Frequently Asked Questions about COVID-19

  “Shared expectations lead to predictability.”

 Impatience over vaccinations

Q:  Is it true that once vaccinations are approved, we can return to normal?

A:  The public clearly expects vaccinations to be the one definitive answer to containing COVID-19 as a wide-spread infectious disease. Caution must be taken to avoid the expectation that vaccine approval will quickly lead to the final resolution of this pandemic.  The previous push to open up the economy resulted in an explosion of the number of infected people.  Care must now be taken that once a vaccine is approved, the public cannot feel that with immunity, it’s really safe to go back to normal times.

First, consider this broad issue: should a trial vaccine in another country be approved, that other country will want to vaccinate its own citizens first before making it available in the U.S.  Many nations have entered into a pact to share their approved vaccines with other nations in the pact.  The White House has refused to enter into this agreement!

The phase 3 clinical trials for the four U.S. trial vaccines are just now starting.  The White House has repeatedly stated that approval of any of trial vaccine could be in October.  This would limit the clinical trials to demonstrating immunity for at most, 6 weeks.  If the FDA grants emergency use authorization (EUA) for any these vaccines by mid-September, it may not provide immunity for very long.  The antibodies developed by the disease itself often has shown a limited time of protection.  Many have been reinfected after recovery.   Vaccination may later demonstrate a short time of prevention from contracting COVID.

Then there is the delay caused by the need to produce and package a vaccine after it gains approval.  The proposed vaccines in clinical trials are now being produced for distribution before approval.  Pfizer BioNTech based in Connecticut, has been given a contract for nearly $2B to immediately start production of 1 million doses in 2020, with another 500 million in 2021.  So even if their trial vaccine is approved in October, it may take 15 months from now before 600 million doses would become available.

There will next be the need for a plan deciding who receives the initially limited available doses.  Would it be hospital staff first, or essential business workers?  Would it be EMS providers, or nursing home staff and patients?  Might it be government workers including fire and police, or school teachers and their students?  No reports have been found that the federal government or any state is currently addressing this issue.  How long would the general public have to wait before their time came as supplies grow in the years ahead?

Another consideration: if the immunity from a single dose is found to be inadequate, a two-dose regimen might be required.  Perhaps even a third!  The first priority would be giving additional doses to those who already have received the first.  This would require waiting into 2022 or beyond before everyone can receive the vaccination

 

  1. Crisis standard of medical care in Texas

Q: Are all hospitals able to provide adequate medical care to COVID-19 patients?

A:  The issue of not being able to provide standard medical care for patients was previously identified.  The American Medical Association has approved, when needed, the process to shift to the “crisis standard of medical care,”  This became a reality this past week in Starr County, Texas (population 64,700).  Eloy Vera, the county judge (chief executive officers in Texas are called judges) reported that the only hospital in that county was so overrun by COVID-19 patients that they have invoked the crisis standard of care.  Jose Vasquez, MD of the Starr County Health Authority announced on July 21 that the Starr County Memorial Hospital is establishing an ethics committee.  This group will define a triage system to decide how best to allocate limited resources  He stated, “For all those patients who most certainly do not have any hope of improving, we believe that they are going to be better taken care of within their own family in the love of their own home, rather than thousands of miles away, dying alone in a hospital room,”   After making this announcement, Starr County was hit hard by hurricane Hannah!

The implications of this provides added difficulties.  Do they discharge a patient already receiving care to make room for one who is deemed “more survivable?”  If not, with all beds full, what is done with new “survivable patients” who can’t be admitted?  What are the implications for the family members who are without PPE and other protective measures?  What are the legal liabilities for not first considering erecting tents or other temporary care facilities and added staff?  What are the emotional impacts from “sending sick patients home to die?”  Much will be learned from this initial use of the “crisis standard of care.”

 

  1. CDC revised guidance for opening schools

Q:  The president sent the CDC guidelines back for revision.  Where are they?

A:  After increasing public demands for more specific guidance on opening schools, the White House last week released a revision of the previously proposed guidance.  It is remembered that a few weeks earlier, a revised copy of initial guidelines was sent back by the White House as being “too tough, impractical and expensive.”  No promised revised copy was ever issued by the CDC. The current revision, released just last week, is reported to have been written by the White House staff, even though it was released under the letterhead of the CDC.  The initial guidelines issued months ago started with checklists.  The first considerations were several conditions leading to the decision not to open the school.  Planning steps were then identified to define how opening schools can best be realized.  In the currently released guidance, there was no discussion about any need to close a school.  This conforms to Trump’s demands for all school buildings to open.

Other variations from the initial guidance also reflect the president’s current demands for opening schools.  The specific reference for keeping students 6 feet apart has now been dropped.  The statement is made that a school “may consider” closing (not “must,” or “should”) “if there is substantial, uncontrolled transmission” of the virus.  CDC customarily offers objective criteria for its guidelines, such as community testing shows an infection rate above 1% – this kind of guidance is now absent.  When asked what situations would meet the definition of “uncontrolled transmission,” Robert Redfield MD, director of CDC named the “hot spots” that exists in 33 states.”  The Washington Post reported, “This mixed messaging was another indication of how health officials at the CDC have been squeezed between Trump’s demand for a normal school year and an out-of-control virus.”

 

  1. Prevalence of COVID-19 greater than reported  

Q:  Is the reporting of COVID-19 cases accurate? 

A:  The CDC on July 21 issued a report that the actual number of infected people is many times greater that the number reported.  The number of actual cases in Connecticut (population 3,563,100 is now reported to be actually between 6 to 11 times greater than the number reported up until April 1. This means that the reported 3,128 cases could represent between 18,800 and 34,400 actual cases.  One major reason for this was before April 1 only positive test results were reported to the CDC.  Testing was not as wide- spread at first, and “presumed cases” from review of medical records identifying COVID-like symptoms and other indicators were not used.  As presumed cases were added and other steps taken, a persistent problem continues to this day:  Infected people who are asymptomatic are spreaders of the virus.  Many never get tested, and are not treated.  These actual patients have to record of their infection.  It is reported that as many as 30% of infected patients are asymptomatic.  This is the major reason for wearing a cloth face covering when in public.  These masks protect everyone else from becoming infected by people who have no idea they are actually infectious and spreading the disease.

 

  1. Younger people now getting COVID-19

           Q: What’s this I hear about younger people getting this disease?

A: Teens and younger adults are increasingly contracting COVID-19.  In a sample study, people in Connecticut between the ages of 20-29 at first represented only 12.5% or all cases.  More recently in July, that nearly doubled to 23%.  Connecticut deputy state epidemiologist Lynn Sosa, MD attributes much of this to “Kids are socializing because that’s what kids do.”  With schools closing early in the pandemic, socialization in schools was not possible.  But with the warmer weather and outdoor recreation more of a possibility, the temptation for this becomes great.  Also, with a sense of a return to normal as the state opens up, the feeling of shedding restraints can be overwhelming.  Finally, it is well reported that younger people have a greater sense of invulnerability, immortality, and willingness to take risks.  “They need to realize that they are not immune to COVID,” Dr. Sosa stated.  Awareness of this issue calls for greater public education and mitigation efforts for local high schools and especially colleges and universities as they open up.  The cultural impulses and expectations for socialization in the young can be quite powerful!

Frequently Asked Questions about COVID-19

  “Shared expectations lead to predictability.”

  1. Air fresheners to clear coronavirus

Q:  Could we use air fresheners in our meeting house to help make indoor group meetings safer?

A:  Air fresheners are often called room deodorizers.  Their primary function is to mask any unpleasant or offensive odors that might be present.  None of the commercially available air fresheners disinfects or destroys bacteria or virus particles that may be suspended in the ambient air.  Using air fresheners in the meeting house would also be contrary to our policy protecting congregants who are sensitive to perfumes or personal colognes worn by others.

