And so we drag over the two year mark with COVID. More variants, more sickness, more cases. And things will “likely get worse” according to experts. I have seem greater numbers in my facility, and “surprise” cases (we test on admit, thankfully). Objectively, we have more cases now than when we tried to lock down! Notice I said tried, because obviously it didn’t work out as planned.
Nevertheless, the CDC has changed guidelines to make it easier for people to get back to work. Or if you’re more cynical, to make it easier for companies to force people to get back to work. Nurses — both union and not — came out against. Other unions, including flight attendants, came out against. Will that change anything? Not known.
For the record, my company has a policy saying don’t come to work of you have a fever, productive cough, vomiting, diarrhea, generalized rash, conjunctivitis, or have been instructed to quarantine. People who are sick should stay home, period. Don’t try to soldier through, because you’ll both do a halfway job and potentially make other sick. I encourage everyone to follow this sane advice even outside a pandemic.
There is good news, however. The influenza rate is sharply down over the pre-panda era. In my area, we’ve had less than two dozen hospitalizations and (so far, knock on wood) no deaths. In fact, one line of influenza may be extinct!
Keep your hands clean and your masks on, folks. The mask goes over the nose, by the way.
Yesterday, I received notification that COVID-19 data would be reported to the Department of Health and Human Services instead of the CDC. That change is effective today. This abrupt change was sent to me from the Association for Professionals in Infection Prevention, then confirmed about a half hour later by email from the CDC itself. As an Infection Preventionist, my duties include reporting regularly to the CDC’s National Healthcare Safety Network. Until today, this was the single largest and most accurate repository of infection information in the United States.
Some hours later, the various news services got wind of the change.
Sometimes professionals use words in very specific ways that aren’t obvious. Just the other day I realized that is what happened with those two words. My Facebook friends have seen me very carefully point out articles like these, which suggest than COVID-19 is airborne, rather than droplet. I did this carefully because before yesterday, the WHO and CDC staunchly denied any such thing and today the WHO merely confirms that there is “emerging evidence.” Today I want to explain why it’s different, and a really big deal, in fairly simple terms.
Standard precautions are what we do to protect everybody at all times. This includes keeping your hands clean, using disposable gloves, and changing those gloves between patients. Hand washing is still the most important thing you can do to keep from getting or transmitting any disease. It’s so important the CDC has an entire section on it.
When we know a person has certain infections that could spread, we use Contact precautions. This is for fairly heavy organisms that can survive for a while on surfaces, and that we can inadvertently transport to a new victim on our hands or clothing. One such organism you may have heard of is MRSA, Methicillin Resistant Staphlycoccus Aureus. We also use Contact for more mundane bugs like head lice. For Contact, we make sure to use gloves, treatment gowns to cover our clothing, and we are extra sure to wash our hands after taking our gear off.
Now for the meat of this discussion. Droplet precautions are for organisms that can move in droplets we create when we talk, cough, or sneeze. These droplets can go maybe 6 feet or so (that’s where the 6 feet apart for social distancing comes from) before they go SPLUT! onto a surface. Droplet precautions always includes Contact precautions. That surface can be somebody else’s face, which is why the protective gear for Droplet precautions includes a facemask and ideally eye protection, in addition to gloves and gown. The most common organism for which we use Droplet is the Flu. Remember, up until yesterday, the WHO insisted this was all we needed to protect ourselves from COVID-19. And as of this moment — subject to change without notice — the CDC still does.
By contrast, Airborne precautions are for organisms that can float in the air a long ways and a long time. Much farther than 6 feet. And to do this, they are very small and very lightweight. Examples include Measles, Tuberculosis, and Ebola. These bugs are small enough to get through and around normal surgical masks. These patients should be cared for in a special “negative pressure” hospital room — the HVAC system is designed to create lower air pressure than in surrounding areas while still having fresh air move in and out, so germs aren’t likely to go into the rest of the hospital. To care for these patients, you need special masks, such as N95 or a powered respirator, and they need to fit correctly to prevent germs getting around the edges. That’s over any above gloves, gown, shoe covers, hair covers, and eye/face protection.
