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COVID-19 Update September 17, 2020: Is it Safe Yet? New Cuyahoga County Guidance on Returning to School & Lessons from South of the Equator where the Influenza Epidemic is in Full Swing

By Dr. Arthur Lavin

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
  • Symptoms- the experience of being ill, for example- fever, cough, headaches, loss of smell etc.
    • Asymptomatic– literally means “without symptoms”.  For COVID-19 it refers a person infected with the virus but has no and will have not symptoms
    • Presymptomatic– This is a person who was infected with SARS-CoV-2, and will feel sick, but hasn’t yet
  • 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.

 

Returning to School

Cuyahoga County’s Board of Health, headed by the nationally recognized Commissioner of Health, Terry Allan, recently issued new recommendations on how to consider going back to school in-person.

The initial recommendations, founded on very sound epidemiology of the current state of the pandemic here in our neighborhoods, was to not open schools, but to conduct learning remotely.  This recommendation was followed by almost all public schools in the County.  Curiously, it was not followed by most of the private and religious schools.

On September 14, 2020, our Board of Health issued a new set of recommendations concerning going to school and participating in sports.  Here they are:  https://www.ccbh.net/wp-content/uploads/2020/09/Return-to-School-Guidance-CCBH-9.14.20.pdf

The commissioner notes that policies should float according to how widely the virus of COVID-19 is spreading in the County.  If we are in an Orange or Yellow level of spread, where test positivity rates are below 5%, then a school can consider, going to a hybrid model that includes extensive efforts to keep the contacts between people in a school to a very strict minimum and that adopts strict contact tracing.

A couple of items stand out in the Commissioner’s updated recommendations:

  1. Our County Board of Health does not recommend, at this time, that it is safe to go back to school in-person full-time.  Instead, it suggests that if our region has a low enough transmission rate of this deadly virus, that a system can consider a hybrid model, which only opens the door to part in-person, part remote learning.
  2. The letter sets as the standard of safety a spread rate of 10 per 100,000 people which would translate to 120 cases a day in Cuyahoga County.  As of the last report, on September 4, we are at about 20-40 cases per day.

Dr. Michael Osterholm has gone on record to recommend the level of safety, defined as the level of spread under which gathering will very likely not lead to super-spreader events, as 1 in 100,000, which in Cuyahoga County would be 12 cases a day.  https://www.advancedped.com/covid-19-update-august-24-2020-three-important-updates-plasma-opening-new-testing/

The very good news is that at 20-40 cases per day, we are under the Commissioner’s threshold for concern and close to Dr. Osterholm’s.

Should current trends continue, very thoughtful increases in in-person learning can be pursued, with the urgent warning that the virus is not vanquished, and very, very far from gone.  Which means gathering again can easily re-ignite major outbreaks.  Which means we gather only if we can detect the first signs of such an outbreak bursting forth.

This is where the recommendations for returning to school only to the extent of the hybrid model, with strict attention to contact tracing, achieving true mask and distancing success, in both school and in sports.

The low rates of spread now seen in our County open the door to seeing if we are smart and capable enough to return to school with caution, with eyes open, ready to act when danger re-appears.

Lessons From South of the Equator Where Influenza Is Active Now

As readers of Real Answers hopefully know from many reminders, the influenza virus appears in our communities nearly every year around mid-December and disappears as strangely as it appears nearly every May, peaking around New Years.

But this same virus washes over lands South of the Equator at a different time, roughly around July-October, peaking generally around now, early September.

So every year we get a sneak preview of what our influenza winter epidemic will look like from South of the Equator.  This year we are particularly curious because these regions, just like ours, have been awash in COVID-19.

The results are striking.

Let’s start with Australia, take a look at the bold red line in this graph:

Number of Cases of Influenza Virus Infection in Australia each Season 2015-Now

Source Link

To get some idea of what you are looking at, these curves trace the number of people diagnosed not with any cold or flu, but specifically who have been proven to be infected by the influenza virus.  The number of cases is on the vertical, y-axis, and the month and week of time is on the horizontal, x-axis.  Each color line is a different year.

