WWFD? What Would Fauci Do?
From the Trenches - # next
To enlarge, tap picture. Click X in upper right corner to return to blog.
Sadly, little has changed since my last blog in July but the rising death count and case load. Perhaps the disease is more real now, perhaps you know or know of someone succumbed to COVID-19.
America leads the world in COVID-19 deaths by many tens of thousands. If you think for one-minute that many of these deaths were not preventable - change your news channel - your information source is inaccurate. More Than 1,000 Current and Former CDC Officers Criticize U.S. Covid-19 Response. An open letter calls for the federal agency to play a more central role in addressing the pandemic. [1]
As we head into winter, flu season will be complicated by COVID-19. As the weather cools and people gather indoors, the risk of viral spread increases. We are already in, what has been named, “the fall surge.” Hospitalizations and cases are rising across the nation. We have not “turned the corner” by any stretch. The virus is surging - it is not disappearing.
Trump is right when he says people are sick of COVID-19. This is called COVID fatigue, we are tired of being apart, we want to hug our grandkids and gather at Thanksgiving - and we may give-in to our wants. The problem is, with 220,000+ dead Americans, COVID-19 is not sick of us. In fact, COVID-19 might just be warming up.
The intention of this blog is to give you the latest data on how to keep you and yours safe until we have the political will to come up with a national plan. Why a national plan? Because the nations who have successfully navigated COVID spread have done so with a unified, national strategy. With the resources of the nation being brought to bear on supply chains for PPE and testing materials, with case tracing and a plan for dealing with those infected and those exposed. 220,000+ American deaths clearly demonstrate that whatever plan this country is working is an ineffective one.
What have we learned since July?
- We’ve learned that the CDC (Center for Disease Control) has been compromised by pressure from the White House. [2] The first obvious example occurred July 8th when Trump tweeted that CDC’s guideline for reopening schools were “too tough.” CDC capitulated and revised them. [3] July 8th was the first (though not the last) time that I logged onto CDC’s website to print their COVID-19 Guideline so I could track changes made in subservience to Trump and against the advice of career epidemiologists and public health experts.
Other examples of CDC compromise:
September 1st CDC announced: “If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms, you do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.” This was a head-scratcher and completely at odds with contact tracing (the bedrock of epidemic management) but consistent with a misguided theory that less testing equals less cases. California’s Gov. Newsom immediately announced that the state would not be downgrading its testing. CDC reversed this guideline on September 24th. [4]
2) We’ve learned that the this virus is aerosolized - like measles - this is a big deal. Aerosolization greatly contributes to ease of infection. Remember the Disneyland measles outbreak during the Christmas Holiday of 2014?
CDC: Measles Outbreak - California, December 2014 - February 2015
As of February 11, a total of 125 measles cases with rash occurring during December 28, 2014–February 8, 2015, had been confirmed in U.S. residents connected with this outbreak. Of these, 110 patients were California residents. Thirty-nine (35%) of the California patients visited one or both of the two Disney theme parks during December 17–20, where they are thought to have been exposed to measles, 37 have an unknown exposure source (34%), and 34 (31%) are secondary cases. Among the 34 secondary cases, 26 were household or close contacts, and eight were exposed in a community setting. Five (5%) of the California patients reported being in one or both of the two Disney theme parks during their exposure period outside of December 17–20, but their source of infection is unknown. In addition, 15 cases linked to the two Disney theme parks have been reported in seven other states: Arizona (7), Colorado (1), Nebraska (1), Oregon (1), Utah (3), and Washington (2), as well as linked cases reported in two neighboring countries, Mexico (1) and Canada (10). [5]
We’ve heard similar COVID-19 stories: In June, a surprise birthday party in Texas resulted in 18 coronavirus cases. In July, a house party in Michigan led to 43 cases, and a family gathering in North Carolina led to 40 cases because the attendees "went about their daily lives" before they started showing symptoms. In some places, in-home gatherings are now responsible for the majority of new coronavirus cases. A recent Centers for Disease Control and Prevention report showed how a chain of family gatherings in Chicago let to three deaths. [6] I think we’ve all heard about the wedding in Maine that resulted in multiple COVID cases and deaths of people not even in attendance.
Aerosolization is a big deal, micro viral particles can hang in the air and be inhaled by another. In another example of CDC flip-flops, CDC finally declared what has been evident (to the medical community) for months: COVID-19 is aerosolized to enable airborne transmission. They quickly reversed that declaration with a backflip, only to reverse the reverse with a running Round-off- Back Handspring-Back Tuck. It would be entertaining and laughable if it weren’t so tragic. We have never seen such a schizophrenic CDC and it is more than disheartening for health care workers (HCW) across the globe who have depended upon the guidance of CDC for decades.
