On Saturday, April 4, I participated in a two plus hour current update webinar by Leslie S.T. Fang MD PhD on the COVID-19 pandemic. Dr. Fang maintains an active international practice in Internal Medicine and Nephrology and is a leading teacher on the faculty at Harvard Medical School. The following is a summary of Dr. Fang’s webinar and what is currently known.
Globally on April 4, 2020, 1,005,507 cases have been reported with 51,606 deaths and 210,555 recovered, which means that over 700,000 cases are still in progress. Plus it is likely that an unknown number, probably in the 100,000s, have gone unreported with mild symptoms. The U.S. has taken the lead in reported cases. Italy leads the death count with 11,591, though it is expected the U.S. will pass that number in the month of April. April is projected to be the peak of occurrences and deaths in the U.S. with numbers beginning to level off in May and June and subside in August. The virus seems to like colder, moister climates but has been found in all counties in the U.S.
The incubation period can range from 2 to 14 days after the exposure to the virus, which is HIGHLY CONTAGIOUS with quick and often severe symptoms. Symptoms often start with soreness in the back of the throat with hacking cough, then muscle pain and tiredness leading to shortness of breath by day six or seven and the Acute Respiratory Distress Syndrome by day nine or 10. Death usually occurs from an incredibly strong immune reaction SIRS [Systemic inflammatory response syndrome] that leads to multiple organ failure, including GI bleeding, acute kidney injury and liver failure. Loss of smell and taste are often early key symptoms.
The virus enters the body through the mucous membranes: the mouth, nose and eyes. This occurs either 1. through direct contact with an infected individual, or 2. from the virus sent through the air sprayed by coughing or sneezing from an infected individual, or 3. from shared surfaces that have been touched by an infected individual. That is why frequent thorough 20 second hand washing with soap, covering ones face with a mask and keeping social distancing and isolation is so important to prevent transfer of the viral infection.
The greatest number of cases is found in the 30 to 60 age group due to work and vacation related travel with work meetings and social gatherings. The greatest death rate is seen in 80 plus year olds, nearly 15 percent. Young have been doing well with 89 percent only having mild cold like symptoms. Mortality rate increases with pre existing conditions: heart disease 10.5 percent, diabetes 7.3 percent, chronic respiratory disease 6.3 percent, high blood pressure 6 percent, cancer 5.6 percent. But it is important to know that death has occurred in all age groups and all levels of health.
A sick symptomatic patient is extremely high risk for causing the spread of the virus with aerosol coughing and sneezing with COVID-19 flying through the air and landing on surfaces. The hands of the COVID-19 patients become covered in the virus from touching their faces and can spread onto any surface they touch.
It is now evident that there are many asymptomatic individuals who are infected with no symptoms at all, but test positive for COVID-19. The number is unclear since most of these individuals are never tested, but are carriers of the disease. In South Korea, 20 percent of 300,000 individuals who tested positive had no symptoms. On the the Diamond Princess cruise ship 51.1 percent of the 634 passengers tested positive for COVID-19 showed no symptoms while being held in a two week quarantine. Infected people without symptoms might be driving the spread of the disease more than we realize particularly children. An asymptomatic individual should be a much lower risk for spreading the disease than an actively sick coughing and sneezing COVID-19 patient.
How long can the COVID-19 survive on
different shared surfaces?
Aerosol 4 hoursSo the virus can stay in the air
for 4 hours after a sneeze.
Copper 4 hours
Stainless Steel3 days
Different techniques can be used to prevent spread from shared surfaces. Use common sense. Never touch your face or mask till you wash your hands. Wear mask. Wear gloves and then wash or throw them away. Wash hands. Thoroughly clean surfaces with disinfectant or soap and hot water. Empty container and throw away plastic or cardboard, then wash hands. Leave boxes in the
‘COVID-19’ see page 4
garage or outside till time lapses. Remember the risk from shared surfaces should be low, but you can never be too safe.
Social distance is considered 6 feet. That distance came from a study in the 1930s that showed droplets of moisture travelled up to 6 feet from coughing or sneezing. Recently MIT did a study that showed fine spray traveling much father, up to 27 feet away, from a cough or sneeze. So better to stay much father apart from anyone sick and better yet both wear masks.
The bottom line is we should all be wearing masks when in public [as much as I personally hate wearing masks] . Sneezes and coughs can travel far and the virus can stay in the air for four hours. Plus, there are many undiagnosed or asymptotic COVID-19 individuals out there touching surfaces like door knobs. That asymptomatic person could be me or you. This is particularly important for anyone around lots of other people, like on mass transit.
Our U.S. Surgeon General initially came out and said that masks were a waste of time; he has changed his tune and masks are now recommended. Masks are difficult to come by right now, but even cloth coverage is helpful. Asia, including South Korea, Japan, Singapore and Hong Kong flattened their infectious curve by having every individual wear masks whenever they leave their homes. The populace of Germany, Italy, Spain, the U.K. and the U.S. rarely wear masks and have shown much higher spiking curves of COVID-19 than the mask wearing Asian countries.
There have been recent encouraging treatment results with the use of George, an anti-malaria drug and even better results when it was combined with azithromycin, an antibiotic drug. This was a French study with only 26 patients, so is still an unknown, though President Trump says he might take it. There should be more information soon, but it will take some time to up production if this regimen is deemed to be effective.
A vaccine has been made, but will probably only be available for next year. China sequenced COVID-19 on January 11 and a lab in Massachusetts formulated a vaccine 42 days later.
Dentistry is considered high risk for COVID-19 transmission. All offices in the U.S. are mandated to remain closed through the end of April and most likely the date will be extended. What makes dentistry high risk is that the high speed drill causes aerosol particles to spray around the treatment room. Only emergency treatment is recommended at this time and only if antibiotics are not effective.
Stay Safe. Enjoy Life and Keep Smiling During This Unprecedented Time. This Too Will Pass.
George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com