August 25, 2020

safe distancing

Some good news today that the number of new infections in the country are starting to fall. The New York Times has a good analysis with an interactive story that shows the data and analysis by officials that the restrictions and mask wearing are working especially in the states hardest hit. The 7 day average of deaths per day is once again below 1000. My friend Sheila Stone sent me this link to this daily COVID update video which gives a quick one minute update.

The British Medical Journal has an excellent article about safe distancing rules with a graphic that shows that the risk of catching COVID-19 goes up with factors such as silence, speaking, singing and shouting, influenced by face coverings, and how many people are together, as well being outdoors or having ventilation and the amount of time. This is an excellent guide and can help you quantify your risks. There is not a lot of green but it does make me feel better about Jamie visiting with his 92 year old mother and two brothers last weekend for her birthday. It was raining so they visited indoors with good ventilation.

My advice is definitely don’t go to weddings. One in Maine on August 7 is now traced to at least 60 cases, one death, and is now causing cases in a jail and a nursing home. Officials are surprised at how fast it spread. Even in Washington state, there is an outbreak at a hospital in Bremerton. This is the worst nightmare for a healthcare facility. How to rein in the damage will be challenging.

I also fear that the 450,000 or more motorcyclists who were in Sturgis, South Dakota earlier this month will reverse the good trend we have of lower infections. Every day, I read of more states added to the list who have COVID-19 cases related to the rally. The spread can be rapid. Sadly some rural areas are not prepared.

And that rapid spread can have an influence on deaths. Data analyzed by UW and University of Minnesota shows that deaths go up after ICU beds are filled but also with any hospital bed that has COVID patients. For every 6 ICU beds OR every 7 hospital beds, one COVID-19 death occurs the following week. Lousy statistics and odds. This was not expected but is thought to be not having enough capacity in ICU beds leads to more deaths.

For all that negative news about transmission, we are learning more about management and risks. We know how to stay safe. We now know that rather than increasing risk, Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) seem to protect the person taking it. Ibuprofen and other NSAID’s (non-steroidal anti-inflammatories) are safe, and some of the newer diabetes medications may help.

Wash your hands, cover your nose, keep safe six, and sing again, but outdoors and masked up, if you are not with your regular pod.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

BMJ 2020;370:m3223