There are also small plug-in air cleaners available.  These pass air through small filters that screens out soot, dust and other particulates.  The individual coronavirus-19 virions are sub-microscopic and will easily pass through these filters.  In addition, the amount of air filtered is very small compared to the large volume in our meeting house rooms.

Coronavirus-19 infects people when the virus in sufficient concentration is inhaled into the respiratory system of a healthy individual.  This is why wearing cloth face coverings is an effective practice by reducing the concentration of coronavirus virions appearing in the space close to an infectious person.  There are other effective ways to reduce the concentration of virus in indoor room air:

  • The least costly way would be to send room air outside replacing it with fresh, in-flowing air. Opening windows is one tactic that could help.  Putting an outward-facing window fan in each open window would greatly improve the result.  In winter, evaluation on the degrees of heat loss in our meeting house would have to be evaluated if a room ventilation system doesn’t already add fresh incoming air to be warmed before it blows into interior spaces.
  • In hospitals, ventilation systems use High-Efficiency Particulate Air (HEPA) filters before air is returned to the interior. HEPA filters are commercially available for many mechanical ventilation systems. Airflow would be more restricted when using HEPA filters.  The rate of air exchange would have to be evaluated in our meeting house to ensure adequate protection.
  • Another system used in health care facilities is exposure of air taken from interior space to ultraviolet light, killing the virus before returning the air. These systems are probably too expensive for us but still could be evaluated.
  • Finally, any ceiling fans, if used, provide a very short-term benefit. These would only stir up the room air lowering the concentration of virus particles near the people, but slowly raising this concentration to critical levels throughout the room.

 

  1. Prolonged medical problems after recovery from COVID-19

Q: Once a person recovers from COVOID-19, are there any lasting effects?

A:  Continuing research is showing new problems that infected people may have after they recover. Previously identified post-recovery issues included heart damage, lung damage, strokes, and other neurological issues.  On June 27, it was reported that another type of problem has emerged.  Anthony Fauci, MD, identified a series of neurological conditions.  Dr. Fauci Identified these as “brain fog, fatigue, and difficulty in concentrating.”  He continued, “So, this is something we need to seriously look at because it may very well be a post-viral syndrome associated with COVID-19.”  Work is continuing to identify the precise causes of this syndrome.  Currently the focus is on small proteins called cytokines which cross the blood barrier and interact directly with brain cells.  Post-viral or chronic fatigue is more commonly observed in women than in men.   It affects patients of all ages, but appears to be more pronounced with older people and people with underlying health conditions.  One positive aspect currently under study is it appears for many people to resolve itself with slow improvement over time.

 

  1. Sleepaway camp CDC investigation a warning for when schools open.

Q:  What problems were discovered when sleepaway camps opened?

A:  The CDC on July 31, released a report on its Morbidity and Mortality Weekly Report studying the experience at the YMCA Camp High Harbour, a sleepaway camp in Georgia, warning that this illustrates what might happen when schools will soon open.  The overnight camp adhered to the measures identified in Georgia’s Executive Order guiding camp operations.  It also followed most of the CDC published guidelines.  This included documentation of a valid negative COVID-19 test taken within t2 days by each person coming to camp.   It opened its doors on June 21 with 597 Georgia residents attending.  Two days later, one teenage staff member felt ill and left the camp.  He later tested positive for COVID-19.  On June 24, staff began sending other campers home.  On June 27, just under one week after opening, the camp closed.

The Georgia Department of Health began a follow-up testing program and eventually reached 344 (58%) of the attendees who live in Georgia.

  • Of the people tested, 260 (76%) tested positive.
  • Among the 136 cases whose symptoms were recorded, 36 (26%) reported no symptoms. They were asymptomatic.
  • The percentage of children testing positive diminished by age group;
    • Of the group that were aged 6-10 years – 51% tested positive;
    • Of those aged 11-17 years – 44% tested positive;
    • Of those aged 18-21 years – 33% were positive.

The camp had not followed some of the CDC guidelines.  Staff were required to wear cloth face coverings but not the children, and doors and windows were not opened to permit air-replacement ventilation.  Also, children were often engaged in singing and boisterous cheering.  The conclusion of this study was stated, “These findings demonstrate that COVID-19 spread efficiency in a youth-centric overnight setting, resulting in high attack rates among persons of all age groups, despite efforts by camp officials to implement most of the recommended strategies to prevent transmission.”

  1. Herd immunity 

Q:  What is herd immunity? 

A:  Many infectious diseases give immunity for those who have recovered.  This protection prevents the person from becoming reinfected.  The more of these recovered patients in a community or nation, the fewer the number of susceptible people who remain to get the disease.  Most epidemiologists calculate that when 60% of a population has recovered from such an infectious disease, the possibility of the remaining susceptible people would be so low that that disease would die out and no longer represent a threat.  This threshold is identified as “herd immunity.”

In Connecticut, 60% of the current population would be 2,138,000 people needing to get such an infectious disease to reach herd immunity.  To achieve this additional number of confirmed cases could be calculated on a recent 10-day average of new cases at 9.14 per day.  This would require 23,390 days (64 years) before herd immunity could be reached.  Obviously, this cannot be a goal for Connecticut to conquer this pandemic.  Some nations started out this way, including the United Kingdom and Sweden.  After closer examination, no one is now proceeding this way.

And, remember that there is early suspicion that immunity for recovered COVID-19 patients may be temporary.  If so, herd immunity might never be possible.

 

  1. COVID “saliva testing” for more rapid results.

Q:   Why do we still have COVID testing that takes a week or more to get results?

A:  Still missing is a national program for COVID-19 testing. Each state competes to identify their preferred platform from the multiple tests that have been authorized.  Many of these involve throat swabs that have to be sent to a laboratory which are all becoming overwhelmed with increased volumes.  This delays prompt reporting of the results. An ideal option would be a self-contained testing system giving prompt results by not using swabs which many people feel are uncomfortable and irritating.

One such test is now being evaluated in Australia.  It has the advantage of allowing the patient to more comfortably provide the test sample by spitting into a container.  Health workers don’t have to wear personal protective equipment to administer the test, Other tests are being developed that allow the saliva sample to be tested outside of a laboratory by offering an at-home testing kit.  Evaluation of this method is still underway.  In one small unpublished test, the saliva test was found to identify as false negatives nearly a fourth of those tested who actually have the infection.  This suggests the concentration of the virus in saliva may not be as high as found by swabbing the nose and throat.  This current effort illustrates the dynamic research underway to find better test methods.  If authority is finally granted for such a test even with many false negatives, it would allow rapid, daily identification of individuals who test positive in groups such as school students and staff. This would reduce the number of swab tests for all the others who tested negative.

Frequently Asked Questions about COVID-19

“Shared expectations lead to predictability.”

