Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
• Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.
• Live Virus Swab– this is the swab which attempts to swipe live virus from one’s nose or throat to see if you are currently infected.
• Antibody Test- (aka serology test) this is the blood test which looks for antibody to the SARS-CoV-2 virus to see if you have been infected in the past.

Spreadability

As the United States rushes into a headlong forgetting of the pandemic, the virus of course remains everywhere and ready to infect and spread.

And so as we enter summer, a moment to look at the current evidence on how you, your children, your parents, your families, your friends, can avoid getting COVID-19 seems more urgent than just prudent.

The SURGE Study in the June 1, 2020 issue of The Lancet

Fortunately, an international group of scientists called the COVID-19 Systematic Urgent Review Group Effort (SURGE) just published their study of how well distance, masks, and eye covers work to keep you from getting COVID-19.   https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext

The authors reviewed over 25,000 sources of data, including 8,859 COVID-19 specific databases to find studies that could deliver valid information on this key question:   What can a person do to keep from getting infected when exposed to the virus?

A massive review of the literature found 172 studies that could deliver some answers reliably.   The studies included the experience of people exposed to the SARS-CoV-2 virus in 16 countries in 5 continents.

Here is what they found about keeping your distance, wearing a mask, and covering your eyes

Staying Some Distance Apart

The studied looked at the chance of you coming down with COVID-19 if you stood next to someone with COVID-19, maintained a 3 foot distance, and maintained a 6 foot distance.    They looked at the impact of keeping some distance in three settings- an exposure that would normally give you a 7%, 2%, and <1% chance of catching it.

If you were in a situation where it was highly risky you would catch the disease, for example, in a large crowded room of many people with active infection, then if you remained in close contact with those infected, you could have a 7% chance of coming down with COVID-19.    But if you kept:

• 3 feet away your risk drops from 7% to 3%
• 6 feet away your risk drops from 7% to nearly 2%
• 9 feet away (extrapolated from the data) your risk drops from 7% to 1%

Overall, taking all situations into account and over time, those who get close to others who are infected will get infected about 12% of the time, staying 3 feet away drops that risk to 2.6% and 6 feet to 1.3%.

Wearing a Mask

The studies looked at the chance of you coming down with COVID-19 if you got exposed, with and without a mask.  The studies looked at the impact of an N95 mask and a surgical mask, not the cloth masks in wide use in the US.

Overall those who did not wear a mask in these studies had a 17% chance of getting COVID-19 after exposure.

Those who did wear a mask dropped that risk to 3.1%.

Although exact percentage chances of getting infected with COVID-19 wearing an N95 v. a surgical mask were not reported, the trend was clear: the N95 mask reduces the chance of catching COVID-19 better than a surgical mask and both did better than cloth masks.

Wearing Eye Protection

The studied looked at the chance of you coming down with COVID-19 if you got exposed, with and without some sort of eye protection- face shield, goggles.

Overall those who did not wear eye protection in these studies had a 16% chance of getting COVID-19 after exposure.

Those who did wear eye protection dropped that risk to 5.5%.

Specific Summertime Tips on How to Not Catch COVID-19

The best path to not catch this dangerous illness is to have our nation shift to the proven strategy of Identify all Infected, and Isolate all Infected.   But there is no indication we are about to accept this approach which has allowed 49 other nations that have to stop the spread of this virus substantially.

So, we must assume this summer that the SARS-CoV-2 virus is all over and that being together with people will put you at risk for coming down with COVID-19, the more people, the closer the space, the more indoors, the higher the risk.

What to do???

1. Minimize the number of people you come into contact with.  The ultimate step in this direction is to remain in lockdown, isolated at home.
2. If you do go out, try to avoid crowds, particularly indoor.
3. If you do go out, no matter where you are, with one other person, with a crowd, indoor, or outdoor, stay 6 feet apart.  We now know this works.   In an actual exposure situation, 6 feet of distance drops your chance of getting this disease by about 75%!
4. If you do go out, no matter where you are, with one other person, with a crowd, indoor, or outdoor, wear a mask.  We now know this works.   In an actual exposure situation, wearing a mask can drop your chance of getting this disease by as much as 80%!
5.  If you  do go out, no matter where you are, with one other person, with a crowd, indoor, or outdoor, consider wearing eye covering, even plain glasses or goggles.  We now know this works.   In an actual exposure situation, wearing eye protection can drop your chance of getting this disease by as much as 66%!

What about getting together with friends or family or play dates?

This is a very common worry and question right now.  I like the approach of counting risk, specifically, trying to guess, if I get together with this person, how will the number of people I am contacting go up?    You might ask, if my 6 year old’s next door neighbor 6 year old comes over to play, isn’t that just one more contact?  Almost surely no.

By counting contacts we mean counting all the people that one person coming over might have been within 6 feet and without a mask, outside of a long isolated home.

That number might be 0.  A household that has truly had no contact with anyone outside that home for over 14 days carries close to a zero risk of having anyone contagious for COVID-19.  Not zero because this virus might circulate in the air across large distances, but not much.  So anyone visiting you from such a home brings along, essentially, 0 possible infection contacts.

That number might be 50.  A household may have a parent who works in a small office, say with 5 people in it.  Each of those 5 people, we can guess, may be in contact with about 10 others, so anyone visiting from that household will bring 50 contacts with them.

That number might be 7,200.  One 29 year old man in South Korea was found to be COVID positive after visiting 3 nightclubs one Saturday night.  By Sunday, they traced all his contacts and all their contacts, the total came to 7,200.  And over 100 were infected!  These 7,200 likely included many who did not come within 6 feet of the first person, but you get the idea.  So if someone comes over who has been in large crowds, the number of people who possibly could have infected that person could skyrocket.

So for now, we recommend that if you go visit, or if someone comes to visit, you try to limit it to people with a rough sense of having a low number of contacts they are bringing to you and your family.

One good example would be two households that have sustained effective isolation for over two weeks, their contact number is close to zero and so anyone getting together from these two homes would be safe in doing so.

Severity

The severity of COVID-19 remains the same.  Remember, it has two faces.  One is very mild, at least half infected won’t even get sick at all, no big deal.   But the other face is deadly, even today about 2,000 Americans are dying every day from this virus.  It is spreading, more and more in 20 states, and the danger is far from past.

Diagnosis

The diagnosis remains challenging.

The swabs detect virus present at the time of the test.  They are wrong about 30% of the time in the direction of false negative, and tend to be more wrong the longer it has been since you got infected.   But swabs are the best test now available to see if you are actively infected today, they are now more widely available.  Adults over 18 can get them on their own at Rite-Aide and CVS.

The antibody test technology is not yet reliable and not widely available outside of inpatient use.

Treatment

No cures or complete prevention are available at this time.

BOTTOM LINES

1. COVID-19 continues to spread across the US and will for some time, unless we adopt the proven strategy of finding as many infected as possible and isolating until no longer contagious.
2.   In the meantime, it remains urgent to avoid getting infected.
3.   The best approach in the US is to remain as isolated as possible.
4.   If together with people we now know that staying 6 or more feet apart, wearing a mask, and even wearing eye cover is effective in substantially dropping the chance of catching it if exposed.
5.   When getting together at homes, try to estimate the contact count that will increase for each get together and try to limit get togethers to low contact count risks.
6.   Outdoors is so much less risky than indoors.

We at Advanced Pediatrics continue to hope everyone stays well through this very dangerous pandemic, and that our towns, communities, and nation does also find a path forward to live together in peace and mutual appreciation.

To your health,
Dr. Arthur Lavin