Dr. Garry Ferroniis a bit of a legend. He is professor emeritus (retired) at the Northern Ontario School of Medicine and was a microbiology professor when I was a molecular biology student at Laurentian University. Most of my classmates and I were in awe of Ferroni.

His area of expertise is medical microbiology and infectious diseases. He has a PhD from the University of Waterloo and spent his career doing research and teaching at LU and NOSM.

At NOSM, he was the founding division head of medical sciences, as well as a professor, and he worked with colleagues in Sudbury and Thunder Bay to develop the infectious diseases curriculum for the medical program.

The Star reached out to Ferroni with some questions on COVID-19. Ever the helpful teacher, he was happy to oblige.

Q. In lay person terms, what is the novel coronavirus?

A. COVID-19 is caused by a virus officially named SARS-CoV-2, which stands for severe acute respiratory syndrome coronavirus 2. This virus is being referred to in the media as COVID-19 or novel coronavirus. It is the newest virus in a family of viruses called coronaviruses, so named because club-shaped protrusions from their surface give them a crown-like appearance.

Most of them infect animals such as bats, pigs and camels, but a few have managed to jump to humans.

In humans, they tend to cause mild upper respiratory tract infections diagnosed as the common cold. The exceptions are the coronaviruses that cause SARS, Middle East Respiratory Syndrome (MERS) and COVID-19. These coronaviruses are more adept at invading the lower respiratory tract where they can cause a very severe pneumonia.

Dr. Garry Ferroni is a retired professor from NOSM and Laurentian University. He taught microbiology and infectious diseases. In fact, he helped establish the curriculum for the medical school.supplied photo

Q. Do we know how the virus was transmitted from animal to human? How is it transmitted from person to person?

A. The assumption is the COVID-19 virus was transmitted from animal to human, and the animal often mentioned is the bat. There are some who suggest that animals called pangolins might be an intermediary host, which means the virus moved from an unknown animal to pangolins and then to humans.

The possibility that an exotic animal market in Wuhan, China, provided the opportunity for animal to human transmission has not been proven. At this point, the origin of the virus just isnt known. Studies of the sequence of the viruss genetic material (genome) relative to other coronavirus genomes do indicate the COVID-19 virus arose naturally as opposed to being created in a research laboratory.

It is likely that infected persons transmit the virus to other persons via respiratory droplets in their coughs and sneezes (such droplets might even be discharged by talking and deep breathing) and by direct contact, such as hand-shaking and hugging. It follows that infected persons would contaminate surfaces and objects via droplets and direct contact. If we touch or handle these and then touch our faces, we can introduce the virus into our bodies, the entry sites being the mouth, nose and eyes. Knowing how infectious agents are transmitted allows us to protect ourselves and our contacts.

Registered nurses Karen Hatton, left, and Theresa Murray stand inside a shelter associated with the drive-through option for coronavirus testing on Walford Road.Jim Moodie/Sudbury Star

Q. How long does the virus live on different surfaces, such as plastic, metal, produce?

A. Viruses can survive on surfaces for a limited period of time, but they cannot multiply. They must invade the cells of an appropriate organism to multiply. Not surprisingly, there is not a lot of information on the survival of the COVID-19 virus when it is outside of the human host.

Studies at or supported by the National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention, both of which are American institutions, have shown survival in aerosols for up to a few hours; on copper for up to a few hours; on cardboard for up to one day; and on plastic and stainless steel for up to a few days.

Concerning produce, as other pathogens can be found transiently on fruits and vegetables as a result of contamination, we should expect this to be true for COVID-19 as well, and we should wash and rinse our produce thoroughly. This means there should be no more tasting of grapes or cherries in the supermarket.

Q. There is lots of (mis-) information online about ways to kill the virus, particularly around heat and the use of saunas. Can you dispel some of those myths?

A. With a few exceptions possibly, cold temperatures do not kill viruses. Heat, on the other hand, definitely kills viruses, but the minimum temperature and exposure time to accomplish this vary from virus to virus.

Generally, 60-minute exposures to temperatures above 60 C kill most viruses, as would shorter exposures to higher temperatures. Nevertheless, using these moderate temperatures to try to eliminate viruses is not very practical.

Viruses are killed by a variety of disinfectants and by hand sanitizers that contain at least 60 per cent alcohol. In the process of proper hand-washing, employing soap and warm water, viruses are physically removed from the skin. Coronaviruses are actually killed because soap removes their membranous envelope that allows them to attach to host cells to initiate infection.

Q. Why and how does the virus make people sick (in lay terms)?

A. COVID-19 is a severe acute infection of the respiratory tract. A likely progression of the disease is as follows:

Upon entering the body, the virus establishes itself in the upper respiratory tract (nose and throat).

