COVID-19, One Year Later. Here’s What We’ve Learned.

“The vaccines are our best hope to contain the virus; and while the CDC’s guidance may change based on new evidence, you should follow their current guidance: Keep wearing your mask, practice social distancing and wash your hands.”  Dr. Andrea Klemes

By Dr. Andrea Klemes, MDVIP’s Chief Medical Officer

It was March 11 last year when the World Health Organization first announced that the coronavirus had reached pandemic stage. At the time, there were 118,000 cases in 114 countries. A year later and there are more than 114 million cases and 2.5 million deaths worldwide.

In the year since the pandemic officially started, doctors, researchers and the American public have learned a lot about the virus. We know how it spreads — through droplets and in the air; we know how it likely doesn’t spread — on surfaces (you should still wash your hands regularly); we know the virus isn’t seasonal like flu – it didn’t go away during the summer; and we know that we can fight it, both through prevention and treatment.

Speaking of treatment, we’ve learned a lot about what works in the fight against COVID-19, the condition caused by the coronavirus. The anti-inflammatory steroid drug dexamethasone, for example, works in many patients on supplemental oxygen or ventilators. Antibodies — either from convalescent plasma or man-made ones from monoclonal antibody treatments — seem to keep some patients from more severe illness. These treatments have been granted emergency use authorization by the Food and Drug Administration.

Even simple things, like turning patients prone (lying face down) have turned out to be lifesaving for many people hospitalized with the disease.

But there’s still much we don’t know. And there’s still a lot of misinformation and myths swirling around 12 months after the pandemic began. I thought it would be helpful to recap some key learnings.

Vaccines are here, but the virus isn’t going away any time soon.

See the source image
It’s hard to believe that in a little less than a year scientists created numerous vaccines to combat the coronavirus. In fact, the Food and Drug Administration approved a third vaccine last week — and this one, from Johnson & Johnson, is a single-dose vaccine that’s easier to transport and store. It should help vaccines become more widely available in the next couple of months.

If you’ve already gotten your vaccine, your behavior shouldn’t change — that’s the advice of the Centers for Disease Control and Prevention. That’s because the vaccines prevent severe illness from infection. You may still be able to get the virus and spread it.

This advice may change. Promising but unpublished studies suggest that vaccinated individuals carry lower viral loads and may be at lower risk to spread the virus. If you’re thinking, why get the vaccine if I still have to wear a mask? Get the vaccine when it’s your turn. The vaccines are our best hope to contain the virus; and while the CDC’s guidance may change based on new evidence, you should follow their current guidance: Keep wearing your mask, practice social distancing and wash your hands.

One rule that has changed for those who have been vaccinated: You may not have to quarantine after exposure if you meet certain criteria and it’s been more than two weeks since your last dose.

Eating at a restaurant increases your risk of getting the virus.
We love eating at restaurants, but many are poorly ventilated and crowded with people. Even at reduced capacity, the CDC rates eating inside at a restaurant to be higher risk than other activities. A study from six months ago suggested that COVID-19 positive patients were twice as likely as those who tested negative to have eaten at a restaurant in the two weeks leading up to their illness.

It’s possible that people who eat at restaurants during the pandemic take other risks that increase their chances of getting the virus, but there are also early studies that track breakouts to restaurant eaters.

It’s still safer to get your food to go — or eat outside away from other diners.

So does gathering with your family.
Just like eating out, there are plenty of studies showing the transmission of the virus when families get together. Among adults with COVID-19, 42 percent reported close contact with a person with COVID-19 — and most of those close contacts were with family members.

In one case study from last summer, a single COVID-positive adolescent on a family vacation with three different families spread the illness to 11 other family members. There are dozens of cluster studies like these from contact tracing efforts — weddings, reunions, holiday parties, barbecues and even more intimate gatherings. Getting together with family without proper protocols can result in spreading events.

Even without gatherings, household members are often the point of contact for new COVID cases. Household transmission of this coronavirus is 16.6 percent higher than with past pandemics like SARS and MERS.

To be fair, more infections have been traced to other kinds of activities than seeing family — from workplaces to prisons to assisted living facilities to colleges. But you shouldn’t let your guard down when you’re around your family.

Six feet of distance probably isn’t enough.
Early guidance from the CDC defined close contact as spending 15 minutes or more within six feet of a person infected with COVID-19. The six-foot distance was based on COVID transmission from droplets, which we emit when we talk, sneeze or cough. We’ve been studying viral transmission by droplets since the 1890s.

