With SMH Drs. Manuel Gordillo & Kirk Voelker
The Healthe-Matters inbox continues to be flooded with reader questions about COVID-19 and how to safely navigate the risks in this “new normal.” So we reached out Dr. Manuel Gordillo, who leads Sarasota Memorial’s infectious disease department as medical director, and Dr. Kirk Voelker, a critical care pulmonologist at Sarasota Memorial, to discuss the spread of coronavirus in the Sarasota community, proper mask wearing, ICU capacity concerns and hospitalizations related to COVID-19.
Mask Wearing: Just Do It
It seems a lot of people are forgoing wearing face coverings in stores and other public places now. Is it really necessary to wear a face mask now, since Sarasota hasn’t been hit as hard as other areas? ~ Toby K.
YES!!! We cannot emphasize enough that wearing a face covering — ideally a mask — is imperative to reducing the spread of COVID-19 in our community. Wearing a mask is not just for your protection, but more importantly for everyone else's protection. Wearing a mask is recommended when you may come in close contact (6 feet or less) with someone from outside your household, especially for a prolonged period (10-15 minutes or more) and especially indoors.
It seems people have begun letting their guard down and aren't consistently practicing recommended behaviors. It’s because of the preventative behaviors — mask-wearing, physical distancing, staying home more, etc. — that our community has not seen the very high incidence of coronavirus experienced in other areas … yet.
The positivity rate of COVID-19 in our county and surrounding counties has been ticking upward recently. Two weeks ago, SMH was down to 0.5% positive cases in the hospital and our ICU pods were emptying. We were doing high-fives because we were so happy that COVID ICUs were empty. Now, we've got 5 or 6 patients in there. While this is not a “second wave,” it is a continuing trend that is worrisome, and one that will continue if people don’t stick to those precautionary behaviors.
There aren’t many things that we can use to prevent COVID-19 from spreading. We don't have vaccines. We don't have monoclonal antibodies. We don't have a medication, like for example, Tamiflu for influenza. We have to resort to the traditional, almost ancient practices of non-pharmaceutical interventions that have been proven effective in other pandemics or in other viruses. And one of those is mask use.
Back in December and January, when we didn't don't know much about the virus, we did not think that masks were the way to go. We thought that in order for health officials to prescribe masks, we needed to prove that the virus could be transmitted before the onset of symptoms. We now know for sure that the virus gets transmitted before you get symptomatic.
We know that this disease is driven by “super spreaders.” Some mathematicians have estimated that about 10% of the cases drive 80% of the transmissibility, because of super spreaders. And there's solid scientific evidence that indeed a mask can help protect people from acquiring COVID and also from passing it on to others.
Hospital Bed Availability vs. Capacity
I’ve seen news reports that hospitals are running out space, particularly in the ICU {Critical Care Unit}. Is SMH short on patient beds? ~ Mike G.
No, SMH is not short on beds. Some of those reports were based on data from the Agency for Health Care Administration (AHCA) online dashboard. That data shows how many beds are available, based on current staffing — the number of patients a hospital can effectively care for given the staff that is on-duty. The data does not reflect the number of physical beds in the hospital (ICU or otherwise), nor does not reflect the number of potential ICU beds that can be made available (surge capacity), if needed. Hospitals staff to meet need, not capacity, so the number of staff on duty is based on the number of hospital inpatients. The bed count shown by the state's numbers does not represent our full capacity.
COVID-19 Exposure & Testing Advice
Person A learned she is asymptomatic Wednesday. Person B spent time with Person A on Monday and Tuesday. Person B worked with Person C on Wednesday. After Person A notified her of a positive test result Wednesday, Person B was tested immediately and result was negative; she then returned to work. Is it possible for Person C to get the virus from Person B if they continue to work together? ~ Marci A.
With COVID-19 infection, symptoms typically arise within 2 to 14 days. If a person suspects he/she was exposed to COVID-19 by being in close contact (more than 10 to 15 minutes at less than 6 feet) with someone known to have the virus, health officials recommended staying home & watching for symptoms (cough, fever, sore throat, new loss of taste or smell, shortness of breath, etc.). Testing too soon after exposure is likely to result in a false negative testing outcome; however, as with Person A, some never experience symptoms.
Experts recommend waiting 4 to 5 days after known or suspected exposure before being tested to avoid a false-negative result. If you are concerned you may have been exposed to the virus, call your doctor or the Sarasota County COVID-19 Call Center at 941-861-2883 (8 am-5 pm weekdays) for guidance.
In your example, B must not return to work and should self-isolate until 14 days have elapsed since her last exposure to A. For C, the status of B during their last close contact is the key. Since B tested negative, then C is clear of any risk, as long as he/she does not get re-exposed to B.
