This was meant to be a weekend – perhaps month – of graduation ceremonies and parties. Facebook reminded me that on this weekend, eight years ago, I graduated with my doctorate degree in Epidemiology. First generation graduate, first in the family to graduate from high school, college, and two graduate schools. Big deal, no doubt. Therefore, I empathize with those unable to experience graduations in person, for whom this too would be a big deal. Although, looking back, I’m certain that it would not have changed the impact of the moment, or everything that I accomplished which led up to that moment. I’m certain my parents would be as proud as they are/were, my friends/family would be as well, and although we wouldn’t have been able to celebrate in the moment, we most certainly have celebrated eventually. If you’re reading this and you were supposed to graduate this spring, I leave you with these thoughts:

 

…and this quote:

“Kid, you’ll move mountains! Today is your day! Your mountain is waiting. So get on your way!”

– Dr. Seuss

COVID-19 has undoubtedly turned our worlds upside down. My first post on COVID-19 was published late January, during a time when we were all very much just learning about the virus and disease. In that time – four short, yet absolutely long-feeling months – science has moved at WARP speed. SO FAST. Faster than I’ve ever seen science advance in my life. Nevertheless, what we know remains rather limited, particularly in light of the most important question everyone is asking now: “What happens now?” So, let’s address the top 5 questions I’ve been asked recently, and what the science says.

My state is reopening. What can or should I do or not do?

This is an interesting question with no straightforward answer. In some cases, states are reopening where we are starting to see a decrease in rates of infection. In other cases, states are reopening and case and death counts continue to increase. See how your state is doing here. Whatever the case may be for your state, it is important for you to consider the following:

Until we have 1) widespread testing, 2) contact tracing, and 3) isolation of individuals who are sick, we may likely have to continue to live life with some form of precaution.

Remember this graphic?? The COVID-19 response is multifactorial and warrants several things to be in place before we can go back to ‘normal’. 

An increase in testing among other things, should allow that social distancing lever to come down a bit. However, if we don’t have widespread testing, contact tracing, etc in place, social distancing remains an important component of slowing down the spread of COVID-19. There are some great articles detailing where the idea of social distancing comes from and when it was used previously (ie The Black Plague and the 1918 flu). You can read a few of those here, here, and here. This isn’t our first rodeo, y’all.  If you’re also wondering what contract tracing and isolation means, read this article I provided definitions for to help clarify.

So…am I saying you have to continue to stay home?? Well, a reopening of your state may mean that you cannot stay home because you have to go to work, take your kids to daycare, continue to grocery shop, etc. Therefore, precautions should include,

• avoid large crowds or group settings,
• practice good hygiene,
• don’t touch your face (virus enters through your mouth, nose, eyes),
• maintain physical distance between you and others (at least 6 feet if possible)
• wear a mask when in public*

*Wearing a mask protects others from you. How? It helps limit the amount of particles of virus coming out of your nose/mouth from spreading. Surgical masks are best if supplies are abundant, but otherwise, cotton masks with filters or masks with multiple layers are also recommended. Remember that wearing a mask does not mean you should stop engaging in the risky behaviors listed above. It is simply an added layer of disease prevention, so when you wear a mask you should continue to maintain your distance from others, wash your hands, and don’t touch your face. Others should do the same around you.

Science says that the virus appears to transmit most frequently in enclosed spaces, where people are in close proximity. Does that mean that the virus does not transmit well in outdoor spaces? Evidence so far suggests probably not if your outdoor encounters are short and you are not close to other people. Being outdoors in close proximity, as is done in sports, concerts, parties, is still a big question. Here’s a nice Twitter thread citing the three which have explored transmission of COVID-19 in three indoor settings:

Bottomline: Continue to proceed with caution, continue to maintain a physical distance from anyone outside your household for the time being. Wash your hands, wear a mask when out and about, and avoid large crowds or group gatherings/settings. Remember that family/friend gatherings fall in this category of caution as well.

Summer is coming. What about summer camps, daycares, and pools? Are they safe?

