COVID-19: Summer 2020 Update

The numbers.

As of this morning we have seen over 4.5 million documented cases of Coronavirus and over 155,000 COVID-19 deaths in the United States.  Looking just at Colorado, we have seen over 46,000 cases and are closing in on 2000 deaths.

Predictive modeling expects 230,822 deaths in the United States and 2,665 deaths in Colorado by November 1, 2020.  The current predictions dwarf our prior expectation.

Just a few short months ago, as the stay at home restrictions were slowly lifting, the same models only predicted about 45,000 deaths in the United states and about 450 deaths in Colorado.

What is happening?  How well do we actually understand this virus?  Are we already in the second wave?  Does social distancing and mask usage work?  What’s with all of the mixed messages?

Let’s talk about it.

The science behind respiratory viruses is quite well understood, particularly when it comes to topics like transmission.  And, generally speaking, Coronavirus has been around for a long time.  So, in many respects we understand this virus very well and we do understand what can be done to contain it. However, the work to make this happen can be challenging as SARS-CoV2 is a tricky version of Coronavirus that is highly contagious.

More misunderstood is COVID-19, the disease caused by SARS-CoV-2, that is unlike anything we have seen in recent history.  When it comes to treatment, we are still quite naïve.  This is why the morbidity and mortality of this disease is so high.

Are we still in Wave 1 or have we moved to Wave 2?  Maybe Peak 2 of Wave 1?  Really it is just semantics.  The important concepts are:

• While we did decrease cases with stay-at-home orders, we never really “squashed the curve”.
• Case counts are very high now, 5-10 times higher than any expert expected at this point in time.
• We will be carrying a lot of infection into the fall, when Coronavirus cases typically flourish.

Most experts, myself included, expected the United States to see around 10,000 to 20,000 new cases daily over the summer as we had just come out of “stay at home” and the summer has many built-in control measures including warm weather, summer break for schools, and (this year) a moratorium on large events.

Rather, we have astoundingly been seeing between 70,000 and 80,000 cases per day.  And our protective mechanisms do not seem to be working.

But we know…

Handwashing works.  The average person touches their face 23 times per hour.  Research shows that moderate-frequency handwashing of 6-10 times per day decreases the risk of contracting Coronavirus by 36% as compared to those who wash their hands 0-5 times per day.

Distancing works.  At less than one meter, one’s chance of contracting Coronavirus from an interaction with an infected individual is about 13%.  By moving to 1 meter of distance or more that risk goes down to 2.6%.  At 2 meters that risk drops to 1.5% and at 3 meters it is even less.

Masks work.  Current research indicates that masks are effective, both for the wearer and for the people around them.  The efficacy of a mask is primarily determined by the type of mask, whether the mask is being worn properly over the nose and mouth, and how many people are wearing masks.  On average masks seem to be about 65% effective in reducing Coronavirus transmission, ranging from as low as about 15% for a single layer of cotton t-shirt, to 77% for a standard surgical mask, to 96% for an N95 mask.

Eye protection works.  In the absence of other protective measures, eye protection and face shields seem to decrease transmission by about two thirds.

Unfortunately, we are failing.

The current projections indicate that we could save over 50,000 lives in the United States, just in the next 3 months, if 95% of the population wears masks in Public.  However, a recent study by Gallup showed that only 44% of Americans are consistently wearing masks.

The Colorado School of Public Health has indicated that if at any time we do not maintain 65% social distancing, we will inevitably experience hospital overwhelm in Colorado.  Coloradoans are currently maintaining about 21% social distancing based on mobility data from Google and other sources.

And we must do better.

Mixed messaging is everywhere.  Restrictions continue to ease while cases continue to go up.  Some counties in Colorado with the highest case counts are being given variances to ease restrictions even further.  A few weeks ago, I saw messaging from the Colorado Department of Public Health and Environment announcing that pools are open and a few minutes letter a message from Governor Polis reminding us to stay at home unless we are doing something critical.  And let’s not even start with social media.  It is all confusing.

We need to take the time to be thoughtful and conscientious.  If you are unsure about something, reach out to your doctor so that you can make informed choices.  This is a challenging time, but also a time of incredible opportunity.

A few basic thoughts to be mindful of.

Making good decisions can be hard in the current complicated environment.  Here are a few thoughts to keep in mind as you make these important decisions.

• COVID-19 is a scary disease with unusually poor outcomes.
• Protective measures such as distancing and masks work very well.
• When it comes to infectious diseases, science is more valuable than politics.
• What you are allowed to do and what you should do are not necessarily the same thing.
• The decisions that you make for yourself have a ripple effect, and can impact your family, friends, community, and beyond.

Stay safe!