A Webinar on Reopening and Operating a University During the COVID-19 Pandemic

Accountable Health, LLC has been working in an advisory role to St. Edward’s University and Baylor University to help them on their reopening and operating plans. St. Edward’s was recognized by the Austin Public Health Department during a press conference regarding their plans which you can listen to below:

The Validation Institute along with the World Health Care Cngress held a very well attended webinar discussing the plan St. Edwards created and their experience to date entitled

Roadmap to Safely Reopening: Evaluate Rapid Testing and Gain Strategies to Move Forward from St. Edward’s University, Other Academic Institutions, and Businesses

The webinar featured:

and was moderated by

Fred Goldstein, President, Accountable Health.

You can access the recording of that webinar here

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This weeks Twofer – COVID-19 Updates

So we missed uploading week 25 of our COVID-19 Update last week, so this week, we’ve uploaded week 25 and week 26.

Week 25

In the week 25 episode Fred digs into a pre published paper:

Long, thin transmission chains of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) may go undetected for several weeks at low to moderate reproductive numbers: Implications for containment and elimination strategy

And the implications for contact tracing that needs to be done quickly and testing that also needs to be done quickly

And we compare experiences on face coverings – with Baltimore showing how it can be done with everyone from the homeless and pan handlers on up, compared to Florida and Fred’s experience in a RaceTrac where no-one was wearing a mask of the roughly 20 people in the store and of the employees that were, none were wearing their face coverings properly or at all.

Week 26

Testing Options and How to Apply Them

The webinar Roadmap to Safely Reopening: Evaluate Rapid Testing and Gain Strategies to Move Forward from St. Edward’s University, Other Academic Institutions, and Businesses put on by the Validation Institute with St Edwards University generated a host of questions we did not have time to answer so we cover some of these questions this week.

We review the available testing options for COVID19 and break down the Diagnostic Test – do I have COVID19 or that detect either the DNA or RNA (aka Molecular test or RT-PCR) in the virus or look for the protein envelope that surrounds the virus (aka Antigen test) and the Antibody test (have I had the disease) and talk about the Rapid Antigen test recently announced by Abbott.

Fred talks through how to apply testing in the context of colleges and businesses, how often you test and how you use this to shrink the funnel of risk in your setting

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COVID-19 Update Week 24

This week Dr. Nick van Terheyden discusses the issue of contact tracing and the importance of talking with your contact tracer. Apparently many people are not speaking with them or divulging contacts. Yes it can seem like an invasion of privacy, but its important. At a minimum if you don’t want to mention close contacts, call the contact and tell them of the potential exposure so at least they can take appropriate action.

Fred, in a similar vein discusses his experiences of this weekend with people not wearing masks, wearing masks with valves, stores removing directional signage and other issues. The question raised is how can we appropriately discuss these issues so we can see continued improvement as people relax, and schools reopen?

Its all about behavior change. Do you have any ideas on how can we incent people to do the right thing? Put them in the comments below.

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Is it education, burnout, complacency, rebellion? How can we help people do the right thing?

This past weekend I went to the Publix grocery store, a Pet Supermarket, a restaurant (Taverna) and a Lowes. This was the first time I had chosen to eat at a restaurant since February and we selected an outside table. What I observed overall was good, but there were a number of opportunities.

Jacksonville, FL is under a mandatory wear a mask policy for “public and other indoor locations and in other situations where individuals cannot socially distance.” All four locations had signs on their doors that couldn’t be missed. Well done.

The dinner began with an employee bringing utensils, paper menus (nicely done) and water to the table. He was wearing a mask, but it had a large valve on it and was clearly one of the types the CDC has said were not appropriate.

The purpose of masks is to keep respiratory droplets from reaching others to aid with source control. However, masks with one-way valves or vents allow air to be exhaled through a hole in the material, which can result in expelled respiratory droplets that can reach others.  This type of mask does not prevent the person wearing the mask from transmitting COVID-19 to others. Therefore, CDC does not recommend using masks for source control if they have an exhalation valve or vent.

