids as much as adults.
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Reveille
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eidetic78 said:

Law361 said:

Reveille,

With the prospect of having my 3 young kids at home for the next several weeks, my wife and i are trying to put a schedule together to help them get out of the house. We know that walks are a good idea, but what about public parks? Not talking about playing with other kids, just playing on the equipment. How long can the virus survive on an outdoor surface that doesn't get regularly disinfected? Thanks
With respect to the duration a virus remains infectious on playground surfaces, it really depends on the local weather conditions. It also varies widely from virus to virus, but obviously we're talking about coronavirus here.

Based on previous SARS and MERS strains, this virus is stable for a relatively short period of time outside of the body. Weather conditions that lead to quick desiccation (warm / dry / sunny) and surfaces exposed to UV will render any virus present non-infections quickly. Within just a few minutes. Some of these reports about coronavirus being stable for many days on inanimate objects are under ideal conditions without any exposure to UV/water/heat/etc... They also are reporting ANY remaining detectable infectious virus. My point being once the virus is out of its host, the particles begin to degrade quickly. So even though there may be a few infectious particles after an extended time, the vast majority of the initial number are inert.

For public playground equipment, as you said those surfaces don't get "disinfected" regularly (or ever), but, depending on where you live, the normal weather can keep them fairly sterile. Specifically in the case of coronavirus, the more exposed surfaces will be safer. Overall, unless the equipment is currently or recently occupied with many kids, in my opinion it's a very low risk activity.



I agree didn't see answer prior to responding but I agree outside I can't imagine the virus living long which is why I said previously in a labratory.
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Reveille
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TAMUallen said:

Are there tips or easy to cite stats/projections to use for my very stubborn grandfather who is 80+ and has had multiple bypasses?

He is stubborn as a damn mule and my grandmother has Parkinson's so she stays home. Made progress with him not going to church this morning but he ****ing went to Costco this morn for FREAKING 3 things that weren't even needed.


Don't know but you have to do the best you can. I fought with eldery patients all last week and will have to this week also. Particularly about church but most have virtual sermons now so that helps.
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FrontPorchAg
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Did you get the Seattle ACEP update today?
All animals are equal, but some animals are more equal than others
TRADUCTOR
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Heard virus can't survive long with summer heat and humidity. @98.6 degrees and mostly water I am a walking summer. Is the summer hope wrong?
ProudAg16
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Rev,
This may be a dumb question, but feel the need to ask. At what point is shortness of breath a symptom that needs to be checked for the virus? I've been having to take deep breaths fairly often for a few days now and with all the talk of symptoms coming on slowly and effecting others, it has me a bit worried/curious. I don't have any other symptoms that I know of, but it's not a normality for me to have labored breathing.
Could it more likely be anxiety causing the shortness of breath? Kind of a lump in throat feeling as well.
Thanks!
Reveille
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Mtn_Guide said:

Did you get the Seattle ACEP update today?


Yes it is not really unexpected. Unfortunately, many of us physicians will get infected. It is a known hazard of the job. We accept these risks when take the job. Of course none of us want to suck but we know that we likely will.

When I was a medical student and resident I was sick all the time. I thought to myself what the hell did I get myself into. But luckily over time you build up immunity to a lot of diseases. However, this is a new disease with no vaccine to protect us so the risk will be greater.

As the article says even with our best efforts sometimes we still get ill. I will pray for those doctors and all of the other medical workers that catch this disease from trying to help others.

Remember we don't fear disease we attack it on a daily basis. We are used to being exposed to dangerous diseases like HIV, hepatitis, tuberculosis, pneumonia and influenza. We will do our best but to not get infected but unfortunately some still will.
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Reveille
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law-apt-3g said:

Heard virus can't survive long with summer heat and humidity. @98.6 degrees and mostly water I am a walking summer. Is the summer hope wrong?


Read my update on my professional Facebook page from the other day addressing the virus and possible effects of heat.
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Reveille
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ProudAg16 said:

Rev,
This may be a dumb question, but feel the need to ask. At what point is shortness of breath a symptom that needs to be checked for the virus? I've been having to take deep breaths fairly often for a few days now and with all the talk of symptoms coming on slowly and effecting others, it has me a bit worried/curious. I don't have any other symptoms that I know of, but it's not a normality for me to have labored breathing.
Could it more likely be anxiety causing the shortness of breath? Kind of a lump in throat feeling as well.
Thanks!


