COVID-19 Q & A With Dr. Carla Holinaty, MD, City Centre Family Physicians

Q: You mentioned you were crushed to hear from teachers that they don’t have a lot of answers from the government on some basic questions you had: what were some of your questions?

Dr. Holinaty: I was hoping I could get some clarification about exactly what symptoms would get a kid sent home from school and hoping that there might be a list of criteria or some clear guidelines for teachers to use because, as you know, they’re not trained in health care. They told me they still don’t have any clear guidance on that.

Q: If a child has the sniffles or a slight cough on the first day of school: what should they do?

Dr. Holinaty: So, my suggestion would be to do one of a few things: go online and use the government’s COVID screening tool, they give some pretty clear guidance on what to do in each situation, you can call 8-1-1 and you can get some advice there, or as always, your family doctors are here to answer those questions. They can listen to the symptoms and because they know your family they can help give you some guidance. Ex. your kid with asthma is probably having a flair with their asthma or it could likely be something else. Families need to be really responsible. If you have a kid who’s sick, this is not the time to think “it’s probably nothing” and send them anyway. We know kids can have mild or potentially no symptoms in some cases. If your kid has a fever or a new cough, we need everybody to be really responsible and keep them home.

Q: Are face-shields more or less effective than cloth masks?

Dr. Holinaty: Less effective, most likely. A face shield can be a great ADDED tool, in some circumstances, like in healthcare because they can help protect your eyes and can help protect the people wearing them from big droplets from people close-up. But, if you think about the construction of face shields, they’re open on the sides and around the bottom. So, they provide lots of space for droplets to escape from the wearer and to allow droplets dispersed in the air to be allowed up and into your mouth/nose.

Q: Should grandparents be keeping their distance now that kids are going back to school?

Dr. Holinaty: I think that’s a really tricky question. Personally, my family has talked a lot about this and we are restricting our social circle again. It takes a lot of discussion with the people in your lives and thinking about their current health situations. I think this probably is the time to restrict contact with vulnerable people, because we know from other jurisdictions that the return to school often is associated with an increased number of cases of COVID and we know that kids can get and transmit it. Like we’ve talked about before, think of your own priorities, the health of the people around you, and making decisions that work for you and your family.

Q: What are the signs of heat stroke?

Dr. Holinaty: Two things we need to think about: heat exhaustion and heat stroke. Heat exhaustion is the more mild form that most people have probably had at least some symptoms of in their life. That would be things like feeling nauseous, vomiting, muscle cramps, feeling tired/weak, dizzy, having a headache, and even fainting after being out in the extreme heat for long periods of time. When you have heat exhaustion, your core body temperature stays at a relatively safe level, when you move into heat stroke, this is where your core temperature rises high enough that it can cause really significant damage to your internal organs and your brain. This is when your core temperature goes above 40 degrees and these people can have some of the same symptoms as heat exhaustion, but they start to have changes in how their brain works. They can become really confused or they might be going in and out of consciousness. Heat stroke is a medial emergency, so if someone around you has symptoms, it would be appropriate to call 911 in those circumstances.

Q: Are the signs different in children or is it all the same across the board?

Dr. Holinaty: It can be similar, but children are more susceptible so they’re more likely to get the heat stroke or heat exhaustion symptoms just because of how their physiology works. The same would be true about older adults.

Q: How do you assist someone showing signs of heat stroke?

Dr. Holinaty: For heat exhaustion, the more mild version, we would do basic supportive things like help the person move to a cooler place, if they’re wearing lots of clothes help take off some layers, or if they’re very tight, try to loosen what’s around them. You can help cool them off by putting cool wet cloths around them and give them some water that they can sip on. For heat stroke, if this is happening, call 911, or we need to be going to a hospital. While waiting for that emergency help, move them to a cooler place, put cool cloths on them, use ice packs against their clothing if you’ve got it, but it’s not a good idea to offer these people a bunch of water to drink because they’re already confused with their brain not working and we don’t want them to accidentally breathe in that water as they’re trying to drink it.

Q: Any preventative measures before you get to that point?

