Phoebe Lostroh, COVID-19, epidemiologist

Dr. Phoebe Lostroh has been in the thick of the battle against COVID-19 since it first reared its head in El Paso County.

A microbiologist, Lostroh has authored a textbook on virology and was a member of the local bridge club where the disease broke out in March.

Although she was not involved in the tournament where the virus spread among members through an infected participant — she was in Virginia on assignment with the National Science Foundation — Lostroh has fielded many questions from club members.

She now has returned to her home and family in Colorado Springs and is working with El Paso County Public Health to learn more about the disease and help control its spread.

Lostroh grew up in David City, Nebraska, and graduated from Grinnell College in Iowa with a B.A. in biology. She then earned a Ph.D. in microbiology and molecular genetics from Harvard University and did postdoctoral research and training at the University of Iowa College of Medicine. She has been a professor at Colorado College since 2003.

Since July, Lostroh has been on a two-year distinguished scholarly leave as a rotating program director at the National Science Foundation, where her job is to facilitate the review of scientific grant proposals by panels of experts and to make funding recommendations.

Since March 4, she has been focusing on proposals from scientists that concern COVID-19 research, some of which the NSF will be supporting through CARES Act funding. 

Lostroh recently discussed her public health work, her thoughts about myths and rumors surrounding the disease and her suggestions for achieving the difficult balance between curbing COVID-19 and economic recovery.

What makes this virus different compared to the flu and other viruses?

Compared to the flu, this virus is probably more transmissible, meaning it spreads to more people per infected case. And it is probably more deadly, for certain age groups anyway. The reason I’m being so equivocal is that we are trying to do these comparisons in the midst of incomplete evidence. I think a big difference is that we don’t have a vaccine and we don’t have a specific pharmaceutical treatment. 

A lot of people are saying they think they have already had the virus; they had it in January. Is that even possible? When was the virus first here?

I think that if someone had been traveling to somewhere like China that it’s possible, but it’s unlikely. I don’t think we have enough information to know whether people locally here were having it as early as January. The first case that I know about was because I belong to that local bridge club where the outbreak was, and that was in early March. It’s reasonable to project that it was in our community as early as February. January is a stretch.

What tests are being used here? Some of the tests that have been developed apparently have higher levels of false results. How do you know that your test is reliable?

We are predominantly using one test, the Abbott ID test, which uses those long, Q-tip swabs to get a good sample.  That is testing for the presence of the virus genome and for virus that is in your upper respiratory tract. There are several issues that could lead that test to give you a negative result, even though you really have it. For one thing, that whole swabbing procedure is not that easy to accomplish, and it’s hard to get a good sample. It’s especially difficult with children. There’s emerging thinking among clinicians and biologists that later on in the infection, the virus might not be found in the upper respiratory tract so much as it’s found down in the lungs. …

You know, any test has a false positive and false negative rate, and a lot goes into interpreting a test. It’s the false negatives that we’re really concerned about. My understanding is that with this test in general, it doesn’t have a very high false negative rate if the sample is good. 

Let’s talk about the myths and rumors surrounding coronavirus.

I’m very concerned that we’re hearing that, for most people, it’s not a very serious infection that doesn’t have very serious outcomes. I think we just don’t know enough to draw that conclusion. … That information is not coming from people who know what they’re talking about. 

There are increasing amounts of cases of a very serious syndrome involving inflammation and blood clotting in lots of places in the body, which can cause heart problems and can be fatal. That’s happening not only among children, but also in young adults. We don’t know if that is going to increase. We don’t know if the virus is replicating all the time, and we don’t know how it’s evolving to adapt to human beings. 

Myth No. 2: I think there’s some confusion about why to wear a homemade face covering, which is sometimes called a mask. In the medical literature, they distinguish between those two. So a mask is something manufactured that we know exactly how it works, and a homemade face covering is something we’ve made on our own sewing machine. People do derive some protection from wearing a face covering for themselves, but wearing a face covering is important to make sure that no one else’s grandma gets it or nobody else’s kid gets it. You can be spreading this disease literally for weeks without having any symptoms. 

There’s a wonderful source of health news that I recommend to everyone. It’s called STAT, so statnews.com. They have updates on COVID-19 almost every day, probably multiple times a day. It’s very high-quality coverage of medical news.

