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Locomotive Breath by Jethro Tull: it
may fool you as it starts, but no, it winds up into classic
rock, like a train engine humming along. Sometimes things
are different than what they originally seem. Our initial
impression may take us down one road and we think we know
what is happening...until we do not. So, it is with
COVID-19.
You might like this article from The Atlantic;
it's long, heady and tedious so I'll give you the Reader's
Digest version in case you don't want to go through it
all. The Rt is an average of a pathogen's contagiousness; it
is the mean number of susceptible people expected to be
infected after exposure. So, if one person infects 3 people,
the Rt = 3.0. When the Rt is consistently <1,0, then there
is no one to infect and the outbreak recedes.
A good illustration of the misleading nature of Rt
mathematics is this example from the article:
"If Amazon’s CEO, Jeff Bezos, walks into a bar with 100
regular people in it, the average wealth in that bar
suddenly exceeds $1 billion. If I also walk into that bar,
not much will change."
The trouble is that this virus spreads in an unsteady
manner. COVID-19 spreads in bursts. And we see this by case
clusters. The term that is used is K for kappa: a measure of
dispersion and so when multiple things happen at the same
time, BOOM! (and
I am not just referring to my book), you have a super
spreading cluster bomb effect.
Over-dispersion is fueled when an infectious person is
present, plus some of these factors:
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poor ventilation
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prolonged contact
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crowding
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yelling, cheering, singing, chanting, laughing loudly,
speaking loudly, breathing heavily (exercise)
And this all happens in bars and indoor restaurants, stadium
events, choir practice, church, funerals, weddings, bridal
and baby showers, large gatherings, etc.
Preparing for Thanksgiving:
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It is possible to reduce your risk at a Thanksgiving
meal with your family.
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Keep it small (<10 people) if indoors.
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Wear a face mask if indoors and not socially distanced
except while eating.
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Resist the need to hug, kiss, shake hands.
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If possible, have it in a more open area like a garage
with doors open.
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Be sure there is excellent ventilation.
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If you are using electric heaters in the garage, keep
the airflow moving from in to out by positioning the
heaters on the back wall facing the garage doors.
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If you are having it indoors, it must be in a large
room.
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If inside, you might consider using portable air
purifiers, they will reduce aerosolization of viral
particles. I have this device in
each of my exam rooms that exchanges the air 10
times/hour. It runs continuously and pulls room air
through a HEPA filter and UV-C light. I use them
at home as well.
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Note - you cannot use propane heaters in an enclosed
area!
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Keep the event short in time, no congregating as a group
in the kitchen unless you have >6 feet. Come. Eat.
Leave.
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Do not allow people to congregate around the food; one
at a time.
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No group watching TV for football or movies (Elf is
my family's long-term tradition).
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Of course, no one can come with any respiratory
symptoms.
Sound fun? In my opinion, it is a far better option than not
getting together.
The numbers:
USA: Yes, the numbers are up; on October 31, there were
>90,000 positives. However, the more you test, the more
positives you find. We must take personal responsibility and
wear a face mask, wash our hands, keep our distance from one
another and participate in small indoor social gatherings
only if social distancing is possible.
Maryland: We are on an upward
trend in hospitalizations. This graph says it all (after
you click this link, look at the top right corner and change
the state from Texas to Maryland.) The number of tests are
up, hospitalizations are nearing the same level as our
previous peak on August 1, the fatality rate has continued
to fall and is now 2.75%. The Maryland Rt is up,
1.18. Is this because a younger, healthier group is getting
it and not following the rules? We need to wear our masks,
gatherings <10 people as long as social distancing is
possible, hand washing often.
The Science of COVID-19:
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