Certainly anxiety can cause this particularly with all this public fear going on. But you need to watch this if it progresses or worsens then you should contact your physician.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Rick Dalton
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So my step kids' father decided to continue on with taking them to Copper Mountain last week (Sun-Thurs) for spring break. They made it back home Friday night. Just saw a notice out of Colorado that if you had visited certain ski resorts in the last week (Copper Mountain being one) to "minimize social contact" because of a large outbreak. Does this mean we are now supposed to quarantine?

Guessing I'll be making a phone call into work in the morning to see what I should do.
NC Ag
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Type 2 Diabetic - Trulicity once a week and Losartan Potassium (ARB) daily. Does this make me higher risk? If yes, what steps should I take to minimize my risk level?
fightingfarmer09
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Live in a rural area of coastal Texas. We have seen 1-2 cases in surrounding counties.

At should we be concerned about daycare for our 9month old? Want to know if we should pull out all together.

I'm less concerned about the illness, and more about spreading it. Our daycare has implemented some stringent cleaning and entry protocols. But kids are filthy.
12thmandy
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Thank you so much, Dr. Rev
CV
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I've lurked on TxAgs for years. Most of you guys are awesome and I'm a proud Aggie Mom. Reveille has motivated me to finally make an account because of his dedication to the Aggie community. I've joined because I'm requesting that we pray for him, his health, and family.

Reveille, take care!
HowdyTXAggie
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Reveille,

Thanks for taking the time to post your thoughts/experience. I have a couple questions:
1) For school age kids, how much do you recommend they do/don't interact with other neighbor kids? Can they play ball together?
2) What about a teen babysitting other smaller kids at their house?

Thanks again
Reveille
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blazing7s94 said:

So my step kids' father decided to continue on with taking them to Copper Mountain last week (Sun-Thurs) for spring break. They made it back home Friday night. Just saw a notice out of Colorado that if you had visited certain ski resorts in the last week (Copper Mountain being one) to "minimize social contact" because of a large outbreak. Does this mean we are now supposed to quarantine?

Guessing I'll be making a phone call into work in the morning to see what I should do.


I don't know about any specific ski resorts but I think I would definitely call in the morning and isolate until you are sure.
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Reveille
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NC Ag said:

Type 2 Diabetic - Trulicity once a week and Losartan Potassium (ARB) daily. Does this make me higher risk? If yes, what steps should I take to minimize my risk level?
.

Yes it does diabetics are for sure higher risk. You take all the precautions being mentioned over and over again with the but avoiding social contact.
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Reveille
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HowdyTXAggie said:

Reveille,

Thanks for taking the time to post your thoughts/experience. I have a couple questions:
1) For school age kids, how much do you recommend they do/don't interact with other neighbor kids? Can they play ball together?
2) What about a teen babysitting other smaller kids at their house?

Thanks again


Since kids are usually not affected I think playing with other kids in small groups is probably safe. I would avoid larger groups for sure.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reveille
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fightingfarmer09 said:

Live in a rural area of coastal Texas. We have seen 1-2 cases in surrounding counties.

At should we be concerned about daycare for our 9month old? Want to know if we should pull out all together.

I'm less concerned about the illness, and more about spreading it. Our daycare has implemented some stringent cleaning and entry protocols. But kids are filthy.


Man this is a really tough question. Typically daycares are a tremendous source of infections, but in this particular virus the infection rates in children are very low. So if they are practicing extra cleaning procedures it is likely ok.
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Reveille
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CV said:

I've lurked on TxAgs for years. Most of you guys are awesome and I'm a proud Aggie Mom. Reveille has motivated me to finally make an account because of his dedication to the Aggie community. I've joined because I'm requesting that we pray for him, his health, and family.

Reveille, take care!



Thank you and I appreciate the prayers. Pray for all healthcare providers because it is inevitable that some will get ill just like in other countries.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Alta
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Sorry if I missed it but some other threads are alluding to how long this has been in the US? Out of curiousity have you seen an uptick this winter in things that make you wonder if it's been around awhile?