Around five to six days after exposure, the first symptoms occur, one or more of fever, dry cough, fatigue, aching muscles, sore throat and nasal congestion. In more serious cases the virus moves into the lower respiratory tract (the lungs) to cause a pneumonia that is indicated by shortness of breath.

The development of the disease is due to the ability of the virus to infect and kill cells that line the respiratory tract, including the air sacs in the lungs, and to an exaggerated response by the immune system that causes extreme inflammation in the lungs. This affects our ability to breathe.

Age and overall health are factors in the severity of the disease. Older adults and those with chronic diseases of the lungs and heart, for example, are most likely to experience serious disease, whereas healthy children are least likely.

An inspirational message is displayed in a window of a home in Sudbury on April 16.John Lappa/Sudbury Star

Q. What about treatment and prevention?

A. Treatment of a viral disease like COVID-19 requires administering an effective antiviral agent or administering antibodies that eliminate the virus. Antibodies are proteins produced by the immune system in response to infection, and for some diseases, they can be made available for therapeutic use.

Currently, neither type of therapy is available, but research and trials are in progress. The major preventative would be a vaccine and this is being pursued.

Q. Does this virus show much capacity for mutation? Should we be concerned about mutation?

A. The genome of a virus can be altered by a change in the base sequence, a process called mutation. It can also be altered by a process called genetic recombination, in which a second virus contributes some of its genome to another genome. Genetic recombination can happen if the two different viruses infect a host cell at the same time.

Mutations tend to cause minor changes in the characteristics of the virus, whereas genetic recombination can result in major changes. It is these major changes that can produce a new strain of the virus capable of causing a pandemic, as there is no immunity to the new strain. Given that coronaviruses have been shown to mutate and to undergo genetic recombination, and to move from one animal species to another, we should expect the same of the COVID-19 virus. This means, of course, that a disease similar to COVID-19 could emerge in the future.

Q. Once youve been sick, are you immune to the virus?

A. It is a reasonable assumption that individuals who have had the disease will have a substantial period of immunity, if not life-long immunity, to subsequent exposure to the same strain of the virus. Moreover, immunity as a result of having had a disease is superior to that acquired by any immunization procedure (vaccine), which should be true for COVID-19 as well.

Q. Can you predict how this virus will travel through the human population? Do you foresee a second/third/fourth wave of sickness?

A. It is difficult to predict virus movement through the population, but if we look at what has happened thus far in our province and in countries further into the pandemic we see that: older adults and individuals with certain chronic conditions get seriously ill; certain sites in a community, for example, long-term care facilities, can have high densities of infection; individuals who provide essential services are exposure-prone; and hospitals can be overwhelmed with patients needing intensive care.

Past influenza pandemics tell us there can be more than one wave of illness, each separated by a few months. Because the reasons for a second or even third wave are not always known in advance, it is difficult to predict waves. It is much easier to account for them after the fact.

Q. What are the best- and worst-case scenarios?

A The best-case scenario would be if our preventive measures had a major positive impact and terminated this outbreak within a few months. For this scenario, as for some others, there would be the issue of individuals at highest risk and without immunity emerging from isolation into a population where some might still be harboring COVID-19. The development of a vaccine or effective anti-viral medication would eliminate this as an issue.

The worst-case scenario would be to experience for an extended period of time what is currently happening in Italy, Spain and the USA.

Q. There has been media attention on the need to strip and change clothes when you come home. Is this necessary? What other measures, besides washing hands, maintaining distance and stifling coughs, should we be putting into practice?

A To protect ourselves, family members and others, it is important to adopt effective procedures and behaviours. As respiratory droplets discharged by infected persons travel in the air for a metre or so, maintain a safe space of two metres. Cough and sneeze into the bent arm or into a tissue. Avoid touching ones face to prevent introducing the virus into your body. Wash hands properly with soap and warm water, frequently and at critical times. Sanitize hands at critical times with sanitizer containing at least 60 per cent alcohol.

If you decide to wear a mask when you are in public, sanitize your hands before putting the mask on and just before and just after taking the mask off, and be aware the mask might collect infectious droplets. Do not use masks designed for health care workers because of their limited supply.

We should be aware that clothing can become contaminated if the two-metre barrier is broken and by contact with or transfer from surfaces and objects. Individuals should assess their own probability of exposure and that of their children, and decide if changing clothes is necessary.

The Public Health Sudbury and Districts website (phsd.ca) should be visited frequently and the recommendations for isolation and in-person socializing followed.

sud.editorial@sunmedia.caTwitter: @SudburyStar

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Sudbury Accent: The best and worse case scenarios for COVID-19 - The Sudbury Star