May 20, 2020
Angst And Ennui Up, But STDs And Food Poisoning Are Way Down
King County Public Health tracks 27 reportable infectious diseases and reports the data monthly. The numbers for April 2020 show a huge drop in cases of food-borne illness, as well as for most types of STDs. It makes sense. Group picnics and barbecues, as well as eating at food carts, buffets, and delis, have virtually disappeared due to COVID-19. Social isolation has also meant genital isolation, which resulted in 58% fewer cases of gonorrhea, 66% fewer cases of syphilis, and 93% fewer cases of chlamydia vs April 2019. To quote Caddyshack, so we got that goin’ for us, which is nice.
Are We There Yet?
We did it. We flattened the curve. The field hospital set up at CenturyLink field was dismantled without seeing a single patient. Our local hospitals were at times filled to the brim treating patients with COVID-19, but we have not run out of ventilators. As we experience the backside of the curve, with smaller numbers of new infections (but continuing new infections and deaths daily) and initial antibody testing results that indicate that the vast majority of the population is still susceptible to the virus, we are shifting our view to the longer term. It’s time to focus on risk reduction that is sustainable and takes into account the need to engage in activities that promote our health and well being while we look into an uncertain future of living with COVID-19 that seems to stretch further beyond the horizon everyday.
In her recent article for the Atlantic Quarantine Fatigue Is Real. Shaming People Won’t Help. Julia Marcus, a professor of population medicine at Harvard Medical School, drew parallel to the AIDS epidemic in the 1980s. At that time, it was clear that HIV was a virus that was sexually transmitted. Advice for how to stay safe initially amounted to “don’t have sex”. That did not turn out to be a sustainable long term strategy. In 1983, activists and scientists collaborated to publish “How to Have Sex During an Epidemic”. It took into account what was known about the virus transmission and outlined the fundamentals of “Safe Sex”. The practices of safe sex have been reducing the rates of the transmission of HIV for decades.
The “Stay Home, Stay Safe” strategy seems to have gotten us through the initial “curve flattening” stage of this pandemic. We are now looking at the “reopening phase”. How can what we know about the transmission of the Coronavirus inform how we go about living in a way that reduces our risk? We know that staying home has helped us to stay safe, but how can we “Have a Life During a Pandemic”?
In her blog Erin Bromage, a Comparative Immunologist and Professor of Biology at the University of Massachusetts Dartmouth, reviews some of the documented super spreader events and what they tell us about how the virus is spread. She notes that infection depends on exposure to an adequate viral load and that the viral load depends on the amount of viral particles and the duration of the exposure. While it is not completely understood at this point, some experts estimate that as few as 1000 SARS-CoV2 infectious viral particles are what is needed to result in infection.
Sneezing and coughing lead to high viral loads. If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them. Singing and yelling release more particles than speaking. Speaking releases more viral particles than breathing (~200 virus particles per minute with speaking and 20 viral particles minute with breathing). The outbreaks that occurred in the Skagit Valley choir group and the meat packing plants are thought to have been partly the result of the increase in viral particles released while singing or yelling (as is frequently required for workers to communicate with each other even in small spaces over the loud noise of the machinery in these settings). She estimates that it would take ~5-10 minutes of speaking face-to-face with someone who was infected to receive the required dose to become infected yourself.
Being outdoors dilutes the virus significantly making it less likely that one would receive a dose large enough to result in infection. Being in a large enclosed space with good ventilation is not as good as being outside, but is better than being in a crowded setting with prolonged exposure, close contact and poor ventilation.
In addition to breathing in aerosolized droplets as a source of infection, introducing virus into our bodies by touching a surface that has virus on it and then touching our mouths or eyes is another way to have a sufficient viral load to cause infection. Bathrooms and kitchens have a lot of high touch surfaces. Being aware to minimize our exposure to these environments outside of our own home and extra attention to hand washing and to not touching our faces will help minimize the transfer of virus particles from surfaces.
As “Stay Home, Stay Safe” transitions to “Go out, Stay Safe”, we can keep these things in mind in order to reduce the risk to us and the community at large. It boils down to: stay home if you are sick. Really. Wear a mask when you go out and visit indoor spaces or outdoor spaces when maintaining a distance of 6 feet apart is not feasible. Avoid crowded spaces. Minimize your time in indoor spaces, especially with poor ventilation. If you want to see friends and family for social connection, keep the groups as small as possible, do it outdoors, keep a distance of 6 feet between people and dance, but don’t sing.
As recommended by the Washington State Department of Health, here are some Do’s and Don’ts on wearing cloth masks.The Public Health Department of King County released an directive effective as of this week recommending the use of masks while in indoor public places including grocery stores and public transportation.
Moderna Therapeutics’ throws us a bone
We are optimistic about vaccine potential against COVID-19 and we are entering the months when results of different human Phase 1 vaccine trials will be reported. Moderna Therapeutics’ Monday media blitz about their interim phase 1 trial results of a mRNA vaccine in 45 humans was just that, a press release of a conference call that leaves us salivating for more information. Here is the link: https://tinyurl.com/y7j7hs2g. “At this time, neutralizing antibody data are available only for the first four participants in each of the 25mcg and 100mcg dose level cohorts.” In other words, we know nothing about neutralizing antibody data in the remaining 37 participants. The National Institute of Allergy and Infectious Diseases (NIAID, which is part of the NIH), directed by Anthony Fauci, funded the trial. Kaiser Permanente Washington Health Research Institute (KPWHRI) is a key leader of the trial and enrolled its initial patients. Neither NIAID nor KPWHRI have put out a press release that we could find to pair with Moderna’s. We’ll get more excited when NIAID or KPWHRI express their excitement and present us with more decipherable data. Meanwhile, we remind ourselves the main purpose of a Phase 1 vaccine trial is to establish safety, not efficacy. That bar has been cleared and FDA has given Moderna and NIAID approval to launch Phase 2 testing of the vaccine, to include around 600 human participants, half of whom are older than 55 years. Each participant will either get the vaccine or a placebo. So hold on tight and look for more Phase 2 vaccine trials to launch in upcoming months.
Calling all Artists
Hello Wise Patients! This is the last week to get your art in before we have it featured all throughout the month of June! Send us your art via Spruce or email. Let us know if you have any questions about this!
Reliable Sources to Stay Updated on the COVID-19 Outbreak
- A comprehensive list of resources is available on last week’s newsletter which is available on our website: https://imwisepatient.com/
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