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Traveling without care.

 

By Paul Goldfinger MD

 

What should you do regarding someone you  know who has just returned from a trip?

There is a great deal of information about COVID-19, but the conclusions are often more general than practical.   We know that some states have higher rates of transmission then others.  Currently over 30 states are “at risk,” but the virus is everywhere.

So If you come from one of those risky states, like New York, you might be asked to quarantine for 14 days.  That is to protect those who live in the destination state.

But if you are traveling, maybe you shouldn’t go to a high risk state because you might catch the virus.  However you could catch the virus no matter where you go–high or low risk.  And  it’s hard to avoid worrisome contacts like using public bathrooms.  So travel has risks, but the risks depend on the epidemiology of that state and how careful you are.  The best advice has been “Stay home.”

But what if you take a trip, what do you do when you get home?  You have been traveling around and staying in motels and eating in restaurants,  and you have been wearing your masks and washing your hands, but you still could have become infected silently  (without symptoms.) You could get tested when you get back, but that won’t be foolproof because you might be infectious even if you test negative. The virus has an incubation period and may turn positive after 2-7 days.

Naturally if you were exposed during your trip to someone who is infected then you must self quarantine, but what if were not knowingly exposed and you return and you feel fine?  Should you self quarantine anyhow?

What is the risk of passing on the virus, if you feel fine, to those at home such as high risk elderly relatives or people with specific medical problems where their immunity may be impaired?   If you traveled through a high risk state, your concern will be heightened. Or can you take a chance and just bop around with your mask and hand washing?  Or just stay away from everybody for 14 days?

The answers are not clear, and the guidelines are inadequate.

After getting home you could wear masks, distance, and wash hands, but you still could be a problem for someone. Testing can be revealing if you are positive, but if you are negative that is not totally reassuring. (See comment below.)

 

Here is what the CDC says:     “You may have been exposed to COVID-19 on your travels. You may feel well and not have any symptoms, but you can be contagious without symptoms and spread the virus to others. You and your travel companions (including children) pose a risk to your family, friends, and community for 14 days after you were exposed to the virus.

“Regardless of where you traveled or what you did during your trip, take these actions to protect others from getting sick after you return:

  • When around others, stay at least 6 feet  (about 2 arms’ length) from other people who are not from your household. It is important to do this everywhere, both indoors and outdoors.
  • Wear a mask to keep your nose and mouth covered when you are outside of your home.
  • Wash your hands often or use hand sanitizer (with at least 60% alcohol).
  • Watch your health and look for symptoms of COVID-19. Take your temperature if you feel sick.

“Follow state and local recommendations or requirements after travel.”

 

If I were at increased risk but traveling nowhere, I would avoid any contact, if possible, with someone who has just returned from a trip–for 14 days even if they have not tested positive or developed worrisome symptoms.

If you can’t isolate yourself from such risky people, then follow the CDC guidelines above and do the best you can.  If it is a relative or good friend who just came back from travel, just tell them that you can’t associate with them for 14 days.   And if they say “how about 7 days?” you say, “Better safe than sorry!”  (Unless they agree to be tested after 7 days of arriving home.—see comments)

KAREN ELSON WITH VINCE GIORDANO AND THE NIGHTHAWKS  from HBO’s  Boardwalk Empire:

 

Karen Elson

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OG boards. May 31, 2020. This is a Sunday morning,  and board walking is OK.  If you walk on the beach on Sunday morning, no one will stop you.   Paul Goldfinger photograph. ©

 

 

Blogfinger Medical Report.   Paul Goldfinger, MD, FACC.

This  headline* is from Reuters Health covering the opinions of some Canadian professors in an article in the Annals of Internal Medicine.  They said, ” While there is no direct evidence yet that cloth masks can reduce  SARS-CoV-2 transmission, the collective evidence indicating that mask wearing by infected people reduces contamination is convincing and should inform policy.”

They say that “there is ample evidence that the masks can prevent infected droplets from getting into the air or onto surfaces.”

The article  said, “There was also evidence, though not as strong, that cloth masks might protect wearers as well.”

