COVID-19: What To Consider Before Leaving Home

Speaker 1: 00:00 Beaches are filling up with sunbathers protesters are marching shoulder to shoulder. And by tomorrow Jim's bars, museums and hotels will be allowed to open as we move rapidly from coronavirus lockdown to living life with COVID some of the messaging about what we need to do to stay safe. Seems contradictory with us to talk about the risks and what we do know about how to avoid them is dr. Francesca Mariani, who is UCLA health director of infection prevention. Dr. [inaudible] thanks for being with us. Oh, thank you for having me. So now all these new, these businesses are reopening in San Diego and, uh, you know, even the zoo is opening yet. The state says the stay at home order remains in place. So it seems like a bit of a mixed message for the public. What should people take away from this? Speaker 2: 00:49 I think, uh, that we are in a situation where we've been essentially with a stay at home order for three months at this point, and the economy needs to restart. And at the same time, we have, uh, the wonderful opportunity of a climate that allows us to do a lot of activities, uh, out where there's a lot of ASMR circulation. And if we approach it with the correct, um, safety measures, I think we can make it work Speaker 1: 01:36 good. Well, let's talk about some specific questions people might have as they venture out. You mentioned air circulation. I mean, going to the beach for instance, how risky is that? Speaker 2: 01:48 Well, they told depends how much interactions you have with others. And, uh, so how much face to face unprotected interactions you have with others? And, uh, we might remember that, uh, we still have an order in place which requires us to use face coverings, uh, when we are out and face to face with other members. We're not about close family circle, Speaker 1: 02:23 right? So last weekend I noticed, for example, at a protest in Oceanside that walked past the beach, virtually everyone in the protest was wearing a mask, whereas virtually no one on the beach was, can you reflect on that disparity? Speaker 2: 02:39 Exactly. So, so that's the point is, is that as long as, uh, we are in a, in contact with the same people that we are always in contact with, uh, we move that environment, that home environment to the beach, and that's okay when we start interacting outside of our close home environment or household environment, uh, where we know where everybody has been. And, uh, and, uh, we know that there's been protection of us out go when we go outside, then when we lose that safety, I think that it becomes much more, uh, possible that an exposure and thus uninfectious, uh, transmission occurs. And so what I'm saying is, as long as you are on the beach with your family, with your household, and you use a face covering when you are doing activities with people outside of your household, then at that point, that is probably your best protection. Speaker 2: 04:06 So I think when we then bring it to the protest, these are protests. There's a lot of speaking, there's a lot of movement. And so there is the possibility that if somebody is infectious without knowing it could, um, I could cough or could, could spread those virus particles to somebody who is near enough to then become infected. If everybody's wearing a mask that will not happen. And so that, that spew out of, of, uh, infectious particles will just be stopped by the face covering. Okay. Do you have anything to say about mosques? What are you noticing? Do you think that most of the mosques we're wearing are effective? The, the, the protection is a physical barrier, right? So what we want is really a physical barrier that stops, uh, spit stops, cough, stops anything from going out. And so we're not asking for a filtering device it's for our protection where the filtration has, uh, a role. And so, um, for that, um, there have been studies that have shown that, uh, depending on what type of face covering, whether it's a two layer or three layer that that may give more protection. Um, but the primary purpose of wearing a face covering is to stop the, um, to stop the spit and, and viral particles from going out. And so that's a physical barrier. And so any physical barrier is effective with that. Speaker 1: 06:10 And I noticed you say going out, so it's not about protecting people to prevent the virus from coming in so much. Speaker 2: 06:17 Yeah. The primary role of these of these face coverings is secondary role, less established, but that also is probably better than nothing that has been established is to wear a mask for your own protection. But the primary role is really to protect others from your possibly infected sputum or cough to reach out and in the air. Speaker 1: 06:48 Okay. So far we've talked about outside activities. What about indoor