By Paul Goldfinger MD 4/2/20. Blogfinger.net Long but worth it:
I’ve been trying to figure out why so many people are acquiring infections with the Coronavirus when they have been “strictly” observing the distancing rules. I made a few observations including that people who think they are observing “strict” distancing are making exceptions.
For example, a friend who works at a golf /tennis club has observed the tennis players keeping their distances, but then, all of a sudden, the action stops and 4 players clump together at the net. The same occurs on golf courses, and that is why some golf courses have closed. And the same thing happens on boardwalks at the Shore.
The other phenomenon I have seen is that some people make exceptions with others who seem healthy and have no symptoms. They believe that such individuals are safe. This morning I saw two women who do not live together sitting side by side in a golf cart as they cruised down a street in the Tropicana Co-op (Florida.)
As a physician, I have known since medical school that infectious diseases such as viral illnesses can “incubate” in a person before overt symptoms (pre-symptomatic) emerge. I have never thought much about whether that symptom-free stage could be infectious, because I couldn’t identify its presence, although it seemed perfectly reasonable that it could. Of course, we now have Corona tests that could identify such people.
And if they are infectious, that could explain many of Corona infections that are caught by people who say that they never go near anyone closer than 6 feet….. except perhaps for those who seem normal, like the card playing circle of friends I spotted in the Co-op.
This phenomenon was also seen when the Tropicana Co-op board scheduled a meeting for perhaps 100 persons while telling those who “are sick” to stay home. Otherwise you were invited to attend. I called them out on that, but did not receive a sympathetic ear.
AMA/Reuters) Now we have a startling but logical clinical trial published by the CDC:
“The researchers found that people infected with the novel coronavirus can transmit the infection one-to-three days before symptoms start to appear, according to a study published by the U.S. Centers for Disease Control and Prevention (CDC).
“It identified seven ‘clusters’ where pre-symptomatic transmission was likely, and in four such groups, where the date of exposure could be determined, pre-symptomatic transmission occurred one-to-three days before symptoms appeared in the source patient.
“The findings suggest that it might not be enough for only people showing symptoms to limit their contact to control the pandemic, the researchers wrote in the CDC’s Morbidity and Mortality Weekly Report, published online on Wednesday.”
Really? It means that we all need to avoid contact with anybody—just assume that everyone might be infected and might harm you.
“With the focus currently on testing only people who show symptoms, the researchers expect asymptomatic illness to be under-detected.”
From the trial paper: “The potential for pre-symptomatic transmission underscores the importance of social distancing, including the avoidance of congregate settings, to reduce COVID-19 spread.
“These findings are supported by other studies that suggest that pre-symptomatic transmission of COVID-19 can occur ”
“Early detection and isolation of symptomatic COVID-19 patients and tracing of close contacts is an important disease containment strategy; however, the existence of pre-symptomatic or asymptomatic transmission would present difficult challenges to contact tracing.
“Such transmission modes have not until now been definitively documented for COVID-19, although cases of pre-symptomatic and asymptomatic transmissions have been reported in China and possibly occurred in a nursing facility in King County, Washington
“Pre-symptomatic transmission might occur through generation of respiratory droplets or possibly through indirect transmission. Speech and other vocal activities such as singing have been shown to generate air particles, with the rate of emission corresponding to voice loudness .
“News outlets have reported that during a choir practice in Washington on March 10, pre-symptomatic transmission likely played a role in SARS-CoV-2 transmission to approximately 40 of 60 choir members. See link below.
www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak
“These findings suggest that to control the pandemic it might not be enough for only persons with symptoms to limit their contact with others because persons without symptoms might transmit infection.
“Finally, these findings underscore the importance of social distancing in the public health response to the COVID-19 pandemic, including the avoidance of congregate settings.”
Editor’s note: This means that no one should get within 6 feet of anyone, symptomatic or not.
But, having read this, I believe that many people do already avoid getting close to anyone, and so that idea should be adopted by all, but is that the whole story?
How do those who are super careful get COVID-19 anyhow?
Consider this JAMA trial which I read in the NY Post. It offers another way that careful people can get infected and suggests, according to the study below, that the distancing guidelines might have to be revised:
An MIT researcher published in the Journal of the American Medical Association, a study that observes that “droplets from sneezing can settle along a trajectory of up to 27 feet and can contaminate surfaces out to that distance,” — and “residues or droplet nuclei” may “stay suspended in the air for hours.”
This means you could walk into an invisible germ cloud after the source has long disappeared.
She notes a 2020 report from China that showed that “virus particles could be found in the ventilation systems in hospital rooms of patients with COVID-19.”
See the 27 foot sneeze. Click on the link below.
JAMA Learning says, “This newer understanding of respiratory emission dynamics has implications for mask and respiratory design, social distancing recommendations, and other public health interventions during and after the COVID-19 pandemic. ”
But Dr. Fauci is not convinced saying, during a Tuesday White House press briefing, that it would take a “very, very robust, vigorous, achoo sneeze” for droplets to even come close to traveling such a distance.”
All this tells us that face masks worn by everyone will be a good idea, even if regular face masks have a weak effect in catching droplets.
To protect lungs from Coronavirus. we need an effective medication now and a vaccine for the long term.. Only an N95 facemask can mechanically protect the lungs from this evil bug.
Regular face-masks or clothes over the mouth/nose may offer small protection. But if it gives people confidence, then go for it, but don’t use the kinds that are needed by healthcare workers.
I have always believed in face masks. They are worn to protect the lungs while painting or working with chemicals. In the freezing cold we wrap a scarf over our mouth. In some places with heavy pollution like Thailand.
A face mask may not prevent this new virus but it will help protect our lungs.