A professor in the trial,  Dr. Catherine Clase, from the McMaster University in Ontario, said, “While the evidence shows that masks can help, they are no substitute for social distancing and handwashing but should be used along with those measures.”

Dr. Supratik Guha, Professor at the Pritzker School of Molecular Engineering  from the University of Chicago said, “I have been stressing that simple reasoning and evidence indicates that the use of a decent cloth mask in indoor or use public places will reduce infection transmission.  If most of the population practices this, the multiplicative benefits can be enormous in reduction overall infection rates within a community.”

CDC says:    “A cloth face covering should be worn whenever people are in a community setting, especially in situations where you may be near people. These settings include grocery stores and pharmacies. These face coverings are not a substitute for social distancing. Cloth face coverings are especially important to wear in public in areas of widespread COVID-19 illness.

 

Blogfinger commentary: By Paul Goldfinger, MD.   I have observed a significant lack of compliance outdoors in Ocean Grove;  probably because people are not sure that the invisible terror will be eliminated by mask practices, and there is some confusion regarding when and how to make use of masks.

Official guidelines by the Camp Meeting Association of Ocean Grove are evasive and unconvincing.  They say on their web site:  “Wearing masks is strongly encouraged.”

So, to practice masking, one needs some faith in the scientific guidelines, such as they are.  I have always tried to practice evidence-based medicine, but the science here isn’t so clear,  and maybe we need to believe somewhat in good judgement and even in magic.

I am not convinced that we should wear masks if we are outdoors in open spaces where we can stay away from others or when alone in our cars.     But keep in mind that this virus spreads by human to human contact, so you can use some common sense in this regard and judge your situation by that principle and analyze your own environment.

We know that the virus can, under certain circumstances, infect the air we breathe originating in coughing, sneezing and even talking.

So don’t take unnecessary chances.  If there is any possibility that human to human contact might occur in any situation, then put on a mask.

The two ladies walking side by side wore masks, but they could have been somewhat more apart.  If I were walking alone there, I  would be tempted to  wear no  mask, as many were not doing, but I would surely weave my way around any humans walking or biking towards me.

If you don’t wear a mask outside, at least carry one, just in case.

Best choice:  wear the mask on the boards.  The beach will be a more difficult decision.

And don’t forget to wash your masks.

 

ALY AND AJ. “Into the Rush:”

 

 

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Ocean Grove boardwalk. May 13, 2020. By Lee Morgan of OG.

 

PINK MARTINI:   “Anna”

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Greetings to you, BLOGFINGER & my beloved town Ocean Grove.

A note of gratitude that you continue to inform and bring an artistic perspective peppered w/ a medical accent to your blog.

In the past few months I have been touched by the loss of my dear closest friend, albeit from across the Atlantic. He loved to walk along the boardwalk here daily during his visits to nearby Bradley Beach.

Now we are in midst of the many changes in our lives brought by the current pandemic. As one who spent many years in a medical career am aware of the NJ governor’s daily updates & although our numbers are high, I too look to the ‘data to determine dates’.

I am in agreement as to a slow pace of reopening here and generally everywhere. Otherwise how can we minimize the efforts by the majority to listen to the facts & act responsibly. My Irish immigrant grandparents who lived in northeastern NJ during the ‘1918 Spanish Flu” experienced the severity of an epidemic which took the lives of family, sadly. In the spirit of generations who fought many battles in our American history (including our immigrants) we can do this!

And I hope to learn; to not only survive, but thrive in the near future.

All the best…. S.H / NJ

May 1, 2020

Ocean Grove, N.J.

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A sample is obtained from a person who wants to be checked. Washington Post photo©

 

By  Paul Goldfinger, MD

May 1, 2020. Ocean Grove, NJ.  Blogfinger.net

 

For days I have been contemplating a post  to answer an important question about the pandemic in America.  But I hesitated because I wasn’t sure of the answer.

The issue is that despite the best efforts of most people that I know to mitigate the coronavirus, the disease keeps growing, and the numbers in New Jersey show it.  If the virus flood should respond to distancing, hand washing and self isolation, then why isn’t it snuffed out already?  What are we missing?

Some would say that mitigation is just not very effective–that it is insufficient to stem the viral tide.