Of course, there are plenty of studies over the years that suggest droplets can travel further. The problem with COVID is that you can become infected from aerosol transmission — smaller droplets and particles can float in the air for minutes and hours and travel far from the source. Still, the CDC says that most transmission comes from close contact with infected individuals.

As for time, that one’s trickier. Some school systems and employers liberally interpreted the 15 minutes to mean that as long as you kept contact brief, you were okay. But repeated exposure can also result in an infection, which is one reason the CDC changed the guidance last fall to 15 minutes over a 24-hour period. Here’s the bottom line: The more you interact with others and the longer that interaction lasts, the greater your chance of contracting COVID.

The best way to prevent spread is to avoid unnecessary exposure.

Yes, masks help prevent the spread of the virus.
I know a lot of people have had a hard time warming up to face masks. Early in the pandemic, public health officials lacked clear evidence about the effectiveness of masks and hesitated to recommend them. But 12 months later, there’s a raft of evidence that masks (double ply cloth, surgical and N95) reduce the transmission of the coronavirus. In fact, the Proceedings of the National Academy of Sciences of the U.S., which recently published a review of studies about masks and COVID-19 transmission, concluded:

“The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts.”

Some study highlights:

Masks were 79 percent effective at preventing household transmission, if used by all members of the household before symptoms showed.

The devil is in the details. We know from COVID studies and previous viral studies that masks reduce risk of transmission for the wearer and for the people around them if the wearer is sick.

Double masks may even be better.
One mask works if you wear it correctly. Two might actually be better.

The CDC recently released new masking guidelines based on studies it did to determine how to improve their efficacy. The agency looked at wearing a cloth mask over a medical procedure mask (often called a surgical mask, but not an N95) and whether knotting the ear loops of a medical procedure mask and then tucking in and flattening the extra material close to the face would reduce risk.

Both modifications improved the masks effectiveness. According to the CDC’s experiments, an unknotted medical procedure mask blocked 42 percent of the particles from a simulated cough. A cloth mask blocked 44.3 percent. Knotting the surgical mask alone blocked 63 percent of particles. When the cloth mask was combined with the knotted surgical mask, it blocked 92.5 percent of particles.

The CDC has since updated its recommendations. If you use an N95 or KN95 mask, the agency does not recommend double masking. It also doesn’t recommend doubling up surgical masks.

Testing negative doesn’t mean you stay negative.
This may be one of the hardest things for people to understand. A lot of people get tested after they’re exposed, but you can test negative one day and positive the next, depending on the time from when you were exposed, the course of the infection and the type of test you took.

When you’re exposed to someone with the virus and become infected, symptoms may show a few days after exposure or up to two weeks later. If you test too soon, a test may not pick up the infection. If you’re asymptomatic, a rapid antigen test may not pick up your infection at all. Accuracy is lower in antigen tests than PCR tests, especially in those who aren’t showing symptoms.

That’s why it’s so important to observe CDC guidelines when it comes to testing and exposure. If you’ve been exposed to the virus, the CDC recommends you quarantine for 10 days, provided you remain asymptomatic. You can reduce this time to seven days if you show no symptoms and do not test positive for the virus on day 5 or later.

The new variants are a reason to be vigilant.
The new variants are more than troublesome. Many of them are more communicable and one, the British variant, is looking like it may be more virulent. This is why we need to keep washing our hands, wearing masks and practicing social distancing. And why we should get the vaccine when it’s our turn. Don’t let up now!

With a little extra effort from all of us, I believe we can beat back this virus, and we’re well on the way. We’re better at treating it, and we know how to stop its spread. If enough of us do these things, there’s a chance these variants won’t make the impact that some researchers currently fear.

We may have to take booster shots in the future, but that’s a lot better than where we were a year ago when we had no vaccine, few promising treatments and knew very little about COVID-19.

What a difference a year makes.


Reference:

  1. https://www.mdvip.com/about-mdvip/blog/what-you-need-know-about-coronavirus-or-covid-19

Double-Masking Offers More Protection

As more transmissible variants of the coronavirus spread, the CDC says wearing a cloth mask over a surgical mask offers increased protection against the virus.

The Centers for Disease Control and Prevention (CDC) found that wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks.

For optimal protection, the CDC says to make sure the mask fits snugly against your face and to choose a mask with at least two layers.

