Originally published in Hideaway Lake News on August 28, 2020

You’re doing everything you can to not get the virus – washing your hands, staying six feet away from people and covering your face. But what if you do get it anyway, what can you do to reduce your risk of severe COVID-19 disease? If you are overweight or obese, you can lose weight. If you’re at a healthy weight, you can maintain your weight. It has become clear that obesity is a major risk factor for developing severe illness from the virus, leading to a greater risk of hospitalization and being placed on a ventilator or breathing machine. 

Obesity is a risk factor independent of other health problems such as diabetes, high blood pressure and heart disease. This is especially true in younger patients in whom these diseases may not have yet developed. So even if you have no medical problems other than obesity, you should consider yourself high risk and behave like someone with diabetes or heart disease, when it comes to COVID-19. One study found that morbidly obese COVID-19 patients were 60% more likely to die or require a ventilator, compared with people of normal weight.  This is because increased fat tissue compromises lung function, leading to greater need for pulmonary support. Fat tissue also promotes inflammation and blood clots, two things that have been closely associated with severe COVID-19 disease. 

Boris Johnson, Prime Minister of the UK, was hospitalized for more than 2 weeks, including 3 days in the ICU with COVID-19. He acknowledged that his weight was a significant factor in the severity of his illness. Since his release from the hospital, he has lost more than 14 pounds. He also started an anti-obesity campaign for severe coronavrius disease prevention, encouraging Brits to lose weight. 

This risk is particularly relevant for us because about 40% of Americans suffer from obesity, compared to 6% of people in China and 20% in Italy. The pandemic, with its stay at home orders, means that many of us are eating more, eating less healthily, spending endless hours in virtual meetings and not exercising much. Most of us have stopped going to the gym and playing group sports. Many of us are drinking more alcohol, often forgetting about the extra calories that adds to our daily intake! Before we know it, we have packed on the pounds. 

If you are already at borderline weight, those few pounds may be just enough to push you into the high risk category. It has been several months since the first case in China and it is likely that the virus will be around for at least a couple more years in the best case scenario, possibly longer if vaccines are not terribly effective or if many people refuse to get them. So we’re in this for the long haul. There’s enough time for us to actually lose weight, reducing risks of complications and death, if we do become infected despite all precautions. Those that don’t need to lose weight can still get back to a healthy regimen of smaller portion sizes, nutritious meals and regular exercise to maintain a healthy weight. 

Best of health – physical, mental and emotional – to us all!

Originally posted on August 5, 2020 in https://cityofhideaway.org/docs-corner/f/how-can-we-help-fight-covid-19

Our community and our lives have been drastically affected in the past few months by COVID-19. The biggest challenge in fighting this pandemic has been the lack of knowledge about the virus. In order to gain insight into how COVID-19 is spreading, the CDC is testing people for antibodies in multiple cities across the nation. Since Hideaway is not one of those selected cities, we have applied for a grant through the Coronavirus Relief Fund for our own testing program. This program will be undertaken by the North East Texas Public Health District (NET Health). We will start recruiting about 300 volunteers in mid August. Participants will be tested sometime in early September and the same group will be tested again in December. This will show how many new positives occurred in three months and how many people who tested positive in September continue to maintain their antibodies into December. 

If you volunteer and become part of the program, a sample of your blood will be drawn from a vein by a medical professional in the same way a sample is drawn when your doctor orders “blood work”.  Your blood will then be shipped to a lab for analysis. The results will be shared with you and no one else without your authorization. We plan to set up blood draw sites here in Hideaway for your convenience.

The most accurate antibody test available will be used. The test can show if you had a past infection with COVID-19. It does NOT test for active infection with COVID-19. It does NOT confirm protection from the virus. All it tells you is whether you developed antibodies as a result of exposure to the virus at some point in the past. The antibody test is currently not of significant value to an individual, but when used in large groups of people, it can provide valuable population information. This study, along with studies from other cities, has the possibility of increasing our knowledge of how this virus is spreading and how we can slow it down. A positive or negative test will not change your life in any way at this point, it will simply provide data for the scientists. Most recently, the University of Texas Southwestern Medical Center announced such a study for the Dallas-Fort Worth area.

