On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
Guest Host: Sasha-Ann Simons
The coronavirus pandemic has transformed life in the Washington region and around the world. What began here as a slow trickle more than five months ago has grown to well over 200,000 confirmed cases and at least 6,000 deaths. So how do we move forward? What can we do to overcome our “quarantine fatigue” and continue protecting ourselves, and each other?
In times of uncertainty, we look to medical professionals for guidance. Public health experts Dr. Travis Gayles and Dr. Leana Wen join us to share their expertise and answer your essential questions.
Produced by Julie Depenbrock
- Dr. Travis Gayles Public Health Services Officer, Montgomery County Department of Health and Human Services
- Dr. Leana Wen Emergency Physician, Visiting Professor, George Washington School of Public Health
SASHA-ANN SIMONSYou're tuned in to The Kojo Nnamdi Show. I'm Sasha-Ann Simons sitting in for Kojo. Welcome. The coronavirus pandemic has transformed life around the world. What began here in our region as a slow trickle more than five months ago has grown to well over 200,000 confirmed cases and at least 6,000 local deaths. So how do we move forward? What can we do to overcome our quarantine fatigue and continue protecting ourselves and each other? Joining us to discuss the latest news and answer your coronavirus questions is Dr. Travis Gayles. He's a Health Officer and Chief of Public Health Services for Montgomery County, Maryland. Hi, Dr. Gayles. Welcome back.
DR. TRAVIS GAYLESGood afternoon. Thank you for having me.
SIMONSOf course. Dr. Gayles, Maryland's average daily coronavirus case load has actually dropped to its lowest level in weeks. So tell us how Montgomery County is fairing among all that.
GAYLESWell, we've -- our numbers in the last three to four weeks have plateaued. We did see a slight increase, you know, were we had a couple days reported were we had a number of days over 100. And so we continue to monitor not only the daily cases. We also look at a host of other metrics including test positivity, the number of folks who are showing up to our hospitals requiring hospitalization or care for COVID like symptoms as well as utilization of resources once they are at the hospital in terms of the type of care they receive whether it's critical care or just acute care.
GAYLESSo there's a host of metrics that we look at to provide a broader context to really give an indication of how we are moving forward in terms of our levels. And so, you know, we continue to see an average somewhere in the mid to high 80s in terms of daily cases, which is a little bit more than where we had dropped to in early July where we were actually seeing some days in the 30s and 40s on a more consistent basis. And so while we certainly are more comfortable with a case load in that level as opposed to the upper 100s or 200s or 300 where we were in June, we still need to see more significant improvement to get to a daily level where we're seeing more evidence of low to moderate transmission within our community.
SIMONSSo we saw the cases drop in June and then the phased reopening began. And then cases started to spike again, sort of what you just sort of illustrated there. But tell us what efforts -- what mitigation efforts specifically the county is undertaking to reign in this pandemic and what can we expect over the next several months.
GAYLESSure. Well, one of the things that we -- if we think back now it feels like we've been at this forever, so it feels like years ago when it was just a matter of a couple of months. When the decision was made to reopen aspects of our lives within the state we chose to take a slower more measured approach, because in the beginning when the governor made the decision to do so the state averages were much better than Montgomery County. And so we decided to delay reopening by a couple of weeks and also scale back some of the activities that we put into place.
GAYLESFor example, we put a face covering mandate back in mid-June ahead of the state, as well as we put in caps related to the size of social gatherings. We set that at 50 when we moved to phase two. And in addition we've had a host of other activities where curtailed based upon the information that we're getting from contact tracing. For example, we did make the decision to alter the sale of alcohol after certain hours based upon some of the preliminary feedback that we got that suggested that there were a number of cases associated with dining -- indoor dining facilities in particular with alcohol consumption. And those types of venues not adhering to the public health guidance around physical distancing and face coverings.