activities like going to the movies is sitting just a few feet apart enough? Speaker 2: 06:56 Um, well, once again, uh, I'm assuming that people would be still wearing face coverings and then that, uh, the businesses that are going to be opening are ensuring that the appropriate distancing, physical distancing in addition to wearing face covering is going to occur. And so we have all seen, uh, you know, when, when we go to a store that we have to wait outside so that not too many people need to be in the store at the same time. And when we wait outside, we have a six foot distance. What the requirement is. If, if we are more distant than six feet, you don't need face coverings. But the point I want to make is that are we really measuring six feet? And what if it's, uh, you know, five feet and, and, you know, nearly six feet and what if it's six feet to show there's there's no, these are measures that, I mean, in my view, I want the most protection. So if I don't want to get sick, I am going to really follow these practices. And if I'm in the side, so I do not have the additional air flow that there is outside, I am still going to wear that mask. Right. So if I go to target, am I now taking away my mask when I'm in target? Because I'm not, I'm further than six feet from other people probably. Right. I still want to protect others from whatever cough I may have. And so the same is at the movie. Speaker 1: 09:05 So perhaps older people need to follow stricter rules for themselves than younger ones. Speaker 2: 09:11 Well, so, so you bring up a very good point, which is really if I'm older or if I'm old, or if I have a, an existing condition, uh, that will make me more at risk for having a bad form, all of the illness. It doesn't, however, make me more at risk to contract this infection. It just makes it that if I have these, these, uh, preexisting conditions, or if I'm older, if I happen to get the disease, then I'm, I'm at higher risk of complications. Right? And so therein lies the rub, right? So if, if I think if I am in, in that risk category, then it is to my advantage to protect myself. And you will notice that of individuals do aware face coverings, uh, to do that, whether they are six feet or less. Right. And so I would argue that that is probably a good thing to do, not so much to protect me, uh, to decrease my chance it's to decrease my chance of acquiring an infection, but not because I'm at higher risk of acquiring the infection. It's a subset or difference. Speaker 1: 10:50 Local public officials have said that they've seen some outbreaks connected to home gatherings, you know, private gatherings at home. Is it safe to gather in a backyard with your friends, if you're all wearing masks and sitting six feet apart? Speaker 2: 11:03 I think that the more exchanges, the larger, the gathering, the larger the risk is because you just are not controlling everybody's movement. And so there's more chances of an interaction that is unprotected, but yes, you, uh, you can, um, if you are having a gathering, even if it's a, you know, less than 10 people, right? Like, uh, accounty, uh, um, has posed as a limit of people wear a mask. And I mean, then, then you, you kind of, you, you increase, you decrease the probability of getting infected don't food, you know, don't share the fork, don't share the same, uh, spoons, don't share the same glass, right. Uh, and wash your hands. I think that's the other finding, right? And people who wash their hands frequently, they is, uh, about, uh, 20 to 30% decrease in acquiring infection. Speaker 1: 12:20 What about pools going to a swim in a public pool? What are the risks there and how can we avoid them? Speaker 2: 12:27 I think that you mean the swimming, swimming, swimming. I think that the water is probably chlorinated and, uh, and the risk is really more, uh, in, in areas where you have when you're not in, in, um, so possibly an inside pool may be a little bit more risky than an outside pool, but I think once you're in the water, um, there's probably some chlorination and, and that may be headed for, I mean, I think there's always more risks than, than not going to the pool. Right. But you have to, you have to measure the, the risks accordingly Speaker 1: 13:18 weigh the risks, but it's in the air rather than the water. And, and, uh, another question that we're hearing quite a bit from our listeners is why libraries are not reopening. Uh, is there any additional risks that a library may present when many other facilities are opening? Speaker 2: 13:34 Well, I would think that a library you'd spend more time in the library and that, um, the risk is more, that that library is, is a closed environment. And so the question is whether the library feels that you have enough staff to, uh, control that the proper measures are being followed. And, um, you