We have received our allotment of the Coronavirus Relief Fund from the State of Texas to conduct this program. Once the dates and locations of testing have been confirmed, we will launch the website and start recruiting participants. We hope to have many volunteers in Hideaway eager to help our city and our nation slow and eventually stop the pandemic.

Thank you for supporting our initiative to study COVID-19 in our community!

Sue Royappa, MD, MPH

Originally Published in Hideaway News on July 31, 2020

We all expect our medical information to be kept confidential by health care providers, hospitals and public health entities through HIPAA. Similarly, our medical information with our employers is protected by the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). Even outside of these settings, most of us in the US have a reasonable expectation of privacy regarding various matters, including our health information. But these are special times when there is real worry and fear of getting and spreading the virus, and we might think that there is a case for breaking medical confidentiality. However, before we do that, we should look to science and the health authorities to determine the following:

Is revealing the identity of someone who is COVID-19 positive truly going to protect us and reduce the spread of the virus to others?

The CDC has made it very clear that the only people who need to be informed are CLOSE contacts, those who were closer than 6 feet from you for at least 15 minutes in the 2 days prior to symptoms. This exposure is regardless of whether either party was wearing face coverings. It says that the person just needs to be informed that they are a close contact without disclosing the identity of the positive case. It has also made it very clear that employers should inform workers and persons that came in close contact with the positive person, again without revealing their identity, as provided in the ADA. Close contacts will be asked to follow CDC guidelines pertaining to them. 

So if you have not been notified by NET Health, your employer, the affected person or their family that you were a close contact of a positive case, then you don’t need to do anything different from the average person. And you don’t need to know their identity.

Having had casual contact with a waiter at a restaurant, being handed groceries, delivery boxes or food, going through the checkout counter at the golf shop, talking to someone for five minutes at the beach, being handed a bill after someone mowed your yard… these are all NOT examples of close contact and should not cause you undue concern. People with such contact do not need to be informed that they were exposed, do not need to be quarantined and do not need to take special precautions. They simply need to do what the rest of us are doing – watch for symptoms, and call their doctor and get tested if they have symptoms. 

The person testing positive has a reasonable expectation of privacy. They should not be made to feel guilty if they don’t want to disclose their medical status to everyone. They should not feel coerced into revealing their status to anyone but their close contacts. There is no risk reduction to the person who had casual contact with the positive case and no benefit to our community at large in terms of virus spread by actually knowing their identity.

On the other hand, “outing” someone with COVID-19 could be potentially damaging to a person’s life, professionally, economically and socially, well after the isolation period. There have been instances of people losing their jobs and being verbally or physically attacked because someone felt that they should not be out, even though it had been weeks since they recovered. Stigma from COVID-19 can persist, causing isolation and depression from ostracization. So let us be very cautious about going down the slippery slope of invasion of medical privacy if there is no health benefit to anyone in the community. If however, someone chooses on their own to publicly share that they tested positive, let us be compassionate and not judgmental. 

The best thing that each and every one of us can do right now to prevent the virus from spreading in our beloved community is to continue to social distance, wear face coverings when that is not possible, wash hands and avoid large gatherings.

Wishing us all the very best of health!

Sue Royappa, MD, MPH

Chief Health Officer

City of Hideaway

 Originally published in Hideaway News July 31, 2020

Every person that I have spoken with who has tested positive for COVID-19 has agonized over how they could possibly have got it and whether they passed it on unwittingly to someone. “I thought I did everything right! Did I get too close to someone? Did I forget to mask up one time? Was I wearing my mask properly? Did I wash my hands enough? Did I wipe down surfaces sufficiently? Did I infect someone else unknowingly? Are my co-workers upset with me for having possibly exposed them to the virus? Are they mad at me because they now have to quarantine themselves for 14 days?”  And the questions go on, tormenting them with doubts of when they might have done something wrong to get this virus and how they might have affected someone else’s life.

