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
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.
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
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.
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:
Wearing a Mask
Not Wearing a Mask
Further than 6 Feet
Within 6 Feet
Short time Indoors
Long 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.
Abbott Labs’ new antigen-based rapid Coronavirus test is a big step towards rapid, inexpensive, at-home test kits. Innovations like this will allow us to reopen more of our economy in a safer way. Dr. Nick and Fred have been discussing this approach and its potential over the past few months.