Next Phase with COVID

May 18, 2020

Are you ready for the Safer at Home order? 
Do you know what that means regarding your risk for you and your family? 
Does it feel safe to go back to your work, your place of worship, your beloved local stores?
How about exercising and walking outdoors? 

 

I recently read this blog (many of you may have seen it as well) from Dr. Erin Bromage, PhD who has helped shed some light on this subject of risk and contamination and I believe it’s both comprehensive yet approachable advice for us on how this virus spreads and what this means for all of us moving forward. Dr. Bromage does not appear to be driven by politics or special interest groups. 

 

How do most people get infected anyway? 

Most people are getting infected in their own home from other household members contracting the virus in the community. People getting COVID in the community are mostly getting it from being in an enclosed area with poor ventilation and surrounded by other humans for a period of time (hours).

 

What are the most contagious ways of contracting this virus? 

In order to get infected with COVID, you need to get exposed by an “infectious dose” of the virus, which is estimated at about 1000 viral particles (studies based on MERS and SARS infectious to date). 

Bathrooms- Remember door handles, toilet seats and faucets are high touch surfaces
Coughing- A single cough releases 3000 droplets which can travel 50 miles per hour. These are mostly large droplets but as I mentioned before some can be small and linger in the air as well.
Sneezing - A single sneeze releases 30-40,000 droplets which can travel 200 miles per hour. These are both small and large droplets and can travel across a room. 


**A single cough or sneeze may contain as many as 200,000,000 virus particles that are scattered throughout the environment and therefore these are considered the most significant ways to spread viral material.


Breathing releases 50-5000 droplets but are at a low velocity and fall to the ground quickly. Nose breathing creates significantly less droplets release than mouth breathing. With general breathing it would take 20 copies of the virus per minute put into the environment and even if every virus ended up in your lungs, you would need 1000 copies divided by 20 copies per minute= 50 minutes for exposure to become infected. Therefore, length of exposure is key here too. 


Speaking releases 200 copies of the virus per minute. So when exposed to someone who is speaking and assuming every virus is by you inhaled during that time (which is unlikely) it would take 5 minutes of speaking face-to-face to receive a required dose for infection. 

 

Dr. Bromage says that at least 44% of all infections occur from people without any symptoms. These people can be shedding the virus for up to 5 days before symptoms begin and one is most contagious the few days prior to symptoms starting. 

 

The “Spacial Distancing” rules of 6 ft are in place for people to protect oneself from brief exposures indoors and the outdoors, where there is very little time and very low levels of viral load exposure (thank you wind for viral dilution). Dr. Bromage says that most people should not worry about getting the virus when shopping in grocery stores (think large space, short amt of time inside), outdoors on bike rides and hikes (wind and air dilution) and in other similar situations.  If you are outside exercising, you would need to be in someone’s airstream for 5+ minutes for a chance of infection. It is true that joggers or someone with deep breathing will release more particles, but the exposure of time is still limited and their speed is a factor too. 

Unfortunately, when you start to take into consideration indoor exposure for longer periods of time, this is where the problems are most significant and simply staying 6 feet away from each other is not adequate. The biggest risk areas are enclosed spaces like workplaces, restaurants, churches, event centers, gyms, nursing homes and loud industrial facilities. In these situations, people are touching surfaces communally and frequently, sharing bathrooms, talking forcefully, breathing heavily, singing, and even coughing or sneezing. Of course, they are also sharing that air space for long periods of time. Any environment that is enclosed with poor air circulation and high density of people is the greatest concern. 

 

When Dr. Bromage studied cases of severe outbreaks of COVID-19, they were all from events that were indoors, with people closely-spaced, lots of talking, singing or yelling. This accounts for 90% of all transmission! 

 

So remember it’s about viral exposure in closed spaces with other people for a length of time (hours) where your biggest risks will be moving forward. 

 

Remember your best protection is to avoid touching your face, wash your hands for 20 seconds often, don’t talk face to face with a person for over 5 minutes and avoid enclosed areas for long periods of time (if you must please wear a mask).  With this information above, I do not believe there is a need to wear a mask when walking alone or doing activities by yourself, but that is your personal judgement call. Please keep exercising outdoors for your emotional and physical health and be considerate to those around, but also refrain from causing yourself more stress and anxiety if you walk by someone without a mask, as it would be extremely rare for you to get COVID as a result. If you are immunosuppressed and are concerned, of course continue to protect yourself by wearing a mask and or stay in your home alone while asking for outside support in your daily needs. If you are sick and not sure if you have COVID-19 or not, please stay home for at least 14 days but 30 days is better and don’t wear a mask if you are alone as there is some evidence that you may recirculate the virus and make it worse for yourself. 


I do have limited swabs available to test you if you are suspicious you have active disease (I would come by outside to your car with my PPE on). 

 

While masks can be protect you from getting COVID-19, you should not rely on them fully. If someone with the infection coughs or sneezes close to you, it can be released from their mask (unless it’s a securely fitted N95) and get on the outside of your mask and depending on the mask quality, possibly inside. Please remember if you touch the outside of your mask make sure to wash your hands for 20 seconds afterwards. 

 

https://www.acpjournals.org/doi/10.7326/M20-1342
“Effectiveness of Surgical and Cotton Masks in Blocking SARS-CoV-2” 

 

Also, remember we do have various methods to prevent this virus from entering our body, first it has to make it past your nose hairs, through your mucous, attach to ACE-2 receptors and get past your amazing immune system (and if your immune system is not amazing, remember the foods, supplements and IV Vitamin C therapy can help, which I have been discussing all along) in order to infect you. If you do get sick, we know that the endothelial damage is the most concerning and detrimental aspect of this virus and I plan to write about that next. In the meantime, to help you assess your cells and oxygenation, you may want to consider buying a home pulse oximeter. Scientists and doctors have noticed the rapid decline of oxygenation requiring ventilation can possibly be prevented by assessing one’s oxygenation ahead of time, as it can be an early sign of worsening disease. You can measure your reading when “healthy” as a baseline and then ongoing if you are sick and if you see you are dropping below 90% (95-97% is normal), this is concerning and you should seek medical attention right away, such as your local E.R. 

 

I hope this information helps you make more informed decisions moving forward into this next phase this Pandemic. Remember, we are here to support you at BIH and have many modalities to offer you during this time. Please remember to stay calm and carry on! 

 

Yours in Health 
Carrie 


https://www.yalemedicine.org/stories/covid-pulse-oximeter/

“Why you’re unlikely to get the coronavirus from runners or cyclists”
https://www.vox.com/future-perfect/2020/4/24/21233226/coronavirus-runners-cyclists-airborne-infectious-dose?fbclid=IwAR1XkiJk6Tu81-QqCP6RZFWfswBzqSZson29ZcRYM_pS9xt5AjGtkXYt020

https://www.ncbi.nlm.nih.gov/books/NBK143281/


Dr. Erin Bromage is an Associate Professor of Biology at the University of Massachusetts Dartmouth where he teaches infectious disease and immunology. Dr. Bromage focusing on the evolution of the immune system, the immunological mechanisms responsible for protection from infectious disease and the design and use of vaccines to control infectious disease in animals. He also focuses on designing diagnostic tools to detect biological and chemical threats in the environment in real-time. 
 

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