What does aerosolization mean for our own safety? It means masks are helpful. They stop droplets and some aerosol. But if you spend 15 or more minutes in a confined space with an infected person (i.e. carpooling, flying, exam room, meal prep in the kitchen), a simple, cloth mask will not keep aerosolized virus out of your respiratory tract.
What about public transportation, flying or carpooling? Best practice would have everyone wearing an N95 mask (get them on Amazon, Home Depot) to contain your own droplets and aerosols. Keeping the windows open will disperse any escaped viral particles thereby reducing the build-up of virus to infectious levels. Avoid the instinct remove the mask to cough or sneeze. DO sneeze inside your mask, that is what its for. I’ve read of a plan to physically distance commuters and open the windows on commuter trains into NYC through the winter.
What if everyone has a negative COVID test? Technically that could work, however, the White House Rose Garden Super-Spreader event gives us a stellar example of when it did not. Twenty-eight people were infected at that event where every attendee had a negative test. If the people living in a biologic bubble can get infected… that ain’t you and that ain't us; don’t let your guard down.
Rule #1 for indoors and out - keep physically distanced from people not in your “quarantine pod”. No close contact (within 6 feet) to any person for greater than15 minutes., wash hands, wear a mask. Keep it outdoors if possible (the odds of contracting the virus are 20 times higher indoors). Keep indoor gatherings small and with people under 60 years.
If not the CDC?
WWFD? = What would Fauci do? I am a fan of Dr. Fauci. He is not beholding to Trump, he cannot be fired by Trump, and he shrugs off the bullying. Yes, Dr. Fauci made some missteps - who didn’t? This IS the novel Coronavirus - a never-been-seen-before virus to which humans have no immunity. Do not get attached to a treatment plan or way of interacting with the virus. Good scientists will change their recommendations as we learn more and the data change. A man who can say, “I thought this, the data suggests that, we were wrong, the new plan of action is…” THIS is not ego driven but science driven; isn’t that what you want?
"Let's see if we could put this to rest once and for all," Fauci said. "Cloth (face) coverings work. If you look at the scientific data, the masks clearly work. I mean, they are part of a multifaceted approach of—masks, keeping distance, avoiding crowds, washing hands, doing things outdoors, much more than indoors. All of that is a combination of prevention modalities that are easy to do relatively speaking.” [7]
Follow the advice of Dr. Fauci and the World Health Organization. Dr Sanjay Gupta of CNN seems to be pragmatic and sound. California’s state or local health department has good information. Beware information dispersed by any politician unless it closely follows that of the Health Department.
And one more thing: listen to epidemiologists and public health professionals. Shun the radiologist who plays a public health professional on TV. He might have slept at a Holiday Express but he’s still bogus.
Bill Gates: I’ve tackled every big new problem the same way, by starting off with two questions. Who has dealt with this problem well? And what can we learn from them?
Look for best practices from other countries.
Totally Under Control is a new 2-hour documentary (streaming on Hulu & Amazon Prime) tracks our COVID-19 response against that of South Korea. Both countries learned of their first case on the same day in January. Both national responses are chronicled at critical decision points, when S Korea went right and the US went awry.
Research and follow best practices of other countries. i.e. Australia (905 deaths), New Zealand (25 deaths), S. Korea (457 deaths), Taiwan (7, yep, no typo, just 7 deaths). To be fair, these countries have a national strategy to protect their citizenry and national healthcare and electronic medical records that provide data in real time. The US could have that, we have the infrastructure, so far we lack the will. But we could personally follow the practices imposed by those countries.
Follow their example: universal mask wearing in public spaces, physical distancing from others, keep rooms well ventilated, avoid crowds, closed spaces with close contact, sanitize hands, cough into elbow, avoid touching your face. WHO instructs those with underlying conditions or over 60 to wear a medical/surgical mask. These practices are simple and the bedrock of interrupting the spread of any contagion.
Australia and other southern hemisphere countries had record low flu seasons. The physical distancing and other public health precautions put in place to combat COVID-19 quashed the flu season. It makes sense, flu is also a viral illness. The US could hope for the same but then, we would have to behave the same.
COVID-19 vs. cold and flu symptoms — Because the symptoms of COVID-19, a seasonal cold, and the flu have a lot of similarities, mild cases of COVID-19 may go undetected. Watch our video to learn more about the different symptoms for COVID-19, the flu, and a cold. [8]
The symptoms which are unique to COVID-19: shortness of breath, new loss of smell and taste, rash on hands and feet. Fever (over 100.5), shaking chills, headaches, cough, sore throat, diarrhea, muscle aches, and fatigue, are common to both COVID-19 and influenza.
Colds come on gradually and the most common symptoms are a stuffy nose, sore throat, and sneezing. They sometimes also include a cough and fatigue. Fevers and headaches are rare.