66. FDA actions to ensure a safe and effective vaccine
Q: Is it possible that a test vaccine could be approved for political reasons without the clinical trials being completed?
A: On June 30, the US Food and Drug Administration stressed the importance of science over politics by announcing it has taken action for the “timely development of safe and effective vaccines to prevent COVID-19.” Significant federal funding has already been approved for some companies to begin manufacturing large quantities of their test vaccines and prepare individual doses in syringes ready for use. It has been reported that Phase 3 clinical trials for several candidate vaccines are just now beginning. To evaluate if a trial vaccine is unsafe, for example by creating a significant number of adverse conditions such as blood clots resulting in strokes, a “double-blind” administration of the vaccine is conducted Half the group is injected with the trial vaccine, while the other half is given a harmless injection such as a saline solution. None of the participants knows which is actually being administered. The subjects then return to their usual routines. They are frequently evaluated for the presence of antibodies, side effects and for COVID symptoms. At the end of the trial, the data from each group is compared. If the trial vaccine created antibodies and there were no symptoms, this could prove the trial vaccine was effective. If the group with the vaccine developed symptoms, it could prove the trial vaccine was not effective. If the vaccinated group developed unusual side effects, the conclusion could be reached it was unsafe. This process usually takes at least two months for the immunity to be proven, and for adverse findings to develop. And, of course if immunity is temporary, lasting only a few month, more study time would be needed to learn this.
This action taken by the FDA appears to make it clear that approval of any trial vaccine will not occur before the clinical trials have had the chance to prove safety and effectiveness. Peter Marks, MD, PhD, director of the FDA’s Center of Biologics Evaluation and Research stated, “Right now, neither the FDA nor the scientific community can predict how quickly data will be generated from vaccine clinical trials. …But make no mistake, the FDA will only approve and make available a COVID-19 vaccine if we determine it meets the high standards that people have come to expect of the agency.”
67. Coronavirus-19 during a hurricane
Q: If we are hit by a hurricane, how do we continue to control the spread of this pandemic?
A: In May, the Federal Emergency Management Agency (FEMA) published a 22-page manual, “COVID-19 Pandemic Operational Guidance for the 2020 Hurricane Season.” This is focused on guiding state and local operations. Its purpose is to offer advance description of anticipated challenges to disaster operations posed by COVID-19, outline how FEMA plans to adapt its response and recovery operations, and to allow state and local officials to plan in advance.
FEMA separates all disaster planning into phases based on when activity is required. In this case, planning guidance is separated into response – while a hurricane disaster is underway, and recovery – restoring normal routines after the event is over.
FEMA has a well-established system layering their operations through its national center, 10 regional offices and multiple joint field offices. These guideline states that FEMA will continue to provide resources to hurricane affected areas when requested. Once the national COVID-19 national emergency declaration was issued on March 15, FEMA activated its national coordination efforts, and authorized $100 million in grants to states to allow them to prepare emergency responses to the pandemic. The newly issued hurricane guidelines are included in the required preparation activities supported by that action.
Specific topics are identified, and considerations are outlined for state and local response plans that must now include:
• Capability available to respond with reduced staffing;
• Continuity of essential functions with no interruptions;
• Ability to stabilize communications between groups and agencies;
• Ability to protect personnel that must be deployed to the field;
• Provided for adequate medical grade personal protective equipment (PPE);
• Hospitals to have evacuation plans for patients, staff and medical equipment;
• Plans exist for the medically appropriate evacuation/sheltering of high-risk patients;
During recovery, many considerations for “mass care” that would require advanced planning are identified and discussed, including:
• “Non-congregate sheltering” of displaced people – providing social distancing and isolation such as the use of hotel rooms and dormitories.
• Special needs addressed for people with disabilities or medical needs such as dialysis;
• Availability of isolation or quarantine areas in remaining congregate shelters;
• Medical supplies, PPE, and individualized pre-packaged food services for citizens, staff and volunteers.
It is comforting to note that in Connecticut, especially in the region around Hartford, this planning is underway and goals are being reached. It remains to be confirmed that FEMA supplies and support will meet demands. That assumption is challenged by past problems of offering testing supplies and PPE for “routine” (non-hurricane) pandemic operations.
68. A recent discovery about T cells and immunity
Q: What’s this I hear about a different way the body defends itself against an infection that doesn’t involve antibodies?
A: All research developing a vaccine has been focused on the development of an agent that can cause people to develop antibodies to combat coronavirus-19 without actually infecting them. The virus is pictured as a spherical object with many spikes. It is these spikes that react in contact with human cells allowing it to be drawn inside the cell where it reproduces thousands of copies of itself and moves on to infect other cells. Antibodies are generated that interrupt the spikes’ ability to penetrate new host cells. A recent study, not yet published for peer-review, has identified another mechanism the body uses to fight this disease. There are two specific types of white blood cells. These are named “T cells” and “B cells.” In a complex way, these interact to stop the ability of the virus to replicate itself once inside a host cell. Early findings indicate that T cells have a longer “memory” of the coronavirus than antibodies. If proven to be true, vaccines using this different approach could prove to offer immunity over greater periods of time. More research is indicated, especially because it’s possible that some antibodies may actually enhance the process of a virus entering host cells making the disease actually more infectious. The more we learn, it seems, the more we find there’s a lot more to be learned!
69. New 15-minute COVID-19 test approved
Q: Is there any improvement in rapid turn-around testing for COVID-29?
A: Early in July, the Becton Dickenson & Co. was awarded an emergency use authorization (EUA) for a hand-held “BD Veritor Plus System” testing device which can deliver results in 15 minutes. The device is authorized to be used in health care settings, and does not require sending samples to a laboratory for evaluation. This and other similar devices still under development will shorten the time spent in lines waiting to take a test. They also provide information earlier to permit better contact tracing and isolation of newly infected patients. As with all COVID-19 testing, questions of accuracy have been a problem. In clinical studies leading up to its approval, the new unit reaches up to 84% accuracy finding true positive cases, and 100% finding true negative results. In other words, as stated by the FDA, “there is a higher chance of false negatives, so negative results do not rule out infection.” “The results may also require another diagnostic test “prior to making treatment decisions or to prevent the possible spread of the virus due to a false negative.”
70. More on the “crisis standard of care”
Q: Are there hospitals that continue to have more patients than can be managed?
A: It has been reported that in the US, 5 months into the pandemic, there have been 1,000 medical and health workers who have died from COVID-19. The impact on the availability of remaining workers, and their comfort continuing to work in EMS and in hospitals cannot be underestimated.
Also, in Texas, it is now reported that tents are being set up outside several hospital emergency departments. Not to treat patients, but for ambulances to offload so they can return to service other patients. In these tents, patients are waiting often more than 4 hours, before a physician is available to see them.

Frequently Asked Questions about COVID-19

Shared expectations lead to predictability.

61. Coronavirus-19 Mutations

Q: Have any mutations been detected in coronavirus-19?

A: In 1918, when The Great Influenza Pandemic first emerged, those who contracted the disease were mildly affected. During the 1919 second wave when it returned to the US, the fatality rate was very much higher. Scientists learned that the virus had mutated as it spread around the world. This history has caused today’s scientists to critically look for this possibility with coronavirus-19. A recent U.S. study by Scripps Research has identified one mutation that has occurred. This mutation has resulted in an increase in the number of “spikes” on the surface of each single virus particle called a virion. “The number of functional spikes on the virus is 4 or 5 times greater due to this mutation,” said Hyeryun Choe, a senior researcher. The spikes are the structures that allow the virion to enter host cells to reproduce – causing the person to become infected. It appears that this mutation increases the rate of infection – the ease with which the disease can be passed from one person to another. This research may explain why early outbreaks in some parts of the world did not overwhelm hospitals and health systems as much as others, such as Italy and New York. Concern is growing that this mutation is becoming the dominant agent of infection over time. This study has been presented for peer-review publication and advance notice has been given to encourage further research efforts. Other mutation studies are underway around the world and have already found different mutations. Future studies will focus on increased disease severity, mortality, and resistance to antibodies resulting from other mutations.

62. Latest on vaccine development – China

Q: Everyone is focused on having a vaccine. Are other countries at work on this?

