Your COVID-19 Questions Answered

Speaker 1: 00:00 As much as COVID-19 has been written about discussed and has changed our daily lives over the last six months, there are still many unanswered questions about the pandemic, and there's still a lot of confusion about what are the best practices and keeping ourselves and our loved ones, safe KPBS health reporter, Terran mento gathered inquiries from our listeners, viewers and online audience and ask local infectious disease specialists. Dr. Christian Ramers for some answers, dr. Ramers is one of the leaders within the local medical community, responding to COVID-19 here's that interview Speaker 2: 00:35 Jumping right into it. Andrew bloom of point Loma has the first question for you. Speaker 1: 00:39 It seems like San Diego kind of plus, or minus is just been hovering around 200, 300 cases. And my question is, does that mean we have a low level of COVID and the risk is not so great or are we doing absolutely everything we can and just hanging on by our fingernails to keep case levels at that level and therefore, you know, letting up at all, you know, we'll make those cases go back up again. I think the first thing we should keep in mind is that the CDC estimates that we're probably only diagnosing 10 to 20% of the actual cases out there. So that two to 300 may actually represent just the tip of the iceberg of those that may be asymptomatic but positive. And so I think two to 300 is actually kind of a big number. Uh, other parts of the world and other other countries are seeing much, much lower numbers and having much stricter lockdowns with lower numbers than us. Speaker 1: 01:30 But of course it's all relative. If we go just to our North to Los Angeles, we're talking more like thousands of cases. So San Diego I think is sort of somewhat in the middle. And I think that some of the measures that we've been taking really shouldn't change, whether we see 200 or 500, they should be the same in terms of keeping your distance and wearing masks. And I'm trying to reduce the transmission, keep in mind that if those 200 people don't self isolate, they could probably pass onto another 200 and then you just get a chain reaction and perpetuation of the epidemic. So what we really want to see is a lot less than that down to just sort of single numbers. You look at places like New York city and New York state, they're getting down to extremely low numbers, which actually opens up the whole ability to open up society again and start schools. And those types of things, Speaker 2: 02:15 Paul, who lives in East County says he's been seeing many people at the beach over the last several months, almost none of them wearing masks or social distancing, but he says there doesn't seem to be a significant increase in cases associated with that activity. And he's wondering if the County is tracking outbreaks at beaches, if you're aware of that and why this behavior may not be resulting in a lot of COVID cases. Speaker 1: 02:36 So being outside is so much better than being inside. This is, this is something we've learned kind of halfway through the epidemic. There was a study that modeled this out and it showed that you were 19 times less likely to be infected with COVID with the same interaction, uh, outdoors compared to indoors. If you read the guidelines, wearing masks really is not mandatory. If you are outside and able to keep your distance than six feet from somebody, for example, there's a lot of questions about exercising outdoors. And do you need to wear a mask when you're running or biking? And the answer is, if you can keep your distance and you're outdoors, you actually do not need a mask in that situation. So it really disturbs people a lot to see a beach full of people without masking, but if they are staying away from each other, there is a very, very low likelihood of transmission. Speaker 1: 03:20 So to Paul's question, seeing people outdoors, as long as they're keeping their distance, you can be with your household members. If you're considered sort of part of one group in one bubble, um, you know, you don't have to separate from those people, but keeping six feet away from everybody else, that's where masks become less necessary. Uh, we're masks are absolutely necessary as in any indoor situation or any situation where you have to be closer than six feet to somebody. So I think what we're seeing in terms of the County case rates is a combination of things. People are kind of getting the idea that being outdoors is better than being indoors. And we are seeing increased rates of mask wearing in people that are indoors, especially in businesses where it's required. I don't believe the County is tracking beach or outdoor related outbreaks. Cause it's just kind of harder to do. They're more classifying things by restaurant bar, haircutting, place, spa business, and those types of things. Speaker 2: 04:08 Can you clarify what we know about how the virus spreads that makes it safer to be outside without a mask than indoors? Because we keep hearing, you know, back and forth over it spreads with only air droplets. Some people say it spreads airborne. So clarify what we know Speaker 1: 04:24 As of today. Yeah. So there's been some reports about more distant airborne spread. These are sort of scientific experiments where they do these idealized conditions and say, well, if somebody brings out a tiny little particle and you're more than six feet away, could you get infected? So there's been a little bit more of an acceptance in the scientific literature that Airborne's bread is more active in an active way of spreading. But I think most of us believe that by and large it's small droplets, which are generally going to fall to the ground within about six feet. That's where that recommendation comes from. But in reality, it's probably a mix and the most important factors here are just proximity and time. Actually, we don't think about it that much, but if you're in a closed room within six feet for somebody for two hours, that's a massive exposure compared to 10 minutes outdoors. Speaker 1: 05:10 And we think about outdoors, there's wind, there's this just massive dilution effect where the wind can just move particles all over the place. Like I said, much, much less risky to be outdoors, but again, small droplets and a little bit of airborne transmission. I personally feel like if this was a primarily airborne related transmitted virus, we would see a whole lot more cases than we're seeing. So while that might be possible to transmit airborne beyond six feet, I don't think it's a major route. That's contributing a lot of debate about this. It's hard to prove