In laboratory testing, CDC discovered that wearing a cloth mask over a surgical mask, and tying knots on the ear loops of surgical masks and then tucking in and flattening the extra material against the face produced substantially improved protection against transmission of and exposure to infectious COVID-19 aerosols.

“A well-fitting masks provided the greatest performance at both blocking emitted aerosols and exposure of aerosols to the receiver”, CDC Director Rochelle Walensky said. “In the breathing experiment, having both the source and the receiver wear masks modified to fit better reduced the receiver’s exposure by more than 95%, compared to no mask at all.”

Walensky said the laboratory findings underscore the importance of wearing a mask correctly and ensuring it fits snugly over your nose and mouth.

Correct and consistent mask use is a critical step everyone can take to prevent getting and spreading COVID-19. Masks work best when everyone wears them, but not all masks provide the same protection, according to the CDC. When choosing a mask, look at how well it fits, how well it filters the air, and how many layers it has.

Two important ways to make sure your mask works the best it can:

  1. Make sure your mask fits snugly against your face.  Gaps can let air with respiratory droplets leak in and out around the edges of the mask
  2. Pick a mask with layers to keep your respiratory droplets in and others’ out.  A mask with layers will stop more respiratory droplets getting inside your mask or escaping from your mask if you are sick.

Where your mask after receiving the vaccine

No one knows and there is no ongoing research to determine how well do the approved Pfizer and Moderna vaccines protect against asymptomatic infection and thereby help achieve herd immunity And, the other looming mystery is how long vaccine-induced immunity lasts.


References:

  1. https://www.npr.org/sections/coronavirus-live-updates/2021/02/10/966313710/cdc-now-recommends-double-masking-for-more-protection-against-the-coronavirus
  2. https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html

Masks Protect Those Around You

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COVID-19 spreads mainly from person to person through respiratory droplets. Respiratory droplets travel into the air when you cough, sneeze, talk, shout, or sing. These droplets can then land in the mouths or noses of people who are near you or they may breathe these droplets in.

Masks are a simple barrier to help prevent your respiratory droplets from reaching others. Studies show that masks reduce the spray of droplets when worn over the nose and mouth.

woman wearing face covering, with a detail showing how the cloth barrier helps to contain respiratory droplets that she exhales

You should wear a mask, even if you do not feel sick. This is because several studies have found that people with COVID-19 who never develop symptoms (asymptomatic) and those who are not yet showing symptoms (pre-symptomatic) can still spread the virus to other people. The main function of wearing a mask is to protect those around you, in case you are infected but not showing symptoms.

It is especially important to wear a mask when you are unable to stay at least 6 feet apart from others since COVID-19 spreads mainly among people who are in close contact with one another (within about 6 feet).

Your mask offers some protection to you

A cloth mask also offers some protection to you too. How well it protects you from breathing in the virus likely depends on the fabrics used and how your mask is made (e.g. the type of fabric, the number of layers of fabric, how well the mask fits). CDC is currently studying these factors.

Who should or should not wear a mask

CDC guidance is that everyone 2 years of age and older should wear a mask in public settings and when they are around people who do not live in their household.  However, according to CDC, masks should not be worn by:

  • Children younger than 2 years old
  • Anyone who has trouble breathing
  • Anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance
  • Wearing masks may be difficult for some people with sensory, cognitive, or behavioral issues. If they are unable to wear a mask properly or cannot tolerate a mask, they should not wear one,

https://youtu.be/dSvff0QljHQ

Key Takeaways:

  • People age 2 and older should wear masks in public settings and when around people who don’t live in their household.
  • Masks offer some protection to you and are also meant to protect those around you, in case you are unknowingly infected with the virus that causes COVID-19.
  • A mask is NOT a substitute for social distancing. Masks should still be worn in addition to staying at least 6 feet apart.
  • Wash your hands with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol after touching or removing your mask.
  • Postponing holiday travel & staying home is the best way to protect yourself & others from COVID19. If you decide to travel internationally, check out CDC’s testing recommendations to help make travel safer. 
  • Masks may not be necessary when you are outside by yourself away from others, or with other people who live in your household. However, some localities may have mask mandates while out in public and these mandates should always be followed.


References:

  1. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html

Return Kids to In-Person Classroom

Many parents are rightfully concerned that their kids are not receiving the quality of educational services that schools are required, by law, to provide when school districts implement a 100% virtual learning or hybrid classroom model [that ask students to come to school on alternating days] options.

