Informing Community and Clarifying Misinformation

Part 1 Overview

Corona virus has been around for a very long time and range from different stranes. Some have symptoms like the common cold and others are much more severe. This current strain is less severe, more like the common cold. SARS had an intermediate mortality level, around 15%. This one is in the same family but is probably around 1%. Don’t be fooled by that though because certain members of the population are much more at risk such as the elderly or those with other conditions such as chronic lung or heart disease. Therefor it is important that we all take this virus very seriously in order to prevent passing it on to the most vulnerable members of our community. Additionally, there are some young and healthy people that will be seriously at risk as well even though it is much less common.

 

How does it spread?

  • It spreads through micro droplets that will carry around six feet from the speaker. So a person who sprays it instead of saying it could put those around them at risk. Keep in mind, that regular talking also spreads microscopic droplets as well.
  • This also covers surfaces with microscopic droplets and the virus can live anywhere from a few hours to a few days.
  • This means if one who is carrying the virus go to a place of worship and sneezes and then a different person can contract it from the objects in the place of worship.
  • It can live on one’s hand as well.
  • It is estimated that people touch their face anywhere from 10 – 30 times per hour.

 

What can we do?

The answer is clear from this transmission pathway.

  • Physical distancing (not social distancing). Stay outside the six foot distance.
  • Keep things clean around you.
  • Wash your hands on a continual bases.

This explains why we’ve become so stringent regardnig gathering as a community.

 

Does everyone have symptoms?

A good chunk of people may have some symptoms or no symptoms. That means a little tickle in the throat or muscle ache could be infected with COVID-19. Studies show that people asymptomatic or presymptomatic can spread the virus. Therefor playdates and riding the train and going to gatherings could actually be spreading the virus. This is a substantial contributant to the spread of this virus.

 

Physical Distancing

If you go about life as normal and facilitate the spread of the virus, there is a significant amoutn of the population that will develop pnemonia. Most will recover although around 10% will become critically ill and require intensive care, resperators, etc. If a lot of people require hospitalization and intensive care then we will immediately overwhelm our medical system. There are a fixed number of ICU beds and resources. In Boston, most hospitals tend to run full. Brigham’s and Women’s tends to run at 105% occupancy without this epidemic. Thus, the ability for the hospitals to absorb this illness will be greatly compromised if the need for this care spikes. 

 

What is the mission?

The mission is to spread out the number of people requiring care over time. Flattening the curve is an attempt to decrease the number of people getting sick at one time. Thus if we slow the spread of the virus then we decrease the number of people requiring attention and then lives can be saved.

 

What are the age brackets?

All people are at risk. However, children and young people handle it very well but elderly do not. There are some young and healthy people who for reasons we do not understand do become critically ill.

 

Is there a tipping point where it stops spreading as much through self immunization (e.g. herd immunization)?

It is up in the air right now. Once a critical mass of the population is infected, the hope is that they’ll develop immunity to the infection and stop spreading it as much. The scenario of two out of three contracting the infection will not infect the third person is wrong because the third person is still susceptible. 

 

Once a person recovers, can they get it again?

Some people who have contracted this virus and have recovered but have gotten it again. Were they rare exceptions or are we all able to get it twice? If yes, it will be around for a long time. If most people won’t contract it again then it likely will go away.

 

Will the warm weather make it decrease of disappear?

We hope so but we can’t know. There is a notion that it decreases in the summer months. SARS had strong efforts to contain it before the cat got out of the bag and it did decrease in the summer months. We will have to see what happens.

 

China took the most aggresive lockdown quarantine ever in the history of the planet. It was extremely draconian and extremely effective. Within three to four weeks there was a tremendous decrease in new cases. Going with the China experience, if we’re able to acheive what they were able to acheive, then it could be imagined ebating this epidemic in a little as  two months. However, China was actively policing people and only one person per household was allowed out every two days. Transportation was shut down. They had contract tracing and testing all people and quarantining everyone even with minimal symptomotology. We are not seeing that. No one is stopping people from going in cars, etc. I don’t think we’ll be able to acheive what they acheived but we’ve gone further than I would have imagined so tehre is hope.

 

If China was late informing the world about the virus in the first place, why should we trust the data  now?

If you’re a conspiracy theorist then thats your [prerogative]. Its not [mine]. From my perspective, I understand how difficult it is to recognize a brand new illness in the population, to have some sense what its scope is, what its agent it, etc. The story of the whistleblower is an important reality tale, what China was able to achieve was unprecedented. I’m highly doubtful that we would be able to achieve that response. Not just in terms of healthcare and citizens response but more importantly in terms of technological innovation

 

What is the timeline that you envision?

How successful is our phsyical distancing program going to be? ARe people still getting together for playdates, communal dinners, secret gatherings, etc. That will undermine the efforts. If we adhere to it then we won’t be as successful as China but it will be possible in a few months, by the summer months.