Some people are judgemental of those who test positive. “They must have been careless. They must not have worn masks. They probably had their mask hanging below their nose. They didn’t stay home enough. They must have not washed their hands or cleaned their homes properly.” Such thoughts and comments are not helpful and often add to the guilt and anxiety that they are already feeling.

Someone could have taken all appropriate precautions and still have got the virus. I know of cases where the person masked up everywhere, social distanced with their own family, washed hands and disinfected everything obsessively and still got infected. Some may hear of this and say, “Well what’s the point of doing all of that if I’m going to get infected anyway, I’m not going to do any of it.” Another may hear the same case and say, “Oh my, if all of that was not enough, maybe I should also wear a gown, a respirator and shoe covers.” I believe the practical and prudent response is somewhere in the middle. There are very few things in life that are truly risk free, and it is impossible to reduce risk to zero. We can minimize risks, but we can’t eliminate them. The only thing we can do is try our best to take reasonable precautions while still living life responsibly and safely. We can’t constantly worry about things we have no control over.

Some may have been super vigilant and others a little lax taking precautions. But we are all human, and however good our intentions, it is hard to stay vigilant 24/7 for months at a time. So if you test positive, give yourself a break, stop torturing yourself with endless questions and be kind to yourself. Instead, redouble your efforts to reduce spread of the virus from yourself to others in the community. Isolate yourself according to CDC guidelines and identify all your close contacts. Encourage others in your family and social circle to avoid large gatherings, practice social distancing, wear face coverings when social distancing is not possible, and wash hands often.  If you know someone who tested positive, please be kind to them and don’t judge them.

If your positive test is making you suffer from worry, fear, guilt, sleeplessness or agitation, or if you are feeling lonely, isolated and sad, please get help early. Make sure you reach out to friends and family and share your thoughts and feelings with them. Having someone to talk to is sometimes all you need. If that is not enough, talk to your doctor about a tele-visit with a counselor, therapist or psychologist. The pandemic has made access to tele-health services much easier. Do not hesitate to use them. Above all, in addition to being cautious, stay hopeful. Even though some people may have serious complications or even die, most people have mild symptoms and recover without complications. Even if you are considered high risk, it is very likely that you will come through just fine. Best of health to all!

To read Dr. Royappa’s blog as the Chief Health Officer of Hideaway, please visit Doc’s Corner at www.cityofhideaway.org.

Originally published on KevinMD.com on July 27, 2020

Should I send my child back to school? A letter to parents.

This is the million dollar question that I’ve been asked over and over again by distraught parents wanting to do right by their children. 

Parents want to have their children stay home so they can keep them healthy and safe. At the same time they are worried about the far reaching consequences of them not being in school. School is not just about academics but also about social and emotional wellbeing. For some children, school may be the only place where they get a nutritious meal, a safe area to play or a kind word from an adult. But even if the home is ideal, most parents have to put in a lot of time and effort to make sure that their child gets the most out of online school. In spite of all the evidence supporting in-person classes, parents are terrified that they will compromise the safety of their children by sending them to school.

I want to reassure all parents that according to the data, children are about as safe as anyone can be in this pandemic. Does this mean they will be 100% safe? No. But when is your child truly 100% safe? Not when they walk on the road, get into the car, go to the pool or do any number of daily activities that you don’t think twice about.

The American Academy of Pediatrics is encouraging children to get back to physical classrooms. Many doctors I know say they would send their children of any age back to school. 

What is the COVID-19 data on children so far

As of now, there have been ZERO deaths in children in California, Texas and New York despite tens of thousands of cases. Florida has had four deaths with over 23,000 pediatric cases. The total number of US deaths is 31 for children under 15 (the CDC groups older children with adults up to age 24). In comparison, the CDC reports 101 flu deaths for the same age group and time. 

