Posts: 918
Threads: 92
Joined: Dec 1969
12-09-2020, 11:53 PM
(This post was last modified: 12-09-2020, 11:59 PM by
akiddoc.)
This idea that we have to wait for science to "prove" that certain behaviors cause the spread of Covid-19 specifically is not workable. Scientific proof is a slow and ponderous process. We just aren't going to have those scientific studies and papers for many months or years. What we need now is extrapolation from previous related science to handle the next 6-9 months of the spread of this virus. Contact tracing and its analysis can be helpful as well.
Alameda County is making a brobdingnagian effort at contact tracing. The most thorough work is being done in the County Clinic network where I work. With regard to patients, it starts with the physician's note, where we document reports from patients regarding known Covid contacts or lack thereof, daycare attendance, parent's work situations and visits to other's homes or visits to the family's home. It then goes to our public health tracers, who try to further delineate who the contacts were and what the social interactions were that likely caused the spread.
Every employee who gets sick has an exhaustive history done, especially because the county health system cannot afford to have it spreading through the employees and affecting the work force.
We had a report today that is not private or privileged. Some interesting points.
The most likely infectious event for all cases, whether patient or employee, was at home or in a restaurant and indoors. Not single caregiver in the outpatient clinics has been documented to have been infected by a patient. There are people who have infected co-workers in the lunchroom, verified by DNA analysis of the virus.
In the hospital system, there have been no infections of hospital personnel by a patient for almost 4 months. We are lucky in the Alameda County system to have an abundant supply of PPE, an early and aggressive training program for infection control, and a very motivated work force.
I have personally seen a number of Covid positive patients, and some of my colleagues have seen more than I have, but we have essentially 100% compliance with PPE protocols. All patient contact personnel must wear a mask, eye protection and gloves while in any patient room. For any suspected Covid case, fuller PPE is worn. We have protocols for minimizing our actual time in the exam rooms, a number of negative pressure rooms, high volume HEPA filtration, and policies that encourage patients to do phone visits if they are sick.
The total number of employees who have tested positive is 2%. There are about 6400 employees in our system. In the community we serve, the positive antibody rate for Covid was about 20% 3 months ago, plus or minus a couple of percentage points. Not sure what it is now.
(The current test positivity rate in Alameda County is only 3.6%, much better than California as a whole. I'm not sure why.)
My point is that these protocols are not based on new scientific literature specifically looking at Covid. That literature is sparse at best. We generally know how respiratory viruses are spread, so we use that information to prevent the spread of Covid in our institution.
As far as outdoor dining is concerned, the problem is that these restaurants are not providing it. They are enclosing their patrons in tents in the parking lot or on the side walk. Anything that lowers air circulation or crowds people together is no longer allowing natural outdoor air movement to cause rapid diluting of viral particles. And indoor dining is a catastrophe for the spread of this virus. This is backed up by epidemiological data.
When exposure is fleeting, infection is unlikely.
In a true outdoor environment, without crowding, infection is unlikely.
In a true bubble, infection is unlikely (but how many are truly doing that?)
By the way, I haven't seen a single case of influenza this season. That's never happened before up to Dec 9. I had 9 positives for Covid in the last three days. It shows how darn infectious this virus is versus influenza. A little social distancing really put a dent in flu cases. Covid continues to roar. I suspect our county positivity rate is about to grow.