May 12, 2020 update
Dear All,
Apologies for gaps between blogs. Will try to do better in the future. Been getting many questions on how best we safely re-open the country and wanted to address this. For starters, there is no simple answer to this. Sorry. While I wish there was an ‘easy’ answer on how to re-open safely, it all depends on your risk tolerance and how you define re-opening ‘safely.’
To me, the important milestones we should be focusing on haven’t changed since our last blog. We should still be focused on:
1) Testing
2) Contact Tracing
3) Monitoring Local Hospital Capacity
What has changed is that many parts of the country are ready to re-open regardless of whether we’ve successfully achieved all 3 milestones above. I’ve accepted we won’t get to perfection with the milestones above, and instead, want to focus on how to mitigate risk now that states are re-opening.
So, how do we mitigate risk as we re-open? There seem to be common characteristics associated with spread of disease. These tendencies are:
1) Indoor spaces
2) Large groups of people
3) Sustained close contact for >10 minutes
4) Shared food and beverage
It seems that most ‘super spreader’ events involve one or more of these variables. While I initially based this on anecdotal evidence, a friend passed along this article that articulates the science behind recent transmission studies. It is a great read for those that are particularly interested in transmissibility and what are considered high vs low risk activities.
The summary for those that want the cliff notes is that almost all recent super-spreader “infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections. Importantly, of the countries performing contact tracing properly, only a single outbreak has been reported from an outdoor environment (less than 0.3% of traced infections).”
Takeaways: Being outdoors and shopping in a store with a mask are far less likely to lead to transmission than indoor events with sustained close contact. But, at the end of the day, these are all just increasing or decreasing your personal odds of contracting the virus.
The best analogy I can think of to compare this is the relationship between smoking and cancer. Every smoker does not get cancer just as every cancer is not caused by smoking. Rather, smoking increases your risk for cancer and not smoking decreases your risk, but doesn’t guarantee you won’t get cancer. COVID-19 is similar in that behavioral choices will increase and decrease your risk of contracting the virus but there are no guarantees no matter how many precautions you try and take. Generally speaking, the more time you spend doing high-risk activities described above, the higher the chances you may contract it, and vice versa. But, at the end of the day, it’s all a game of probabilities and each of you will have to determine your own risk tolerance.
The other important message I wanted to pass along is that you should not be postponing medical care for fear of catching COVID-19. While you may consider healthcare settings such as hospitals to intuitively be higher-risk places than another indoor setting, the data may suggest otherwise.
Below is a chart depicting the results of antibody testing sampling in New York comparing rates of antibodies between general public and healthcare workers. We will review testing tomorrow but to remind you, positive antibodies indicate you were exposed to COVID-19 previously:
If you had asked me before looking at this, I would have guessed that healthcare workers would have higher rates of antibodies than the general public but the statistics suggest otherwise.
Why is this?
I’m not certain but have a few theories: First, healthcare workers started wearing masks indoors before the general public. Second, since healthcare workers see the deadly effects of the virus every day, they may be more likely to take precautions when outside of work more so than the average person. Third, widespread testing in hospitals of patients and some staff may have limited the risk of a healthcare worker coming into close contact with infected person (except when wearing PPE).
Regardless of the cause, the fact holds that being in a healthcare setting with a mask on is probably not putting yourself at tremendously higher risk than any other indoor space. Thus, you should not delay your medical care out of fear of contracting COVID-19.
The rest of the week, I will be giving updates on where things stand with regards to the 3 milestones of ideal state re-opening. Tomorrow I will address testing followed by contact tracing and monitoring local hospital capacity on the following day. I know I am bad with predicting when my next post will come out, but I will release my update on testing tomorrow followed by an update on contact tracing the following day. I know this because I’ve already written them this time before promising a release date.
Be well and stay safe,
Harry