A: Concern has recently been expressed over a recent report in the Philippine newspaper The Manila Times that China is widely testing one of its new vaccines. The article stated that the World Health Organization has identified 17 candidate vaccinations of which more than half involve Chinese companies or organizations. The specific vaccine being reported was developed by CanSino Biologies jointly with the Chinese Academy of Military Medical Sciences. It is claimed to have a “good safety profile” and a potential to prevent the disease caused by coronavirus-19. The current third phase testing has been authorized by China’s Central Military Commission for a period of up to one year and may include all members of the extensive Chinese military before testing is concluded. The report stated, “Its use cannot be expanded without further approvals.” The Chinese Military Defense authorities have refused reporters’ questions for clarification. The newspaper also reported, “CanSino added that it cannot guarantee the vaccine will ultimately be commercialized.”

All of this has led to widespread speculation that China’s strategy is to increase its military’s immunity from the disease without allowing the vaccine to be used by other country’s military leaders. It also raises the economic benefit to China if it can sell to others at a monopoly-level expanded price. The military and economic impact on international relations could be tremendous.

63. Fraud alert: scam contact tracing

Q: I received a call telling me I was in contact with someone who tested positive. I was asked to state my Medicare Number to verify that I was the person contacted. Is this appropriate?

A: A recent warning was released jointly by the US Department of Justice the US Health and Human Services and the US Trade Commission. “COVID-19 fraud is rapidly expanding. Operating contact tracing schemes is just one method that criminals use to target unsuspecting patients nationwide, attempting to steal their personal information and commit healthcare fraud,” said HHS Deputy Inspector General for Investigations Gary Cantrell, Asking for Medicare or Social Security Numbers is not part of legitimate contact tracing.

64. Mitigation processes in North Central Connecticut

Q. Is there a relationship between federal mitigation efforts and local officials?

A. In Connecticut, planning for disaster and emergencies since 2007 has been facilitated by five designated regions. Unlike most other states, Connecticut has no county government, and these five regions were created to be the focus for coordinating local programs and resources under the state-level program. The north-central region is called the Capitol Region Emergency Planning Council (CREPC). This region is made up of 41 towns centered around Hartford. The current pandemic is considered a health emergency, and each level of government (local, regional, state, and federal) have emergency management sections organized to lead specific responses. Thus, within the region in which Manchester, Vernon, Ellington, Hartford, and 37 other towns belong, the health and medical section has identified the local needs for personal protective equipment (PPE).” This includes face masks, gloves and gowns. The needs of hospitals, nursing homes, local health departments, and ambulance providers in the 41 towns and cities were included. This information is then sent to the state level Division of Emergency Management and Homeland Security (DEMHS). The state then consolidates the requests for all five regions and gives it to the national-level FEMA (Federal Emergency Management Agency). This is an elaborate, but familiar system for those who frequently use it to manage disasters.

In a recent report from the north-central Connecticut emergency planning group (CREPC), the following information was provided: “The regional distribution center in West Hartford was opened on March 25 and operates every Tuesday, Wednesday, and Thursday. The site continues to receive, stage, and distribute personal protective equipment (PPE) as it becomes available.” Trained volunteers and staff members from various towns and organizations organize the logistics of sorting and loading allocated supplies onto vehicles sent by the different local groups requesting these items. “Last week… we distributed 2.7 million pieces of PPE to first responder (fire, police, and EMS) agencies within the 41 communities, 99 long term care and assisted living (nursing home) facilities, and 37 home care and hospice agencies.” (In addition,) to date there have been 1.07 million pieces of PPE distributed to the 14 local public health agencies in (North Central Connecticut) Region 3.”

It is significant to note that many local people, groups, and agencies are effectively at work in Connecticut positively contributing to successful mitigation efforts during this pandemic.

65. “and one more thing…”

Q: What are some of the other coronavirus-19 bits of information people are talking about?

A: First, Crisis Standard of Care: When hospital capacity cannot meet the increasing demands of people in need, the usual standard of care cannot be provided.

  • In Texas, it was reported last week that ambulances bringing in COVID, as well as trauma, cardiac and other patients, are being held in the parking lot outside the emergency department entrance before the crew can bring the patient inside to be seen by a physician. This wait sometimes takes more than an hour, delaying medical care as well as tying up the ambulance from being available for other calls. This, with an increasing number of EMTs and paramedics becoming infected reduces the EMS responder’s ability to respond to other calls and the level of pre-hospital care available to a community.
  • In other jurisdictions, it is reported that ambulance crews responding to patients who are in cardiac arrest are directed not to perform CPR. Instead, they are to make themselves available for other calls. As a result, it will be up to the family or others calling 911 to arrange for the removal of the body.

Secondly, Waiver of liability at colleges: Heidi Li Feildman, a law professor at Georgetown University, published a column in the Los Angeles Times (reprinted in the July 2 edition of the local Journal Inquirer). She strongly urges readers to NOT to sign any COVID-19 waiver of liability for students entering college. From the college’s viewpoint, such waivers protect against possibly expensive judgments that could threaten the future of the institution. But Heidi points out that “the technical term for this sort of defense is “primary assumption of risk.” This prevents lawsuits from even being considered when the college fails to conform to CDC and other standards of prevention. This in turn may reduce the vigilance of college officials to strictly enforce appropriate standards. Heidi concludes, “under no circumstances should anyone sign a waiver for harm inflicted by COVID-19 caused by their college’s policies.” It could be said the same advice should apply to waivers requested by any group or agency providing a service to the consumer.

More Covid-19 FAQs

“Shared expectations lead to predictability.”

56. “Crisis level of care” when hospitals are overwhelmed
Q: What happens when the number of COVID-19 patients needing hospital-level care exceed the capacity of existing facilities?

A: When the number of patients exceeds a hospital’s ability to give routine levels of care, several tactics are used to expand the number of additional patients that can safely arrive. Patients in the emergency department who require in-patient care can be held for transfer to another facility. Under previous federal initiatives, many states have set up a state- or region-wide central clearinghouse that can identify the nearest bed and facilitate the transfer. The next level of “surge capacity” might be to stop elective, non-emergency surgeries to open existing beds for the emergency. After this, a hospital might locate unused space within the facility and set up additional areas with beds, equipment, personal protection equipment, and staff. Finally, as well publicized in New York, federal and other outside resources can be brought in to set up remote facilities in large open areas – tents in fields, enclosed exhibition halls or the US Navy’s hospital ships in nearby ports.

The question then becomes what happens if all these surge capacities do not match the increasing needs of overwhelming numbers of patients. The process of triage, or sorting and categorizing patients is then required. So far, no state has yet faced this crisis point. But indications lead to the possibility that one state, Arizona. may soon be there. During June, the governor has suspended following the CDC guidelines for “opening up” the economy in several separate controlled stages. In rapid succession, businesses are opening indoor restaurant seating, bars, beauty salons and barbershops. There are no state guidelines on social distancing or wearing cloth face coverings. Only recently, the governor decided to allow local communities to make separate decisions mandating use of masks. Testing was never adequately developed as a system, and people in long lines may now wait up to 6 hours before they can be tested – if at all. The number of tests available are quite limited. And it takes up to a week – or longer – for people to receive their test results. This, of course, makes contact tracing nearly impossible. Recent news reports have shown that many people, especially under the age of 40 are not wearing masks, even when locally required. The public views this disease as either “overblown” by the media, or as innocuous as the common cold. The daily new hospitalizations are exponentially increasing, and public health officials are projecting the state’s health care system will reach capacity early on July. There is no reporting that temporary federal or other resources to set up remote temporary hospital capacity is being considered.

When and if this happens in Arizona or any other state, some patients may not be given the customary standard of care they usually would, and decisions will be required on who will be denied. The American Medical Association has a well-established ethics section to guide such decisions. In its stated principles, “a physician shall, while caring for a patient, regard responsibility to the patient as paramount.” Yet, “during public health emergencies like pandemics, this commitment of fidelity to the individual patient is counterbalanced by the need to protect the welfare of a population of patients.” Guidance is offered when allocating limited resources. Decisions should be based on “likelihood of benefit or to avoid premature death…” Each hospital has already developed ethical guidelines in detail, following these AMA guidelines.