Dr. Holinaty: Tons of water is super important and being prepared is also important. Plan your day: if you want to exercise, exercise in the earlier morning or later evening when things are cooler. Make sure you’re paying attention to the people around you. If you’ve gone for a jog and your jogging partner is all-of-a-sudden stumbling over their feet and falling down, you need to stop and make sure they’re okay. Take breaks to cool off, if you have access to air conditioning, taking breaks to cool off their is important. If not, still finding a shady place, you can mist down your skin and get in front of a fan to help some of that heat evaporate off. Get wet in the water or a spray park: anything that cools you down and making sure you’re taking breaks regularly to do that.

Q: Does beer help cool you down?

Dr. Holinaty: No. Alcohol and caffeine actually increase your risk of heat exhaustion or heat stroke.

Q: What should I do if I’m stung by a wasp?

Dr. Holinaty: A couple things that you can do right away is to move to a safe area. If you’re outside mowing the grass and suddenly you get stung, chances are, you probably have disturbed a colony of some of those stinging insects. So moving away can help prevent more stings from happening. Important to remember: honeybees are the only thing that leave their stinger behind. They do typically die after they’ve stung a human; wasps, hornets, yellow-jackets can all sting multiple times, they don’t have a barbed stinger. Once you’ve been stung, they release a pheromone that attracts the other stingers and so once you’ve been stung in the day, you’re more likely to be stung again.

Q: How do I treat a sting?

Dr. Holinaty: Have a look at your skin. Honeybees will leave a stinger behind, most other stinging insects won’t. If you still see a stinger in the skin it’s important to remove that. You could use a credit card or a non-sharp knife to scrape that stinger off of your skin. Then you can wash it with soap and water to get it nice and clean and then probably the easiest thing to do would be to apply a cold compressor and ice pack because that can help prevent some of the swelling and help control some of the pain as well.

Q: Is waving your hands/swatting at a wasp a bad idea?

Dr. Holinaty: When you wave and you’re swatting at it, the insect you’re attacking doesn’t know whether you’re trying to defend yourself or attack them. So, they usually perceive that as you being a threat to them and are more likely to attack.

Q: How can you spot someone having an allergic reaction to an insect sting?

Dr. Holinaty: So, if you or someone around you has been stung and they’re noticing that they’re having difficulty breathing or they’re getting swelling in their face or mouth. If all of a sudden they’re starting to get really intense abdominal cramps or they’re starting to feel faint or light-headed, those would be reasons to contact 9-1-1 and get them emergency treatment right away.

Q: Should I be concerned about bringing groceries home from someone who may have COVID-19?

Dr. Holinaty: The bigger risk in grocery shopping is probably the people and not the food. Number one, only go when you need to. Limit how many times you’re going to the grocery store in a week and avoid crowds. So, choosing stores that limit the number of people allowed in the building try and shop quickly: have a list, go in with a purpose. Now is not the time to browse. While you’re in the store, please honour the physical distancing, six feet apart from people. Follow the rules in the store if they’ve got one-way lanes, then do what they’re asking you to do, this is not the time to try to break rules to prove you don’t have to follow them. You could also wear a mask to help protect other people from yourself.

Q: How concerned should I be about my clothing after being out for the day? Do I need to wash my clothes after just going out for a walk?

Dr. Holinaty: Not necessarily, this might be more important if you are being exposed to people who may be sick, so things like physicians or nurses or other health-care workers that are probably being exposed to germs that have the risk of being COVID. It’s probably more important to consider, especially if you’re living with small children who have the potential of putting their faces right up into your clothing when you come home and give you a hug or people that are immune-compromised

Q: When washing your hands, does it matter if I’m using cold or hot water?

Dr. Holinaty: No. Actually there’s quite a lot of literature around this and there’s no difference in the terms of how clean your hands get. There are some suggestions that using warm water can actually cause more skin irritation especially if you’re washing your hands more often so the bottom line with hand washing is do it properly and do it often but the temperature of the water should just be what’s comfortable for you.

Q: If you were in a joint-custody situation, where one week they’re with mom, the next with dad: is this sort of visitation a concern?

Dr. Holinaty: Important to note, I’m not a lawyer or a judge, but there has been a potentially precedent-setting case in Ontario around this and the decision that was made by the judge there is that the child’s right to have both of their parents be involved is probably the primary thing to consider in that situation. So, families still need to respect physical distancing and keep doing excellent hand hygiene and obviously if one parent has tested positive for covid the kids shouldn’t be transferred into that home. Or if one part of the family is sick they should be following self-isolation protocols.

