I’m Confused ..

.. are you?

Candidly, between my real job and the compression (and confusion) of the news cycle .. It’s been a bit since I’ve written, and this one will be lengthy. Apologies.

Let’s catch up .. first, a quick quiz:

• Masks: good or bad?
• Soap and water: really?
• Social Distancing: yes or no?
• Distance: six feet? Twelve feet?
• Is it safer outside?
• Surfaces: which, and for how long, and does it matter?
• The Asymptomatic: contagious .. more, less or at all?
• The Resolved: are they immune? Forever? For how long?
• Testing: are we doing enough? Is that why there are more positive cases?
• Hospitalization counts: how important is that number?
• Death counts: a global tragedy. What do they tell us?
• Are we opening too quickly?
• Will there be a second wave?

Umm .. Lessee: Good, really, yes, twelve, less, no, yes, ahh .. not so quick after all. Let’s discuss:

• Masks: at the public / social level, your mask protects me from you and my mask protects you from me (please see “Wear / Where’s Your Mask?“):
  • Our masks protect each other from everyone else that we may have encountered.
  • This is common sense, and is backed up by substantial data from NYC: the lowest number of cases occur with medical workers who are always wearing masks. Granted: they wear the really good masks .. but even the use of a paper mask protects people from each other as can capture moisture droplets that may contain the virus discharged by breathing and speaking.
  • Please wear your mask when out or when you cannot be socially distant from others.
• Soap and Water: YES, as you’ll read in “I’m not a Doctor ..” (I’m not). The corona of the coronavirus is a lipid shell that dissolves when it interacts with soap, breaking apart the bad stuff within. Any soap will do, and taking 20 seconds of your life is worth your life.
• Social Distancing: a solid yes: Distance is still important right now, but granted, unexposed groups (i.e., couples or families with no other outside contact) can certainly can stay close together, but separate from others. We see this in tables at restaurants, groups on beaches and so on. Until we know much, much more, respect the space of others.
• On Distance: more is better .. but impossible in all situations:
  • Tests in still air showed emissions traveling over six feet after coughs and sneezes, but the bigger concern is the air circulating in closed spaces. Please see “Contact Tracing Study“, referencing an early contact tracing effort from a closed restaurant in China.
  • FWIW, the CDC recommends avoiding large indoor gatherings in general.
• Outside: Definitely better .. to the above, many churches are meeting outside, which makes better sense to me. Note that Coronavirus spreads through the air outside with shocking ease during walks and exercise, largely because of the rapid dispersal of aerosol and droplets.
• Surfaces: A few bits on surfaces:
  • The Coronavirus can live on surfaces for varying durations, depending on the surface and the environment (i.e., metal in sun for a short while, cloth in the dark for a longer period).
  • Putting objects outside to kill it? Yes, works just fine .. minutes, not hours, and rotate for best effect. Avoid perishables, of course. The CDC provides guidance on this.
  • Do laundry often .. as above, soap kills the Coronavirus on surfaces beyond your hands.
• Asymptomatic: another solid yes. The rate of transmission is still the big question, triggering a very confusing report from the World Health Organization about the rate of spread. With all that: it does spread from people who don’t know they have it, period. “Behave like you have it ..” is my suggestion .. because you might, they might, or you both may spread it or catch it without knowing it.
• The Resolved: The good news: there is an Antibody test (blood) that is quite reliable that lets you know if you’ve had it. However, other news is disturbing on a few fronts:
  • It’s not clear that once you’ve had it that you are safe from it in the future .. potentially even the near future.
  • It is likely that you are free of symptoms, and that you may still be able to transmit the disease. We don’t know all we need to know yet.
• Testing and Positive Cases:
  • We are finally showing signs of test availability. “Testing, Testing, Testing ..” is good, good and good.
  • While some questions regarding the accuracy of some tests is a valid concern, the swab test supported by a variety of labs seems to be valid. Note that the diagnostic test is a point-in-time test: testing negative means you don’t have it only at that moment.
  • When we test, we detect more cases. That is the idea, and goes without saying. However, the count of tests themselves is being used as the positive talking point by politicians pushing for reopening. More below.
  • Don’t get me wrong: Testing is good. What matters the most: the percentage of COVID-positive results (determines the count entering the funnel), the subsequent actions of the individual (did they isolate?) AND what do the health authorities do with these positive cases? Please see “Testing .. Tracing .. Isolating” for some thoughts.
• Hospitalization Counts are the most important and reliable number in my mind:
  • Patients who are hospitalized will have symptoms, receive a reliable laboratory test, are isolated and will be treated with a higher level of care to ensure they are on the best path to getting well.
  • This number ensures we are monitoring the hospital capacity as cases are still occurring to ensure we can treat the infected.
• Counting those who have passed:
  • A global tragedy and many could have been avoided in many countries if governments and individuals acted sooner or more appropriately. We need to face forward and act to ensure the death toll stops as soon as possible.
  • Even worse, the deaths may even be higher than the published number, given that in the early days many were counted as ‘respiratory illness’, while others who passed at home may not have been tested at all.
  • We may get an accurate count one day, and must recognize those who passed before their time.
• Reopening too quickly?: I have been fortunate to be working throughout the SAH orders .. I tease that the only thing shorter about my workday is the commute .. and I’m not kidding. With that said:
  • I do not feel we are reopening too quickly, but from what I see, watch and hear we may be re-opening too carelessly. Too many snaps of pool parties and churches, the protests and marches, and far too few masks for my taste when I venture out.
  • A kudos to the businesses that require masks and for my Fellow Americans who wear them
• “The Second Wave“: We’ve all heard talk about ‘will there be a second wave in the fall’? To me, the data is suggesting (YMMV):
  • It’s not a wave .. It’s a tide: the tide rose rapidly, SAH stabilized and reduced it, and careless practices are keeping us at standing / rising level.
  • The tide will rise if careful behaviors aren’t maintained. I don’t mean SAH, but I do mean caution, masks, avoiding gatherings and closed spaces .. you know: common sense stuff.
  • Fall will bring Influenza (it always does). The Flu is also a respiratory illness and may make us more susceptible to contracting COVID-19 along with it.

Careless activities and no vaccine are a sure recipe for COVID-19 to continue spreading.

Be smart. Stay connected. Stay safe. Stay home when you can. Be careful when you’re not.