 

Even if we are successful we will be under constant threat of reinfection again and again. The irony is that the safest place to be in the world right now is China. The irony is that other countries who are at threat of constant reintroduction.

 

There are a lot of respiratory viruses…. What we don’t know is what will happen with the introduction of this virus into the ecology of the respiratory viruses that are part of our normal background. There are so many that are similar background and increase morbidity mortality in our society. We take them as normal. 

 

30 – 45 million Americans per year will get flu and 30,000+ might die from it each year. The big question mark is that sometimes a new virus will replace other viruses, other times it will add to the other viruses. For example, 2009 the H1N1 Swine Flu wich began with an outbreak in Mexico City where 10% mortality rate, very scary. Public health tried to contain it and failed. It came to the United States and spread to the entire world and infected 25% of the world population. If you get a flu in 2020 in March there’s a good chance that what you have is H1N1 Swine Flu. So is this the future Corona Virus and it will become part of our normal ecology of viruses and displace the others so the net signal will be no better or no worse? Or will it be additive? If its additive then it will be far more dangerous and at some point we would just accept it as part of life.

 

Part 2 Practicality (31 minutes)

We will now get into the practicality of staying home. We are obviously keeping a dialogue with our religious advisors and halachic authorities but your perspective will shine a lot of light on what we are dealing with here so we can even formulate questions and look into it more deeply.

 

Family 

Should each family just assume that they have it at this point?

Assume it is very widespread and that there are many many more cases out there than you would imagine. If someone has a cough or sneeze do you have to assume they have it? Its entirely possible they have it. I can tell you that at our hospital we are doing lots and lots of testing and are only testing people who are symptomatic and we are finding around the 10% – 20% range have it. So a lot of people who are symptomatic do not have it.

 

The model is projections are that 80% of the population will get this virus. There are lots of mathematical projections and are only as good as their underlying assumptions so I would put too much stock into them. But the [main idea here] is that the majority will get it.

 

At what point can two unrelated children study or play together?

As long as they’re using a telephone facetime or skype its fine. I strongly recommend not having playdates. 

 

At one point will they be allowed to play together?

The logical answer would be when there is a clear perception when its reached a point of herd immunity (see explanation of herd immunity above).

 

Can people go out of state with grandparents over the age of 60 years old?

I recommend not going because there are even people with minimal symptomatology who can spread it. We’ve all heard stories about people attending communal gatherings and coming back infected. Ages 60 and above the risks substantially increases. If you pass it on then you will have been the agent to pass it on.

 

If one is exposed, what is your advice? (36 min.)

I think that the [?] out there right now is that all of us have been exposed. Thus continue to practice physical distancing, keep surfaces clean and continuously wash hands. Also, if you develop the illness stay home and don’t go about interacting.

 

Under age 60 group meals? Having a guest over who is under 60 years old?

Don’t do it. You shouldn’t be involved promoting the virus. You don’t want to contribute to the raising of the curve and overwhelming the medical system.

 

Flying on an airplane?

Don’t do it. The more mixing of people in a country results in continuous spread. 

 

If a person can stay asymptomatic after 14 days and has not been tested, can they be a danger to others?

I think if you’re asymptomatic for 14 days there is a good chance that the virus is gone. I don’t know that for sure. 

 

What we do know is that people who go on to get the illness are relatively slow onset kind of illness. For a couple of days you feel lousy, run down, a cough or two…not to bad. The second week of illness bring more fever, more shortness of breath, etc. and some subsets go on to develop pneumonia. Its kind of a drawn out process. In those individuals the recovery can be from 2 – 3 weeks. However, for the person who is asymptomatic we have less data to shed light on how long they continue to share the virus. I would imagine that if you truly had no symptoms that you’d be getting rid of the virus in a week or two but I actually don’t know.

 

Watch from 39 min. 30 sec….transcripting the next 20 min. In progress.

 

Dr. Michael Klompas

Dr. Michael Klompas

Associate Professor at Harvard Medical and Infectious Disease Physician/Epidemiologist at Bringham's and Women's Hospital

Dr. Michael Klompas is an associate professor at Harvard Medical and an infectious disease physician and associate hospital epidemiologist at Brigham and Women’s Hospital in Boston. He works on public health surveillance using electronic health information with a particular focus on finding ways to make electronic surveillance sensitive, specific, objective, and reproducible. Examples include healthcare-associated infections, communicable diseases, and diabetes. He is the clinical leader for the Electronic medical record Support for Public Health Project (ESP) under the umbrella of the CDC Center of Excellence for Public Health Informatics. The ESP project aims to create generalizable tools for real-time public health surveillance using electronic medical record data.

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Articles and other resources to understand COVID-19

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