So how can people protect themselves?

It depends on what setting you’re in and how good ventilation is and all that. The best way to protect yourself is to stay away from other people. Washing your hands is still super important. Wearing a face covering absolutely does help.

I think a lot of transmission is happening because someone in a family catches it, like at a workplace, and then brings it home and sheds it around the house before they get symptoms, and then everyone else gets it. I have to say I’m pretty worried about Mother’s Day. I hope that everyone met with their mothers and grandmothers outdoors on Mother’s Day. Everyone should act as though they could give it to someone. 

Should we give everybody who’s at risk N95 masks?

I think that could be a good idea. It’s a good idea to set aside times for people who have high risk to do activities such as shopping. But I actually think that activities such as shopping are very low-risk compared with going to work. So really what’s important is that when employers have an employee who is in a vulnerable group, that those people have maximum flexibility to work from home so that they can continue social distancing and continue to get paid and keep their employer-based health insurance.

Are we reopening too soon?

I think that the country is opening too soon. The original guidelines were that there should be decreasing cases for 14 days, and I don’t know very many states that have seen that. And yet, almost everybody is opening. So I am concerned that we’re going to see an increase in cases in the next few weeks, not just here, but in all the states that are opening up, but I understand why people are feeling that it’s really urgent to try to open back up. 

Are we ready for restaurants to reopen? How do you do that without further endangering people?

Well, I think that’s a really good question. Microbiologists and epidemiologists and doctors don’t all have a unified opinion about that right now. It’s probably less risky to eat at a not-crowded restaurant outside on the patio, than it is to eat in a crowded bar where no one’s wearing a mask. So I think we’re going to have to make some judgments that are more of a gray area rather than black-and-white. Black-and-white was really important when the epidemic was starting here, because the increase per day was so high. I’ve done the calculations, and we literally would have had 100,000 people sick in El Paso County if we hadn’t gone to stay-at-home when we did. The idea now is that we can have some space to move around in and still keep the number of cases per day low enough that our health care system doesn’t get overwhelmed.

How do we strike a balance between reopening and reigniting the economy? 

Well, I have a suggestion about internal work environments. There’s an organization of people that design HVAC systems, and they have some recommendations for what ventilation should be in place to keep the building safe in terms of respiratory virus transmission. So my suggestion would be that if there are workplaces where people have to work in person and cannot do their work from home, that they consult with people who understand HVAC systems and see if there’s anything that can be done to improve air exchanges, or even if there are filtration devices that could help remove virus particles from the air. There are ultraviolet treatment systems that can help inactivate microbes that are in the air. So I think that’s an intervention that workplaces could look into. 

There are other simpler things, like putting up Plexiglas so that every 6 feet, there’s a barrier between people. On the public health side, we’re really hoping that there will be some local employers who want to collaborate with us to do some kind of testing of their employees to see if it’s in the community and to be like sentinels who will let us know, like, there’s now people who are infected at XYZ business. We wouldn’t, of course, share that information publicly. Then we would know that maybe we need to start ramping up our testing capability or our contact tracing. 

We’ve already seen pushback about contact tracing; people are seeing that as even more invasive than wearing a mask.

Right. It’s just very not good. Since we have no vaccine and we have no specific treatments, the No. 1 thing we have is contact tracing, testing and isolating. We have to do those things. It has nothing to do with wanting to invade people’s privacy. You know, this is really a burning-building kind of situation. The rescue personnel don’t stop to find out if you’re a Republican or a Democrat or whatever, when they drag you out of the burning building. And that’s kind of the situation we’re in. …

I just wish that people would be willing to wear face coverings out of empathy for fellow human beings and not worry so much about what it says about your politics. … 

There’s no way to endanger only yourself. You are already endangering other people if you choose to behave that way right now. 

I mean, I’m assuming that I will get it at some point. I’m just trying to get it as late as possible because with each passing week, the doctors learn much more about what to do and what not to do to help treat somebody with a serious case. So every week buys you and your family and everyone you love time for doctors to learn how to save them if they happen to get one of the serious cases. 

I do think we’re going to get through this, but it might get worse before it gets better.