COVID-19 Pandemic

Society Groundhog Day Amidst a Prolonged Pandemic
From Columbus Medical Association Blog: 

HCGC is an affiliate of CMA
Dr. Sugat Patel’s thoughts are based on what is known as of 4/17/2020.

My aim is to start a discussion on the restart of our society considering the COVID-19 pandemic will endure until there is a significant treatment or vaccine. Understanding that we may have to wait for a year or possibly more, we will have to eventually emerge, risking exposure of ourselves and loved ones to the virus. I don’t want to be long-winded, so I am going to try and present this argument by given, assumed, then proposed.

Given (learned)
Our practices of staying at home, social distancing, and using masks have helped to flatten the curve. We are below hospital capacity and need to stay there. Our top priorities are to not exceed hospital capacity and to have enough PPE to make healthcare as safe as possible. Circumstances, where the virus is aerosolized, require maximum grade PPE. Any plan that compromises those priorities is a failure. Spread is largely through asymptomatic carriers. Many asymptomatic carriers are children. The elderly and people with comorbid conditions are extremely susceptible to morbidity and mortality.

Assumptions (my)
Measures implemented are all liquid, with the goal of keeping hospitals under capacity and with appropriate supplies. The original desire for widespread testing involved the goal of finding a carrier, then isolating the carrier and contacts to prevent spread. I think once the contagion has become widespread and the asymptomatic carrier rate is significant, the value of that measure decreases. Also, the psychology of testing value may become over perceived by the public giving a false sense of security. The best way to address the contagion spread is to assume everyone is a carrier. Keeping hands clean should now be a common and frequent practice, and is the simplest preventive measure. The second most valuable measure is to block one’s own respiratory or oral secretions. To implement this measure, people should wear homemade and other masks or mouth/nose shields in public. Masks to protect oneself from inhalation of the virus, especially homemade, may be less effective, but don’t hurt and should be used as a special precaution when risks are higher (comorbid patients, broken social distancing, etc.).

Proposed (once the curve is flat and comfortable… hopefully within a month)
I am hoping most people become familiar with the practices of social distancing, frequent hand washing, and face mask or shield wearing, for these may continue for a very long time. Strict use of these practices will allow us to restart and reintegrate. A breakdown in these measures and we are back where we started. Current practices of telemedicine, teleconferencing, and tele-business should continue where practical. Most businesses should be able to restart with those constraints, along with frequent disinfecting. There will have to be enough hand washing stations and hand sanitizer for the business. These are already practiced and mandated at essential businesses. People should wear masks at work if they are not alone and 6 feet social distancing is not possible at all times. Nose and mouth shields are acceptable in low-risk environments with healthy young people.
Workplaces, where social distancing breaks down, becomes difficult. I think restaurants will have to wait a few more weeks to reopen after the lifting of the stay at home order if all goes well. When they reopen, servers and food preparers will have to wear masks. The restaurant can’t allow crowding. Bars are unique in that they depend on crowding, socializing and drinking, which make virus precautions almost impossible. They will be the last to open, which may be a long time, unfortunately. Schools are likely a hub for virus spread. I think they could restart a few weeks after the stay at home lifting. Masks or nose and mouth shields should be worn, and there should be hand sanitizer in every room. Social distancing practices should be in place. Lunchtime spacing must be created. To prevent a fail and complete pull back, high schools should start first, followed a couple weeks later by middle school, then lastly elementary school. Daycare for toddlers is a tough question. I can’t, practically, think of a way to control that environment. I would leave that to other experts, or they would have to suffer duration similar to bars and lounges.
Public transport should mandate masks or nose/ mouth shields. There should be signs to remind people to clean hands upon exit.
Gyms could also reopen as patrons could wear masks, and hand sanitizer and wipes should be aplenty. Cardio equipment should be appropriately spaced. Lap swimming at pools should be acceptable, but no “open pools” where distancing cannot be maintained.
Sports can resume if social distancing can be implemented. If not, then nose/mouth shields should be worn, by players and coaches. I can think of a simple design of a flexible over the nose fit with a firm plastic mouth shield that would leave plenty of room for breathing, but block almost all spit from talking or yelling. Hand sanitizer will, of course, need to be on the sideline. This may be difficult for wrestling to implement. Overcrowding at stadiums for spectators should not be allowed, and masks or shields should be required, along with hand sanitizer or wipes. Food and beverage should not be sold unless consumed in a private area with distancing (not at their seats).
There would have to be self-policing and social media should be helpful in whistleblowing. There will be a surge, but hopefully a very limited one. I think the under hit rural areas will especially feel a surge when the restart begins. Discipline and vigilance will be key.

What I have written here serves as my self-therapy to realize that we may be able to build a bridge to normalcy. Hopefully, it gives some hope

Sugat S. Patel, M.D.April 17, 2020

---