Q: Can COVID-19 stick to your beard or mustache? Can I make my spouse sick from kissing me?

Dr. Holinaty: Covid is spread through droplets. I know that’s a word we use a lot. You know those pictures of people sneezing? That stop-action with the spray of snot and spit going everywhere? Those are the droplets that we’re talking about. Yes, droplets can get stuck in your beard but the way that those would be transmitted from your face would be either if you’re touching your face and touching other things, which is one of the things we’re asking people not to do or if your face is touching someone else’s face. So, yes it could be spread, but again maybe if you are particularly sick or if you tested positive for covid-19 that’s not the time for tonsil hockey.

Q: Do we have to be worried about COVID-19 being transmitted via mosquitos?

Dr. Holinaty: No, Covid-19 is not transmitted through mosquitoes. There are other coronaviruses that live in the same family and we know that those don’t get spread by mosquitoes. Like I said, it gets spread by droplets. Those gross sneezy things that come out of you when you’re talking or coughing: mosquitoes are not going to be a concern.

Q: Are you getting a sense of restlessness among your patients as the numbers stabilize? Are you a little fearful of folks starting to ignore the rules a little, get in larger numbers. Thoughts?

Dr. Holinaty: I think so, and I think we can see that if you’re just out and about, you know, in your community that you’re seeing more and more people out and more and more people may be bending the rules or ignoring the rules a little bit. I think part of that is human nature, we’ve been cooped up for a while, it’s been winter for a long time and people are social. They want to be outside, they want to be visiting with their friends but I think we have to keep reminding ourselves that as we do that we’re risking ourselves and the people around us and it’s not something that’s fun but it’s something that’s very important to keep maintaining that physical distancing.

Q: One of the biggest COVID turns this week is the discovery of what they’re calling pediatric multi-system inflammatory system showing up in children. What is this? How concerned should we be now?

Dr. Holinaty: This is luckily something that’s still quite rare, but it’s an association that people around the world have seen. Where kiddos get a sort of collection of symptoms that can resemble a known, also rare, inflammatory condition. It’s rare, but the most important thing your listeners need to know is that if you have kids and you’re noticing something unusual with them, I always talk about Parent Radar. That voice inside your head that says something is wrong with my kids something is not quite right here that is the time to call your family doctor and to say this is going on I don’t know what it is and we will talk to you, we will assess them by phone or video, we will bring them into the office if we think it’s necessary to make sure that we’re not missing something serious that’s happening.

Q: What do you tell patients in pain who’ve been waiting for surgeries they’ve been expecting? Are you concerned the longer these cases wait, the greater chance of addiction to painkillers or do you feel that this needs to get going?

Dr. Holinaty: I think we have to remember that the reason that all of those surgeries were cancelled was to be able to do all the things that we’ve done that allowed us to flatten the curve and to prepare our system and our hospitals for a surge of patients. Now we were lucky that we were able to do that and not get the massive surge that places like New York or Italy saw, so I’m very thankful for that. In terms of what I tell patients, I think the most important thing is to recognize that it sucks. They’re in pain, and they’ve had to wait longer than they thought that they had to, and that’s difficult. We’ve asked them to make a sacrifice to help the system. In terms of pain medication addictions, I think we can very safely manage pain and help keep the risk of addiction to painkillers low, but like we do with any patient who we’re starting pain medication that has the potential to be addictive, we need to screen people first and make sure that the people who have a high risk of developing addiction are managed maybe slightly differently or that we check in on them more often and are even more cautious than we would be with some other people.

Q: It’s all about testing, testing, testing. What does that mean to me? We keep hearing it’s up to the testing to tell us where to go: who should be tested?

