COVID-19: Truths, Misinformation, Symptoms, Possible Vaccines, Why Social Distancing is Important, and More by Epidemiologist Dr. Will Bulsiewicz

You, yes YOU, have the power to alter the course of the SARS-coronavirus-2. Here’s how to do it.

It’s so easy these days to get overwhelmed by fear of the SARS-coronavirus-2 that’s spreading through our communities. I totally understand why this happens – the daily barrage of scary information from our media outlets, Instagram and Facebook, and the rumor mill of (mis)information spreading on the internet and among friends. But as a medical doctor and epidemiologist, I would LOVE to reframe this conversation for you. Excessive fear and anxiety is more than just counterproductive, it can actually damage the gut and weaken the immune system (which is connected to the gut.)[1] This can leave us vulnerable to infection, which is the last thing we need right now.[2] 

Instead, let’s try to be optimists grounded in reality. No, this isn’t the situation that any of us want to be dealing with right now. But I want you to realize how much we’ve learned already. Knowledge truly is power. We are empowered to be the ones to stand up to this virus, and there are simple measures that we can take to alter the course of this virus and save human lives.

Among all the swirling misinformation, there is one rumor that definitely is true – you have the ability to save the world by simply laying on your couch and watching Netflix. Either way, this is a once in a lifetime opportunity to be a superhero. Let me show you how to do it.

The basics of SARS-CoV-2 and COVID-19.

Understanding how to protect ourselves from this coronavirus starts with building our knowledge foundation about the properties of the virus. So let’s take it from the top… The coronaviruses are a group of related viruses that cause diseases in mammals and birds. In humans, they are one of the causes of the common cold. We have had two outbreaks in the past – SARS in 2003, and MERS in 2012 – that we were able to contain. Different strains have different effects.

This particular virus, which we call SARS-coronavirus-2 (SARS-CoV-2) lived among animals. We’re not completely sure, but we believe it was circulating among either bats or pangolins. Unfortunately, it mutated into a form that could infect humans. Then, in the third week of November of 2019, it transferred from an animal to a human. From this point forward, all transmission of this virus has occurred from human-to-human. Animals are no longer part of the equation.

Transmission occurs predominantly through respiratory droplets. A cough aerosolizes the virus, where it can exist for up to 3 hours.[3] It’s still possible to transmit the virus through simple breathing. It’s for this reason that we believe that a safe distance of separation is six feet. There is also the possibility of transmission through infected surfaces. This would occur if you unknowingly touch a surface that contains SARS-CoV-2 and then transfer the virus to your nose or mouth, where it can infect you. The virus can survive for 24 hours on cardboard, 48 hours on stainless steel, and 72 hours on plastic.[4]

In humans, SARS-CoV-2 causes coronavirus disease 2019. We call it COVID-19 for short. You’ve probably heard both of these terms, so just understand that SARS-CoV-2 is referring to the virus specifically while COVID-19 refers to the illness that humans experience as a result.

The many faces of SARS-CoV-2 allow it to fly below our radar 

The spectrum of symptoms for COVID-19 is extremely broad. We’re taught that fever (90%) and dry cough (70%) are the classic symptoms.[5] This can progress to shortness of breath in about 20%, which may require hospitalization.

But COVID-19 has many faces, which allows it to often fly below the radar of detection. It can present with fatigue (38%) and muscle or joint pain (15%), which taken with the fever will lead you to believe you have influenza. Or it can lead with sputum production (33%), sore throat (14%), and headache (14%), masquerading as something on the common cold or seasonal allergy spectrum. There are reports of people experiencing loss of taste or smell. And in my field, gastroenterology, we are finding patients that present with loss of appetite, diarrhea, nausea or vomiting, or abdominal pain. It could easily be mistaken as a simple stomach bug. And it can precede the onset of respiratory symptoms, so this may be the warning shot.[6] 

Perhaps the biggest challenge in controlling the spread of COVID-19 is the absence of symptoms. It’s possible to spread the infection to others prior to the onset of actual symptoms.[7] There are also some people who never develop symptoms, yet are capable of transmitting the infection to others.[8] Generally speaking, the clinical course of COVID-19 is mild for eighty percent or more.