But that’s deaths! I don’t want my child to get seriously sick. 

Of course that is totally understandable. Fortunately, most children are asymptomatic, and the ones who do get sick, mainly end up with mild symptoms similar to that of a cold. 

A rare syndrome called Multi Inflammatory Syndrome in Children (MIS-C) which causes inflammation of multiple parts of the body has been observed. Researchers are still studying this and hopefully we’ll have more information soon. The good news is that only about 200 possible cases have been reported.

To put it all in perspective, there have been a little over 30 deaths and about 200 cases of MIS-C out of about 74 million children in the United States.

Of course when it is your child who is one of those numbers, it’s a wholly different issue. It’s devastating when it’s your child who gets killed in a car wreck or in a pool accident, but you still looked at the odds and made the decision that the risk was acceptable. Hopefully you will feel the same way about COVID-19 as well.

How can I make sure they don’t get COVID-19?

You cannot be sure that they will never get COVID-19, just like you cannot be sure that they won’t get in a car wreck. But you put them in a car-seat or have them wear a seat-belt. The same principle applies to COVID-19. You know what to do and what works – ask them to wash their hands, wear masks and spread out whenever possible. Despite all these precautions, it’s still possible that your child might get COVID-19, but you likely won’t know that they had it or they may just come down with the sniffles. And yes, your child might be the one that gets MIS-C or dies, just like your child might die in a car or pool accident. But you know now that the chances of those happening are miniscule.

It’s terrifying to read reports of surges in cases among kids in daycare and schools…

You can get over that terror by understanding the difference between testing an individual who is sick so you can treat them, and testing people in large groups for public health purposes to see how the virus is spreading in that community. Most of these recent surges in childhood cases are from states’ public health efforts to understand the load of the virus in communities and reduce its spread. Not because all of these kids were seriously sick and needed to be hospitalized. So be more analytical when you read about cases. Dig a little deeper into hospitalization and mortality numbers.

So if children are at such low risk, then why all this controversy over school openings?

The controversy exists because of adults. Adults in the school and at home. Unfortunately, COVID-19 is way, way worse for them than for children. We don’t want the kids to infect high risk teachers and family members. Therein lies the problem. 

Since we can’t leave the kids by themselves at school with no adults to teach or supervise them, nor leave them home alone taking care of themselves, we need to figure out how to protect adults who care for children.  

Most teachers and parents of young children will be 65 years or younger, which means that the highest risk category, those over age 65, don’t enter the equation. The high risk teacher or parent with medical problems will need to be addressed separately. But the majority of adults caring for these children on a daily basis will be in the lower risk group of generally healthy and under 65 years old. 

It is clear that the issue is not really over the safety of children, but over the safety of adults. We adults must figure out ways to reasonably protect ourselves while giving children the opportunity to safely flourish in school again.

Sue Royappa, MD, MPH

Originally published on July 20, 2020 in https://cityofhideaway.org/docs-corner/f/moderna-vaccine-trial-results-in-plain-english

140 vaccines for COVID-19 are now being developed all over the world, with more than 30 in early human trials, and three in large scale, late stage human trials. Moderna in the United States is the first to have its vaccine’s Phase 1 trial published on July 14. Vaccine development is usually very time consuming, often taking 5-10 years to come to market, but the US government’s “Operation Warp Speed” and the billions of dollars invested in it, have resulted in a human vaccine trial just months after the viral genome was first sequenced.

The Moderna COVID-19 vaccine: Phase I trial summary and more

45  healthy adults between 18 and 55 years old were enrolled in the study. So no children, elderly or high risk patients with underlying medical conditions in this round. 

The 45 people were divided into three groups, they either received 25 mcg, 100 mcg or 250 mcg doses of the vaccine.

Each person received TWO shots of the same dose 28 days apart.