But what does this mean? If a COVID-19 patient on a ventilator goes into cardiac arrest, CPR would normally be performed unless the patient has an authorized “do not resuscitate (DNR)” on file. Under crisis standard of care, CPR would not be considered at all. If a patient in a completely full ICU is pronounced dead, and two patients are in the emergency department waiting to be admitted, one will remain in the ED until another space is later opened. Several patients requiring a ventilator may be held aside in the ED without one, stressing the capacity of the ED to manage “routine” patients (trauma, cardiac care, etc.). Patients presenting by walking into the ED with difficulty breathing who otherwise might be admitted, will now be sent home with an order for oxygen. We may soon learn more about this crisis standard of care from actual reporting – we all hope this will never happen.

57. Methanol in hand sanitizer
Q: I found a supply of hand sanitizer using methanol instead of ethanol. Is this just as effective?

A: Everyone should check the label on their bottles of hand sanitizer! Many are sold as “No Germ” or “antibacterial.” Coronavirus-19 is a virus, and this requires a “viricide.” Antibiotics do not destroy virus particles. In addition, a company in Mexico: Eskbiochem SA de CV has distributed many products in the US listing the contents as “80% alcohol.” These include such product names “All-Clean”, “CleanCare”, “The Good Gel”, and “Saniderm.” These products contain methanol rather than ethanol as the primary ingredient. On June 17, the FDA advised consumers not to use these products. Methanol, otherwise known as “wood alcohol,” when ingested or absorbed through the skin, is toxic. The FDA further advises that anyone who has been using a methanol-based hand sanitizer should contact their physician to prevent adverse effects. Especially if ingested, methanol poisoning can lead to neurological problems including seizures, blurred vision, blindness, even coma and death.

58. “No-swab” saliva test
Q: Is the use of a swab the only way to get tested for coronavirys-19?

A: On Monday, June 22, the British government reported a clinical trial is underway for a weekly testing regime using a “no swab” saliva test. The goal is to make testing for the presence of coronavirus-19 less dependent on the availability of swabs, easier to administer and to provide more rapid results. Saliva test results usually are available in just 48 hours. One result of this study might be the availability of “at-home” testing kits. The test uses a different laboratory process, which promises to be more accurate. Developed by the British Firm Optigene, this is being tested by a group of 14,000 participants in the city of Southampton.

59. Social distancing effectiveness
Q. Just how effective is social distancing?

A: In June, an article in the British journal The Lancet reinforced and elaborated on the value of social distancing to prevent infections of coronavirus-19. The World Health Organization (WHO) reported that by keeping at least 1 meter (about 3 feet) away from others the risk is reduced of the virus spreading from the larger droplets that people spray out when they cough, sneeze and talk. In Switzerland, a study demonstrated that a distance of more than 1 meter reduces the risk of infection by 80%. This study also reported that the risk even then is greater when a larger number of droplets are expelled as when people sing or speak loudly. It has also been recognized that regardless of the distance, one’s risk increases when other factors are considered, including duration of any close proximity, the number of people in a given space, use of cloth face coverings, availability of air-exchanging ventilation, and if people talk quietly or loudly.

60. List of conditions indicating “Stay-at-home” is expanding
Q: I hear that more factors and medical conditions have been added to the original list indicating more people than before need to stay at home as the economy is re-opening. What are these?

A: Over time, increasing data and analysis is identifying several factors associated with poor outcomes for people who contact coronavirus-19. CDC on June 25 published an updated guideline identifying this.
With respect to age, 8 out of 10 people who died from COVID-19 were over the age of 65. The number of people hospitalized per 100,000 population over age 75 was 843; between ages 40-75, the rate was 319; under age 40 the rate was 35.

For people of any age, the risk of severe illness rises if there are underlying medical conditions. Newly identified medical conditions responsible for this now include:

Chronic kidney disease
COPD (a pulmonarydisease)
Immunocompromised state
Obesity
Serious cardiac conditions
Sickle cell disease
Type 2 diabetes

The following MAY present a greater risk:
Asthma
Cerebrovascular disease
Cystic fibrosis
Hypertension
Dementia
Liver disease
Pregnancy
Pulmonary fibrosis
Smoking
Thalassemia (a blood Disorder)
Type 1 diabetes

All people in these high-risk groups should continue to remain at home, if possible, as others participate in economic reopening through the recommended sequential phases. Strict use of social distancing, use of cloth face coverings and frequent hand washing or sanitizer use are all recommended when it is necessary for anyone to go out in public.

More Covid-19 FAQs

Frequently Asked Questions about COVID-19

  “Shared expectations lead to predictability.”

 

  1. Studies on coronavirus-19 immunity

          Q:  What is the latest about if and for how long immunity might be given after someone recovers from COVID-19??

A:  Many studies are underway to examine people who recover from COVID-19 identifying what immunity results that would prevent them from catching the disease a second time.  This, of course, has importance in the development of a vaccine that would provide antibodies to prevent future infections.  Scientific studies take time to complete.  The normal process is for an investigation to examine data, then to write down the methods and results leading to a conclusion.  These are then reviewed for validity and reliability by editors before they are published in a peer-review journal.  Once published, other investigators can replicate the investigation and confirm similar results are found.  This “peer review” leads to discussions where methodologies, sample sizes and characteristics, variable doses and so on are challenged.  Only then can a study be confirmed as being accepted as true.  Of course, during a pandemic, there is a great pressure to speed up the process as many lives are at risk during the weeks and months required for proven knowledge to be accepted.  This results in the public learning about possible “facts” before they are proven, and “accept” them at face value assuming they are the final conclusions.  Several studies have been recently reported that have yet to be evaluated under this framework.

Coronavirus-19 is one of many coronavirus strains that exist.  The common cold is also caused by four other coronavirus forms.  Assuming that different coronavirus share similar general traits, a study was recently conducted by the Amsterdam University.  Data had been collected over the past 35 years on the four coronavirus strains that cause the common cold.  Each year, 10 men were tested for their coronavirus antibodies.  Their ages were between 27 and 66.  The result was reported in the press as “frequent reinfections at 12 months post-infection and substantial reduction in antibody levels as soon as 6 months post infections” were observed.  “Coronavirus protective immunity is short-lasting.”  This study is yet to be published for peer-review.  The obvious factors that restrict this as being fact for the coronavirus-19 include that this specific virus was not studied, only men were used in the study, and the sample size – 10 participants – was very small.  But the general conclusion can be reached that more studies are needed and there is no guarantee that coronavirus infections always grant immunity.

The Korean CDC is now studying the specifics of coronavirus-19 immunity.  This and other investigations have led to a trend being identified – prior infection with a milder form of a coronavirus (like the common cold) may correlate with higher antibody levels after recovery from COVID-19.  Other studies are comparing COVID-19 with SARS and MERS (previous epidemics caused by a coronavirus).  Early data indicate immunity from coronavirus may last from 1 to 8 years.

A more thorough study has been submitted for publication by the St. George’s University of London.  This study attempts to learn how antibody production takes place differently by different patients.  Blood samples from 177 patients was examined.  19 percent showed positive for the disease but had no symptoms.  94 percent were hospitalized with COVID-19, and a fourth of these died.  Some 73 percent of the patients had an underlying health condition.  Among the conclusions are that antibody responses are greater when there is inflammation in the body, and that “non-white” people had a higher chance of having more antibodies and being ill enough to be hospitalized.  Other research has found that higher antibody levels are linked to disease severity.