One reason I ask is in mid February I was in enough pain from coughing, very heavy breathing that I went to an ER (I felt bad enough that this was the first trip to a Dr. I had made in 17 years - which I know is horrible) and tested negative for the flu, strep, etc. I got Codeine cough syrup and a steroid shot and went on my way. I also had pink eye a couple days prior to this all starting which is the first time I ever had pink eye. After about 5 days it was gone and a week lady I felt pretty normal again.

Anyways - I don't want to be one of those folks who thinks I must have had it but I do kind of wonder what that was. That's why I wonder if once this all passes if I could go to a Dr. and see if they could do a test to see if indeed I ever did have it.
Reveille
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Most recent update

https://www.facebook.com/1998386763777604/posts/2641575666125374/?sfnsn=mo
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TAMUallen
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Reveille said:

Most recent update

https://www.facebook.com/1998386763777604/posts/2641575666125374/?sfnsn=mo


Date at top of write up says 2014 FYI
88planoAg
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Tylenol is recommended over those pain relievers/fever reducers that are processed through the kidneys. My family uses Aleve to treat normal aches/pains/headache. Is there a reason to switch to Tylenol prior to getting sick with CV?
Capitol Ag
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TAMUallen said:

Reveille said:

Most recent update

https://www.facebook.com/1998386763777604/posts/2641575666125374/?sfnsn=mo


Date at top of write up says 2014 FYI


The good doctor went back in time and sent this from 2014 in an attempt to stop the virus before it happens. He's attempting a time heist. Worked in Endgame!
maroonbeansnrice
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Reveille said:

eidetic78 said:

Law361 said:

Reveille,

With the prospect of having my 3 young kids at home for the next several weeks, my wife and i are trying to put a schedule together to help them get out of the house. We know that walks are a good idea, but what about public parks? Not talking about playing with other kids, just playing on the equipment. How long can the virus survive on an outdoor surface that doesn't get regularly disinfected? Thanks
With respect to the duration a virus remains infectious on playground surfaces, it really depends on the local weather conditions. It also varies widely from virus to virus, but obviously we're talking about coronavirus here.

Based on previous SARS and MERS strains, this virus is stable for a relatively short period of time outside of the body. Weather conditions that lead to quick desiccation (warm / dry / sunny) and surfaces exposed to UV will render any virus present non-infections quickly. Within just a few minutes. Some of these reports about coronavirus being stable for many days on inanimate objects are under ideal conditions without any exposure to UV/water/heat/etc... They also are reporting ANY remaining detectable infectious virus. My point being once the virus is out of its host, the particles begin to degrade quickly. So even though there may be a few infectious particles after an extended time, the vast majority of the initial number are inert.

For public playground equipment, as you said those surfaces don't get "disinfected" regularly (or ever), but, depending on where you live, the normal weather can keep them fairly sterile. Specifically in the case of coronavirus, the more exposed surfaces will be safer. Overall, unless the equipment is currently or recently occupied with many kids, in my opinion it's a very low risk activity.



I agree didn't see answer prior to responding but I agree outside I can't imagine the virus living long which is why I said previously in a labratory.
I think I also read, in the most-often cited study, they used a nebulizer to see how long the virus could float around in the air. I thinks this (I blame the press) has led to a misconception of what the virus can do. Correct me if I'm wrong doc, but your body doesn't create these kinds of "floating" micro-particles through normal exhalation.

Obviously this is different than a cough or sneeze (that can project droplets up to like six feet?). Stay away from sick people for sure.
“It ain’t like it used to be.”
-Jimbo Fisher
maroonbeansnrice
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88planoAg said:

Tylenol is recommended over those pain relievers/fever reducers that are processed through the kidneys. My family uses Aleve to treat normal aches/pains/headache. Is there a reason to switch to Tylenol prior to getting sick with CV?

The docs can weigh in on this one as well, but if you switch to Tylenol vs NSAIDs, maybe limit/reduce your alcohol consumption.
“It ain’t like it used to be.”
-Jimbo Fisher
BiochemAg97
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Alta said:

Sorry if I missed it but some other threads are alluding to how long this has been in the US? Out of curiousity have you seen an uptick this winter in things that make you wonder if it's been around awhile?