28 days after the second dose, 100% of participants had antibodies in their blood, the levels were higher than in those who had antibodies after a natural exposure to COVID-19.

The antibodies produced in the blood by the vaccine were neutralizing antibodies, which means they can bind to the virus in a manner that blocks infection.

Most side effects were mild, including fatigue, chills, headache, muscle aches and pain at the injection site. Side effects were more common after the second dose, especially with the highest dose of 250 mcg. 

Participants will be followed for one year after the second shot with periodic blood collections.

All the above is good news for a Phase 1 trial, which is always small for safety reasons.

What we don’t know at this point:

• How will the most vulnerable people, i.e. the elderly and those with underlying medical problems, react to this vaccine? Will they produce the same level of antibody response that the young and healthy volunteers did or will it be weaker?
• How effective is the vaccine going to be in preventing infection, symptoms, hospitalizations and death? For example, the seasonal flu vaccine is effective 45 -70%  of the time, depending on the year.
• Will it provide complete protection or just enough to keep you out of the hospital?
• If you do get infected despite the vaccine, will you be able to infect others?
• For how long will the antibodies provide protection? Will you need booster shots? And if so, how often? Will the initial dosing consist of a two shot series?
• How many of us will need to be vaccinated to get herd immunity? In other words, what is the minimum percentage of people that need to get vaccinated so they can protect others who can’t or won’t get the vaccine?

Hopefully the above questions will mostly be answered in Phases 2 and 3 of the study. However, some of the answers may not be available until well after the vaccine has been given to the masses.

Later Phases:

Moderna’s Phase 2 is already ongoing with 600 people evenly split between 18-55 year olds, and older than 55 years. Participants will get either a placebo, 50 mcg or 100 mcg doses at both vaccinations, again 28 days apart.

Phase 3 will be significantly larger, and will start enrolling volunteers on July 27 with a goal of 30,000 participants. Half will receive a placebo and the other half will receive 100 mcg doses of the vaccine.

If Phase 3 is successful at the 100 mcg dose, Moderna says it can produce 500 million doses in the first year.

The record time for a new vaccine thus far is 4 years. Less than 10% of drugs in trials are actually approved by the FDA. Let’s see how Moderna performs in the end.

The AstraZeneca/Oxford vaccine Phase 1 trial summary coming soon…

Sue Royappa, MD, MPH

Originally published on July 15, 2020 in https://cityofhideaway.org/docs-corner/f/you-got-tested-for-covid-19-now-what

Once you make the decision to get tested, please isolate yourself at home until you get your results back. Depending on where you got tested, and what type of test was used to check for active coronavirus infection (a.k.a. COVID-19), you may get your test results back in an hour or it may take several days if you’re in a hot spot with a backlog of tests. 

Until you get your results back, behave like you might be positive for the virus and could expose others to it. Please stay home. If your test result is negative, then please read the section “If you test negative for COVID-19” by clicking on the link below https://cityofhideaway.org/docs-corner/f/covid-19-viral-testing-info

If your test result is positive, you may get an email, text or call from the lab or directly from NET Health (the North East Texas Public Health District) if you went to a free testing site that was operated by the Texas Division of Emergency Management. If you went to a private lab or to a local clinic, they report the positive test result to you and to NET Health. You may get asked by the testing lab to isolate yourself according to CDC’s recommendations and inform all your close contacts. If this happens to you, then here are some guidelines to help you do the right thing to reduce further spread of the virus:

● Call your doctor immediately and follow their directions for medical care.

● Isolate yourself at home until at least 72 hours have passed since recovery, which is defined as (A) no fever without the use of fever-reducing medications such as acetaminophen, (B) improvement in respiratory symptoms such as cough and shortness of breath AND (C) at least 10 days have passed since symptoms first appeared.  All three of those situations must occur before you are officially considered to be recovered from COVID-19.