I chose to stay and we ate dinner, but I was a bit nervous and did not mention the issue.

The next day I went to a Pet Supermarket. There were four customers in the store with no masks and one of their employees was not wearing their mask while the other had it below their nose while speaking with customers. Oh well, again after buying my items and not saying a word, I left. Perhaps I’ll feel more comfortable with mail order for the dog food in the future after I get our last free bag.

The Publix had an interesting change since my last visit. While all customers were wearing masks, a few employees again had them below their nose. This location they still had the six-foot distancing lines at the checkout counters, but, they had removed all of the directional signage which had created one-way aisles.

During a prior visit I had seen one individual apparently intentionally walking the wrong way. When I stated quietly as he passed,

“You might want to look at the signs on the floor”, he responded

“Mind your _____ business” loud enough that the elderly couple in front of me turned around and said,

“what a jerk”.

I wondered if Publix had decided that one-way aisles do not lower risk, or did they get too many complaints, were there confrontations?

And finally at Lowes, everyone was wearing a mask except for a few employees who were talking with each other and had pulled them down.

We are clearly doing better, more people are wearing masks, distancing appropriately and trying; so how do we keep from becoming complacent, educate and remind people in a nice manner to wear a mask, wear it correctly and keep practicing safe behaviors? Many are wondering the same thing as we factor in schools reopening, more people heading out and their potential impact on the infection rate.

Here are some good ideas on how to approach people in this article Mask the rage: How to talk to people who don’t wear face coverings

If you have any good ideas or experiences whether good or bad, I’d like to hear them.

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What is a Safe Distance for Social Distancing?

A recent study by MIT (which has an excellent risk chart) questioned whether a blanket rule of 6 feet for social distancing is appropriate for activities during the COVID-19 Pandemic. This raises a number of interesting points that many have considered and it has to do with gaining knowledge of the virus and relative risk.

Over time we have learned more about the virus and how is spreads, we moved from a primarily contact based form of transmission where we focused heavily on hand washing, cleaning and disinfecting, to a recognition that the virus spread via droplets (now don’t use this to assume you don’t need to continue to wash your hands frequently, use a hand sanitizer and clean and disinfect surfaces, you still do). This led to distancing and the six foot rule and wearing of masks when close to others.

Now with more data its believed the virus is primarily spread via the air and there are additional concerns about aerosols or smaller particles that are able to float for sometime and spread much further than the larger and heavier droplets and we have more information on just how far these droplets can be spread.

This information is now leading to some questioning the six foot rule as we discover that the aerosols can travel much further dependent upon things like how loud someone was talking or singing, the amount of air flow, humidity, whether someone is in an enclosed space, etc.

All of this is actually good to know because its all about reducing risk, and as we factor in more knowledge we can develop better, and more precise mitigation strategies. Lets use this simple chart with just a few risks:

Lower RiskHigher Risk
OutdoorIndoor
Wearing a MaskNot Wearing a Mask
Few PeopleMany People
Further than 6 FeetWithin 6 Feet
Quiet Talking/SingingLoud Talking/Singing
Short time IndoorsLong time Indoors

While each of these is a relative risk with different variations in the amount of risk, lets for simplicity sake assume all of the lower risks are equal and all of the higher risks are equal and that the difference between low and high risk is to double the risk.

So we assign each low risk a value 1 and each high risk a value of 2. But some of these risk factors when put together may change the risk even more than to just to double it. Perhaps if we are indoors in a small space and people are talking loudly, that increases the risk by double the amount of counting them alone.

In that case you begin to say, hmm, maybe we should be 12 feet apart if we are indoors with a bunch of people talking loudly and should only do it for a short period of time.

This less rigid approach is how you should think about risk in your daily activities. Consider the various factors, similar to above and others and adjust accordingly; its not a one size fits all approach.

This article talks about the issue and is well worth reading for a deeper dive. In particular note their thoughts on the relative safety outdoors. That looks pretty safe and is one of the reasons, schools, gyms, restaurants and others are moving their activities there.

COVID and Social Distancing: Is 6 Feet Enough? By Kathleen Doheny

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