Sunday scaries

Covid-19: What Americans can do to protect their lungs, according to a top expert

Should you wear a mask? The chief medical officer of the American Lung Association explains.

Collage of x-ray lung view and bacteria drawings over it

Scientists are still learning exactly what symptoms accompany Covid-19, the novel coronavirus that has gripped communities around the world. What is definitely known is that, as a respiratory illness, it can cause infection in the upper respiratory tract, as well as pneumonia. The lungs are the main body organ affected by Covid-19 — meaning that if you're not taking steps now to protect lung health, you should.

Dr. Albert Rizzo is the chief medical officer of the American Lung Association (ALA). Here, Rizzo offers guidance on how to keep your lungs healthy during this pandemic, explains what is safe to do and what isn’t, and talks about why the ALA’s past has prepared it for the present.

This interview has been edited and condensed for clarity.

When it comes to people who don’t already live with lung disease, are there effective strategies that you would recommend when it comes to protecting the lungs?

First of all, I would try not to perform any behaviors such as cigarette smoking, vaping; the inhalation of any combustible substance. Changing that lifestyle behavior is the best way to help your lungs.

Secondly, try to maintain overall health with exercise and proper nutrition. All that plays a role because, in order to get the best out of your lungs, you want to be active, and pump air in and out. The more sedentary individuals are, the less effective their lungs.

Those are broad, general points. You can also be more aware of your surroundings from the standpoint of the type of work you do. Does it involve being around potentially hazardous substances, or a very dusty environment? In general, the quality of air that you breathe in — not only outside, but indoors — can play a role in leading to some health issues over the course of time.

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Is the idea that, because the virus attacks the lungs, it’s more important than ever to take these healthy steps, that we should already be thinking about?

Right. We now know enough about the coronavirus, that if you have a chronic illness — especially if you have a chronic lung illness — you seem to be not necessarily at a higher risk of getting infection. But, if you do get the infection, you fall into a category of individuals that have a higher risk of developing complications linked to that infection, which include worsening oxygenation, and problems with breathing, to the extent that you might need a ventilator.

The healthier your lungs are, the less likely you are to be in that group of individuals that will develop complications. Having said that, we realize that people with normal lungs — young, healthy, 30-year-olds — can, unfortunately, be severely affected by it. But that’s not as prevalent as those who have a chronic illness, or the more elderly population.

One theory is that the virus can be transmitted through microscopic aerosols. How concerned should people be about going out to outdoor public spaces, like parks, especially if they have a lung condition like asthma?

I think it’s important to realize that in this stay-at-home world of social and physical distancing, it doesn’t mean you can’t get out of the house. It does mean that if you want to get out of the house, you need to follow the social distancing figure that’s quoted so often now — six feet apart.

Now the reason for that is that we know that when people cough, or sneeze, or just talk loudly, the droplets that come out of their mouth travel no more than about three to six feet. After they drop on a surface, they pose no more harm to you — but that’s also why it’s important to clean surfaces often, and not touch your face, nose, or mouth with unwashed hands. But being outside and being at least six feet away from other people is actually very safe. [If you'd like to read more about how Covid-19 can stick to surfaces, read this.]

It should not lead someone to feel that they’re putting themselves at a higher risk. It’s really the proximity to an infected individual that leads to a higher risk of getting an infection. But if you do go out — sit on a park bench, touch something on a playground — you need to remember to wash your hands. All of these common-sense precautions still need to be in place, but going out is not likely to lead to an infection — even if you have asthma or COPD. The biggest thing that people with asthma or COPD need to keep an eye out for when going outside is the air quality in general.

Guidelines on whether or not all Americans should wear masks have changed. Still, there are already not enough masks for medical professionals. What is the stance of the ALA on this debate?

All along, we try to follow what is recommended by the authorities, especially the CDC. But as you know, even the CDC has changed and loosened some of the restrictions on masks. When it comes to the general public, part of the reason why masks may be more often used is that we are starting to realize now that people can spread the virus, even if they don’t have any symptoms.

Early on in this pandemic, it was felt that people were most infectious as soon as they experienced a cough or shortness of breath. We now know that many, many people are getting the disease as a mild case, with no symptoms, and for several days before any symptoms develop. These are the individuals where, frankly, wearing a mask would prevent that spread to others — but now you’re going down the road of potentially everyone should be wearing masks, and that becomes a supply-and-demand issue.

The ALA has seen a handful of historic public health emergencies, like tuberculosis and the Spanish flu. Are there lessons from a public health standpoint that can be taken from those historical events, and be applied to the present?

The public, government, and regulatory agencies have to come together and realize there is a problem in the first place. From there, at the ALA what we know it’s important to be a trusted champion of information that’s put out to the public. We try to dispel myths; try to sort through what is fact or fiction, so that individuals can use that information. That applies to any public health crisis we have. That’s one arm of the ALA’s mission — the educational component.

"We can’t believe that this is going to be the last test that we have."

The other important part is the advocacy side. We know in situations like this, there has to be a fair, equitable distribution of access to care, and accessibility to things like testing and treatment. In order to have the whole community benefit, we have to make sure that every person who can potentially get infected is treated and isolated. It is also important to track their contacts as best as we can. That was particularly helpful during tuberculosis.

The third priority to consider is research, and certainly, that has a longer timeline usually. But in situations like this, like it’s been for previous coronaviruses like the SARS and MERS epidemic, there’s a rush to create a vaccine. But there needs to be ongoing effort on the research side, supported by non-governmental and governmental agencies, to make sure that we have a continued level of preparedness as we go forward — because there are going to be other emerging diseases.

We can’t believe that this is going to be the last test that we have. And if steps can be taken, not just in regard to therapies and vaccines, but also preparing access to emergency equipment, we can be better prepared for any public health crisis that comes along.

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