● If you tested positive during a testing drive but never had any symptoms (a.k.a. being asymptomatic), then isolate yourself for 14 days.  

● Make a list of people that came into close contact with you in the 2 days prior to your symptoms of your testing day if you had no symptoms. These are not people you passed by at the golf course or said hi to at the grocery store. These are people that were CLOSER than 6 feet from you for AT LEAST 15 minutes. If you choose to inform your close contacts before NET Health calls you, then here is a link to the CDC close contact information that you can share with them: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/contact-tracing.html

• Testing is recommended for ALL your close contacts.
• Those contacts who test positive should be managed as a positive case
• Contacts who test negative should self-quarantine for 14 days from their last close encounter with you and monitor for symptoms.
• Those who simply had casual contact with you do not need to quarantine themselves but need to continue to wash hands, use face coverings, and social distance.

NET Health has their own contact tracing program and will connect with you once they are notified by the lab of your positive result.

Do not despair if you test positive. Follow your doctor’s advice and seek prompt care for worsening symptoms. Go to the ER if you have any life threatening symptoms like shortness of breath or confusion. Remember that while most people have mild symptoms and recover without any complications, some individuals may develop severe symptoms that require hospitalization. COVID-19 may not affect you in the same way it may affect someone else.  Continue to encourage your family and friends to wash, distance, and mask.

Sue Royappa, MD, MPH

Originally published on July 3, 2020 in https://cityofhideaway.org/docs-corner/f/main-takeaways-from-the-governor%E2%80%99s-mandate-yesterday

In order to reduce the spread of COVID-19 in Texas, Governor Abbott has mandated the following:

1. No outdoor gatherings larger than 10 people. This is to prevent a whole bunch of us from getting sick at the same time.
2. When around people from other households, stay at least six feet away from them, if at all possible. This is one of the most important things you can do. The primary mode of transmission of the virus is respiratory droplets, so if you stay far away, it’s harder for droplets carrying the virus to reach you.
3. It is now required that you wear a face covering over the nose and mouth in public whenever social distancing is not possible.
4. Businesses can now require you to wear a mask.

Main exceptions to mask requirements:

1. You are younger than 10 years old. This exception was likely made because no children under the age of 10 have been known to transmit the virus to an adult thus far.
2. You are eating or drinking. Unless you have one of those funky masks on YouTube!
3. You are exercising. This is likely because of reports of problems such as low oxygenation, especially in people with compromised heart and lung function.

What does the mandate mean for us?

Of course, we’ve had to reschedule our fireworks to comply with the initial mandate of no gatherings larger than a 100 people. However, we can still celebrate in small groups of 10 or less. Here are some things to consider if you’re having a party at home:

1. Move your party outdoors if possible. Continue to stay 6 feet apart even if outside. Make sure you drink plenty of fluids in the heat. 
2. If your outdoor area such as patio or deck, or your indoor living space is not large enough to allow social distancing, then please wear a mask.
3. High risk people, regardless of age, who are staying at home, but are interacting with people from other households, should wear a mask even if they feel they can social distance most of the time.

How do you know if you are six feet away?

In general, if you and a friend extend arms and come close to touching each other’s fingertips, then step back a little to make sure you’re over six feet away.

A mask is not an impenetrable armor. Just because you have one on, does not mean you should forget about social distancing and get close to people. Stay six feet apart unless you have no other choice. 

Here’s to the quick discovery of a safe, effective, long lasting and affordable vaccine so we can all look forward to a “normal” Fourth in the future!

Sue Royappa, MD, MPH

Originally published on June 28, 2020 in https://cityofhideaway.org/docs-corner/f/covid-19-viral-testing-info

 What you need to know about COVID-19 viral testing

Texas has set up multiple COVID-19 viral testing sites across the state in an effort to reduce the spread of the virus. With new cases in Hideaway and the availability of free testing in Tyler on certain days, please make sure you arm yourself with knowledge before you get tested.