Even if immunity is found to not be long-lasting, advancements in therapeutics and vaccine development over time may be effective in limiting the high infectious and fatality rates.  We are used to getting an annual “flu shot” to protect against influenza.  If the fatality rate and severe side effects can be mitigated, we could end up living with coronavirus-19 as an endemic disease requiring a second annual “shot.”

 

  1. Steroid (dexamethasone) as a therapeutic

          Q: What’s this I hear about a steroid being used to cure COVID-19 patients?

A:  There is no “cure” for this disease – at least not yet.   A recent investigation shows an existing inexpensive steroid drug, Dexamethasone, can improve the survival of some COVID-19 patients, especially for those with severe forms of the disease.  A group of 6,400 patients were studied.   2,100 of these were given dexamethasone in low or moderate doses over 10 days.  A control group of 4,300 patients received standard care without the steroid being given.  The results show a reduction of death by 30% with patients on ventilators, and by 20% for those just taking oxygen.  This study has yet to be published for peer review, and the investigators caution against accepting this as an approved method of treatment at this time.  They point out that only a fraction of patients with COVI-19 can benefit from this therapy, that use of the steroid for some patients carries added risks, and that prevention (social-distancing, masks, and hand washing) are far more effective by preventing the infection from happening.

 

  1. Hydroxychloroquine no longer authorized

          Q:  Is hydroxychloroquine still being used?

A:  On June 15, the Food and Drug Administration revoked the emergency use authorization (EUA) for the use of hydroxychloroquine to treat COVID-19,  Based on accumulating evidence, the judgement was made it was no longer reasonable to believe the drug might be effective in treating the disease.  The pharmaceutical, which has been touted by president Trump as being effective, can no longer to be used in studies to evaluate this application.

 

  1. History repeats itself

          Q: Is there anything to be learned from the 1918 pandemic influenza? 

A:  The author, John M. Barry wrote a comprehensive and detailed history, “The Great Influenza, the Story of the Deadliest Pandemic in History.”  His discussion includes the science – as then known – the people, the politics and the impact surrounding our nation’s and the world’s responses.  A comparison exists with the planning leading up to the recent Trump rally in Tulsa Oklahoma.

In 1918, the president was Woodrow Wilson.  He was unifying the country to support sending soldiers to Europe to participate in World War I.  The draft was recruiting thousands of people to serve, and Wilson was forcefully keeping the public’s attention away from the growing pandemic.  Military installations were filled with recruits for training and deployment.  Shipyards were adding thousands of workers to already crowded cities like Philadelphia.  The pandemic was already ravishing the military installations, and public health officials were trying to keep the infection out of the civilian population.

In 2020, president Trump was trying to unify his popularity preparing for the upcoming elections.  His focus shifted to renewing the economy and keeping the public’s attention away from the coronavirus-19 pandemic.

Wilson needed to raise money for the war effort.  In Philadelphia, it was proposed to hold a large parade to encourage people to buy government Liberty Bonds.  In Tulsa, Trump needed to demonstrate he was in control and a rally was proposed to encourage people to come to witness this.  In Philadelphia, public health officials at all levels pleaded that the parade should not be held.  In Tulsa, public health officials at all levels pleaded the rally should not be held.  In Philadelphia, on September 28, 1918, the parade stepped off.  It was at least two miles long with several hundred thousand people jammed the entire parade route.  In Tulsa, on June 21, 2020, six thousand two hundred people spent from 2 up to more than 4 hours inside the convention center for the rally.

In Philadelphia, with an incubation period of 24 to 72 hours, the pandemic influenza resulted in every hospital bed available being filled after just three days from the parade.  Banner in his book states, “In ten days – ten days –  the epidemic had exploded from a few hundred civilian cases and one or two deaths a day to hundreds of thousands ill and hundreds of deaths each day”     Within a week, over 5,000 deaths had taken place, and this trend continued long into the future.

In Tulsa, after the rally with an incubation period of up to 14 days … (reports will follow!)

To be sure, the characteristics of COVID-9 and the 1918 pandemic are different.  Communications technologies are not the same, and scientific knowledge during each of these diseases is not comparable.  But even then, lessons can be learned if we can just look back to avoid the mistakes of the past.

 

  1. White House Coronavirus Task Force

Q: Is the White House Coronavirus Task Force still there?  What’s the latest from Dr. Fauci?

A:  The task force, as far as known, still exists.  But there has been limited reporting on what is being discussed.  Anthony Fauci, MD, who attended many past meetings and press conferences of the task force, is the director of the National Allergy and Infectious Diseases agency.  On June 19, the McClatchy news service reporter Michael Wilner reported that Dr. Fauci disapproved of the term “Operation Warp Speed,” the name given to the federal vaccine development effort.  The article stated president Trump has pushed the US DHHS to expedite a vaccine “so that the public can glimpse an end to the pandemic ahead of the November presidential vote.”  Dr. Fauci said if this happened. He would oppose it because the clinical trials cannot be completed by then.  “There can be no chance in the world that I am going to be forced into agreeing to something that I don’t think is safe and scientifically sound.  I’ll guarantee you that.”

Stand by.

More Covid-19 FAQs

Frequently Asked Questions about COVID-19

  “Shared expectations lead to predictability.”

 

  1. When patients are the most and the least infectious

          Q:  Is there any understanding on when and if infected patients can infect others?

A:  A WHO epidemiologist and technical lead on the pandemic, Maria van Kerkhove, created an unintentional controversy recently by stating that “transmission of COVID-19 by asymptomatic patients is very rare.”   To an epidemiologist, an “asymptomatic patient” is someone who is infected and has the disease resolved without showing any symptoms.  Testing later shows antibodies indicating they did have the disease.  But in common language, a patient who is asymptomatic means that at that time, no symptoms are present.  Thus, a patient who does later become sick usually does have a few days where they are asymptomatic, and in fact is able to place others at risk.  In fact, studies now show that the transmission rate of infection is actually greatest just at the point when they first begin to feel unwell.

Dr. Mike Ryan, the top emergencies expert at WHO stated, “The novel coronavirus lodges in the upper respiratory tract, making it easier to transmit by droplets than related viruses such as SARS and MERS, which are in the lower tract.”  He continued, “That means you can be in the restaurant feeling perfectly well and start to get a fever.  That’s the moment your viral load could be actually quite high.”

Later studies have found that even asymptomatic patients, who never experience symptoms, can actually spread the disease, but at t much lower rate (below 40%) of the contagion of symptomatic patients.

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  1. Therapeutic medicines for children

          Q: Are there any new medications being tested to treat children who get COVID-19?

A:  Starting on June 10, The National Institutes of Health (NIH) launched a study in the United States to evaluate drugs used to treat children and adolescents who are infected with coronavirus-19.  The studies will include several antiviral and anti-inflammatory drugs, and will study drug dosages and safety factors for special populations including premature infants, critically ill children with Down’s syndrome, and obese children.  The study to be accomplished will not be a clinical trial, but will analyze blood samples to assess how drugs move through children.  As a result, this study will not be evaluating the best treatments for COVID-19 in pediatric patients.  It is apparent that there is much to learn about coronavirus-19 that is still unknown – this being named a “novel” coronavirus.  For now, the emphasis remains focused on the largest population of infected people, that being adults.

 

  1. High value given for universal use of cloth face coverings

          Q:  People still feel uncomfortable wearing cloth face coverings.  Is it really worth doing this?

A:  A research study led by scientists at Britain’s Cambridge and Greenwich Universities was recently published in the scientific journal, “Proceedings of the Royal Society, Part B” indicated that lockdown, or “stay at home” policies, cannot alone stop the resurgence of COVID-19.  Even homemade cloth masks can “dramatically reduce transmission rates if enough people wear them in public.”

