Q&A: Coronavirus and COVID-19 Basics

The following is an edited transcript of an interview with bacteriologist Allen Helm, a senior biosafety officer in the Office of Research Safety at the University of Chicago, about the novel coronavirus that causes COVID-19, conducted by host Jamie Trecker. The interview aired on March 11 on Lumpen Radio, WLPN: 105.5 FM. Reprinted with permission.

Jamie Trecker: We wanted to try to talk to someone who deals with bugs [pathogens] in the laboratory and has some insight into biosafety. So I’m really pleased to welcome the University of Chicago’s Allen Helm. He’s [a] biosafety officer over there. Let’s start with the basics: What is the coronavirus? Can you tell us a little bit about exactly just what this is?

Allen Helm: Sure. But first, I’ll preface this by saying that I’m not a virologist by training. I’m a bacteriologist, but I’ve been in the biosafety field at the University of Chicago for ten years. And part of that job is learning about things that maybe you didn’t have in your previous education, so I have done some crash courses in virology. 

There are quite a few different coronaviruses—it’s a class of viruses. It’s a family, I think, in the virus nomenclature. Predominantly they infect animals. But virologists have identified seven of them that will infect humans.

There are four risk groups [of biological hazards, viruses or otherwise]. Number one will not get you sick at all. If you’ve ever had a beer, you’ve drank Saccharomyces cerevisiae [yeast], which is risk group one, and will not hurt a healthy adult with a good immune system. Risk group two, if you’re healthy, they’ll get you sick, but you’ll usually recover or they’re treatable. Risk group three are more severe. Even if you’re healthy, they have the potential to be fatal, but they’re usually treatable, or the fatality rate is low. And then the highest is number four. Number four are bugs that will get you sick and will very possibly kill you. Now four of those coronaviruses are basically the common cold. We would call that risk group two. But since 2002, they have identified three of them that are a little more severe. In 2002, they recognized SARS, [which] would be [risk group] three. [Ed: SARS-CoV-2 is the virus that causes COVID-19.]

The fatality rate that we’re seeing [for COVID-19] is relatively low [though still much higher than something like the flu]. And that fatality rate appears to be in people that are usually older people or people with respiratory conditions or suppressed immune systems. So that’s why it would be in [risk group] three. You might not be able to treat the virus per se, but there is treatment for the symptoms.

JT: So, this current COVID-19 strain. We believe it came from another species, and it was transmitted to human beings. According to some of the reporting we’ve seen from China, they believe it may have come from bats. I know you’re not a virologist, but why is it that some viruses affect us and make us sick, and then other viruses, they seem like the little androids of the world? They’re almost not even alive. What is it that they do that is so harmful and so dangerous?

AH: Many a true biologist would say they’re not living organisms, because they cannot replicate on their own. They require a host. They have the genetic material, they have the blueprint to make more copies of themselves, but they can’t do anything by themselves. They require a cell, which has all the machinery needed to make new things. They have to attach to that cell, deliver their genetic material into that cell, and often the cell doesn’t know the difference. It’s like, “Okay, I see some genetic material, I’m going to make this and this,” and before the cell knows it, the cell has made multiple copies of this given virus. And then each of those viruses escape and repeat the process. A lot of times that’s not a big deal, but it can be a big deal, when they’re important cells.

JT: It’s like a cuckoo taking over a nest, in a weird way.

AH: It’s exactly what it is. Yep.

JT: Okay. So what the hundred-thousand-dollar question is, is how is this new virus transmitted, and are people right to be so worried about it from a kind of biological safety point of view?

AH: Based on the data that I’ve read—and by the way, I’m getting most of my information from the World Health Organization and the CDC—it looks like the [primary] route of transmission is respiratory droplets. Let’s say someone has it: you cough, you sneeze, there are droplets in the air. Now, droplets are a little different from aerosols. Aerosols are very, very, very, very tiny, and they actually just hang out in the air. The only way an aerosol usually will leave the room is through the building ventilation system. It appears, at least from the data so far, that COVID-19 doesn’t really spread by that true aerosol route, but by droplets. And droplets can expel it up to six feet. But let’s say if somebody coughs, and two minutes later, you walk into the room, you’re not going to catch it from the air.

