Coronavirus: Getting Back to Normal Means Living a New Normal

Here in Massachusetts, the numbers are sloooowly improving. Per the MA Department of Public Health COVID-19 dashboard, here is where we are as of Sunday May 17:

Here at my hospital, our COVID-19 admissions have come down to a reasonable simmer, with 246 inpatients, 75 in the ICU. (That’s down from a peak of over 400 inpatients, and almost half of those in the ICU). As a matter of fact, just last week I was all set to work another block of inpatient shifts on a COVID-19 surge floor. But the night before– even after I had taken signout–I was notified that there were so few patients on the floor, they moved them to different unit and converted my floor back into a surgical unit. I was off the hook! And back to telemedicine…

This is good, but we’re not out of the woods yet. Look at the chart, and that spike that began around April 23rd. Gee… What was happening around ten days before that? Oh yeah, EASTER.

So let’s talk about that, about Easter, and about how this virus spreads. This will help us to understand how not to spread it, which is important because this will need to be our new normal, if we want to get back to normal, ever.

Maybe someone could analyze some of the best-documented COVID19 outbreaks and point out what they had in common, so we can avoid these situations. Oh wait! They did that! In this really helpful article, UMass biology professor Erin Bromage uses plain English to sift through a bunch of global “super-spreader” events, and describes how infections happened:

“All these infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events.”

It’s a great article, and I recommend it, but here’s the main points:

No one at these events was wearing masks yet. Data show that if everyone is wearing a mask, especially the person who actually has the infection, the risk of spreading it is significantly lowered (and I wrote all about it already).

Some studies define “prolonged contact” with others that increases risk of transmitting infection as fifteen minutes or more. Limit your time spent indoors with other people to fifteen minutes or less, if possible. This can be longer if you are moving through a large space and you’re not near the same people for any amount of time (like grocery shopping). And even longer if the ventilation is really good. And even longer if you’re outside in the open.

And don’t forget hand hygiene! Washing hands well with soap and warm water for at least 20 seconds, or rubbing alcohol-based hand sanitizer all over your hands can help kill many germs, not just SARS-CoV-2. Make it a thing. And then don’t touch your face.

So if we want to try to reopen, let’s all wear masks, avoid prolonged (over fifteen minutes) indoor interactions, and wash/sanitize hands like crazy. If you have to be indoors with others, wear masks, be as far apart as possible, and make sure there’s really good ventilation. An outdoor gathering, especially out in the open where people are moving around, is ideal. Sharing food with others, no matter where you are, is not ideal.

If everyone can do this, then we can get back to business. It’s not normal, no, but it’s a new normal, and everyone needs to realize that.

*****************************************

For more reading that outlines evidence-based guidelines for getting back to “a new normal”, see Professor Julia Marcus’ article in the Atlantic, or physician/ writer Atul Gawande’s piece in the New Yorker. Happy reading!