But I believe that if it weren’t for our efforts, the situation would be much worse, however, how is the virus still claiming so many victims?

Experts say that the epidemic just needs some more time to burn itself out, while others say that it will take a year or two unless an effective treatment appears and/or a vaccine.  There is no natural immunity in the world’s population because this is a new virus.  And we have had inadequate testing sufficient to tell us how pervasive the virus still is.

And the natives are getting inpatient and want to be set free. Israel and some other countries have done  well, with the process,  but when Germany tried to open their economy, there was a flair.  So what are we missing?

The answer appeared in today’s Washington Post in which they say, “More than 20,000 Americans are testing positive for COVID-19 each day despite widespread quarantines. Who are these people and how are they catching the virus?”

There has been no published evaluation of the occupations and living conditions of those who are now testing  positive, so we don’t know who is getting sick.

But through further analysis, it appears that the “pandemic is increasingly infecting those who have limited ability to socially distance.”

“That includes grocery store workers, housekeepers, nursing home workers, jail inmates, construction workers, the person who delivered your dinner.”  And it also  includes police, security people, healthcare workers, food workers and other essential people.  And it is impossible to track down all the contacts that such people have every day.”

“Experts and anecdotal reports all confirm that the disease is largely still spreading among people who can’t afford not to work—or whose work the rest of the country can’t afford to do without.  And sometimes people who are very careful still wind up with the disease, and they don’t know how it happened.”

“It is community spread, and then taking it home to their families,” said Sonja Bachus, chief executive of Greater Baden Medical Services in Maryland.  “It is disheartening.”

So that is where the new cases are arising despite the best efforts of those who can isolate themselves.  And, still, despite all the optimism in the last week, we must remain vigilant and we can’t expect this thing to shut down and end abruptly.  Israel looks great, but it is a small nation, and we are a complicated huge country.

So, as far as Ocean Grove is concerned, imagine what will happen if our town is flooded with tourists, and among them will be infected individuals.  This will place those of us who live or visit in town at great peril of becoming ill

Something must be done to shut down the corona spewing tourist machine to be turned on  by the CMA. Don’t be fooled by the CMA which has big plans for programming;  and don’t worry, they “are watching the situation hour by hour.” And the boardwalk should be closed along with our neighbors. We need residents only parking and beaching.

This April 30 piece in the Washington Post is by Kyle Swenson and Jenna Portnoy.  The references to Ocean Grove and New Jersey  are by Blogfinger.net

 

 

 

 

 

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We have no idea of the impact of coronavirus so far in Ocean Grove. Exactly what is the CMA’s Badger monitoring “every hour?”  Do we have any test results for the Grove?

 

This APP article offers very little of substance, but this is what was said in their 4/30 piece today:

a.  The reporter says that the CMA and not the Township decides if the boardwalk remains open.  What is the truth?  According to Jack Bredin, it’s the other way around.

b. Andy Levine, the head of the Better Parking Alliance in OG, who likes to jog on the boards, says that he agrees with keeping our boards open, but he believes that as the weather gets warmer, the CMA “will have to follow everyone else and probably shut things down.”

Hey Andy—stick to parking. “No comment” would have been a better choice for you.

c. ” Barbara Burns, President of the Home Groaners, said she was supportive of the approach taken by the CMA.”

She also is a mind reader saying, “Most people I think are pretty comfortable with following whatever guidance we get from the state.”

It seems she thinks the state has offered “guidance” about our boardwalk, but they have actually shown no interest in the subject.

d.  Michael Badger of the CMA said, “We are monitoring it hourly.”  He explained the CMA’s plan “is to keep the boardwalk and beach open, with a phased approach to events as the summer months approach, but he cautioned that if there is any danger to public health, that approach could change quickly.”

So, the CMA is monitoring the situation “hourly,”  but has he noticed that New Jersey has more cases and more deaths every day?

Evidently he doesn’t see any danger to public health in the Grove.  Is he so ignorant of the infectiousness of this virus that he  thinks that so far, it’s all fine?

Badger still has not mentioned publicly that there are thousands of people who live in the Grove and who can be impacted by his policies.  He doesn’t want to recognize that we have a community of residents who live here and should be factored into his plans which seem to ignore the priority of public health.

