November 22, 2020

Keeping things small

We are gearing up for the surge sure to come after Thanksgiving. Most people are trying to do the right thing and follow guidelines. Others are ignoring the warnings, especially in the areas hardest hit right now. I fear infections will explode in about 2 weeks, with hospitalizations and deaths sure to follow. This map from Georgia Tech can help you assess how risky it is to gather in your county. The truth is that risks go up as the number of people at a gathering increase, keeping things small is best.

Testing ahead of travel is no guarantee of safety. Getting a test is just one point in time, a test can be negative one day and positive the next. Usually people turn positive 4-6 days after exposure, but it can take up to 14 days. Relying on testing alone is not a good way to prevent sharing the virus, especially if people aren’t wearing masks around each other. Testing can be helpful if combined with self-quarantine though.

At the same time we are seeing hope from the coming vaccines, we are still seeing people in denial about COVID-19 in some of the hardest hit areas. Convincing people to wear masks is easy in some places and harder in others. This is frustrating for me because despite seeing the light at the end of the tunnel, we are putting severe stress on our first responders, RN’s, physicians, and other health care workers. They will be hurt by an increased surge. If we can just hold on a few months longer!

This just published epidemiological report out of Kansas shows the differences in counties between those who followed the mask mandate and those counties that opted out. The Kansas governor declared a mask mandate on July 2, 2020, allowing counties to opt out. In early June before the mask mandate, the 7 day rolling average for cases was 3 per 100,000 in the counties opting in and 4 per 100,000 in the counties opting out. By July when the mandate began, the counties opting in had a rate of 17 per 100,000, while the counties opting out had 6 per 100,000. After the order, the counties that followed the mask mandate had a 6% decrease in rate, while those that opted out of wearing masks doubled their rates of infection to 12 per 100,000, supporting masking as a way to slow down transmission.

This other report from the CDC compiles reports and data reinforcing the effectiveness of masking. We know that the person wearing the mask prevents spreading the virus, and we have wondered if wearing a mask protects the wearer. There is more data supporting that mask wearing protects the wearer. Perhaps not by preventing actual infection, but by decreasing the seriousness of the infection by reducing the amount of viral exposure. We are starting to get data that shows a lower inoculum, or amount of virus, that infects someone matters. This is why longer exposures, like choir practice or eating in a restaurant or living with someone, increase the risk of infection and serious illness.

The University of Washington just published data showing that the “viral load”, or the amount of virus in a drop of blood, effects how sick people did when hospitalized. The higher the viral load, the sicker the patient. Now we need to understand if it is higher because of the amount of virus exposed at the time of infection, or some other factor or factors of the host (infected person). But it makes sense that mask wearing reduces exposure to high amounts of virus, which prevents more serious illness, as well as reducing the rate of transmission.

Wash your hands, cover your nose, keep safe six, be grateful this year with just the people you live with. Keep it small now so you can celebrate big when we can all be together safely.

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.

https://www.nytimes.com/2020/11/22/us/coronavirus-thanksgiving-warnings-travel.html

https://covid19risk.biosci.gatech.edu

https://www.medpagetoday.com/infectiousdisease/covid19/89796

https://www.theguardian.com/us-news/2020/nov/19/kristi-noem-trump-strategy-denial-covid-ravages-south-dakota

https://www.cdc.gov/mmwr/volumes/69/wr/mm6947e2.htm

https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html

https://www.seattletimes.com/seattle-news/health/higher-viral-load-more-deadly-for-covid-19-hospital-patients-uw-analysis-finds/