Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
• Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.
• Live Virus Swab– this is the swab which attempts to swipe live virus from one’s nose or throat to see if you are currently infected.
• Antibody Test- (aka serology test) this is the blood test which looks for antibody to the SARS-CoV-2 virus to see if you have been infected in the past.

Spreadability

Memorial Day 2020.  

This is an strange, ominous, and unique Memorial Day.  No parades, closed swimming pools.  Summer has begun, but this Memorial Day, we truly are faced with remembering the people whose lives were lost from the SARS-CoV-2 virus, just this year.   As I write this post, that number is 99,396, which means we will mourn the loss of over 100,000 Americans this week.

And so summer this year opens on a grim note, even though the sun is shining and the light is glorious, we find ourselves hesitating.  Do we throw caution to the wind and lean on the protection of being outdoors, flock once more to the beach, send our kids to summer camp, go to the pool?

Some More Basics on How Viruses, and this Virus Spreads

As long as a deadly virus is present, and able to spread, the answer to any question regarding any activity has to be:  how much more likely will my participation make me coming down with COVID-19?

So the first point to be made is that the virus that causes COVID-19, the SARS-CoV-2 virus, is still all around us. This virus has not gone away yet, it is here, and it is in every country, every state, even today.  We know this, because we have heard of the one hairdresser exposing 91 people to the virus, the rises in cases being reported this week.

The only good news about this virus is that is doesn’t spread as well outside, and sunlight appears to neutralize it (but don’t try to shine light inside your body).   It appears the most likely place to get COVID-19 is in an indoor room with many people, even if only one has the infection.   It is in these settings that we are hearing of large outbreaks, you have heard of some of them- churches and any place of worship (even one time large funerals), large factories with densely arranged indoor workers, nursing homes, prisons, homeless shelters.  And so being outside helps, that is good news.

One could hope that the SARS-CoV-2 virus would go away in the summer.  Lots of viruses do, and I mean lots, like the influenza virus, RSV to name two, basically gone from our towns until next winter.  But this virus has not vanished in the warm weather, at least not yet.  So that is bad news.

More bad news, although indoors is worse, outdoors is not entirely safe.  In Arkansas, several people came down with COVID-19 only after exposure at an outdoor pool party.

The question remains,  as long as a deadly virus is present, and able to spread, the answer to any question regarding any activity has to be:  how much more likely will my participation make me coming down with COVID-19?

There is a range of answers that question, and they are all determined by how many contacts those contacts you just had connect you to?

At one extreme is the case of the lone individual in a cabin stocked with two years of food and water, 20 miles away from any other human.  That person has no chance of catching COVID-19.

An isolated home is also fairly safe.   That is one home where everyone in the home knows they have not left the home property for over two weeks, there is some exposure from deliveries of food, but not much.

The number of contacts rises if members of a home go to work.   And that number rises, again, according to the total number of contacts someone brings home.  How is that number calculated?

Consider the case of one 29 year old man who in one Saturday night connected to 7,200 people.   He attended 3 nightclubs in South Korea, say he was within 6 feet of 500 people, and that each of those 500 people were within 6 feet of about 15 people that night.  That would be 500*15= 7500 people.

Now reverse that flow.  Say you go to work and 15 people are at work, but each of them have been within 6 feet of 100 people over the last week.  That means you have been exposed and in contact with 1500 people’s viruses!  And, when you go home from work, you are bringing exposures from 1500 people home.

That same analysis can be performed for any place anyone goes, let’s try it out at summer camp and swimming pools.

Thoughts on Summer Camp in the Era of COVID-19

What could be more innocent than summer camp?  It’s just kids, it’s outdoors, they are just having fun.  And who doesn’t need some fun after 2 months of isolation?

But summer camp is no different than home, grocery store, work, anywhere.  It’s a place like everywhere, where people get together, and the SARS-CoV-2 virus will transmit once enough people get within 6 feet of each other.   That’s true anywhere, as long as this virus is around people who have not yet been infected by it.

Let’s take one camp I was asked about as an example.  This camp demands no camper attend until negative no more than 4 days before camp begins.  The cabins will be less full.  Counselors abide by restrictive contact measures too.   Now, I suppose, if I sent my kids to a camp that had say about 6 campers in a camp built for 200 or so, and that no one got within 6 feet of anyone, and everyone was negative before arriving, that would be a fairly safe bet.

But.  And here we go, no camp will only have 6 campers.  Can you imagine a bunch of kids staying 6 feet apart from each other all day and night? And how about the 4 day negative test idea.  Say you test your kids on Thursday, and camp starts Sunday.  How sure are you that your kids won’t give a big hug goodbye to all their dear friends who are not going away for the summer?   And how about the bread at the meals, who is delivering that?

All it takes is for one person with COVID-19, even with no symptoms, to come within 6 feet of someone who has not had it, for the virus to spread.  This virus has leaped from China to Wyoming, it takes little imagination to think it can leap from Cabin A to Cabin B.

Thoughts on Swimming Pools in the Era of COVID-19

The same thinking is true at any swimming pool.

I suppose that there is a community pool somewhere that will only let one person in the pool in a day, that pool will not spread this dread virus.

But kids thronging pools, like they do and should every summer, will allow the virus to spread.  As we saw above, contacts pile up and fast.  Imagine 50 kids in a pool, and that 25 of them have parents who go to work with say about 15 exposures to people within 6 feet each.  That means every child in the pool just got in contact with 1,250 contacts!  More than enough to get an outbreak going.

We know this is so, because of the spread of the disease at the pool party in Arkansas.

This is so well known that all area swimming pools have decided to close for the summer already.

BOTTOM LINES

1. The SARS-CoV-2 virus remains in our midst.  Get together, and it will spread.  Stay really apart and it will not.
2. It spreads best in indoor areas with lots of people in one room.    Even now, large gatherings of people can and do spark outbreaks.
3. It does not spread as readily outdoors, but it does spread outdoors.
4. Putting these simple facts together, the more people packed together, the more risk of COVID-19 infected those in the group.  This makes attending camp and going to crowded pools a recipe for increased risk of getting infected.  As a result, many pools and many camps have already decided to close for the summer.

Our advice is to reduce exposure, decrease the chance of getting infected.

This will be a summer of fun at home for many kids, but there are many ways to make that fun, and at the same time protect so many people, including yourselves.

To your health,
Dr. Arthur Lavin