And the APP also has also not recognized the community of residents who are most vulnerable to out-of- control tourism.  This is journalism at its worst. The reporter couldn’t even come up with stats  (cases and deaths) about the virus in Ocean Grove and neither has his paper. He doesn’t seem to understand the public health issues here as well as the clash of opinions.

Why not take the most careful approach and close the boards, like our neighbors, and then, later, if the numbers work out, to consider opening along with other towns around us?

Who in this town is paying attention to the health risks for our citizens?  Certainly not the ding dings quoted above.

Paul Goldfinger MD, Editor.

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COVID-19.    Internet graphic from the NIH.

 

Is the July 4 parade next to be scheduled? Paul Goldfinger photo. 2019. ©

 

Tents begin to “go up” each April. Blogfinger photo April 2018.

 

Friday, April 25, 2020. 4 pm

 

We have learned from a reliable source that the Ocean Grove Camp Meeting Association will be “opening the tents and the beach on June 15.”

 

 

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A worker sprays disinfectant to sanitize Duomo square in downtown Milan, Italy, March 31, 2020. (AP/Luca Bruno)

NOTE:  This was reported on Friday April 25 by the Guardian.

“Scientists in Italy find coronavirus on airborne pollutants, suggesting that the disease could travel further by air than previously assumed.”

“It could also explain the high rate of infection in heavily polluted northern Italy. ”

“Larger droplets carrying the virus land within two meters of the carrier, but smaller droplets can linger in the air for longer, and move farther. It is unclear whether the smaller droplets can cause infections.”

“The study has not yet been peer-reviewed, but previous studies and experts suggest the premise could be valid, and should be researched further.”

“It is unclear whether the virus is viable or able to cause infections when carried by pollution. ”

Something to think about when considering the close quarters among the tents.

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It’s not all black and white. Don’t just stand there; go wash your hands. Paul Goldfinger photo. Ft. Myers, Fla. April, 2020 ©.

 

 

THE AUSSIE  BUSH BAND

“Home Among the Gumtrees.”

 

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Taking care of an ICU patient with COVID-19 at Maimonides Hospital in Brooklyn.    Washington Post photo. 4/15/20

Paul Goldfinger, MD, FACC

Ocean Grove.  April 15, 2020.

 

Washington Post April 15, 2020:    Covid-19 kills by inflaming and clogging the tiny air sacs in the lungs, choking off the body’s oxygen supply until it causes organ failure. But doctors are seeing that the virus may be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems.

As we have pointed out, this epidemic is, from a medical point of view, creating more questions than answers even as new questions tumble out of ICU’s and research labs all over the world.  The earliest observation was that the virus attacks and damages the small lung air spaces causing oxygen lack around the body and leading to the need for ventilator care.

But so many have been dying despite the ICU and ventilator approach, that other ideas are being considered.  American physicians have been obtaining a great deal of information from researchers in Wuhan, China and from their own, in the trenches, observations.

It is now becoming clear that the virus attacks other organ systems directly including the kidneys resulting in renal failure and need for dialysis.

Liver damage causes liver failure, and the virus attacks the linings of the intestinal tract as well.

In some patients, the immune system reacts by spewing out damaging substances called cytokines, resulting in “cytokine storms.”

And other issues include neurologic damages, heart injury,  and blood clots in the legs which can cause pulmonary embolism.

So it seems that the coronavirus infections can overwhelm most of the body’s systems and overwhelm the ability of healthcare workers to save patients from death or lingering and nonredeemable complications.

I can imagine the scenes in ICU’s all over the world, where patients tumble downhill with one problem on top of another, after another, after…. I can imagine the stress on the doctors, nurses and other medical personnel who try to plug holes in the dyke, but then other leaks pop open.  I can picture the horror that they experience as they lose one patient after another.

And I can imagine the terror in the hearts and souls of patients and their families.

It must be like a tsunami hitting a peaceful island of tranquility and then tearing it apart in no time.

It’s hard to believe that this disaster will completely subside for some time.  The search is on for all sorts of ways to stem the tide. And all of us who are outside looking in and getting frightened for ourselves and our families can only do what we are told and asking everyone else to do the same.