One reason I ask is in mid February I was in enough pain from coughing, very heavy breathing that I went to an ER (I felt bad enough that this was the first trip to a Dr. I had made in 17 years - which I know is horrible) and tested negative for the flu, strep, etc. I got Codeine cough syrup and a steroid shot and went on my way. I also had pink eye a couple days prior to this all starting which is the first time I ever had pink eye. After about 5 days it was gone and a week lady I felt pretty normal again.

Anyways - I don't want to be one of those folks who thinks I must have had it but I do kind of wonder what that was. That's why I wonder if once this all passes if I could go to a Dr. and see if they could do a test to see if indeed I ever did have it.
The rapid flu test has a significant false negative rate. The longer more accurate test takes at least 4 hours to run on the machine. Most doctor offices do a rapid test while you wait. A hospital lab probably has the equipment to do the longer test, but you can probably figure out what you had by the time it took. Just because you test negative on the rapid flu test doesn't mean you don't have the flu.

Interestingly, I have seen doctors get a negative on a rapid strep test and say they were sending it off for a culture to verify. In my admittedly limited experience, I have not seen a doctor send a flu test off for the longer test to verify a negative result on the rapid flu test. I assume that part of the reason is by the time you send it off to the lab and get the results back a few days later, most people are through the worst of it and getting better already.

Also, there are a lot of things that cause similar flu like symptoms. People need to stop assuming that just because they tested negative for the flu they must have had Corona. The risk with that assumption is people thinking they are immune now they had it and then actually get it.

At some point, researchers are going to need to sample a population for antibodies to determine extend of exposure that was never identified to get a true mortality rate. That work won't need to be widespread. so it is unlikely to include all of us.
claydeezy
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Reveille, thanks for what you're doing. Really appreciate you putting in the overtime on this...

Came across this on my timeline:



What are your thoughts on chloroquine being used to treat coronavirus patients?
Alta
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I never said I assumed it must have been Corona. There is all sorts of things it could have been. I probably shouldn't have even included the specifics about myself. I wonder what I had but the biggest reason I asked my question was I was curious if Rev had seen an increase in cases this winter that made him scratch his head a bit (the ER Doctor who treated me said he had). The ER Doc specifically said he had seen several folks in the last week who had similar symptoms and was surprised the tests were all negative. The pink eye in my case he was a bit baffled by as well.
cisgenderedAggie
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maroonbeansnrice said:

88planoAg said:

Tylenol is recommended over those pain relievers/fever reducers that are processed through the kidneys. My family uses Aleve to treat normal aches/pains/headache. Is there a reason to switch to Tylenol prior to getting sick with CV?

The docs can weigh in on this one as well, but if you switch to Tylenol vs NSAIDs, maybe limit/reduce your alcohol consumption.


This is true. You really shouldn't be drinking much while taking NSAIDs anyway, but drinking with acetaminophen can cause a very severe liver injury.

One of the metabolites of acetaminophen can be very toxic, but usually isn't a problem at OTC doses due to the timecourse of its generation and removal. Alcohol can cause a rapid increase of this metabolite in a very short time, similar to taking a very high and unsafe dose of acetaminophen.
Badace52
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BiochemAg97 said:

Alta said:

Sorry if I missed it but some other threads are alluding to how long this has been in the US? Out of curiousity have you seen an uptick this winter in things that make you wonder if it's been around awhile?

One reason I ask is in mid February I was in enough pain from coughing, very heavy breathing that I went to an ER (I felt bad enough that this was the first trip to a Dr. I had made in 17 years - which I know is horrible) and tested negative for the flu, strep, etc. I got Codeine cough syrup and a steroid shot and went on my way. I also had pink eye a couple days prior to this all starting which is the first time I ever had pink eye. After about 5 days it was gone and a week lady I felt pretty normal again.

Anyways - I don't want to be one of those folks who thinks I must have had it but I do kind of wonder what that was. That's why I wonder if once this all passes if I could go to a Dr. and see if they could do a test to see if indeed I ever did have it.
The rapid flu test has a significant false negative rate. The longer more accurate test takes at least 4 hours to run on the machine. Most doctor offices do a rapid test while you wait. A hospital lab probably has the equipment to do the longer test, but you can probably figure out what you had by the time it took. Just because you test negative on the rapid flu test doesn't mean you don't have the flu.