Beware the wolf in sheep’s clothing (mild in most, but severe in too many) 

While the generally mild nature of SARS-CoV-2  would seem reassuring, there’s a very dark side to this virus. In up to twenty percent of patients, the virus can cause respiratory issues. These respiratory issues may be as mild as shortness of breath that warrants oxygen. But they can also be as severe as respiratory failure, sepsis, cardiopulmonary collapse, and acute respiratory distress syndrome (ARDS). Although the minority (about 5%), these are patients that require life support (like mechanical ventilation) in an intensive care unit.

The problem is that intensive care unit beds and ventilators are a limited resource. We only have so many of them, and they’re designed for routine community needs, not for the surge of patients that can be created by a global pandemic. What this means is that if we don’t slow the roll of this virus, the demand created by a surge in infections will overwhelm our healthcare system. As a medical doctor, this is my biggest fear. This is what you already see playing out in other countries, such as Italy. If this happens, the mortality of the virus will spike because some patients who require a higher level of care will be unable to receive it. 

One rumor about this virus that I’d like to dispel is that it’s only a problem among the elderly. That’s simply not true. The Center for Disease Control recently analyzed cases from across the United States and found that the majority of hospitalizations (69%) were in people under age 65. What’s more, about half of the intensive care until hospitalizations were in people under age 65.[9] Keep in mind, each person admitted to the ICU, regardless of their age, is contributing to the potential for a shortfall. So while younger patients are, as expected, more likely to survive this virus, they still have the ability to get extremely sick and to also contribute to an ICU bed shortage.

I’m calling a quick time out from the coronavirus to connect with you. Hi guys! I realize that last section comes across a bit scary, and I led you into this blog post by saying that we would be “optimists grounded in reality.” Don’t worry, we still are! Here’s the key – we cannot allow this virus to do whatever it wants. Our worst case scenario projections are all about what happens if we allow the virus to spread unchecked and without restriction. But do you know who checks and restricts the virus? You do! And I’m about to show you how. So stick with me here because the outlook can absolutely be optimistic if we all do what’s right.

Hey Doc, how did this virus spread so fast?

No doubt, the spread has been incredibly rapid. By December 31st, 2019, the World Health Organization was alerted to several cases of pneumonia without known cause by the Chinese government. The first attributed death was on January 9th. By that point, the virus had already been detected outside mainland China. The first known case in the United States was January 20th. Now here we are, and the United States has the most known cases of SARS-CoV-2 in the entire world.

Many people ask me how we got here. The answer goes like this… This virus is highly contagious. It’s easy to spread. In epidemiology, we actually have a measure of how contagious a virus is called the R naught (R0). This statistic represents how many new cases, on average, a person who contracts the virus would be expected to generate.

Let me give you an example. The R0 for influenza is about 1.2. This means that if I get influenza, I would be expected to infect on average 1.2 other people (about 1 new person). As for SARS-CoV-2, the number is much higher. Most estimates have the R0 for this coronavirus at somewhere in the 2.0 to 2.5 range.[10] 

But there’s a problem. We don’t have a good handle on how many cases of the virus actually exist. What about the asymptomatic cases? What about the ones that never formally count as a case, even though they have symptoms, because they can’t get access to a test? The point being, our estimates of the total number of cases that exist certainly fall short of the number of cases out there, and the only question is how far short.

To truly calculate the R0, you need to have a solid handle on how many cases there are within a population. Many people who have this virus haven’t developed symptoms yet, or they have no symptoms at all. And so they continue their usual routine – slapping high fives, giving hugs and kisses, attending concerts or church – without realizing how many people they may be infecting along the way. It is for this reason that recent models have suggested that the R0 may be as high as 6.6!

The key point is that SARS-CoV-2 is a highly contagious virus. It can be spread by people who are completely asymptomatic. The main form of transmission is by respiratory droplets, not only coughing but from just breathing in proximity to others. It can also spread to surfaces, and then be transmitted to others. It is this challenging combination of a highly contagious virus that can be spread by simply breathing or touching a contaminated surface, and that can be spread by people who are completely symptom free, that has led to the rapid spread of the virus across the globe.

So how can we change the course of history, slow this spread, and save lives?

I said in the very beginning that you, yes YOU, have the power to alter the course of the SARS-coronavirus-2. Let’s pull it all together and I’ll show you how.

