Spread Facts
MEDICAL AND MENTAL HEALTH UPDATE
This weekend I made a VOW to turn my phone off for at least 24 hours and hike outside with the family. It worked! I’m more rested, less irritable, and more pleasant to be around (per a non-peer-reviewed polling of family members). Onward!
But naturally I woke up this morning with FOMOCO (= Fear Of Missing Out on COVID medical updates). My first mission is to track down and digest new information that would directly affect patient care or medical decision-making. And after checking in with my go-to sources, I realized that the big picture remains pretty much the same as last week.
In short, the bad news continues: COVID-19 is surging across the U.S. with 39 states showing an increase in cases. Yet over the weekend partygoers in places like Wisconsin, Michigan, and Missouri ignored public health advice by gathering, unmasked, in crowded spaces.
The good news is also the same: we are getting better at treating this disease, specifically (and importantly) in our sickest patients. For ventilated ICU patients, the combination of Remdesivir (antiviral) plus Dexamethasone (steroid) plus anticoagulation (blood thinning) plus convalescent plasma (antibodies from recovered patients) seems to be working—though studies are ongoing to prove the mortality benefit of each component of this cocktail. And a recent randomized controlled trial of convalescent plasma casts doubt on its efficacy, particularly if given late in the clinical course. Dex is the only medication above that is proven so far to decrease mortality; nonetheless critical care/intensive care doctors around the country are essentially throwing the kitchen sink at our sickest patients when able.
What does this mean for healthy people and people with COVID who are NOT in the hospital? Not a whole lot. It means that hope is alive and that prevention is still the best medicine. Until we have a vaccine or therapeutics (don’t hold your breath), we’ve got our own behavior as our only defense.
Numerous studies, models, and real life examples suggest that if everyone in this country were to wear a mask, practice social distancing, and wash hands, we’d be able to shut the virus down and reopen the economy.
In defense of mask-wearing, we have learned that:
Coronavirus is largely spread person-to-person by droplets.
Coronavirus MAY also spread by aerosols, i.e., smaller particles that can hang in the air (particularly indoors) longer than droplets. The WHO has stood firm that coronavirus is spread primarily by larger respiratory droplets. However over 200 scientists from around the world will publish research later this week arguing that aerosols account for a significant amount of transmission and call for the WHO to revise its statement. It’s an ongoing hot debate!
Approximately half of COVID infections are transmitted between people who do not feel sick (e.g. they are asymptomatic or presymptomatic)—which is why EVERYONE, including people who don’t feel sick, needs to wear a mask.
A handmade or simple cloth face mask can block the majority of respiratory droplets and aerosols—we think. The best cloth masks are three-ply. Bandanas look cute but unfortunately don’t seem to be up to the job.
So what about face shields (like the one I am wearing here) and N95 masks?
Recall that masks protect other people more than the mask wearer. The mask somewhat protects the wearer from infection, but the extent has not yet been proven. (The latter makes intuitive sense which hopefully helps with compliance.)
Face shields further protect the wearer from infection by blocking droplets and aerosols to the eyes, nose, and mouth (the three entry points for coronavirus). But current data suggests that a mask is still better than a face shield for keeping germs to oneself.
An N95 mask offers better protection to the wearer than a cloth mask, but because these are in short supply, are essential for healthcare workers, are ineffective if not properly fitted—and because cloth masks do a very good job if worn by all—we do not recommend universal N95 masks.
Upshot:
We should all be wearing masks, particularly in indoor spaces (schools, office buildings, bars, gyms, airplanes, buses, trains, subways, for example).
People who also work indoors and have regular, close contact with other people (e.g. community medical professionals, school teachers) should consider wearing a face shield—in addition to a mask—to further protect themselves from infection.
If it turns out that aerosols account for more transmission than previously thought, this has implications for indoor ventilation systems, for example in schools and nursing homes.
Mask-wearing should be part of a broader mitigation strategy which includes handwashing, social distancing, and strict limitation of contact with other people in indoor spaces. Remember MOSH PIT!
Spread the word! The more we spread the facts about how the virus is transmitted and how to shut it down, the sooner we can get back to life.
Just as limiting screen time helps with mood (and impulse Amazon purchases), IT IS POSSIBLE to resurrect our lives if we all do our part.
Programming note: JOIN me and Dr. Clay Ackerly (one of my go-to sources for medical wisdom) for a Facebook LIVE Q & A at 8 pm on Monday, July 13! Click HERE to submit your questions in advance. See you there!
I will check in later in the week. Until then, be well.