Reopening Maryland: Yay Or Nay

Governor Larry Hogan  on May  14 gave the go-ahead to reopen Maryland on a limited basis, but he allowed the individual counties to have the final say. His decision was based on the fact that hospitalizations and death rates from the COVID-19 virus have stabilized across the state. Our Anne Arundel county executive, Steuart Pittman, realized that both of our county hospitals still haven't shown a decrease in admissions or deaths, so there have been few reopening changes for Anne Arundel County so far.

Many governors across America have loosened their restrictions that the COVID-19 coronavirus has placed upon us. This could be viewed as a great decision to advance toward a Phase 1 of slowly resuming our way of life, or it could be the wrong decision. In reality, it all depends on us and how we behave moving forward.

The following information is based on a few articles that I have read from very credible sources. My opinions have always been science-based and not borne from my “gut instinct.” Supposedly, Maryland has peaked in its COVID outbreak, but please remember, the backside of the curve declines slowly with deaths continuing perhaps for months, even with a social lockdown. As Maryland reopens, we will be giving the virus more fuel.

The big wild card is the fact that this disease can be spread before symptoms start. Unfortunately, there have been many transmissions of this virus by asymptomatic people, as the virus symptoms start approximately five days after infection. Infectivity starts before symptoms do, it peaks right around the day that symptoms start, and it declines substantially within five days or so. Nonetheless, patients who do not yet show symptoms, or have just begun to, are turning out to be important vectors of disease. That’s why we combined social distancing with masks. They provide “source control” — blocking the spread of respiratory droplets from a person with active, but perhaps unrecognized, infection. They are designed to safeguard others, not the wearer. The basic logic is, “I protect you; you protect me.”

Some examples of how the infection spreads:

Sneezing is the worst and this action releases droplets in a very wide area.

Coughing releases aerosol droplets that can stay in the air for a small period of time.

Speaking also releases aerosol droplets and more so than just breathing.

Breathing releases droplets but at a lower velocity and distance.

Therefore, a higher rate of infection is caused by the concentration of the virus and the propulsion of the respiratory droplets. Most people get infected in their own home. Somebody contracts the virus in the community and brings it into the house where the infection then occurs. A high concentration of the virus combined with extended time of exposure will lead to infection.

The biggest outbreaks are in any environment that is enclosed, with poor air circulation and high density of people! The main sources for infection are the home, workplace, public transport, social gatherings and restaurants. Wherever and whenever people are up in each other’s faces, laughing, shouting, cheering, sobbing, singing, greeting and praying can be considered high-risk behavior for the spread of the virus.

Outbreaks from shopping appear to be responsible for only a small percentage. The low density, high air volume and the restricted time you spend in the store contributes to the low infection rate. There is also a low contagious effect with people being outside due to the low concentration of virus in the abundant air as well as the small amount of time exposed.

While focusing on respiratory exposure here, please don't forget surfaces. Those infected respiratory droplets land somewhere. Wash your hands often and stop touching your face! Bathrooms have a lot of high touch surfaces, door handles, faucets and stall doors. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.

As a physician, I lead by example, especially in my primary care office in Arnold. Since the COVID crisis started two months ago, we have separated the evaluation of our respiratory patients by seeing them only outside in our parking lot. That means the inside of our office is not being contaminated by the sickest patients of this nasty virus. We are also taking precautions on the inside of our office by screening both patients and staff with temperature readings, maintaining social distancing, wearing masks, washing our hands frequently and using hand sanitizer robustly. We are testing patients for the actual viral infection by swabbing either their nose or their mouth and also performing the blood-based antibody tests, which will show if they have been infected with COVID-19 in the recent past. Both of these tests have high accuracy rates.

There are four elements to our strategy of containing this virus —hygiene, social distancing, testing and wearing masks. These will not return us to normal life, but, when signs indicate that the virus is under control, they could get people out of their homes and moving again. I have come to realize that there is a fifth element to success: culture.

Culture is the fifth, and arguably the most difficult, element of a combination therapy to stop the coronavirus. People tend to focus on two desires: safety and freedom; “keep me safe” and “leave me alone.” But we don't live in an individual bubble or solo on an island. In our society, we have to interact with others. It’s one thing to know what we should be doing; it’s another to do it, rigorously and thoroughly.

A recent extensive review of the research from an international consortium of scientists suggests that if at least 60% of the population wore masks that were just 60% effective in blocking viral transmission — which a well-fitting, two-layer cotton mask is — the epidemic could be stopped.

Therefore, people need to make their own good choices when resuming the reopening of society. Please practice these elements of hygiene, social distancing, testing and wearing masks. It’s about never wanting to be the one to make someone else sick. That should be the grass roots of our American culture.

The basis of this article was taken from the articles below and I would like to thank and give credit to these authors.

Dr. Atul Gawande
https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry

Dr. Erin Bronbage
https://www.erinbromage.com/post/the-risks-know-them-avoid-them?campaign_id=9&emc=edit_nn_20200511&instance_id=18384&nl=the-morning&regi_id=124147567&segment_id=27239&te=1&user_id=7285fe9fc8a7b2297175cd18525f1d6b

Jonathan Kay
https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/