The other route [of transmission] appears to be by contact. First of all, it won’t go through your skin; skin’s an amazing barrier. Things like [the novel coronavirus] will get in through your mucous membranes, which are your eyes, nose, and your mouth. So what happens is, let’s say somebody sneezes on their hand, they touch the doorknob. Then somebody who’s not infected touches that doorknob and rubs their eye, rubs their nose, puts it in their mouth without washing their hands or sanitizing their hands—then it can transfer that way. So it’s my understanding, we’re looking at respiratory droplets and contact and direct inoculation to the mucus membrane.

JT: So basically, there is some good news about this, that the data so far does not suggest it’s an aerosol transmission, [which] means potentially it is less transmissible than it could be. And second, it seems that people can do some fairly straightforward and easy things to protect themselves from it, namely number one, washing their hands.

AH: It really is. We keep hearing this over and over, but it really does help. And normally I’m not a big advocate of hand sanitizer, because it doesn’t remove anything from your hands. It kills certain things. But a good hand sanitizer is going to be ethanol-based and at least sixty percent alcohol. (Seventy percent is the magic number. If it gets too low, it doesn’t work. If it gets too high, it doesn’t work very well.) Coronaviruses fall in a group of viruses called enveloped viruses, ’cause they have this lipid membrane around them—they’ve got this fatty membrane. And if you can trash that membrane, then the virus is dead, and alcohol dissolves fats pretty easily. So if you’ve got a hand sanitizer that’s at least sixty percent alcohol [it gets rid of this virus].

If you want to remove the grease and stuff like that from your hands, then soap and water will do that, [and remove the virus]—twenty seconds of hand washing. Another cool thing is these enveloped viruses, they’re not particularly stable in the environment for very long. And soap [also] kills them. Soap will kill enveloped viruses because again, we’re talking about a fatty envelope, and soap breaks up fat. [Ed.: Allen Helm writes to clarify: The number one reason to wash your hands is removal. There are many types of pathogenic microbes that will not be inactivated/killed by soap such as bacterial spores, mycobacteria, and non-enveloped viruses such as norovirus and rhinovirus. But washing with soap and water will remove them. Enveloped viruses however, such as coronaviruses, will be inactivated by soap because it strips away their lipid membrane (the envelope). So, for viruses like coronavirus, soap is a double whammy: it removes the germs and can inactivate them. Washing is the first and most important defense because it removes so much stuff. In the case of coronaviruses, sanitizer can help as a secondary protection because it also kills it.]

JT: So like any kind of detergent, Dawn, for example, when birds get caught in environmental disasters, you can clean seagulls with it to get oil off them.

AH: And when you strip the oil off a coronavirus or other enveloped virus, then it’s out of commission. It’s done. It can’t do anything.

JT: So, it’s interesting because, you know, people die from the flu. There’s no question about that. But it is less than one percent of people that get infected with the flu that die from it. And the reason COVID-19 is causing so much concern is because the mortality rate seems to be around 3.7 percent, which is many times more extreme than even the seasonal flu.

AH: The data are still coming in, but I take that number with a couple of grains of salt. Because that is, you take the number of known deaths divided by the number of reported cases. [But] there’s probably a lot of people that have had COVID-19 and never even reported it. But at least so far, the fatality rate does seem to be higher, and epidemiologists could tell you if the infection rate is higher than the flu.

We’ve got what, [330] million people in this country? About ten percent have been thought to have the flu [this flu season]: 34 million people. [Ed. The CDC estimates between 36 and 51 million people have had the flu this season.] And of them, about one percent were hospitalized. We’ve had about 350,000 hospitalizations because of influenza so far. And again, this is this flu season, not just [since] the beginning of the year, but when the flu season started last fall, we’ve had over 20,000 people in the United States alone die from the flu. And that number will increase tomorrow, and the day after that, until the flu season is over. So you know, you ask how concerned should we be? Well, we should be concerned. I’m also not an immunologist, but it looks like the immune response that spikes from this thing is not really sufficient to give you lifetime immunity.

