Monthly Archives: June 2020

Reopenings create renewed risks—stay vigilant

Last month we gave a quick overview of the origins and vectors of COVID-19, and warned that reopening would likely cause a “second wave” of summertime illness.

Epidemiologists are now saying that’s happening—and it’s trending highest in areas where reopening rules are the most relaxed.

Young people are the fastest growing affected segment. Maybe because of spring break, the recent crowds of protestors or simply “spring fever,” but a lot of young people have been exposed to the virus, and are either getting sick or spreading the illness. A new CDC report confirms that COVID-19 does not discriminate by age. Half of all new hospitalized patients were under 65, and 20 percent were between 20 and 44 years old.

Increased travel and population movements during the warm summer months are creating significant new ways the virus can move around the country. The rise in cases and affected regions will certainly tax hospitals, ventilator supplies, and other critical systems.

There have been some fascinating developments, including a link to male pattern baldness that suggests a possible treatment pathway, and a promising vaccine candidate that has been shown to protect hamsters which is rapidly moving towards human trials.

But until those promising areas of research pay off, we must stay safe. Healthcare workers, vulnerable populations and their families must continue to protect themselves and those they care for.

OK, what do I have to watch out for?

1. Close proximity is the highest risk. The CDC’s latest guidance is that transmission mainly occurs by droplet spread. Masks and physical distancing are especially high priority for those caring for or living with vulnerable people.
2. MY mask protects YOU; YOUR mask protects ME. Wear them! Even simple dust masks help prevent the spread of droplets from the mouth caused by coughing, sneezing, and speaking.
   And the mask may help reduce unconscious face touching. Touching your mask is preferable to touching your mouth, nose and eyes. To increase your protection, wash your face often, as well as your hands.
3. Help counter the mask protesters. Masks are a proven infection preventer. One researcher’s model shows that widespread mask use could dramatically reduce the spread of COVID-19. Even if you are the only mask wearer in the group, you’re setting a good example for others to consider. Don’t give in to peer pressure—BE the peer pressure!
4. Surfaces are still a priority. Objects, handles and surfaces are the next most common source of the virus. Sanitize ALL surfaces you touch, and wash or sanitize your hands after every shopping cart, door, gas station pump handle, etc. The virus may travel on the soles of shoes, so mop the floor often near the door and wash your hands after touching them.



5. Need to sanitize? Drop into a store. Ask to use the sanitizer they put there for customers (and thank them for their contribution to the public health as you leave!).
6. Don’t just distance—separate. Two meters (six feet) is just the minimum recommendation. As a healthcare worker or if you have vulnerable family members, you should make protecting yourself a priority. Try to stay out of other people’s “airstream.” Whichever way the air is moving, stand upwind of everyone else as much as possible.
7. Take extra precautions when eating, in the workspace or in public. Breakrooms can be a source of infection—you can’t wear a mask while eating. Sit apart, and don’t linger.
8. Glasses—safety and regular—have been shown to protect eyes from exposure to virus contamination. If you have them, wear them. If dry eyes or allergic eyes are a problem, use artificial tears or antihistamine eyedrops. Wash your hands after handling your glasses—they may be contaminated with cough droplets.
9. Are you “re-COVID?” If you had a case of coronavirus and recovered, congratulations—so far, the evidence suggests you are at least temporarily immune to reinfection.

Now help others: Donate plasma, shop for your family, look after vulnerable friends and neighbors, and cooperate with disease tracking. But don’t track the virus into your house on your clothing, shoes, or on packages and groceries. Wash, sanitize, and separate!

Bottom Line: Be socially aware, surface-conscious, and risk-averse—and save lives!

COVID-19: How Did We Get Here? Where Are We Headed?

As the world grapples with this pandemic, our understanding of it is changing rapidly. This can be seen even in the names we use.

Let’s be precise:
On February 11, the virus was officially named “Severe Acute Respiratory Syndrome Coronavirus 2”, or “SARS-CoV-2,” because it is related to the coronavirus that caused the SARS outbreak of 2003 in Asia.

Since SARS was so deadly, using that name in Asia might cause communications issues and unnecessary panic. So, the World Health Organization (WHO) uses the terms “the virus responsible for COVID-19” or “the COVID-19 virus” when communicating with the public.

The disease itself is formerly referred to as COVID-19. The press tends to use “Coronavirus” and “COVID-19” interchangeably. In the healthcare environment, however, it pays to be accurate.

The typical contagion routes have changed.
Previously, the primary sources of infection were person-to-person contact, and in NYC that meant being in a direct chain of contact with a traveler from China or from one of several European or Middle Eastern hot spots. Contact tracing in cases like these was a fairly simple, linear problem—Patient A to Patient B, etc.

A typical example is the direct spread of infection from one nursing home to another by health care workers working in both places while asymptomatic but infectious. Later those same asymptomatic workers transmitted the virus to their family members who were factory or meatpacking industry employees, resulting in the disease emerging in both locations.

Spring—and other things—are in the air.
In the months that followed the initial outbreak, people in major US cities began becoming ill from environmental exposure alone. Simply being in the same space as sick people seemed to be enough to contract the virus once it became widespread. Purely airborne transmission, rather than contact with surface contamination, appears to be the primary source. In fact, based on a statistically significant testing project involving 3000 people, nearly a quarter of New York City dwellers have developed antibodies to the coronavirus—meaning they were exposed, even if they didn’t show symptoms—and may have been “silent spreaders” of the disease.

In one carefully studied case, one sick person dining in a restaurant in China infected nine other people, and the pattern of infection was directly linked to the air conditioning system’s air distribution pattern. It’s clear that the coronavirus was simply blown around the room, causing indirect exposure. And in Mount Vernon, Washington, a single infected singer at choir practice caused 52 cases! They had practiced limited physical contact but not strictly observed social distancing and no one wore masks. In this case, the act of singing was a perfect means of airborne spreading of the virus, rapidly and with devastating results.

Lately other patient cases have arisen that seem to defy the defensive measures taken. Non-obvious transmission routes have emerged, or are suspected, as indicated where people who have practiced careful isolation have still become ill:

• Shoes, clothing and personal accessories may be contaminated with the virus, and they may track the virus from surfaces contaminated by cough droplets into otherwise protected spaces.
• Pets are another possible source. Dogs have shown exposure to the virus, but none have been symptomatic; while cats, including large zoo animals such as lions and tigers, have actually contracted the disease. It is being investigated whether pets with outside access may be a source for contamination of homes with the virus.
• While young, healthy adults and children are far less likely to have serious complications from a COVID-19 infection, it is not clear whether their rates of infection are lower than adults. It’s clear that children with underlying conditions such as such as immunodeficiency, obesity, diabetes, seizure disorders, asthma and other chronic lung disorders are at greater risk of complications than was previously believed. So, schools, daycare and playgrounds must be considered as serious hazards for virus transmission—especially as adults go back to work and children spend more time in these places.

Although many areas have shown steady declines in infection, there is a serious concern that the strong demand for isolation easing—including the reopening of businesses, beaches and houses of worship—and growing resistance to social distancing and responsible use of masks among some of the population may result in a widespread second wave of infection this summer.

It is likely that visitors from “reopened” regions in the United States may become the primary source of new infections as the disease progresses. In fact, one expert predicts this outbreak may linger for up to three years.

Our facility has put in place strict measures to protect our patients and staff. Read more here.

Next Month: Updated guidance tailored for patients, their caregivers and families in the field. Stay tuned!