Time for another COVID AMA
Just like the pandemic itself, Covid questions haven’t stopped. A quick update on where we are right now before we get into some questions.
Things still aren’t so good. The daily US death numbers are around 1,000 people. There is still a lot of community spread.
The state by state numbers have huge variation.
Things are worst in the Southeast and Sunbelt, where quite a few states have positive test rates of over 10%. Positive test rate as a function of total testing is a leading indicator suggestive of accelerating community spread.
Our testing still sucks. I know it’s the middle of August and I can’t believe this is our current testing situation, but it is what it is.
Faster and more frequent saliva testing seems like it’s on the horizon.
But there are pieces of good news for us to use to look at the bright side.
We’re getting slightly better at treating patients who are sick enough to be hospitalized.
It seems that the spread the virus seems to have plateaued in parts of the Southwest.
There are some suggestions that herd immunity may be closer than we initially imagined.
Is the Russian Covid-19 vaccine the real deal?
I doubt it. The vaccine hasn’t been sufficiently studied for effectiveness and there are real concerns about safety.
I’d take hydroxychloroquine before I’d take this vaccine. And I wouldn’t take hydroxychloroquine.
What’s the deal with these temperature screenings that I’m starting to experience in various locations?
Temperature checks have the feel of TSA screening. It’s a bunch of theater with little real impact on the outcome you’re hoping to influence.
Fewer than a third of patients sick enough to be hospitalized have fever. An even lower proportion of patients who aren’t sick enough to be hospitalized that have fever is going to be even lower.
As a consequence, temperature screenings are going to miss a huge proportion of people who could potentially spread Covid.
Seems like a waste of everyone’s time and effort to me.
What is the best type of mask for me to be wearing?
The best mask is one that you can wear without needing to frequently pull it below your nose.
As a consequence, I would emphasize comfort over theoretical effectiveness.
If you don’t have a surgical mask, then cloth masks with two layers of fabric that don’t have holes when you hold them up to the light may be a little bit better than more porous fabrics.
There are true differences in effectiveness of blocking particles between an N95, a surgical mask, and a cloth mask, but I suspect they don’t have a huge amount of practical impact.
Unless you’re exposed to a very high risk situation - think aerosolized droplets from people at high risk of infection or performing medical procedures - a regular mask is almost always going to be adequate.
Can I reuse my N95?
Reusing N95 masks decreases their effectiveness because they lose their fit. If an N95 doesn’t have a precise fit, it stops protecting you as a true N95, and this effectiveness seems to degrade with multiple days of wear.
The process of testing effectiveness of an N95 is a huge pain - look at this 12 minute video to get a sense of what we do at the hospital for our N95 testing.
What about a face shield? Can I use this for my kids?
While there isn’t clear data on this, we can apply some common sense to think about it.
A face shield is probably going to be better than nothing and less effective than a mask. The concern is that sneezing, coughing, and talking may lead to aerosolized viral particles escaping underneath the shield and possibly spreading infection.
What can I do to prevent Covid or reduce severity of my infection?
The advice hasn’t changed all that much since the beginning of the pandemic.
Wear a mask
Don’t touch your face
Wash your hands well
Physically distance
But if you want to go the extra mile, it might be worth considering the Forrest Gump approach to Covid prevention.
There’s a hypothesis that lifestyle factors that impact our levels of inflammation affect expression of the receptors that SARS-CoV-2 uses to enter cells, so I don’t think it hurts to focus on more exercise and reducing sugar consumption.
It won’t hurt and it might help.
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