Epidemiology can be a confusing subject. Like all branches of science, epidemiology has perplexing terminology and, perhaps, a certain level of mystery about its’ inner workings. We kinda like it like that. Normally the arcane lingo and methods of a scientific pursuit are fine, but in 2020, epi concepts and terms are being tossed around by the unitinitated and even the ignorant. The result is confusion for many people trying to deal with the fear and burden of Covid on their families and communities. In this essay, I am going to try  and simplify all of this and provide you with the information to understand what is really happening and to make good decisions about dealing with this epidemic. All of it, epi-lingo free.

SPREAD – Patient A is infected with a highly communicable, respiratory virus (Covid). Patient A has not been tested or isolated and has indoor contact for a period of time with individuals B, C, and D. These 4 individuals sat at the same table in a restaurant and talked and laughed for 2 hours. Good times! In 3 days, B and C become symptomatic. As is typical, B is unable to get tested, while C is tested but must wait for 7 days until receiving her positive test result. Neither isolates. Consequently, Patient B infects 2 additional people, while Patient C infects 3 more people. In a matter of days, patient A, who only wanted to go out to dinner with friends (which is his constitutional right, somehow) is responsible for 7 additional cases of Covid. Of course, this chain continues into the future with more and more people becoming infected and, in turn, infecting others. Meanwhile, there are “Patient A’s” all over the population (city, state, country) doing the exact same thing with the exact same result in a virgin population with no level of immunity to this highly contagious virus. That is exactly and simply how a single human case from a bat in China becomes a worldwide pandemic and that is how the US got into this situation and cannot seem to get out. One more point – Covid is spread by exhaled droplets (large and small) that are then inspired by some poor bastard in sufficient number to cause infection; rarely, it seems, is Covid spread by contaminated objects (fomites). Symptomatic and pre-symptomatic people can spread this virus, as can children, though children seem to spread the virus only about half as effectively as adults.

INTERVENTIONS – So, what is the public health response to the scenario described above? Obviously, the best response would be to inoculate the population with an effective vaccine that boosts the individual’s immune response and prevents infection. In lieu of a vaccine (which is never immediately available for a novel virus), public health must look at how the disease is transmitted and assess how to interfere with that transmission. For Covid, to control this disease and to reduce an individual’s risk of infection, we must prevent people from coming into contact with the cloud of exhaled particles that form around every infected person. Simply put, the combination of rapid testing with isolation and tracing of contacts is our best weapon in this fight. Since we have none of those essential public health interventions nationally right now, we need to implement and follow the well known practices of 6 foot distances, outdoor public dining and socializing, and WEARING MASKS. Masks work. All the scientific evidence points to the undeniable fact that masks work to reduce the transmission of this virus. As we hope for an effective vaccine (I am, however, not sanguine about this possibility), this country must embrace the interventions that we know can be effective and we have to embrace them wholly – from the White House to the Governors’ mansions.

That’s it. That’s what you need to know to make good decisions for your personal health and to interpret what you’re hearing from your elected leaders. That’s how the disease travels in humans and this is how we can stop it. In practical terms, if there’s a line of people to pay at a store or restaurant (where you’ve dined outside), do not stand in that line unless there’s sufficient distance between each person. If you have a mask and a stranger starts to talk to you without one, just say, “I’m sorry” and walk away. Rude? Maybe, but I would say that unmasked person was more rude. If you’re outside and exercising and don’t want to wear a mask, go ahead. I am not saying you cannot ever get infected with Covid from outside exposure, but the risk is small if you practice 6 foot distancing. I don’t wear a mask outside, but I always wear one indoors in public.

SCHOOLS – One final word about schools reopening. We all know that we need our schools and we need our children to be in school. We all know the reasons, I’m not going to go through them. This is not a Republican vs. Democrat issue. All of us want the schools open.

I am convinced that there are a number of school districts in this country where schools can open in the fall. These are areas where Covid case numbers are nonexistent or in single digits and the metrics point in the right direction. Even for these districts, however, it is compulsory to have a plan in-place to respond to a Covid infected student or teacher or a Covid outbreak.

The decision to open “brick and mortar” schools in counties and states with current epidemic levels of Covid (Florida, Texas, Arizona, Georgia, and 35 other states) needs to be made with this fact in mind – students and teachers will become infected. Your political positions and economic theories will not change that unassailable fact. If you have a raging fire of infections going on in the community, it will come into the school. Your teachers and students will become infected. Children can transmit this virus and will transmit Covid to other children in their normal kid-to-kid way of interacting. Teachers are just going to be kindling fed to the fire. So, if you’re willing to have that happen, then open up, but it will happen. I am not wrong on this. Look at my earlier essays – I said exactly what would happen if states pulled back on the interventions too early and it all, unfortunately, came to pass. Besides, predicting that schools will become incubators for Covid outbreaks across the nation does not require eerie prognostication, just a cold assessment of the facts. Hope they don’t open.

Be careful. Be informed. Be safe.

Be careful whom you listen to

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