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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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Paul Goldfinger MD,  Blogfinger.net

MEDSCAPE.  “Fauci, the outspoken director of the National Institutes of Allergy and Infectious Diseases, said the United States was starting the flu season with a high baseline of around 40,000 new cases a day and deaths are averaging around 1,000 daily.”

CDC.  (data based info.)

Restaurants appear to play a key role in the spread of COVID-19, researchers at the Centers for Disease Control and Prevention (CDC) say.

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” write Kiva A. Fisher, PhD, from the CDC, and colleagues.

“In addition to the difficulty of wearing a mask while dining, some reports have implicated the ventilation systems of restaurants, the researchers note.”

COVID19.NJ.GOV. (New Jersey)   Bars and restaurants can reopen for indoor dining at 25% capacity on Friday, September 4, 2020.

Editors note:  When we went to Bonney Read restaurant last week, they offered some indoor seating, but no one accepted the offer.

DAILY NJ NEWS ROUNDUP.   From Montclair State University:  Total NJ cases as of 9/15/20 is 197,404.  Total deaths (most lab confirmed) are 16,043.  Statewide transmission rates are still too high

MEDSCAPE MEDICAL NEWS:

“If a second wave of COVID-19 hits the United States, the nation will be much better prepared,” said Admiral Brett Giroir, MD, assistant secretary for health at the US Department of Health and Human Services, because “the availability of equipment and testing has improved and communication is better.”

“Ventilators alone in the Strategic National Stockpile, which numbered about 9,000 at the beginning of the pandemic, now number 119,000, he reported.”

“We are never going to use all those ventilators, but they are there,” he told the audience during his plenary at a virtual conference organized by the Society of Critical Care Medicine (SCCM), entitled COVID-19: What’s Next. Preparing for the Second Wave.

DAILY NEWS ROUNDUP. from Montclair State University.

National data:  New cases are down an estimated 38%, hospitalizations are down 37%, ICU patients are down 50%, and deaths are down about 10%.

AMA MORNING REPORT:   Federal officials “outlined details Wednesday of their preparations to administer a future coronavirus vaccine to Americans, saying they would begin distribution within 24 hours of any approval or emergency authorization, and that their goal was that no American ‘has to pay a single dime’ out of their own pocket.” The officials with “Operation Warp Speed – the multi-agency effort to quickly make a coronavirus vaccine available to Americans – also said the timing of a vaccine was still unclear.”

The Hill   reports that more people than average “are dying from dementia this year as seniors battle the coronavirus pandemic, according to an analysis of federal data by The Washington Post.” Patients are “dying from dementia at higher rates because of isolation measures in place amid the coronavirus pandemic, the Post found.” People who are “over 65 were encouraged by health officials early on to isolate because of their vulnerability against the virus.”

Blogfinger segment from our May article about pandemic risks in Ocean Grove:

“When they discuss epidemic concerns, which they almost never do publicly, the CMA never mentions the several thousand citizens who live here, and those numbers go up sharply in season, and that population will be at increased risk with the importation of huge numbers of strangers coming and going from our town.”  There will be a big event next Saturday, Sept. 19, 2020.

Blogfinger commentary:  Paul Goldfinger,  MD.  We want to believe that we are going through a sort of step-wise logical process that will have a predictable ending, but we don’t know, and it seems that we have now entered a stage of  “wishful thinking.”

I saw some photos of Jersey tourists visiting Amish country in Pennsylvania. They are going on horse rides, buggy rides, petting zoos and farm tours, but also there are motels and restaurants.  In the photos the tourists and the the Amish nearby are not wearing masks.
Internet talk about the Amish describes COVID-19 spikes due to their lifestyles.

So when these tourists return home, they need to avoid contacts with others for two weeks.  Health departments in Amish country are concerned.

Dr. Fauci thinks that this pandemic will be with us for quite a while into 2021, so we can’t be complacent regarding this invisible invasion.

Please, please:   a vaccine!

FRANK SINATRA.      Don’t lose sight of   “a marvelous view.”

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