The American Academy of Pediatrics’ (AAP) contends that based on experience and research, remote learning is likely to result in severe learning loss and increased social isolation. Social isolation, in turn, can breed serious social, emotional and health issues: “child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. Furthermore, these impacts will be visited more severely on Black and brown children, as well as low-income children and those with learning disabilities.”

Children are safer in their schools. And, there are lots of kids in this country who are, for example, food insecure, who may be experiencing abuse at home — not to mention the obvious academic benefits of simply being in school. We know that remote learning is just not that good.

Nation’s Pediatricians support in-person schooling

The AAP guidance “strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school.” Their guidance says “schools are fundamental to child and adolescent development and well-being.”

The AAP cites “mounting evidence that transmission of the coronavirus by young children is uncommon, partly because they are less likely to contract it in the first place. Tests showed lower coronavirus rates in schools than in their surrounding communities.”

The guidance for in-person schooling includes recommendations to maintain physical distancing, cleaning and disinfection of classrooms, frequent hand-washing, and using outdoor spaces whenever possible.

Largest school system

New York City’s Mayor Bill de Blasio plans to reopen the city’s public elementary schools and return to partial in-person learning. The plan is to reopen schools at the pre-k and K5 levels because “we have so much proof now of how safe schools can be” amid the contagion”, de Blasio remarked.

Yet, concern remains at what is the critical amount of community transmission that is at a safe enough level to open schools.

Parents and schools responsibilities

Schools are requiring parents to attest to the fact that their children are not showing symptoms and that they took their temperature in the morning prior to the student arriving at school.

Additionally, many schools are segregating kids into what they’re calling cohort groups, so that the same small group of 10 or 12 kids will stay together all day. That way, if there is a reported infection from one of those kids, then ideally you’re only contact tracing and quarantining that group instead of every child in the building.

Furthermore, students will be socially distanced and will be wearing masks. The challenge of footprint and the ability to space out desks remains a challenge for most schools. Some schools have put those kids in the gymnasium or had to start holding class outside, but that often requires more teachers.

“There seems to be less transmission from kids to adults than there is adults to adults. Kids don’t seem to be super-spreaders”, said Pediatrician Aaron Carroll of Indiana University. “We don’t have reports of sort of, you know, a kid going somewhere and spreading it to a bunch of other kids or even a bunch of other adults.”

Public health experts and infectious disease experts agree that we all have to do the right thing if we plan to send our kids back to school.


References:

  1. https://www.npr.org/2020/07/15/891598558/is-school-safe-will-districts-test-for-covid-19-answering-back-to-school-questio
  2. https://pediatrics.aappublications.org/content/146/3/e20201440
  3. https://nypost.com/2020/11/29/nyc-elementary-schools-to-reopen-for-in-person-learning-dec-7/
  4. https://www.msn.com/en-us/news/us/american-academy-of-pediatrics-says-benefits-of-in-person-learning-outweigh-coronavirus-risks/ar-BB16b9W9

U.S. in a “Bad Position”

White House coronavirus advisor Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that the United States is in a “bad position” as coronavirus cases and hospitalizations surge in many parts of the nation. “When you look at the country and the heat map color, when you see red dots, which indicate that that part of the county, the city … is having an uptick in cases … all of that puts us in a precarious situation.”


References:

  1. https://www.cnbc.com/2020/10/28/coronavirus-dr-fauci-says-us-is-in-a-bad-position-as-daily-cases-hit-record-highs.html?__source=iosappshare%7Ccom.microsoft.msedge.EMMXShareExtension

Cotton cloth masks are effective preventing spread of virus

“Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting.”  Robert R. Redfield, director of the Centers for Disease Control and Prevention

A group of researchers from Duke University are providing answers to the continuing questions about the efficacy of masks.  The researchers analyzed forteen different facial coverings ranging from hospital-grade N95 respirators to bandanas. Of the 14 masks and other coverings tested, the study found that some easily accessible cotton cloth masks are about as effective as standard surgical masks, while popular alternatives such as neck gaiters made of thin, stretchy material may be worse than not wearing a mask at all.

A fitted N95 mask proved was the most effective from the tests noting that the mask allowed “no droplets at all” to come out, according to researchers. Meanwhile, a breathable neck gaiter ranked worse than the no-mask control group.