All three infections are viral illnesses - we don’t use antibiotics for viral illnesses. We use Tylenol for fevers, Robitussin for cough, Cepacol and salt water gargles for sore throat, inhalers for wheezing, etc. Even for COVID-19; its a virus.
If you have symptoms, contact your doctor. Many doctor offices do not have PPE (personal protective equipment) so we do not necessarily want you in our office. We will try to treat you over the phone or by video visit. We will send you to the Emergency Department for shortness of breath - where staff are properly protected and chest X-rays and blood oxygen saturation can be assessed.
What about the Holidays?
WWFD? Dr. Fauci's Tips for Celebrating the Holidays in a Safe Way During the Coronavirus Pandemic
1. Go small-scale or go virtual.
"Be very careful and prudent about social gatherings, particularly when members of the family might be at a risk because of their age or underlying condition," Fauci told CBS Evening News. "You may have to bite the bullet and sacrifice the social gathering unless you're pretty certain that the people that you're dealing with are not infected ... either they've been very recently tested or they're living a lifestyle in which they don't have an interaction with anyone but you and your family." As he explained this, Dr. Fauci pointed to his relationship with his wife, Dr. Christine Grady. The duo only socializes with each other and no one else.
2. Don't assume that just because you feel OK you are OK.
While explaining this on CBS Evening News, Fauci referred to nationwide observation reports from his fellow coronavirus task force member, Dr. Deborah Birx. Those reports discovered that family members are spreading the coronavirus to each other more often than at the beginning of the pandemic.
"Household transmission is assuming a greater element of the transmissibility," Fauci said. And since researchers are learning that about 1 in 5 people who become infected with the coronavirus are asymptomatic, it can be a big challenge to know if you might be at risk for spreading the virus to someone who may experience more severe symptoms or complications. (Say, someone with any of these high-risk medical conditions pointed out by the Centers for Disease Control and Prevention.)
3. Travel early.
If you do decide to gather in person, follow the CDC's safer holiday travel tips: Drive and don't stop along the way (What about bathrooms? See below); then, after arriving, quarantine at a separate dwelling (such as a no-contact Airbnb) for at least five days (the median time it takes to test positive). Then get tested before gathering with your family.
4. Keep things small.
"When people do things in crowds without masks—particularly indoors—it's just asking for trouble. We know without a doubt that those are the events that have spreading among people. It isn't as if we haven't been there before. We know that's trouble. It just seems obvious you've got to avoid that," Fauci said in the interview with CBS Evening News.
(Check out one poignant example of this in our story about a coronavirus survivor who spoke out after hosting a gathering that infected 14 and killed 2 family members.) So only invite a small crew that can stay safely spaced at least 6 feet apart in the event of any congregating.
5. Speaking of masks, wear one with anyone outside of your household—even relatives.
At the beginning of the pandemic, Fauci wasn't a huge proponent of masks, fearing that there might be a shortage for health care workers. But just one month later, Fauci reversed his stance, once he learned that masks—even the cloth face masks you can buy or make—help prevent infection.
"When you find out you're wrong, it's a manifestation of your honesty to say, 'Hey, I was wrong. I did subsequent experiments and now it's this way,'" Fauci said during a 60 Minutes segment that aired on October 18. So in case you're looking for his final answer, it's wear a mask—even with your family—each and every time you're sharing space with anyone outside of your household and especially anytime you're inside. (That is, when you're not eating or drinking.)
While not seeing family might feel like a tough pill to swallow, those are some sage doctor's orders as turkey time inches closer and closer. [9]
What about bathrooms; both public and private?
Public bathrooms continue to pose a problem. [10] Ever heard of toilet plume? Aerosolized viral particles can hang in the air of an enclosed bathroom. Scroll to my previous blog dated July 12th to the paragraph: What about bathrooms; both public and private?
Lastly, remember the 3 W’s: Watch your distance, Wear a mask when you can’t watch your distance, and Wash your hands.
e malama he pa waiho ai = keep safe
Footnotes:
[1] https://www.wsj.com/articles/more-than-1-000-current-and-former-cdc-officers-condemn-u-s-covid-19-response-11602884265
[3] https://khn.org/morning-breakout/cdc-to-revise-school-reopening-guidelines-after-trump-blasted-initial-ones-as-too-tough-and-expensive/
[4] https://www.bmj.com/content/370/bmj.m3386
[5]https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm
[6] https://www.theatlantic.com/politics/archive/2020/10/it-safe-have-dinner-together-inside/616568/
[7] On CNN’s Reliable Sources with Brian Stelter 9/27/2020
[8] Kaiser Permanente
[10]https://www.washingtonpost.com/lifestyle/2020/10/15/coronavirus-public-restroom/