SARS-CoV-2 poses a challenging combination of being highly contagious, spread in the absence of symptoms, and capable of overwhelming local healthcare systems with a high percentage of severe disease that requires an intensive care unit with mechanical ventilation to treat.

But the virus has a fatal flaw. It is spread by person-to-person contact. What this means is that if you never come into contact with a person who has the virus, and never touch a surface that contains the virus, then it is literally impossible for you to get the virus.

I explained to you that SARS-CoV-2 has a high R0. Unchecked, it has the ability to infect a lot of people. But this number isn’t etched in stone at all. In fact, there are a number of factors that can change the R0, and by far the most powerful one is you. Let me put it this way: What’s the R0 of the virus if you (hypothetically) had the virus but never come into contact with another person? Zero.

So regardless of symptoms, if every one of us created enough physical distance from each other such that we could not transmit the virus by breathing or cough, then the virus would soon cease to exist. It’s important that we not wait for symptoms to set in for us to do this, because it’s the asymptomatic spread that’s fueling the pandemic. The solution is to do as Dr. Leaf and I discussed in our podcast episode:

“Act as if you have the virus already.”

We could dramatically reduce asymptomatic spread. Heck, we could dramatically reduce spread by respiratory droplets period. Combine this with regular hand washing (20 seconds or more) or hand sanitizer use and we will substantially reduce the R0 and slow the spread of this virus. This prevents the sudden surge of cases that overwhelms our healthcare system. By “flattening the curve”, lives will be saved.

So remember, SARS-CoV-2 is a nasty virus that is easily spread, and will rear its ugly head far too often and lead to severe respiratory disease. But in recognizing the fatal flaw of the virus, that it requires person-to-person contact to be spread, we have the ability to use this information to alter the course of history and save lives. So yes, you really can be a superhero by lying on your couch and watching Netflix. So grab that controller, pop some popcorn, and when your mother calls  to see what you’re up to, let her know, “I’m busy trying to save the world, Mom.” She will be proud.

Dr. Will Bulsiewicz is a practicing gastroenterologist in Charleston, South Carolina and internationally recognized gut health expert. He is an award winning clinician who also did a fellowship in epidemiology and contributed to numerous peer reviewed publications. He is the author of the highly anticipated book Fiber Fueled, which is a plant based plan to optimize gut health and immunity and lose weight. It includes more than 70 recipes and an entire four week plan.



[1] Tetel et al., “Steroids, Stress and the Gut Microbiome-Brain Axis”; Foster, Rinaman, and Cryan, “Stress & the Gut-Brain Axis”; Gareau, Silva, and Perdue, “Pathophysiological Mechanisms of Stress-Induced Intestinal Damage”; Maes and Leunis, “Normalization of Leaky Gut in Chronic Fatigue Syndrome (CFS) Is Accompanied by a Clinical Improvement”; Ait-Belgnaoui et al., “Probiotic Gut Effect Prevents the Chronic Psychological Stress-Induced Brain Activity Abnormality in Mice”; Glaser and Kiecolt-Glaser, “Stress-Induced Immune Dysfunction.”

[2]  Huan Song et al., “Stress Related Disorders and Subsequent Risk of Life Threatening Infections: Population Based Sibling Controlled Cohort Study,” BMJ 367 (October 23, 2019),

[3] van Doremalen et al., “Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1.”

[4] van Doremalen et al.

[5] van Doremalen et al., “Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1.”

[6] Lei Pan, MD, PhD1,2*, Mi Mu, MD3,4*, Pengcheng Yang, MD5 et al., “Clinical Characteristics of COVID-19 Patients with Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study.”

[7] Du et al., “The Serial Interval of COVID-19 from Publicly Reported Confirmed Cases,” 19.

[8] Li et al., “Substantial Undocumented Infection Facilitates the Rapid Dissemination of Novel Coronavirus (SARS-CoV2)”; Mizumoto et al., “Estimating the Asymptomatic Proportion of Coronavirus Disease 2019 (COVID-19) Cases on Board the Diamond Princess Cruise Ship, Yokohama, Japan, 2020.”

[9] CDCMMWR, “Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020.”

[10] Li et al., “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia.”

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