The Changing Nature of the COVID-19 Response

Dr. Kessler took the virtual stage again on July 9 to share more crucial information and help separate fact from fiction when it comes to the virus.
He explained that science, clinical care, epidemiology and public health processes around the virus are constantly undergoing change. As a result, guidance sometimes shifts or changes direction. That can be confusing for the public.

“One thing that we say today may not necessarily hold true tomorrow as the science changes … as the truth comes to light,” he said.

For example, there is growing evidence that mask wearing by the public helps reduce the spread of coronavirus, he explained. Overall, the public health messages from early on in the pandemic are still critically important to prevent and lessen the spread and impact of COVID-19:

• Keep social distancing in place, whether you’re indoors or outdoors.
• Wash your hands regularly.
• Keep very close attention to your cough hygiene and cough or sneeze into your sleeve or a tissue.
•  Learn more >

Now, wearing masks or facial coverings will join that list.

Evolving Treatment

Techniques for care have changed dramatically, even over the course of the last 12 weeks. Proning, for example, which is a process of strategically turning a patient onto their stomach, and medical guidance involving mechanical ventilator use for critically ill patients have evolved. The medications used to treat COVID-19 have also changed quite dramatically, he said.

But experts have learned about and responded to serious epidemics before – the H1N1 epidemic in 2009, the West African Ebola outbreak in 2014 into 2015. In both of those cases, experts learned a great deal very quickly and eventually had a vaccine, novel therapeutics and care strategies to save lives.

Understanding the Numbers

Two main terms are used to describe the transmission of a communicable disease like COVID-19.

• Reproductive number or R₀: Pronounced “R naught” refers to the number of secondary infections that an individual will usually pass on. According to classical thinking, a number of two or greater will result in continued epidemic spread within a community. In this example, a person with COVID-19 would spread the virus to at least two other people. Studies done early in the epidemic suggested that there’s variation, but the R₀ for COVID-19 was certainly greater than two, he said. Measles, which is one of the most transmissible diseases, can have a R₀ greater than 10.
  
  “The reproductive number is dependent both on the virus itself or the pathogen itself, its characteristics and how it behaves, but it’s also, in large part, determined by what we do in response to it.”
  
  
• Dispersion Factor: This metric describes how much a disease clusters. Not everyone transmits the virus equally. Some people, called “superspreaders,” seem to transmit it much more widely, while others seem to transmit it very little or not at all. Dr. Kessler believes this may be partially influenced by the person and in part by the virus, but probably has the most to do with the behavior of the individual, the setting, and their encounters with others.

When it's Safe to See Family

There’s no one-size-fits-all when it comes to an individual’s risk of anything – driving in a car, taking an airplane, crossing the street or visiting grandchildren amid COVID-19.

These are some factors you should consider:

• Have you or your family been following the recommendations for the area where you live? Usually that means social distancing, not going to crowded indoor events or areas, and other protective measures.
• Are you particularly susceptible to COVID-19? If you got infected, would you be at high risk for a very poor outcome?
  • Age is the greatest predictor for bad outcomes in COVID-19, but not all older people are the same.
  • Younger people can have very significant and serious medical conditions that put them at very high risk.
• What’s the spread in your area? After surges early on, the New York metropolitan area has had fairly low community spread, unlike other parts of the country. Because of that, Dr. Kessler said he thinks the risks are lower here than they were 12 weeks ago.
• Where will you get together? The concentration of virus in a contained space is going to be greater than in a much larger space, like outside, Dr. Kessler said. Wind patterns also disperse particles much quicker.

A visit with a grandparent can be beneficial to psychological well-being and may be ok if you’re healthy, you’ve been following the precautions including social distancing and masking, and your grandparent is generally well without severe chronic medical conditions.

“With care and with thoughtfulness, I think it can be appropriate.”

Safe Care

Atlantic Health System has learned a tremendous amount about how to keep people safe while taking care of them in the hospital. Many enhanced safety measures are in place to ensure that patients are cared for safely.

Patients scheduled for certain surgeries and procedures are tested for COVID-19 to make sure they don’t have an asymptomatic infection.

“We know that patients who have COVID-19, compared to patients who do not have COVID-19, have poor surgical outcomes. So, we don’t want to be doing non-emergent surgery on a patient who has COVID-19. We’d like to delay it, if we can.”

When it comes to urgent needs – like a heart attack, stroke or severe trauma – our standard, universal masking policy and safety procedures for team members look out for the best interests of our patients.

Patients who have been diagnosed with COVID-19 are also geographically separated from any patient coming into the hospital for another reason. “So, the chances of cross-contamination are extremely, extremely small,” Dr. Kessler said.

Risks for Different Ages

We’re still learning about the differences in susceptibility and infections between school-aged children, and older children or older adults, he said. Children tend to be at much lower risk of severe illness or death than older individuals.

“I think that’s pretty clear, based on our experience. But young people can die in very rare cases of COVID-19. So, it is not something that we should be taking lightly.”

In New York and New Jersey, which were among the places initially hit hardest by COVID-19 in the U.S., most people who were diagnosed with COVID-19 were under the age of 50, he said. So, young people contracted the virus at an equal if not greater rate than older people, he said.

Young people are at much higher risk to become infected because they’re out in the communities, he said. They’re working. They’re in closed offices. They’re interacting socially. But, when you look at the people who had the most severe outcomes of COVID-19, we’re talking about those living in nursing homes or with severe chronic medical conditions, Dr. Kessler explained.

The Dangers of Community Spread

SARS-CoV2, the virus that causes COVID-19, is still a very serious virus and COVID-19 is still a very serious illness. Though most of those infected will recover without hospitalization, the virus is easily spread. A person can give it to a lot of people in a very short span of time and we have a highly susceptible population, he said.

If you look at the population of the United States, for instance, and a death rate of 1% or even less than 1% would be a lot of people.

“You take a small percentage of a big number, you’re going to get a big number … I think people really do need to take it very, very seriously and continue to take it seriously.”

Dr. Kessler thinks the case fatality rate has stayed stable or decreased compared to what we saw early on because people have changed their behaviors and interventions are in place.

A Second Wave

“We’re doing a lot of things differently than we were in the beginning of March,” Dr. Kessler said, citing social distancing, hand washing, wearing masks, and an increase in general caution.

Despite that, he would be very surprised if we don’t have an increase in our incidents of COVID-19 at some point before a vaccine becomes available. He believes it will be different in scope and intensity, however, because of those precautionary measures.