 

JUDY KUHN  ;”Dividing Day” from Adam Guettel’s The Light in the Piazza
“Beautiful is what you are,
Only somehow wearing a frightening disguise.
I can see the winter in your eyes, now, telling me:

“Thank you, We’re done here, Not much to say.

We are together but I have had Dividing Day.”

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Internet graphic

 

Kevin Chambers, a long-time Grover, has been making a case on Blogfinger that the Corona scare is a hoax drummed up by the “main stream media.”    Recently, in New Jersey, a state with high rates of Corona infection, we have been warned about an impending “spike” in viral infections and fatalities.  Citizens are appropriately worried, except perhaps for citizens who are doubters, like Kevin.

Here is his latest comment  (4/10/20):

“You state that the death rates continue to spike, but for whom? That is the question that should be addressed. Is the death rate spiking for the elderly, especially in nursing homes? Are they spiking for people with severe underlying health issues? Or are they spiking for normal healthy people?

“The ‘main stream media’, looking to scare the public through its fear-mongering, never seems to give these facts.”

 

At Blogfinger we encourage readers to express opinions, but they must adhere to our “rules” which include such concepts as no name calling, no attributing of motives, no false information, sticking to the subject, providing facts, no repetition of ideas, and others.   Our rules have been re-posted on top of this home page.

Kevin’s remarks, in my opinion, are ill informed and not backed up by facts. They are insensitive to all those who became ill or died in our area, in our state and in our country. They are disrespectful to all those healthcare workers who are truly placing their lives on the line to help others.

And he doesn’t tell us how he would change public policy at this time, and especially in the face of climbing numbers of infections.

However, giving him the benefit of the doubt, here are some facts for him and all of you to consider:

NJ.com offers a headline:  “NJ hospitalizations near peak.”

As of yesterday, April 9, 7,570 New Jerseyans remain hospitalized, and 1,663 are on ventilators—(NJ Department of Health.)

NJ.com reported:  “The peak number of hospitalizations is expected to hit within a few days, said the Governor, with a new total of 14,400 people expected to be hospitalized.”

“The number of cases reported and deaths from the virus continue to climb. Officials said at the Thursday (April 9) press briefing that there were 3,748 new positive tests and 198 more deaths reported during the 24 hours between Wed. (April 8 and Thurs April 9) bringing the State’s number of people affected to 51,027 and raising the death toll to 1,700.

The number of infected people would be even higher if more extensive virus testing could be done.  Some people who actually have symptoms report that they cannot get tested.  And there is another group of those who are infected and infectious but have no symptoms yet. No one will test them.

“And, as of today, April 10, NJ has 3,627 new cases and 233 new fatalities.  The total number of coronavirus cases for this morning April 10 is 54,588 and 1,932 deaths. “

And “officials on April 9 said the peak number of hospitalizations could come in two to three days.”

The New Jersey counties with the highest numbers of people who have tested positive are in Bergen, Essex, Hudson, Union, and Passaic.  But just below them are Middlesex and Monmouth counties.

In Monmouth County, as of April 7, there have been 3,248 cases with 98 deaths.  Neptune reports 156 positive tests, but there is no breakout for Ocean Grove.  Again, where are our local officials with the OG numbers?

Asbury Park has 60 testing positive so far, Belmar has 4, Bradley Beach has 13, and Avon-by-the-Virus has 9.  Ocean has 140. Long Branch 152.  Marlboro 239, Freehold has 226.  And Deal has 20, and Holmdel 100.

Kevin implies that the numbers are fake, and that we would have a totally different impression if only the reports were categorized by age, residence, and medical history. But to be complete, the risk categories ought to then be broken out by race, gender, socioeconomic group, geography, home conditions, community problems such as crowding, poverty, crime, sanitation, etc.

But although there are variations of risk within categories, that doesn’t change the fact that we are under assault by this virus and that it is peaking in our community as we speak. We are not talking mostly about numbers; we are talking about people.  So whether or not one group or another is at greater risk, we as a civilized society must view all the risks as all our concern.

 

Paul Goldfinger MD.  Blogfinger.net

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