know, it may not be yet time to open libraries where less, you know, you, there's basically more exposure because of the length of time you may spend in an ivory. Speaker 1: 14:30 Right. Right. So let's talk about the, the, the numbers that we're seeing. Um, some areas of the state of seeing rising hospitalization rates in recent weeks. I mean, in, in San Diego, we haven't hit triggers. That would move us back into lockdown, but in Sacramento hospitalizations quadrupled over two weeks, how concerned are you, uh, about spikes like these coming? Speaker 2: 14:54 I think that that's a risk. I think that it will be very hard. Two. We have to be very careful of, of, of monitoring this and sending out, um, information to the population when, when we, uh, feel, uh, when we see that numbers are not going in the right way, I think that continued, uh, education of the population. And, and particularly, uh, the ones who are at Taya risk of complications that, uh, they, they should be wearing face covering that they should be doing social distancing and, uh, that, um, they should be allowed to get tested if they present with certain symptoms, uh, the prompt, uh, um, case finding and contact tracing, uh, by the public health departments is essential in, in really decreasing the number of transmissions in the community. And therefore by that, you know, keeping those numbers down, I think you need a very, very strong public health system and, and a testing strategy that I think, you know, we, I, I, I think we have, uh, we, we are getting better, uh, towards that in San Diego County. So I think we have, we have our authorities looking at, um, the numbers conversing with the hospitals on a, a weekly, if not daily basis and, uh, really monitoring the changes very carefully. Speaker 1: 17:09 So scripts, scripts, hell, stop taking new cover transfers to preserve bed space, you know, for local patients is UC San Diego preparing for a possible spike. Speaker 2: 17:20 We have been stable. Uh, I it's it's, I mean, this is a script's health, um, close to, um, additional transfers from the East County, uh, not from taking patients from the community. They simply could not afford to, could not, did not have enough capacity to accept for the transfers from these County. Uh, we'll all, all of the hospitals are meeting on a regular basis and, uh, you know, they are discussing with the County what their status is. And I think that, that, that is important. So we were worried VLE, uh, all hospitals are worried as the community and the County is worried, but we're watching it very carefully. And each hospital will have to adapt to their own capacity. Right. Speaker 1: 18:22 Right now, in regards to asymptomatic detections in San Diego County, public health officials said yesterday that 10% of local positive results are from individuals who are asymptomatic. Is that what you would expect? Speaker 2: 18:41 Um, I think that they are huge health systems that, um, test, um, only so a lot of healthcare systems and also testing the units in the County are testing, um, symptomatic patients and the range of symptoms has widened, right? So about two weeks ago, uh, other symptoms were added to the list of symptoms by the CDC and therefore our screaming, um, for symptoms. And then our testing strategy has, has loosened a little bit, meaning that we're testing people with less, uh, CVS symptoms on, at the same time, we certainly have expanded our testing of patients coming into the hospital. Uh, any patient who's coming into the hospital, regardless of COVID related symptoms, patients who undergoing surgeries or procedures, and therefore with testing more asymptomatic patients. So I think that that number may vary, but, but I think it sounds, it sounds, um, it seems to me that it's a reasonable number, but as I say, because of the difference in, in how we screen patients and, and decide whether a patient has symptoms has COBIT symptoms that, that has led to more testing of patients with less symptoms and also, right. Speaker 1: 20:46 Okay. So dr. Is, as, Speaker 2: 20:48 as parts of the region continue to open, what will you be looking out for specifically? I will be looking at, uh, the rates of positivity. Um, the number of patients admitted to the hospitals, uh, and so how, uh, capacity health care capacity is being tested. And, um, clearly, uh, the number of deaths due to COVID in the County. So I'll be watching at our numbers very carefully, our numbers South of us and our numbers East of us, um, and how we can help these regions, uh, uh, you know, um, respond to their health needs because what happens in Tiguan or what happens in South Bay or what happens in East Bay will affect us. And so the more we can help them the better, uh, everybody will be. Well, doctor, thank you so much. You're welcome. Very welcome. And thank you.