Friday, March 6, 2020

COVID-19 in TX. Take Another Deep Breath, Y'all.

Well, Howdy Folks!
      So, the new coronavirus has made it into TX. Sure enough, someone traveling out of the country and then back into Texas, was infected somewhere along the way. And he was not part of the repatriation and quarantine efforts in San Antonio. Let's talk about where this person is and what this means.

      A Fort Bend man in his 70s was confirmed to have COVID-19 by a Houston city lab. This identified case near Houston, and the virus showing up in a city near a major airport, is what I have been expecting. In fact, living near Houston myself, I have been telling my friends and family this. It's what we are seeing in WA, OR, and CA with cases near Seattle, Portland, and San Francisco/Oakland/San Jose). The good news here is that unlike in those areas, this TX case is the person who traveled, not someone who was exposed in the local community. This means the public health department can trace this person's contacts since he returned, and the contacts of those people, etc, in an effort to keep this line of transmission from, hopefully, turning into a larger outbreak. But what does it mean for the rest of us in surrounding areas?

What Now?
      If you live in the area, there is no real risk from this person unless you were in his circle of contacts. If that's the case, you will be contacted. If you are not contacted, but you know you were in contact with him, then contact the Public Health Department to let them know.
      For the rest of us, the situation remains the same. Because we are in an area near a major airport, I recommend social distancing: avoid crowds, air travel, and sick people. Wash your hands with soap and water as you always should, right? 20 seconds. Really get in there. Avoid touching your face. Clasp your hands in your lap if that helps. Avoid handshakes. Give someone a nod, instead.

Do we need masks?
      The truth is that the only people who actually need masks are those caring for people with health care settings or at home. People simply walking around and going about their day do not need a mask if they are practicing the protective measures we should all be practicing. Let's reiterate what we should be doing. With bullets:
  • Stay 6 feet from strangers who are coughing.
  • No handshakes. Nod and smile.
  • Get your flu shot - don't let the flu confuse the issue
  • Cover coughs. Every damn one.
  • Wash hands. With soap, people. 20 seconds.
  • Avoid touching your own face. Don't touch strangers' faces either. That would be weird.
  • Sanitize surfaces, including cell phone - front and back.
  • Don't share drinks/toothbrushes/eating utensils
  • Use tissue to open public doors etc. Clean tissue. You knew I meant clean tissue, right?
  • Avoid crowds - that means church, concerts, airplanes, rodeos, 'Cons' of all kinds, and yes, political rallies.
  • Schools/work - follow all precautions above while at work and school. If someone is diagnosed with this virus in a school or business, they will likely close temporarily to sanitize and do contact tracing to prevent further spread. Unless and until that happens, keep plugging along.
  • If you have cold or flu symptoms STAY HOME from school or work. Forgive me for yelling, but please, stay home. Keep your child home. It really is important for preventing spread. 
      We do those things, we are good. We do not need masks. And the truth is, masks will not provide the protection you think they will, anyway. Here's why.
      "Masks" can be one of many things in this context. What we hear about the most are surgical masks and N95 respirators.
      Surgical masks: These people in China are wearing surgical masks. But they are doing it wrong. Surgical masks are not designed to protect the person wearing them. They are designed to protect the people around that person. For example, to protect a patient on an OR table from being coughed on by the surgeon. You don't want your ureteroscopic kidney stone removal contaminated by Dr. Coughsalot, do you? I didn't think so.
      If a person develops respiratory symptoms, then a surgical mask can be worn by that person with symptoms, to protect those around them. That is what they are for and how they should be used. What you see in the photo, gives people a false sense of security. This mask cannot keep infectious virus droplet from reaching you if a sick person standing in front of you coughs on you. Microscopic aerosols of infectious virus will find their way into that mask. Will they find their way out of the mask? Sure, some will. But because of airflow and physics, the fallout from that will be far less than the other way around. Pun intended.
      N95 Respirators: These masks are made and tested to protect people from infectious aerosols generated by coughing. Unfortunately, they require proper fitting, which, I can tell you, is no small task. Check out this photo. That is a man being fit tested for an N95. That hood is for the test. To better understand the reality of fit-testing an N95, I recommend this twitter thread. It's fantastic. Read it and you will understand this idea a lot more. Suffice it to say, N95s will not work as you think they will unless they are fit tested properly. So having them around for this outbreak is unnecessary and creates a shortage for the people who actually do need them, our health care providers.
      If you'd like more info on aerosols and what that means for risk of infection by someone coughing, this post from one of my favorite virology blogs, Virology Down Under, is all you need to check out.

The Bottom Line
      This virus is a newly emerged virus that causes respiratory illness in humans. We have no existing immunity, so everyone is susceptible. It will move through communities unless transmission can be stopped early through appropriate public health measures. The most vulnerable are the elderly and the sick; those with compromised immune systems.
  • Symptoms of COVID-19: respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. There are also reports of gastrointestinal symptoms appearing before the respiratory symptoms. It's possible it could start with nausea, vomiting and/or diarrhea. This is not uncommon for coronaviruses.
      So let's take care of the vulnerable by taking care of ourselves. By following the guidelines above and doing what we can to stay healthy. Don't panic. Be smart. And stay informed. Follow me on Twitter (@pathogenscribe) and you will have access to some amazing scientists and reporters covering this pandemic. And if you see info from a public health official that contradicts what other experts are saying and you're confused, go ahead and ask questions. We are learning in real time here, so as new data roll in, inferences will evolve.
That, my friends, is the inimitable beauty of science.

Stay healthy,


Respiratory Protection for Airborne Exposures to Biohazards
NIAID’s RML in Hamilton, Montana, images of the novel coronavirus
How to Prevent the Spread of Respiratory Illnesses in Disaster Evacuation Centers
The efficacy of medical masks and respirators against respiratory infection in healthcare workers

Useful links
WHO Rolling updates on coronavirus disease (COVID-19)
CDC Preventing COVID-19 Spread in Communities
CDC: About Coronavirus Disease 2019 (COVID-19)