[FRIAM] Practical Covid Guidlines

Thu Jun 11 13:35:35 EDT 2020

I wonder what The Congregation, including the Diaspora, thought about this.
Nothing very dramatic, here, but that's just the point.  Nothing on travel.

>From Dr. James Stein, Professor of Cardiovascular Research at the University
of Wisconsin School of Medicine and Public Health.

 COVID-19 update as we start to leave our cocoons. The purpose of this post
is to provide a perspective on the intense but expected anxiety so many
people are experiencing as they prepare to leave the shelter of their homes.
My opinions are not those of my employers and are not meant to invalidate
anyone else's - they simply are my perspective on managing risk.

 In March, we did not know much about COVID-19 other than the incredibly
scary news reports from overrun hospitals in China, Italy, and other parts
of Europe. The media was filled with scary pictures of chest CT scans,
personal stories of people who decompensated quickly with shortness of
breath, overwhelmed health care systems, and deaths. We heard confusing and
widely varying estimates for risk of getting infected and of dying - some
estimates were quite high.  

Key point #1: The COVID-19 we are facing now is the same disease it was 2
months ago. The "shelter at home" orders were the right step from a public
health standpoint to make sure we flattened the curve and didn't overrun the
health care system which would have led to excess preventable deaths. It
also bought us time to learn about the disease's dynamics, preventive
measures, and best treatment strategies - and we did. For hospitalized
patients, we have learned to avoid early intubation, to use prone
ventilation, and that remdesivir probably reduces time to recovery. We have
learned how to best use and preserve PPE. We also know that several
therapies suggested early on probably don't do much and may even cause harm
(ie, azithromycin, chloroquine, hydroxychloroquine, lopinavir/ritonavir).
But all of our social distancing did not change the disease. Take home: We
flattened the curve and with it our economy and psyches, but the disease
itself is still here. 

Key point #2: COVID-19 is more deadly than seasonal influenza (about 5-10x
so), but not nearly as deadly as Ebola, Rabies, or Marburg Hemorrhagic Fever
where 25-90% of people who get infected die. COVID-19's case fatality rate
is about 0.8-1.5% overall, but much higher if you are 60-69 years old
(3-4%), 70-79 years old (7-9%), and especially so if you are over 80 years
old (CFR 13-17%). It is much lower if you are under 50 years old (<0.6%).
The infection fatality rate is about half of these numbers. Take home:
COVID-19 is dangerous, but the vast majority of people who get it, survive
it. About 15% of people get very ill and could stay ill for a long time. We
are going to be dealing with it for a long time.

 Key point #3: SARS-CoV-2 is very contagious, but not as contagious as
Measles, Mumps, or even certain strains of pandemic Influenza. It is spread
by respiratory droplets and aerosols, not food and incidental contact. Take
home: social distancing, not touching our faces, and good hand hygiene are
the key weapons to stop the spread. Masks could make a difference, too,
especially in public places where people congregate. Incidental contact is
not really an issue, nor is food.

 What does this all mean as we return to work and public life? COVID-19 is
not going away anytime soon. It may not go away for a year or two and may
not be eradicated for many years, so we have to learn to live with it and do
what we can to mitigate (reduce) risk. That means being willing to accept
*some* level of risk to live our lives as we desire. I can't decide that
level of risk for you - only you can make that decision. There are few
certainties in pandemic risk management other than that fact that some
people will die, some people in low risk groups will die, and some people in
high risk groups will survive. It's about probability. 

 Here is some guidance - my point of view, not judging yours:

1. People over 60 years old are at higher risk of severe disease - people
over 70 years old, even more so. They should be willing to tolerate less
risk than people under 50 years old and should be extra careful. Some
chronic diseases like heart disease and COPD increase risk, but it is not
clear if other diseases like obesity, asthma, immune disorders, etc.
increase risk appreciably. It looks like asthma and inflammatory bowel
disease might not be as high risk as we thought, but we are not sure - their
risks might be too small to pick up, or they might be associated with things
that put them at higher risk. 

People over 60-70 years old probably should continue to be very vigilant
about limiting exposures if they can. However, not seeing family -
especially children and grandchildren - can take a serious emotional toll,
so I encourage people to be creative and flexible. For example, in-person
visits are not crazy - consider one, especially if you have been isolated
and have no symptoms. They are especially safe in the early days after
restrictions are lifted in places like Madison or parts of major cities
where there is very little community transmission. Families can decide how
much mingling they are comfortable with - if they want to hug and eat
together, distance together with masks, or just stay apart and continue
using video-conferencing and the telephone to stay in contact. If you choose
to intermingle, remember to practice good hand hygiene, don't share
plates/forks/spoons/cups, don't share towels, and don't sleep together.

 2. Social distancing, not touching your face, and washing/sanitizing your
hands are the key prevention interventions. They are vastly more important
than anything else you do. Wearing a fabric mask is a good idea in crowded
public place like a grocery store or public transportation, but you
absolutely must distance, practice good hand hygiene, and don't touch your
face. Wearing gloves is not helpful (the virus does not get in through the
skin) and may increase your risk because you likely won't washing or
sanitize your hands when they are on, you will drop things, and touch your
face.

 3. Be a good citizen. If you think you might be sick, stay home. If you are
going to cough or sneeze, turn away from people, block it, and sanitize your
hands immediately after.

 4. Use common sense. Dial down the anxiety. If you are out taking a walk
and someone walks past you, that brief (near) contact is so low risk that it
doesn't make sense to get scared. Smile at them as they approach, turn your
head away as they pass, move on. The smile will be more therapeutic than the
passing is dangerous. Similarly, if someone bumps into you at the grocery
store or reaches past you for a loaf of bread, don't stress - it is a very
low risk encounter, also - as long as they didn't cough or sneeze in your
face (one reason we wear cloth masks in public!). 

5. Use common sense, part II. Dial down the obsessiveness. There really is
no reason to go crazy sanitizing items that come into your house from
outside, like groceries and packages. For it to be a risk, the delivery
person would need to be infectious, cough or sneeze some droplets on your
package, you touch the droplet, then touch your face, and then it invades
your respiratory epithelium. There would need to be enough viral load and
the virions would need to survive long enough for you to get infected. It
could happen, but it's pretty unlikely. If you want to have a staging
station for 1-2 days before you put things away, sure, no problem. You also
can simply wipe things off before they come in to your house - that is fine
is fine too. For an isolated family, it makes no sense to obsessively wipe
down every surface every day (or several times a day). Door knobs, toilet
handles, commonly trafficked light switches could get a wipe off each day,
but it takes a lot of time and emotional energy to do all those things and
they have marginal benefits. We don't need to create a sterile operating
room-like living space. Compared to keeping your hands out of your mouth,
good hand hygiene, and cleaning food before serving it, these behaviors
might be more maladaptive than protective. 

6. There are few absolutes, so please get comfortable accepting some
calculated risks, otherwise you might be isolating yourself for a really,
really long time. Figure out how you can be in public and interact with
people without fear. 

Steven W. Tabak, M.D., F.A.C.C.   |   Medical Director, Quality and
Physician Outreach 

____________________________________________________________________________
____________________________________________________________________________
____________________

Nicholas Thompson

Emeritus Professor of Ethology and Psychology

Clark University

ThompNickSon2 at gmail.com <mailto:ThompNickSon2 at gmail.com> 

https://wordpress.clarku.edu/nthompson/

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