Lotsa questions here, so let’s start with summer camps and daycares. First and foremost, let’s recognize that many of you may have to return to work soon, if not already had to,  and childcare is a significant need. Some childcare centers are reopening, with several sanitary and physical distancing precautions in place. The same holds true for some summer camps, although I’m seeing summer camps more willing to open if they typically host outdoor activities/camps. I am hopeful that the protocols put in place at daycares and summer camps will be sufficient to reduce spread in those encloses spaces with multiple people in one building/classroom. In general, kids do tend to do better with COVID-19, but that does not mean that they do not get infected.  It also doesn’t mean they don’t get super sick. It does mean they tend to get super sick in numbers that are fewer than adults, for example, but nevertheless, important to keep in mind as you make decisions about how to move forward with care. Be especially careful if you are sending your kids to daycare/camp, and they are coming back to a home where older individuals or anyone who is considered high risk, lives.

What about swimming pools? Evidence from the SARS epidemic in 2002/2003 suggests that the chlorine in swimming pools should be able to kill the virus that causes COVID-19. The biggest concern with pools, is close interactions with people outside and inside the pool. In the pool, you should continue to try to maintain a physical distance from others; for example, swim with one lane between you and other person in the pool. Outside the pool, and especially important for parents with kids, is to keep physical distance and avoid touching surfaces. Hand hygiene continues to be important. Here’s a good article to read for those who are avid swimmers or considering returning to a pool this summer.

Bottomline: A lot will depend on what safety measures are put into effect in the pools you plan to visit this summer. Open water sources similarly. Most important is to maintain a physical distance from others if you decide to visit your local pool or go to the beach/lake.

I’m seeing a lot of posts about Vitamin D deficiency and COVID-19. Does that mean I should start taking Vitamin D??

This is a tricky question, because we have seen a disproportionate number of deaths in 1) individuals who are older and 2) African Americans. Scientific studies suggest that these two population have a higher probability of vitamin D deficiency. Does that mean that vitamin D deficiency is CAUSING worse COVID-19 disease? Not necessarily.

When studies find an association between two things (eg, low vitamin d and COVID-19 disease severity), that does not automatically mean that low vitamin D causes more severe COVID-19 disease.

Remember, correlation does not imply causation!

Bottomline: There are a number of other factors that may play a role in disease severity. Most importantly, consult with your physician before taking vitamins to determine 1) if you need them (you can have a blood test to determine your level) and/or 2) to determine what dose you need, if any. Do not attempt to self-dose on Vitamin D without physician guidance.

Antibody tests are advertised everywhere these days. Should I go pay $100 to get one?

Let me say this: I have seen a number of local businesses and medical practices advertising antibody tests and all I can say is that scientific studies suggest that the utility of these tests is pretty low. Why? Many of them aren’t specific or sensitive enough to detect past infection. Not to mention the fact that we still don’t know 1) if you have been infected with COVID-19 in the past, whether you are still able to infect others, 2) whether you can be infected again, 3) how long the immunity – if any – will last.

Bottomline: Scientists are still actively working to answer questions about immunity, so hang tight and save those $100 for a rainy day, or until a fully vetted antibody test is on the market.

What in the world is happening in kids and what is Multisystem Inflammatory Syndrome in Children (MIS-C)??

Let me start by saying that experts do believe this is still a rare occurrence in children. While we don’t yet have a denominator for disease incidence and prevalence for the magnitude of spread of COVID-19 in kids ages 19 and younger, a health warning from the Centers for Disease Control and a scientific brief from the World Health Organization give some information on the topic.

Bottomline: Information for MIS-C is still limited, so as we have more information, I will be sure to include it in future Science Says Sunday posts. In the meantime, here are some symptoms to be on the lookout for, in case your child or a child you know should have them. If they do, make sure to consult with a pediatrician.

 

 

Finally, let me finish by saying that I recognize that all of this is so very new, so very overwhelming, and that it can be hard to figure out what information is correct. I wish I could say that science speaks for itself, but when people take science and manipulate findings to prove their own biases or points, that’s when – for me – being in science, becomes ultra frustrating. We don’t know a lot about COVID-19 right now. Just because experts/scientists/physicians change their mind, does not mean they are wrong. It simply means that they are taking new evidence into account and adjusting recommendations accordingly. COVID-19 has only been around for a few months, and science is working as quickly as possible to get answers so we can decide what steps to take next. Don’t know someone with COVID-19 or didn’t see a hospital surge in your city or state? Please don’t let that alone be the indicator for severity of disease. COVID-19 is something we need to get a handle of and so far, we know that 1) social and physical distancing works, 2) COVID-19 can be deadly, 3) it spreads efficiently, 4) kids are not immune to it. I hope we will know more in the months to come, but for now, stay healthy, be careful for you and others, and for those who continue to adhere to public health recommendations…THANK YOU!