one way or the other, but just think about this in a household contact situation where one member of the household is infected. The transmission rate to other household members is only about 20 to maybe 30% in the literature. So I think really it is that proximity being within six feet and time of contact between the individual, which tells me that it's mainly those respiratory droplets, Speaker 2: 06:01 Speaking of being outdoors and it's minimizing the risk, but saying that you said that it's still possible. We have a 76 year old listener who has a granddaughter that lives with her and the granddaughter contracted COVID at the beach while hanging out with friends, the group of a all got COVID, but weren't hospitalized. And here she is asking you a question, Speaker 3: 06:19 Oh, my name is Maria. I live in [inaudible]. And my question is, could you get coffee again? One time, Speaker 1: 06:29 This is a hot topic right now, you know, early on when we had these massive outbreaks in New York city and in Europe, we just were not seeing re-infection as an entity. There were so many millions of infections in these places and reinfection was just not being observed. And so most people thought that there was at least some immunity from those that have been infected. And we think at least it's probably about 90 days that you have some protection. Of course, all human beings are different and we're going to have different immune responses to the virus. Some people will develop a very robust response with what are called neutralizing antibodies and they're just protected. They're going to be fine. It's other people, especially if they have an immunocompromised conditions or take chronic steroid medicines may not develop as strong of an immune response and people that have asymptomatic infection may develop a little bit of a weaker response. Speaker 1: 07:17 So there's a little uncertainty around how long we are protected for, but what is sure now just in the last two to three days is there's a report from Hong Kong and then two more reports from Europe. So that's a total of three cases that have been confirmed that are definitely re-infection. Now I think that the details of the Hong Kong case are just being released this morning. So I haven't studied it in detail, but my understanding is that the reinfection was a very, very mild re-infection. In fact, I think the individual was asymptomatic, which means that reinfection though it may theoretically occur. It probably does not occur within the first three months or so after being exposed in the beginning. And it looks like it might actually be a milder version if you get re-exposed. This is very, very important for us to study because it may be that the vaccine provides relatively temporary immunity, uh, with our, our long history of Corona viruses, which cause many common cold viruses immunity tends to be on the sort of months to maybe a year, two years maximum in terms of immunity. So in that respect, reinfection is possible and it probably is going to be mild from, from what we're seeing so far. So here's another one for you. Speaker 3: 08:26 Hi, dr. Amaris, my name is Monica Stapleton and I live in Solana beach. I have three children. And I'm wondering what your opinion is about the vaccines and how likely are you to get a vaccine or to give one to your children? Speaker 1: 08:40 Good question. Uh, Monica. So I, as an infectious disease doctor who has literally seen people die of vaccine preventable diseases and have followed the public health benefit of these interventions, I'm very, pro-vaccine just, I'm just going to get that out there. As a disclaimer, I took my family to Africa to work for several months and got everybody as vaccinated as possible, including my two year old son at the time. Uh, so how am I going to evaluate a vaccine? You know, we have a process in this country. Uh, that's been very well worked out with phase one, phase two and phase three studies, uh, where safety and efficacy are evaluated very rigorously and in a, in a double blinded placebo controlled way. And that process has not deviated. It may be going slightly faster than usual. And people may, may be concerned, especially because the name of the whole program is operation warp speed. Speaker 1: 09:28 But the process is the same in and of itself. A vaccine will have to show that it's at least 50% effective at reducing disease of by COVID by 50% in order to be approved by the FDA. And I think we just have to have faith that it's going to be a transparent and open and non political process the way it has always been. I would like to cite the examples of China and Russia, which have actually gone ahead and approved vaccines without doing large phase three trials. That's not how we are doing things. We are doing things by our usual process, looking through the phase three data and ensuring that it's safe, not only in a couple of hundred people or a couple thousand people, but these big trials are going to be 30,000 people. And we hope that that's a big enough number to catch any adverse effect or any side effect in terms of whether I'm going to get a vaccine myself. Speaker 1: 10:15 I would really like to, at this point, these are available only in research trials and the research trials tend to be focused on those that are highest risk. So it's actually easier to enroll in a vaccine trial right now, if you're over age 65, or if you have an underlying condition. And in my own case, I'm not really a prime research candidate at this point, but I'm certainly going to sign up, um, in terms of getting my kids vaccinated. Like I said, I I'm very pro vaccine because looking at the numbers, I think our vaccine is really the best way for us to get out of this mess. You know, we think that you have to have herd immunity of about 60 to 70% of the population immune to COBIT at least over the short term, in order for us to really, uh, see the case numbers go down significantly. Speaker 1: 10:55 We're not going to get there by natural infection. If we did, we would have to just be wide open and there'd be a whole lot more death in our healthcare system would be overwhelmed. So supplementing natural immunity from infection with vaccine vaccination is really where we need to be. Not everybody needs to take it. And I've seen some surveys that, you know, 30 to 40% of the population is a little wary right now of getting vaccinated because things are moving so fast, but as long as 50, 60% of the population gets vaccinated, that will be from a public health perspective, a way to get out of the epidemic that was KPBS health reporter, Taryn, Mentos speaking with dr. Christian Ramers.