Neck gaiters are extremely convenient since which they don’t restrict air and droplets which is the reason why they’re not doing much of a job helping people stopping the spread of the virus.

Several studies find that wearing masks will curb the transmission and reduce the risk of coronavirus infection.  Masks do work and they do cut down transmission of the virus.  And, some masks are better than others.


References:

  1. https://www.washingtonpost.com/lifestyle/wellness/mask-test-duke-covid/2020/08/10/4f2bb888-db18-11ea-b205-ff838e15a9a6_story.html?utm_source=twitter&utm_medium=social&utm_campaign=wp_main
  2. https://www.washingtonpost.com/health/2020/06/13/spate-new-research-supports-wearing-masks-control-coronavirus-spread/

Wearing a Facial Mask in Public

Updated:  August 5, 2020, 10:45 p.m.

Masks are important tools in slowing or stopping the spread of COVID-19.

Wearing masks in public has become a politically charged subject. Even with the rise of COVID-19 infections and deaths across the South and West, Americans continue to debate the need to wear facial coverings in public despite the plethora of scientific evidence showing mask effectiveness in preventing the virus spread.

Despite the universal recommendation to wear masks while out in public from government officials, epidemiologists and medical experts, there stills appears to be a reluctance by the American public to adhere to the guidelines.

Everyday while out in public, even in locations and inside establishments where facial coverings are mandatory, you can observe people out in public refusing to wear masks or wearing them incorrectly and ineffectually.

Periodically, you can observe people with their noses, a critical pathway of the respiratory system, exposed from beneath their masks or their masks worn on their chins.

Whether donning masks incorrectly was being done out of ignorance or political sensibilities, it accomplishes the same end, it does not help reduce the public spread of the coronavirus.

Cloth masks

Cloth masks are at their best when preventing the wearer of the mask from spreading the virus to other people, either when they are already sick, asymptomatic, or even pre-symptomatic.

N95 masks or surgical masks work

According to the CDC, N95 masks and surgical masks are best used in a medical setting, when the amount of virus in the environment is quite a bit higher. The intention of these masks is to reduce the transmission of the virus to the person wearing the mask.

Wearing a mask

Wearing a mask in your neighborhood, in your workplace, or around your community is a way to show you care about those around you. You are essentially saying, “I care about you. I am member of this community. And my intention is to not give this infection to you, even if I don’t know if I’ve got it.”

Washing cloth masks

Cloth masks should be washed every day. It’s helpful to have multiple cloth masks available so you can rotate through your supply while others are washing or drying.

N95 masks or surgical masks are intended to be worn through the course of one day and discarded.

Should You Wear a Mask | Mayo Clinic

Should you wear a face mask to protect yourself from the virus, even if you’re not sick?

In a video posted by Dr. Nipunie Rajapakse, a Mayo Clinic infectious diseases specialist, states CDC current recommendation:

“The current recommendations regarding masks are that if you yourself are sick with fever and cough, you can wear a surgical mask to prevent transmission to other people. If you are healthy, there is not thought to be any additional benefit to wearing a mask yourself because the mask is not airtight and does not necessarily prevent breathing in of these viral particles, which are very tiny,” says Dr. Nipunie Rajapakse, a Mayo Clinic infectious diseases specialist.

If you are going to a clinic or hospital to be seen by a health care provider because of concerns of cough or fever, Dr. Rajapakse recommends wearing a face mask to avoid transmitting possible infection or virus to other patients and medical staff. Face masks also are recommended for health care workers and people who are taking care of someone infected with COVID-19 in close settings (at home or in a health care facility).

“Most people who do not work in a health care setting have not received training on how to put on and take off the masks properly. Doing this incorrectly can actually increase your risk of infection. Also, people who are wearing masks tend to touch their face more than those who are not, which can paradoxically result in an increased risk of infection as well,” says Dr. Rajapakse.

She says instead of wearing masks, people need to:

  • Wash their hands frequently using soap and water for 20 seconds or an alcohol-based hand rub.
  • Avoid touching their eyes, nose and mouth.
  • Practice cough etiquette. Cough into a flexed elbow or tissue, discard the tissue in the trash, and wash hands.
  • Stay home from school, work and public places if feeling unwell.


  1. Nipunie Rajapakse, M.D./Infectious Diseases/Mayo Clinic
  2. https://newsnetwork.mayoclinic.org/discussion/covid-19-when-should-you-wear-a-face-mask/