Dr. Holinaty: Anybody that has any symptoms that are potentially associated with covid should be tested. We should have a really low threshold to test people, even if we have just the slightest suspicion and the reason for that is those asymptomatic or those very low symptom cases that we’ve been talking about over the last several weeks. We need to be able to find those people effectively and quickly because they are the ones who are the most likely to spread that illness to a lot of people. They might just think I’ve got a touch of a cough but I feel fine otherwise it’s probably not covid, no big deal. And if they are in fact covid positive and then they’re mixing with their family and maybe their extended virtual family and maybe they snuck in a visit with the neighbours or maybe they went to the grocery store and weren’t particularly cautious. That’s where we see those giant spikes in our case numbers. If you have absolutely no symptoms and no risk factors (you haven’t been exposed to anybody, you haven’t been contacted by public health, you haven’t traveled) Then I would say no, you don’t need to be tested. But, if you have any symptoms at all, or any potential risk factors, you should be reaching out to your healthcare professionals and I would suggest you should be tested.

Q: Will the summer heat help conquer COVID-19?

Dr. Holinaty: Probably not. We see cases of COVID from places that are hot and sunny and humid and as far as we know, that’s not stopping it dead-in-its-tracks.

Q: Could I have had COVID with minimal symptoms and not have known it?

Dr. Holinaty: That’s entirely possible. What we know from covid is that the majority of people that are infected can have quite mild symptoms. So, it’s entirely possible that a person could have been infected and had those mild symptoms and attributed it to something else and had it resolved completely on its own.

Q: Can COVID-19 be spread through sharing lip balm?

Dr. Holinaty: Yes. We’ve talked before about how covid is spread through droplets, those things that you see come out when people sneeze. So, those spit particles, when you’re using your lip balm, I mean your lips are where your spit lives and those are going to be spread onto the lip balm which then could be transmitted to other people.

Q: What about wind? Can Coronavirus travel by wind putting me in danger when someone jogs or bikes past me?

Dr. Holinaty: Again, it’s those droplets that spread. In the situation that there’s a wind and one of those droplets get picked up by that breeze, in theory it could travel farther than if there was no breeze at all.

Q: How long can an asymptomatic person of COVID-19 be infectious?

Dr. Holinaty: Now that’s a question that we don’t have a really clear answer to. We know that people probably are infectious for around two weeks after they start showing symptoms but, the guidelines for people who have improvement infection have two criteria: usually it’s two weeks after they’ve been diagnosed or 48 hours after their symptoms have completely gone away and they should have negative tests. We don’t want to just assume that there’s a period of time that once it’s passed it’s a green light and everything is good. We’re being abundantly cautious and making sure that we know very surely that that infection has cleared in that person.

Q: Can a sick worker in a meat-packing plant, transmit the virus via the meat that they’ve touched in that plant?

Dr. Holinaty: As far as what I can find in the available research that exists right now it doesn’t look like there has been a documented case of covid being spread through food items. So, in that situation it would have to be probably a larger-than-normal piece of droplets that got onto something and really quick exposure. The risk with food still remains quite low.

Q: This isolation has taken a toll on people’s mental health, how can people get help?

Dr. Holinaty: The first thing is to remember that you need to check out of whatever media you’re using at some point probably every day, maybe take a day or two break. It’s important to stay up-to-date but sometimes that constant stream of information can be really overwhelming and can cause a lot of anxiety for people. So that would be the first thing that I would suggest to people: turn off your Facebook, and Twitter and not checking your news feed for a few hours every day as a time where you can recharge. Another thing you can do is remember that a little bit of anxiety in situations like this is normal and you’re not alone and the next thing that I would suggest to people is to check in with your family doctor. We’re here, we’re open, we can see you very safely virtually and we can make arrangements to see you in person safely if we think that you need it, but your family doctor is a great resource and can provide one-on-one counselling with you themselves and they can help people get connected with their local resources if they need more help than that.

Q: Have you heard from friends or others, whether it be optometrists, doctors, or dentists: is it a struggle getting PPE in our province for these businesses to re-open?

Dr. Holinaty: I haven’t had any direct contact with people from the dental or optometry associations, but I’ve heard that people are buying what they can find and being cautious to make sure that they’re using it appropriately and using it wisely. I know our veterinarian’s office seems to have full PPE and have been using it, so I hope there’s now enough supply we’ve flattened the curve enough that we’ve allowed for some catch-up in terms of manufacturing and supply of those things but I think PPE remains a concern that’s really at the front of everyone’s minds. They want to be able to re-open if they’re allowed as part of what the plan is, but they only want to be able to do that if they can do it safely. Safely is protecting themselves and their staff, but also being able to protect the public that is coming in to see them.