As you can see, there’s actually a huge difference between droplet and airborne transmission. And although many experts have privately held that COVID-19 is airborne, its a huge step for the WHO to admit that. I hope the CDC joins them shortly.
Masks in public has become the new normal. So let’s talk about this for a few minutes.
Masks are a whole lot like condoms: they do work; they only work if you use them, and use them correctly; they don’t work with holes cut in them; and they are not foolproof — you and the people around you are safer if you’re all doing something to prevent the spread of disease.
Nor are masks a substitute for things like quarantining the sick, isolating those who are known to have unprotected exposure, washing your hands, or social distancing. Hand hygiene is still the number one thing you can do to keep from getting almost any disease — it will even stop you from accidentally making somebody else sick. That last point is really important, because people can spread COVID-19 two days before they feel sick, and worse yet they can spread it and never feel sick at all.
Again, just like condoms, masks are only one tool to prevent the spread of disease.
We haven’t got a cure or a vaccine for this thing yet. Prevention is literally all we’ve got to prevent more people from getting sick and possibly dying.
Now for those of you who like actual research results: here’s the Mayo Clinic; Journal of the American Medical Association (JAMA); some research from Hong Kong; and The Lancet. For those of you who are total data nerds, here’s some more fine studies.
Wear the damn mask, people. There’s nothing “unconstitutional” about it. Your “rights” end when you interfere with the rights of others, such as when your selfishness accidentally spreads disease.
Today I would like to make some comparisons between COVID-19 and Influenza. For simplicity, we will look at data from the Southern Nevada Health District, which serves Las Vegas and surrounding communities.
This page will give you SNHD’s flu reports. Flu season is generally considered to run from October to March or April here. Let’s call it 6 months. Please note that when they refer to the week number, they mean for the year. So the first week of January is week 1. It is true that we never know exactly how many cases of the flu there are (the CDC estimates tens of millions of cases and tens of thousands of deaths nationwide). That’s because a lot of people recover at home without tests or hospital visits. However, if you look at the latest report, you’ll see that 47 people died of the flu this flu season. This number is pretty close to accurate; someone is either dead or they are not.
The fact I want to point out is that as of April 29, Southern Nevada has had 202 deaths from COVID-19. In 6 weeks, 202 COVID-19 deaths, compared to 47 influenza deaths due to influenza in 6 months. Same population. Same location. Same risk factors. That’s four times as many deaths in about a quarter of the time.
In a nutshell, that is why we need to take this thing seriously.
I have become aware of voices on the Internet saying we shouldn’t waste time on a vaccine, but go for a cure. I would like to remind those folks that we never did get a cure for measles, polio, or rabies, just a vaccine. Even tuberculosis had a vaccine decades before we had a cure.
Stay safe out there. Wash your hands. Don’t stand too close to other people. Wear your mask in public. And remember that the economy is meaningless if you’re dead.
First, I’d like to point out that at best this is a minimum number, and may in fact be a wild underestimate of the people who have lost their job in the last 3 weeks. Many state systems were slammed by not just 2 or 3 times normal volume, but 20 or 30 times normal volume. Turns out that many of these systems work using an ancient operating system called COBOL. For perspective, my late father used COBOL in the 60s and 70s. As if that’s not bad enough: “Still more people likely won’t qualify for unemployment benefits: parents who have to stay home with school-age kids, people quarantined because they’re at high risk for COVID-19 and new graduates who can’t even look for work.” That number probably doesn’t include most “gig economy” workers either.