The study examined the dynamics of disease spread using population-level models to determine the reproduction rate, R value, of different situations with and without mask usage.  An R value of 1 is when each infected person in a group infects just one other person – the disease remains static.  An R rate greater than 1 is when the number of infected people grows exponentially.

The purpose of the cloth face mask is to reduce the spread of the disease from those who are infected but have yet to show symptoms.  The study found that if everyone wears a face covering when they are in public, it is twice as effective at reducing the R value than if the masks are only worn after symptoms appear.  In all scenarios examined, it was found that when 50% of the population uses cloth face coverings, the R factor was less than 1, meaning that this practice alone flattened the future disease waves and spikes, allowing for less stringent lockdowns being required.

The WHO updated its recommendations to all governments on June 5 stressing the need to ask everyone to wear fabric face masks in public to reduce the spread of the disease.

 

  1. Lack of public desire to follow CDC guidelines

          Q: Why aren’t people following the guidelines as we open up? 

A:  Mixed messaging from Washington on the pandemic appears to enhance public confusion over the guidelines and encourage behavior that in some states is expanding the number of COVID-19 cases.  The president continually refuses to wear a cloth face covering, sending the message that this isn’t really important.  The White House exclusive focus on opening the economy is allowing many citizens to perceive the threat from the disease is already over.  White House guidelines have been promulgated stating when states can effectively open their economies in stages, but the president then supports protesters demanding their governors ignore these recommendations.  This all feeds the natural human tendency for many people to want to “get back to normal” and ignore the early warning signs as the number of cases in some states are rising exponentially.

According to Reuters, Arizona, Utah and New Mexico reported rises in new cases of 40% or higher for the week ending June 7.  New cases in Florida, Arkansas, South Carolina and North Carolina rose by more than 230% in the past week.  Ashish Jha, the head of Harvard’s Global Health Institute stated the United States was the only major country in the world to reopen without getting its case growth rate – people tested positive – remaining at or below 5% of the population for at least 14 days.

The lack of patience, the lack of accepting guidelines and agreeing to follow them can only lead to an expansion of the disease in the US.  And the greater it spreads, the more difficult it will be to reduce its prevalence.  And, more critically, the more people may become ill without the availability of hospital care as we have come to expect.

 

  1. Update on inaccurate testing

          Q: Is COVID-19 testing still unreliable?

A: (This is a follow up to FAQ 32, previously published.)  The Hartford Courant on June 15 published an Associated Press article by Matthew Perrone reporting that diagnostic testing as well as serum testing for COVID-19 remain inaccurate, hampering management of the pandemic in the U.S.   Early in the spread of coronavirus-19, the World Health Organization (WHO) offered a specific diagnostic test to all governments to determine if a person was infected with the virus.  The CDC did not use this WHO process, and developed and released its own testing method.  It was found that this FDA test was unreliable, and it was withdrawn.  The White House directed the Food and Drug Authorization (EUA) to turn to the private sector and issue Emergency Use Authorizations to as many business and laboratories as possible to fill this void.  The FDA requires a minimum of 60 sample tests be documented by the applicant to ensure accuracy before an EUA is granted.

The AP reporter Matthew Perrone reports, “In recent weeks, preliminary findings have flagged potential problems with some COVID-19 tests, including one used daily at the White House.  Faulty tests could leave many thousands of Americans with the incorrect assumption that they are virus-free.”  He identifies there are more than 110 different diagnostic tests and “roughly 80” commercial serum test with an EUA available for use.

The article continues, “’Requiring bigger studies of all coronavirus tests could provide valuable information, but it could also strain the FDA’s already stretched staff and resources’ said Dr. Daniel Schultz, former director of the FDA’s medical device center. ‘Dr. Colin West of the Mayo Clinic worries doctors and patients have put too much confidence in the current crop of tests, when an unknown number of patients are likely receiving false negative results.’”  Dr. West gave an example – if a test with 95% accuracy is given to 1 million people, there could be 50,000 people receiving a report they don’t have the virus and left in the population to infect others.

This article identifies many of the problems resulting from not having an early and effective national testing program.

More Covid-19 FAQs

Frequently Asked Questions about COVID-19

  “Shared expectations lead to predictability.”

 

  1. Coronavirus-19 could become endemic

          Q:  What if a vaccine cannot be proven to give immunity – will the disease rely only on treatment intervention to keep it in control?

A:  There are viral diseases for which attempts to find a vaccine have failed.  HIV (Human Immunodeficiency Virus) is one of these.  This means the disease is referred to as being endemic.  An endemic disease can only be controlled by two interventions: avoiding actions that allow it to infect others and by developing therapeutics that mitigate against it from becoming so severe they disable or kill those who contract it.  On Wednesday, June 3, the World Health Organization stated that coronavirus-19 is at a point where it could keep circulating around the world and would soon require a “massive effort” to counter it.  Mike Ryan, the WHO emergencies expert, stressed how little is really known about this disease when he said, “I think it is important we are realistic and I don’t think anyone can predict when this disease will disappear  This disease may settle into (becoming) a long term problem.”

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  1. Politics and vaccines

          Q: Why is the U.S. spending so much money to produce millions of doses of a vaccines that haven’t yet been approved for distribution?

A: It was previously discussed (FAQ 34) that The US government had awarded up to $1.2 billion to AstraZeneca to develop a potential vaccine for coronavirus-19.  This contract is to complete a combined Phase II and III clinical trial that was reported to take months to complete, followed by evaluation and potential licensing.  Production of the vaccine and delivery of the product in syringes would usually then follow – taking perhaps several more months before the vaccine could be administrated.  This timetable is consistent with several recent estimates given by CDC and FDA officials.

The news service Reuters has now reported the contract was given “after president Trump demanded a vaccine.”  “This contract with AstraZeneca is a major milestone in Operation Warp Speed’s toward a safe, effective, widely available vaccine…”  Reuters now reports the Department of Health and Human Services has stated the US has now secured 300 million doses of the new vaccine in its push for October vaccinations. (emphasis added).  It was also reported by Reuters that “AstraZeneca recognizes that the vaccine may not work but is committed to progressing the clinical program with speed and scaling up manufacturing at risk.”  This is only 5 months away.  Is the trial vaccine being manufactured and packaged now – before the clinical trials have begun?

In other news reported on June 1, the US awarded another $628 million contract to boost the availability of manufactured vaccines to the public.  As Alex Azar, secretary of US Department of Health and Human services said, this “will help get a vaccine to American patients without a day wasted.”  The contract was awarded to another federal agency The Biomedical Advanced Research and Development Agency (BARDA) that funds disease-fighting technology.  BARDA has already invested over $2 million in vaccines, diagnostics and therapies.  This new grant will support several organizations and groups competing to be the first to develop a coronavirus-29 vaccine.  These include Johnson & Johnson, Moderna, Inc., Novavax, Inc., and Vaxart Inc.

This multiple funding of several groups to have a manufactured vaccine available to the public just before the next election raises several concerns:

  • Under these contracts, are AstraZeneca and other groups now manufacturing and packaging their trial vaccines in millions of syringes ready for immediate distribution if and when they are approved and licensed?
  • Will there be enough time for the 35,000 people participating in the combined AstraZeneca Phase 2 and Phase 3 clinical trials – and the tens of other thousands for other manufacturers’ clinical trials to show the safety and effectiveness of each trial vaccine?
    • Would the existence of millions of already packaged vaccine ready for distribution affect the decision to license a trial vaccine if problems are identified in the clinical trials?
      • If a trial vaccine shows only marginal immunity is achieved, would there be pressure for the FDA to approve it anyway?
      • If the clinical trial shows that a trial vaccine actually infects a small number of healthy people who end up with COVID-19, might this be judged as not a safety issue?
    • If other pharmaceutical companies now conducting clinical trials later find that their products are more effective or safer than the first one licensed, what disruption might result if only the first one is immediately available?
    • If more than one vaccine is finally licensed, but each has different effectiveness or safety issues, how might this be resolved.
  • If any vaccine is licensed that later demonstrates problems in general use, how would this affect the public’s expanding distrust of all vaccinations? (In the history of polio vaccine, it was found after it was approved some of the people actually became paralyzed by the vaccine.)

