It has been a while since Andy, Tanner and Drew talked COVID-19 and there is a lot to catch up on. We will discuss the past 4 months since we last tackled the topic, what has changed, what hasn’t and were we go from here. As always, our hope is to discuss this in a way that brings our listeners to the front lines with us and for those that are already there, to know they are not alone.
EM Over Easy · EMOE Takes on COVID: Part 5
The More Things Change, They Stay the Same
If you feel like we are spinning our wheels and not making much progress on the coronavirus front, well, you are not alone. When we last posted an update near the end of April, it seemed like we had flattened the curve, NYC was slowly starting to recover and maybe, just maybe, the worst was behind us…
Not so fast, due to the virus doing what it does and us not doing what we should, COVID-19 is back with vengeance across the country. This virus has permeated every corner of society and rural America is being hit hard while urban New England seems to finally have a bit of a grasp things. Some of our struggles to contain the virus is plain and simply, this is a nasty little thing that doesn’t care how much we want it to do away. Even New Zealand, a country that had prevented community spread for 101 days, had another community outbreak.
Add in the American resistance to mask wearing, restrictions and an disorganized approach to controlling the virus, we are nowhere near getting things under control. If you are curious about community spread in your state, this is a great site that tracks how quickly the virus is spreading. The charts are based on Rt, the effective reproduction number, which shows how likely an infected person is to infect anther. A lot more goes into this calculation and it’s just one marker of how we are doing, but put most simply, a number <1 means the virus is not spreading rapidly.
Masks and Tests, Test and Masks
While there is so much we still don’t understand about this virus, we know a couple things really well. First, foremost, primarily and whatever other adverb we can use to drive this home, MASKS WORK! Ok, masks are not the panacea but they are certainly part of significantly reducing community spread and one easy, reliable method we can use to protect other and thus ourselves. Yes, that is right, wearing a mask (standard cloth or surgical, not N95 and the such) provides only minimal protection to the person wearing it but a lot to other. Now, if we all wear masks, then we are all protecting each other… Let’s drive this point home a bit more, a recent study published in JAMA showed that universal masking, when everyone wears a mask, dramatically reduced healthcare provider COVID-19 infections. With just providers wearing masks, there was an exponential increase in provider infections but once universal masking was instituted for patients and providers, there was a linear decrease in provider infections. This is in a high risk setting, now imagine how well universal masking works in society with a much lower disease prevalence. This is further born out in states that have mask mandates, where nearly every one experienced a decline in Rt 10-14 days after the mandate went into effect.
As for testing, let’s just say it’s not going as well as we would like. There are two main types of test on the market for active disease, one is a PCR test and the other an antigen test. Both have a significant number of false negatives (negative test on a patient with the disease) and a few false positives that leaves room to be desired. Just a couple weeks ago the governor of Ohio tested positive on the antigen test than had two subsequent negatives tests. Now imagine that happening everyday in ED and other healthcare facilities. Additionally, despite being 6 months onto a pandemic with no end in sight, the testing supply continues to hamper rapid detection of the virus.
Is there an end in sight?
Yes, maybe, probably at least. The closest we can compare this pandemic to was nearly 100 years ago with the Spanish Flu of 1918-19 and that lasted nearly 2 years. Right now its hard to say if we will be dealing with COVID-19 as a major societal and medical disrupter for shorter or longer but there is no doubt we are no where near out of the woods. Our best hope is preventing spread for the short-term and continuing to pursue an effective vaccine that confers lasting immunity in a safe manner. There are a lot of vaccines in various stages of development and some have a lot of promise so far.
We all have no doubt that whatever the future holds, it will not be the same as pre-COVID. Hopefully with a successful vaccine, we will have the ability to once again be the social beings we are, beyond that, out crystal ball is not very clear at this point.