JT: That’s a really interesting point. So there is no vaccine right now for COVID-19 at all. And you know, some people believe that there’s this herd immunity, but immunity only happens when a very large number of people have been vaccinated [or recovered from infection] and are immune to a disease. And with COVID-19 we are at least eighteen months, maybe more, from a viable vaccine for this, according to the CDC. We have flu vaccines that change every year. COVID-19 is not just going to suddenly disappear because someone magically says, we’ve got a vaccine. So even if this does burn out, let’s say in May or June, November could roll around, and we could have another outbreak of this. How important is it—and again, you’re a biosafety guy, you’re not an immunologist or a virologist, but you do work with this. When these vaccines are available, how important will it be for people to get vaccinated?

AH: Well, if you’re talking about a two-to-four percent fatality rate, I think it’s very important. If there’s a COVID-19 vaccine, I think it would be silly not to get it—and also honestly, selfish. Because again, I’m going to survive COVID-19. I’m not in the demographic that seems to be dying from it. But I can become a carrier. And then I can transmit it to other people. And that [community benefit] is true for many vaccines, including the flu vaccine. I’ll be honest with you—I’m obviously very pro-vaccine, I think I’m up on all my shots, but I hesitated on the flu vaccine ’cause I’m like, “Oh, it’s not really a hundred percent [effective], and, you know, flu is not going to kill me.” But I talked to a virologist, he was actually an influenza researcher, and I asked him what he did, and he’s like, “Yeah, I get it because I’m taking care of the people around me.” [Editor’s note: Flu vaccination has also been shown to reduce severity of illness even in those who do get sick, and it can be life-saving in children as well as adults. The CDC recommends that everyone older than six months should get a flu vaccine yearly with only rare exceptions.]

JT: This week has been a crazy week. We’ve seen the stock market go up and down. There’s no people going out. Italy locked down the entire country. Is this a rational and logical thing? Because I think, sometimes you look at it, you know, we’re hearing this, “Oh, you know, maybe this is a little kind of crazy town.” What’s your take on this?

AH: I hate to keep deflecting, but epidemiologists, people who have made their career of studying these kinds of numbers, they’re also very likely physicians. They’re also very likely microbiologists with a lot of expertise, and they’ve come to this decision. I don’t think a decision like that comes easily. I don’t have to trust them, but I do trust them. Because they’re experts. And again, I think whenever you deal with any of this kind of stuff, you find experts with different sets of eyes, different levels of expertise, and expertise in different things. And you get them all together and you come to a decision.

JT: How concerned should we be about the response that our government has taken to this, from a biosafety point of view?

AH: Well, I honestly don’t trust the head of the executive branch of the federal government at all. But I did look up the director of the CDC, and although he was appointed by this current president, and it looks like there was some controversy about his pay and some of his political stances, he’s a virologist. I’ll also point out the National Institutes of Health (NIH). You know, the NIH has multiple institutes underneath it, and one of the biggest ones is the National Institute of Allergy and Infectious Diseases. And Tony [Anthony] Fauci, he’s been there for multiple administrations. And I haven’t seen him being restrained. So, I have the same skepticism as you do of the federal government at that very top level. But so far from what I’m seeing, the information that is coming out is free and reliable. I kind of look around at the World Health Organization and then the CDC, and you know, closer to home, we have the Illinois Department of Public Health that’s updating their information on a very regular basis. And even closer to home, the Chicago Department of Public Health, they’re updating their information.

JT: Scott Gottlieb, who was the Food and Drug Administration commissioner, said, “We’re past the point of containment. We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country. We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty.” 

Are there any other steps, Allen, that people can do to keep themselves as safe as possible?

AH: Well, not to go back to this again, but [get] a flu shot. ’Cause I would imagine that a combo of influenza in this thing and COVID-19 together, it’d be a mess. So get a flu shot, wash your hands, and do what the CDC says. That’s what I’m doing. If you see somebody coughing or sneezing, stay at least six feet away from them. And conversely, if you are the one coughing, stay six feet away from people. But keep up with the CDC, the Illinois health department, the Chicago health department, and just one quick plug for an organization that I’m part of. They used to be called the American Biological Safety Association, so their acronym was ABSA, but over the years, they’ve gotten an international following. People from all over the world are part of this. So now it’s called ABSA International. They’ve got a wonderful toolkit for looking at this kind of thing both for the public and for biosafety professionals, and all this information is free online.

Correction, March 18, 2020: This interview has been updated to include more specific information from Allen Helm about the importance of washing one’s hands as a defense against coronavirus.