The CDC also recommends that if a healthcare worker gets exposed, he/she should be tested for the first time within 3 days of the exposure and should be re-tested 2 or 3 days later; that's not so much to find out what is the status of that person, but also to find out what other group of people we need to test that could have been in contact with somebody who’s asymptomatic.
Community COVID-19 testing is available at multiple sites in our area. Hospitals are not community test sites. To find a free public health testing site, call 941-861-2883 or visit floridadisaster.org/covid19/testing-sites
Other helpful related resources: floridahealthcovid19.gov/exposure; call the 24/7 COVID-19 Call Center (866-779-6121) or email COVID-19@flhealth.gov.
MMR Booster & COVID-19
I recently read a study suggesting that people over 60 should get an MMR vaccine booster because it lessens the severity of symptoms of COVID-19 infection. Is this true? ~ Jerry G.
Health experts recommend keeping up to date on all vaccinations and health screenings. While these will not have a direct impact on symptoms resulting from a COVID-19 infection, they do support your overall health and well-being, which in turn helps your body fight infection and disease. Talk to your doctor about the MMR booster, and if you are due for one, then certainly go ahead and get it.
Precautions for ‘High Risk’
In 2019, I was diagnosed with pneumonia twice and then lung cancer. I had the upper lobe of one lung removed and began chemotherapy. After I completed therapy, my scan was negative for cancer. In March 2020, I had a quadruple bypass. I feel pretty good and am very careful, but is there anything special I should be doing? ~ Greg R.
Given your medical history, you likely would be considered “high risk” for COVID-19 infection. Talk with your primary care doctor or specialists about your risk and what precautions they recommend you take to reduce your risk of contracting coronavirus.
Certainly, you should always wear a face covering in public places, in other spaces where physical distancing isn’t possible and when you are around anyone who does not live in your household. Practice physical distancing and avoid high-risk situations like crowded events or areas. Wash hands, wash hands, wash hands.
For further guidance, we also suggest checking out the Centers for Disease Control and Prevention (CDC) website.
Daycare as Cases Climb?
Due to work requirements, I need to put my kids (ages 2 and 5) in daycare soon. The facility is not letting parents in classrooms, is sanitizing toys 2x day and handwashing more than ever. What are your thoughts about them going back at this time? ~ Katie K.
That’s really a personal decision and depends on your risk tolerance, given the necessity of daycare so you can work weighed against the potential risks. If you have to send them to daycare, be sure to teach the children how to wash their hands properly (consider investing in a kid-friendly timer and practice, practice, practice), teach them to cover coughs and sneezes, and explain physical distancing to the older child. Ensure the daycare is actually following CDC recommendations across the board for the early childhood care facilities, including staff wearing face masks, symptoms screenings, increased disinfection, small class sizes, no shared toys/supplies, etc. (You can find that information here.) If the facility is not taking these precautions, consider switching to one that is.
More Cases Among Younger Population
Current testing numbers show that younger and younger people are testing positive for COVID-19. Why is that? ~ Anonymous
We don't know for sure, but health experts think there are a few factors. One is that in the past, the young population with mild symptoms didn't have widely available access to testing or treatment. In March and April, if you were young and had mild symptoms, we'd tell you to stay home because we did not have a test for you. Now, there's more testing availability for everyone.
The other factor is that younger people are the ones that are going work, now that businesses have begun re-opening. They are the people who are working at restaurants, grocery stores, the ones serving drinks atthe bars. This is the population that's most at risk. Obviously, they're going be exposed to customers who are not wearing a mask, and if they are not wearing masks, it creates a dangerous environment for them. The younger population is also the one that tends to go to places where people congregate: restaurants, bars, sports venues and parties, get-togethers.
Flattening the 'Spike'
There seems to be a new spike in positive cases of COVID-19. What can we do to “flatten the curve” again without shutting down the economy again? ~ Ally W.
As businesses and the economy begin to open back up, we have to be smart about how we do that. If we start acting like the pandemic never happened — like there's no virus around — we will see another resurgence of the virus, as we are now.
The virus hasn’t changed. Humans have not changed. So, the same situation will be repeated until we have a vaccine or until we reach what's called “herd immunity,” where enough people are infected with the virus that it cannot affect more, but at the current rate of infections, that's about 2 years away.
Right now, we need to stick to the tried and true: physical distancing, mask use, hand hygiene and staying home when you're sick. All those recommendations still stand.
** NOTE: The information above was last updated June 22, 2020. For the most up-to-date COVID-19 info, visit smh.com/covid19 or the CDC’s website at https://www.cdc.gov/coronavirus/2019-nCoV/index.html. **