Game Time Decisions


To my Patients and Friends,

Here are some of the latest thoughts and news items on COVID-19… I hope this helps.

Getting our sea legs

After a brief reopening, South Korea has again begun to close schools in response to a resurgence of coronavirus cases.  Over the course of the COVID-19 pandemic, much has been learned from South Korea’s successes and failures.  Although the country was hit hard initially, they were able to flatten their curve by implementing several important measures.  They were able to reorganize their healthcare system in order to keep hospitals and healthcare workers safe; they instituted aggressive disease tracking and contact tracing protocols; they wore masks; they practiced safe physical distancing; they were able to successfully isolate those with the virus from those who were unaffected; their government covered all coronavirus-related medical expenses; their communications were transparent.  In short, they adapted.

This most recent lesson from South Korea highlights the importance of fluidity.  We can only speculate as to the ways in which the pandemic will evolve in the coming weeks and months.  Many experts anticipate one or more waves of COVID-19; others have suggested that this may simply smolder on until mass vaccination becomes a reality.  Either way, we must assume that COVID-19 will remain with us for the foreseeable future.   In doing so- as we reopen businesses, recreational facilities, schools and places of worship- we need to be prepared to shift directions in accordance with the vagaries of the virus.  Schools may or may not stay open for the duration of the upcoming semester;  restaurants and other businesses may need to temporarily close once again; stay-at-home measures may need to be re-implemented with some periodicity.  While we all eagerly anticipate the eventual end of this pandemic (and it will end), it would behoove us to remain focused on the nearer-term, particularly as the disease incidence continues to increase in several U.S. states, including Alabama, Arizona, Georgia, Arkansas, Wisconsin, Missouri, Florida, North Dakota, North Carolina and Texas.  The more adaptable we become as individuals and as a community, the more prepared we will be- logistically, economically and emotionally– for the inevitable yet ill-defined changes that lie ahead.

Of that we can be certain.

Life is a cruise

It’s important to remember that the majority of those who are infected with the coronavirus remains asymptomatic. By way of example, a recent study of passengers on an Antarctic adventure cruise (in which all passengers were tested for COVID-19) found that 82% of those passengers who were determined to be infected were asymptomatic.  Admittedly, the dynamics of viral transmission may be different in the context of a cruise ship than in other real-life settings. That said, this example helps to explain why symptom and temperature screening alone may not be sufficient for the purposes of viral containment, and systematic testing on a mass scale can play a vital role in tracking and containing COVID-19.

Is 6 feet enough?

Current CDC guidance suggests that we can remain safe by wearing masks, washing our hands frequently, and maintaining a 6-foot distance between each other.  However, mounting evidence indicates that a 6-foot perimeter may not always suffice.  For instance, a recent article published in the journal Science indicates that aerosols can accumulate and remain infectious in indoor air for hours.  The researchers noted that the CDC’s 6-foot recommendation was based on studies of respiratory droplets carried out in the 1930s.  We now know that a vigorous cough or sneeze can propel viral particles over 20 feet, and that aerosolized virus can linger and be carried over greater distances by airflow (i.e., breezes).  To be clear: the probability of becoming infected is largely dependent on one’s total amount of viral exposure, such that brief moments in environments in which trace amounts of aerosolized virus may be present in all likelihood do not pose great risk.   That said, the researchers’ recommendation is to consider wearing masks even in indoor environments or when maintaining the recommended 6-foot perimeter.  They use cigarette smoke as an example: if you can smell it, you are inhaling it.  My response to that example: a tiny, isolated whiff of second-hand cigarette smoke will not cause emphysema.  I don’t believe that these more rigorous measures are realistic or even necessary in most circumstances.  But it’s worth bearing these realities in mind, particularly if you’re at high risk for severe COVID-19 disease, or- for whatever reason- you find yourself outside of what you consider to be your “safe zone.”  Simply stated, there may be times when a little extra caution- or a few extra feet- would be appropriate.

Wastewater tracking

We know that coronavirus can be shed in stool, so it makes sense that wastewater analysis has been proposed as a novel mechanism by which we can track the movement of COVID-19.  And although we don’t know for sure how readily these exposures can lead to disease transmission in the real world, this nonetheless serves to remind us as to the importance of frequent handwashing.

Another sign of the times

CVS Pharmacy has just announced that beginning in June, they will be partnering with the technology company Nuro to test the viability of delivering prescriptions via driverless vehicles to customers in the Houston, Texas area.  They propose that customers will receive their prescriptions within an hour of placing the order.  Nuro has already tested its technology with other companies, including Domino’s Pizza and the Kroger grocery chain.  It seems that the future is here.

That’s all for now.  Be safe, be patient, be optimistic, and be kind!  I hope you have a nice weekend, and I’ll see you soon.

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