Notice how the lines tend to be near zero in January, February, mostly through June, except the light green line which represents cases last year, in 2019, when the influenza virus showed up early in April and surged in June and again in August, but disappeared as in all other years in October.

But one of the lines, the bold red one, is wildly different than the others.  It has no peak, it is flat, it hovers around zero.  This line tells us that in Australia, the influenza epidemic of 2020 never showed up, there is essentially no influenza there this year, for the first time in their recorded history.

This is not a triumph only seen in Australia.  The massive drop in influenza virus infections is seen in Australia, and Chile, and South Africa.

And why is that?

The data are convincing, when you stop the spread of the SARS-CoV-2 virus, you stop the spread of all viruses that spread in the air, which includes all cold viruses, and the influenza virus.

These patterns do not suggest or prove that somehow the spread of the SARS-CoV-2 virus halts the ability of the influenza virus to spread.

I find these observations reassuring, helpful, and terrifying, all at the same time.

The near elimination of the great annual influenza virus epidemic across the South of Earth is reassuring, for it dramatically demonstrates that large nations, across the planet, have it in their power to stop the spread of virus in the air, that now includes COVID and influenza.  That is terrific news because the spread of COVID-19 brings in its wake mass killings, so it is reassuring to know we can stop mass killings from happening.

The information is helpful, because across the world, and in the USA, we have long established abilities to track the influenza virus.  Readers of Real Answers over the years may recall that long before we offered COVID-19 Updates, we had Influenza Virus Updates.  All those updates were based on very detailed reports of how many people in each state had influenza.  Testing for this virus is widely available, literally in every hospital and nearly every doctors’ office.  This means we can trace how well America, and our neighborhood is managing to stop the flow of virus in the air by looking at our influenza virus patterns starting in mid-December, when they first appear here.

These data are terrifying, because they remind me that it is by choice, that we have chosen, to let nearly 200,000 die in America.  For no other reason than deciding to ignore the danger and let COVID-19 go where it will.  These data remind us that other people, other nations, have chosen a different path, and so in Chile, South Africa, and Australia, there are few deaths from COVID-19 and almost no deaths from influenza.  It is terrifying to live in a nation that knowing it could save so many soon to be hundreds of thousands of lives, has chosen not to.

Bottom Lines

  1. COVID-19 continues to spread across the United States causing illness and much death in its path.
  2. Children catch this virus and spread it very well.
  3. Good news in Cuyahoga County- our Board of Health led by the highly honored Commissioner, Terry Allan, has certified that when our County is in Yellow and Orange levels of COVID-19 spread, it is now acceptable for schools in Cuyahoga County to consider opening PARTIALLY and CAREFULLY.
  4. By Partially the idea is to only open in a Hybrid model of part in-person and virtual.
  5. By Carefully the requirement is that the school be able to track the appearance of COVID-19 in their school community, contact trace, all so that outbreaks are contained early while small.
  6. There is NO recommendation from the Cuyahoga Board of Health for schools to fully open at this time.
  7. Cuyahoga County case numbers are thankfully down, we hope they continue to drop, but the danger is not past.  Just look at Israel which had low case numbers, but re-opened carelessly and now is facing one of the worst outbreaks in the world, closing the entire nation down for 3 weeks starting this Friday.
  8. The word from the Southern Hemisphere is that if we succeed in stopping the spread of COVID-19, the influenza epidemic of 2020-2021 could be a major dud.
  9. And, it turns out, the tracking of the annual influenza virus campaign will give us a good indicator of how successful our ability to stop COVID-19 is going.

And, we close with a reminder for all families in Advanced Pediatrics, we have the flu shot in the office, book your appointment now while our supplies last, this year if we do not control the spread of COVID-19, having a flu  shot could turn out to be very important.

To your health,
Dr. Arthur Lavin

 

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