One has to also remember that vaccines create antibodies specific to a particular disease to ward off future infections.  But there is still no evidence that the coronavirus antibodies grant lasting immunity preventing anyone from contracting COVID-19.

 

  1. Demand for vaccination

          Q:  How many people really want a vaccine?

A:  On June 2, the results of an ABC News/Washington Post poll were announced.  It was found that 27% of those surveyed are unlikely to be vaccinated against the coronavirus-19.  A breakdown shows that 45% of strong conservatives, 40% of Republicans, and nearly 40% of evangelicals said they were unlikely to get vaccinated, even of it was provided at no cost.  Of those not likely to be vaccinated, 15% were definitely, and 12% were probably not willing to get the caccine.  Half of this group stated they didn’t trust vaccines in general, and a quarter didn’t feel it was really necessary at this time.

 

  1. Getting ready for school in September

        Q: Is there anything new concerning opening of schools in the fall?

A: The CDC updated its guidance for K-12 school administrators, teachers and patents on June 3.  The new guidance includes information on three levels of community exposure to coronavirus: no community spread, minimal to moderate community spread, and substantial community spread.

  • No community spread:
    • Teach and reinforce hygiene procedures;
    • Intensify cleaning and disinfection procedures;
    • Monitor and plan for absenteeism;
    • Assess group meetings and events; and
    • Require sick students and staff to stay home
  • Minimal to moderate community spread:
    • Cancel field trips, assemblies and large gatherings;
    • Cancel or modify classes where students are close to others.
    • Increase space between desks to at least 6 feet;
    • Stagger arrival and departure times;
    • Limit nonessential visitors; and
    • Limit access by students from other schools (e.g. for robotics, etc.);
  • Substantial community spread:
    • Follow local health department guidance for community-wide actions;
    • Consider extended (longer than 2 weeks) dismissals;
    • Cancel field trips and after-school activities; and
    • Consider distance-learning methods.

Schools are encouraged to revise their emergency plans to give specific advice on specific areas.  Every school in Connecticut for several years is required to have an emergency plan.  Parents should feel free to ask for a copy of the coronavirus-19 section of their school’s plan to learn of their school’s expectations for managing this pandemic.

 

We Can Make Face Masks #5 (For Hartford Hospital)

Friends:

Throughout the month of May, UUS:E has been delivering homemade face masks to our neighbor, Crestfield Nursing Home.  Thanks to everyone who has sewn and donated masks! For the month of June we will donate any masks we receive to Hartford Hospital. Now that the state is beginning to re-open, many of the hospital’s non-essential office staff are returning to work, and masks are needed.

If you are sewing masks and would like to contribute to our collection for Hartford Hospital, please know you can drop them in the plastic bin outside the entrance to the UUS:E office at any time. They will be picked up for delivery every Sunday at 3:00 PM.

Questions, contact Rev. Josh.

More Covid-19 FAQs

“Shared expectations lead to predictability.”

 

  1. Isolation while recovering from COVID-19

Q:  Someone close to me is recovering from COVID-19.  How long should she remain in isolation?

A:  On May 24, the CDC released the following guidance:

If you think or know you have had COVID-19. You should remain isolated to prevent infecting others.  You no longer need to stay in isolation after:

  • If you think or know you had COVID-19:
    • 3 days with no fever, AND
    • Symptoms have improved, AND
    • 10 days after symptoms first appeared.
  • If you tested positive for COVID-19 but had no symptoms:
    • 10 days after the test was taken
  • If you have a weakened immune system due to a health condition or medication, you may need to stay home longer than 10 days:
    • Contact your physician for guidance,
    • Be tested to see if you are infected with coronavirus-19.
  • If anyone has been around another person who has COVID-19:
    • Remain isolated for 14 days after exposure.

 

  1. Antibody Testing and Immunity

Q: I have tested positive for having antibodies from COVID-19.  Do I have immunity?

A: Be careful!  You should not assume you are immune from becoming infected in the future.  As previously discussed, the existing serum or antibody testing has a significant number of false positives – positive results when in fact there are no antibodies.    On May 24, the CDC published interim guidelines for COVID-19 testing. 

Strategies are outlined for using tests that have a lower number of false positive results, testing in ways that lower the number of these unreliable findings, and making better assumptions on interpreting the results.  It is also noted that the correlation between the presence of antibodies and immunity has not yet been established.

As a result, recommendations are made for persons who test positive for COVID-19 antibodies:

  • It cannot be assumed that individuals with truly positive antibody test results are protected from future infection.
  • Asymptomatic persons who test positive by serologic testing and who are without recent history of COVID-19 have a low likelihood of active infection, and should follow previous guidelines including hand washing, social distancing and wearing face cloths.
  • People who have had a confirmed case should also follow previous guidance.
  • For health care workers and first responders ho test positive for COVID-19 antibodies, there should be no change in clinical practice including the use of PPE.

 

  1. Further evaluation of how COVID-19 spreads

Q:  Is there any new information on how this disease spreads?

A: On May 21, the CDC updated its analysis on how the corocnavirus-19 spreads.

This analysis stresses the importance of direct person-to-person transfer. 

  • Between people who are in close contact with each other – within 6 feet
  • Through respiratory droplets produced when an infected person coughs, sneezes or talks
  • These droplets can land in the mouths, or noses of people nearby.
  • COVID-19 may be spread by people not showing any symptoms.

It is possible that by touching a surface that has the virus on it then touching the face, COVID-19 can be transferred.  But this appears a less likely way to contact the disease.  Hand washing and avoiding touching one’s face remain recommendations while this is being further studied.

The risk of spreading the disease from animals to people remains very low.  There have been documented a few cases where animals (pets) have caught a COVID-19-like disease from a person.

 

  1. CDC Guidelines on Religion

Q. Connecticut is now allowing religious services to be held.  What CDC guidelines apply before we can even think about having in-person services at the meeting house?

A: In addition to guidelines issued by the State of Connecticut, there are two other guidelines that apply.  The CDC “interim Guidance for Communities of Faith” was issued on May 23.  It includes following all state and guidelines, which are in place.  It also suggests requiring all other organizations that may use the facilities to comply as well, and for any religious education and social group activities to follow related CDC guidelines (e.g., for schools) as well.  It is stressed that consideration must be given to protect staff and congregants at higher risk for severe illness (including older adults and people of all ages with certain underlying medical conditions). 

A long list of topics is covered under safety actions, including washing hands, social distancing, cloth face coverings, and frequent disinfection of surfaces.  One mitigation step of interest is to limit community sharing of worship materials and other items.  This includes hymnals, collection baskets and having pre-packaged foods during social periods.

A warning of sorts is issued at the end: “In the event a person diagnosed with COVID-19 is determined to have been in the building and poses a risk to the community, it is strongly suggested to dismiss attendees, then properly clean and disinfect the area and the building where the individual was present before resuming activities.”

The national Unitarian Universalist Association, anticipating these CDC guidelines, has recently released a 7-page document “UUA Guidance on Gathering In-Person when COVID-19 Subsides.”   All of the above-described CDC guidelines are included, as is a more thorough presentation of considerations for us to consider.  The Policy Board is developing our approach to this issue.  Everyone should look forward to learning about, and participating in our future decisions.  But everyone should remain patient so care and consideration of safety remains the highest priority. 

As often stated before:

“It’s better to be patient than be a patient!”