Another direct ripple: those 16M+ people now don’t have health insurance. In a pandemic. I talked about this briefly very recently. COBRA is still a joke. If this isn’t a wake up call that we need true universal health insurance — not a patchwork of employer based benefits, not the “mandatory insurance” that Romneycare and Obamacare got us, but true “your citizenship is your insurance” universal health insurance — I don’t know what is. A lot of people are going to get a bill for tens of thousands of dollars just to keep from dying. And unlike diseases that can be traced to lifestyle, you can’t easily blame the victim. Keep that bill in mind, we’ll get back to it later.
A public health ripple: those unemployed people without insurance aren’t going to the doctor. They aren’t getting help for their small medical problem, so it’s becoming a bigger, more expensive medical problem. And if the problem turns out to be a communicable disease, they’re making other people sick. So yeah, the uninsured are a problem to your health.
Another ripple: people without jobs are having a hard time paying their rent or mortgage. Some of the renters who can’t pay in turn mean landlords can’t afford the mortgage. Sure, many areas have placed a moratorium on eviction and foreclosure, but that’s not a permanent solution. The forbearance plans in place still mean someday everything owed must be paid. Not meaning to sound insensitive, but how far do we kick the can down the road?
And here’s where our ripples crash into the rocks. Eventually — not today, maybe not this quarter. Eventually, those rents and mortgages must be paid, or foreclosures and evictions will happen. Eventually the past due bills will grow including the medical debt, and bankruptcies will happen. Eventually we will have to confront the ways our health care system is not working. Eventually we will have to look at whether we can sustain an economy on services. Eventually we will have to come out of our shelters and see what is actually left of our economy.
Some of these are things we are now learning. Some are things we should have long since learned but are now becoming obvious.
We should be taking medical advice from medical experts, not politicians. Insert the Fauci Facepalm here. Some of our Governors are remarkably well informed, because they choose to be informed by medical experts. Gov. Cuomo’s presentation Sunday was particularly level, and riddled with facts. Gov. Sisolak is doing the best with what he’s got. I wish him and NV Attorney General Aaron Ford much luck making banks follow rules.
Employer based insurance was [still] never going to cover everybody. Long time readers know I’ve been beating this drum for over a decade. First, it’s never going to cover all children. Second, it inhibits the growth of small business. And finally, there’s the unemployed. Which brings me to….
The uninsured aren’t somebody else’s problem, they’re everybody’s problem. Cancer isn’t communicable, nor diabetes, nor hypertension. But TB sure is. And now, COVID-19 sure is. There’s a couple of problems with the uninsured in an epidemic or pandemic. First, people who don’t think they can afford a doctor are not going, not getting help, probably still going to work (because they can’t afford not to work, duh), and most importantly infecting other people. So yeah, now it’s your problem. Oh, I said a couple problems, didn’t I? All those unpaid costs are going to drive your medical costs up. The hospital isn’t getting paid for a bunch of critically ill patients? Your bed cost goes up.
It turns out a lot of jobs can indeed be done from home. I’m hearing radio shows from home studios, seeing TV shows done via videoconference. There’s a lot of “important meetings” that can now be done remotely, or not at all. That is a trend I hope sticks. Of course, this may mean that business travel is in for a longer term slump, since it’s easier, safer, faster, and cheaper to teleconference to San Jose than fly there.
It turns out a lot of jobs are essential. We all knew medical personnel, firefighters, and the like were essential. Some of us in reality-land also knew that “environmental services” (cleaning staff) were essential — I can’t keep people from getting diseases in a hospital if the hospital isn’t clean. Maintenance staff? Essential. Supermarket staff? Essential. Oh yeah, and that “kid” who makes minimum wage making your burger at lunchtime when an actual “kid” should be at school? Essential.
$1200 a month isn’t a lot of money. I don’t know if Congress actually considered this, but with a minimum wage of $7.25/hr, 40 hours of minimum wage a week for 4 weeks is $1160. Round that up to the nearest $100, and that’s $1200. So if you’re kvetching that you can’t pay your bills on that, think about the “essential” employee who does just that. More on what Congress did here.