Interestingly, I have seen doctors get a negative on a rapid strep test and say they were sending it off for a culture to verify. In my admittedly limited experience, I have not seen a doctor send a flu test off for the longer test to verify a negative result on the rapid flu test. I assume that part of the reason is by the time you send it off to the lab and get the results back a few days later, most people are through the worst of it and getting better already.

Also, there are a lot of things that cause similar flu like symptoms. People need to stop assuming that just because they tested negative for the flu they must have had Corona. The risk with that assumption is people thinking they are immune now they had it and then actually get it.

At some point, researchers are going to need to sample a population for antibodies to determine extend of exposure that was never identified to get a true mortality rate. That work won't need to be widespread. so it is unlikely to include all of us.



You are very close. The reason we usually don't send off for the longer flu test after a negative rapid flu is really two fold.

One is that you have to start antiviral treatment for the flu within the first 48h from symptom onset and by the time we got that test back and called the patient with the result they would almost always be out of the treatment window.

Two is tamiflu is not necessary for the treatment of flu for a large majority of patients. In fact there is some evidence that due to the low benefit for some patients (patients between 2 and 65 who are not immune suppressed or pregnant, or have another high risk condition for flu) and tamiflu's relatively high rate of side effects, we may be doing more harm than good by prescribing it to them.

In the patient population above, all tamiflu really does is shorten the course of disease by around 1-2 days and the course of disease in flu can last 10-14 days.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
88planoAg
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cisgenderedAggie said:

maroonbeansnrice said:

88planoAg said:

Tylenol is recommended over those pain relievers/fever reducers that are processed through the kidneys. My family uses Aleve to treat normal aches/pains/headache. Is there a reason to switch to Tylenol prior to getting sick with CV?

The docs can weigh in on this one as well, but if you switch to Tylenol vs NSAIDs, maybe limit/reduce your alcohol consumption.


This is true. You really shouldn't be drinking much while taking NSAIDs anyway, but drinking with acetaminophen can cause a very severe liver injury.

One of the metabolites of acetaminophen can be very toxic, but usually isn't a problem at OTC doses due to the timecourse of its generation and removal. Alcohol can cause a rapid increase of this metabolite in a very short time, similar to taking a very high and unsafe dose of acetaminophen.
We are not heavy drinkers but stress on the liver is why we use the other products instead of Tylenol.
Badace52
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maroonbeansnrice said:

Reveille said:

eidetic78 said:

Law361 said:

Reveille,

With the prospect of having my 3 young kids at home for the next several weeks, my wife and i are trying to put a schedule together to help them get out of the house. We know that walks are a good idea, but what about public parks? Not talking about playing with other kids, just playing on the equipment. How long can the virus survive on an outdoor surface that doesn't get regularly disinfected? Thanks
With respect to the duration a virus remains infectious on playground surfaces, it really depends on the local weather conditions. It also varies widely from virus to virus, but obviously we're talking about coronavirus here.

Based on previous SARS and MERS strains, this virus is stable for a relatively short period of time outside of the body. Weather conditions that lead to quick desiccation (warm / dry / sunny) and surfaces exposed to UV will render any virus present non-infections quickly. Within just a few minutes. Some of these reports about coronavirus being stable for many days on inanimate objects are under ideal conditions without any exposure to UV/water/heat/etc... They also are reporting ANY remaining detectable infectious virus. My point being once the virus is out of its host, the particles begin to degrade quickly. So even though there may be a few infectious particles after an extended time, the vast majority of the initial number are inert.

For public playground equipment, as you said those surfaces don't get "disinfected" regularly (or ever), but, depending on where you live, the normal weather can keep them fairly sterile. Specifically in the case of coronavirus, the more exposed surfaces will be safer. Overall, unless the equipment is currently or recently occupied with many kids, in my opinion it's a very low risk activity.



I agree didn't see answer prior to responding but I agree outside I can't imagine the virus living long which is why I said previously in a labratory.
I think I also read, in the most-often cited study, they used a nebulizer to see how long the virus could float around in the air. I thinks this (I blame the press) has led to a misconception of what the virus can do. Correct me if I'm wrong doc, but your body doesn't create these kinds of "floating" micro-particles through normal exhalation.

Obviously this is different than a cough or sneeze (that can project droplets up to like six feet?). Stay away from sick people for sure.


You are correct. The body does not naturally nebulize viral particles and that study was a bit misleading. It is still believed to be spread by droplet transmission from person to person.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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