It is vital to understand that a negative test does NOT mean you can carry on as usual with people not in your household. Here’s some important info to know about testing:

• Viral tests check samples from your respiratory system, such as from the inside of your nose, to tell you if you are currently infected with the virus. 
• Some tests are run directly at the testing site and results might be available in less than an hour. Other tests need to be sent to a lab and results can take 1–2 days to return.
• If you have symptoms of COVID-19 and want to get tested, call your doctor first and stay home until you hear from them. If you have severe symptoms, go immediately to the hospital and inform your doctor’s office. Symptoms include fever, chills, cough, nasal congestion, sore throat, headache, loss of taste or smell, fatigue, shortness of breath, nausea, vomiting or diarrhea. 
• If you think you may have been exposed to someone with COVID-19, but do not have symptoms, then you can get tested directly.
• If you were identified as a close contact of someone with confirmed COVID-19, you will be contacted by the health department for further testing instructions.
• If you test positive for COVID-19, you will be contacted by the health department and instructed to follow guidelines set by CDC.
• If you test negative for COVID-19, it could mean one of the following:
  • You did not have COVID-19 at the time of testing. 
  • You might test negative if the sample was collected early in your infection and test positive later during your illness. This means you could still spread the virus.
  • You could be exposed to COVID-19 after the test and get infected then. 
  • If you develop symptoms later, you might need another test to determine if you are infected with COVID-19.
  • If you have symptoms but your test is negative, your doctor might still diagnose you with COVID-19 based on clinical judgement and ask you to follow all guidelines for a COVID-19 positive person.
• Regardless of your test result you must continue to wash your hands, clean high-touch surfaces frequently, social distance to 6 feet with people not in your household and wear cloth face coverings when social distancing is not possible.

Ref: https://www.cdc.gov/coronavirus/2019-ncov/testing/diagnostic-testing.html

Sue Royappa, MD, MPH

COVID-19 in Hideaway – June 28th Update

June 28, 2020

Originally posted on https://cityofhideaway.org/docs-corner/f/covid-19-in-hideaway—june-28th-update

We have three active cases as of this morning in Hideaway. Our first case of COVID-19 in March did not create any community spread since the individual was exposed during travel and sadly died shortly after his return home. Our true community spread will happen now, as expected, while our country begins to reopen in stages to establish a new normal. 

The good news is that although the number of cases in Smith County continues to rise daily, the number of deaths has stayed the same, at a total of just four since March. Also, as the number of cases skyrockets in the nation, the total number of deaths per day continues to decrease. This is because younger people are now getting infected as they go out of their homes for work and entertainment, but are not dying in as large numbers. On average, 99% of people still recover from the virus. Even in the highest risk patients, 85% pull through, but some may have long term complications. 

The bad news, however, is that “younger” people with the virus, i.e. those younger than 50, are now being hospitalized, mostly with underlying medical conditions such as obesity, high blood pressure, diabetes, heart disease and kidney disease. Although most of them will survive, some with prolonged hospitalizations may have problems that persist even after they come home. So we need to not just protect our elderly, but also our “younger” patients with pre-existing medical problems.

At present, there is no shortage of hospital beds and ventilators in Smith County, but there is potential for shortages in large metro areas like Houston and DFW if current trends continue. If we do not want to run into similar problems in Smith County, we must avoid infecting large numbers of high risk people at the same time so they don’t all need simultaneous hospitalization. The best way to do this is to restrict larger gatherings, especially large indoor gatherings, because of the risk of a potential super-spreading event.

It may take several months to years to get a safe and effective vaccine to create herd immunity, but until then, all we have is social distancing, face coverings, surface cleaning and hand washing. Work on virus specific treatments and vaccines is proceeding at break-neck speed, but things are still at least months, if not years away.

If we cannot social distance, then it is essential that we wear face coverings to reduce the spread of the virus via respiratory droplets. High risk people, regardless of age, should avoid larger gatherings and stay home whenever possible.