SIMONSBarbara in Silver Spring emailed us and she says, "I got a rapid COVID-19 test yesterday. It was negative. But I found it almost impossible to get public information about where to get a rapid test or how long it would take to get the results. I only learned about the site in Germantown by word of mouth. The staff there told me that they were the only site in Montgomery County offering a rapid test; is this correct? And why is that so?"
GAYLESWell, so the technology related to rapid testing has been highly variable. I know there was a large push to utilize those technology and those platforms early on in the process. But there were some concerns related to the sensitivity related to things. And so from a large scale rolling out of rapid testing many public health venues and local health departments have not leveraged that technology. Not to say that we aren't continuing to look into it and explore how we can make that available to folks.
GAYLESNow a lot of the health systems do have platforms where they are able to test the patients within their hospital and get back results in a timely manner in a very rapid manner. And so to answer your question they are the only site that at least I'm aware of that is offering rapid testing open to the general public at this point.
SIMONSAs you see places like Florida and Georgia setting single day records, Dr. Gayles, you know, for COVID-19 deaths. What lessons are you taking away from that?
GAYLESWell, I think one of the big lessons that we take from those areas are if you think back to when they first started to see the surge and their cases they had moved forward significantly in terms of approaching their phases of reopening. And they were doing so -- most of them were not doing that in the context of having other parameters in place in terms of requiring face coverings and respecting and requiring physical distancing. And so that was a recipe for even though, they had a little bit of a lower viral load at that point in terms of cases it was a perfect storm and recipe to see the cases increase.
GAYLESAnd so that's something that we have to mindful of in our jurisdiction. I know we opened the conversation by stating that cases are coming down. And recognizing that, you know, when we see the numbers come down there's this tendency to be like, Okay, yeah, let's run to phase three. Let's run to phase four. Without respecting the fact that we do need to see a sustained period where the cases are trending downward and staying down, because if you open up to quickly even with lower viral loads within the community the cases can spike up really quickly, and particularly if you're not reopening with a strict adherence to those public health guidelines that we've put forward.
GAYLESSo I think that's a big take home message. And we can't have a false sense of security. When we see a couple of days improvement -- now, don't get me wrong. All of us want to see the numbers continue to improve and continue to come down. But that does not mean that we rush to reopen right away, because we recognize that we could be hit with more cases if we open up too quickly.
SIMONSBefore I move off of testing I wanted to just read this email from Brad in Eastern Shore, Maryland. Well, he actually called us to leave a comment. He said, "There's no way out of this without hundreds of millions of free five minutes tests. Anyone with a brain knows this is the only solution." Dr. Gayles, if someone is looking for a coronavirus test, where do they go especially if they have no insurance?
GAYLESWell, we've -- so to answer the first part of that question is yes. What the caller, their comment highlights is there has to be more of a coordinated national strategy around testing. You're right. We should have testing that is quicker in terms of getting results because we know that timely results will allow for us to maximize the benefit and potential of contact tracing, because we're catching people. We're getting the results quickly and we can isolate them more effectively in a timely manner.
GAYLESAnd in terms of being able to get folks access to it regardless of your ability to pay and regardless of your insurance status. So we took that in mind when we built our public health testing network that is provided and supported by the county as well as leverage the resources from our healthcare entities within the county to make sure that we had options and opportunities to address an individual's ability to access whether that's by their insurance status. So if you utilize any of those platforms particularly any of the test sites that the county has stood up, you're able to come in regardless of your ability to pay and regardless of your insurance status.
GAYLESWe've also looked at it in terms of being able to make sure that those testing opportunities are readily available within those zip codes that do have the highest volume of cases. And we also have created different opportunities leveraging the stationary sites. For example, using the vehicle emissions platform or the regional recreation centers to add on, you know, pop-up test sites as well, so that we have different options for folks that are accessible regardless of their ability, their transportation access.
SIMONSIf you're just tuning in we're talking to Dr. Travis Gayles. He's the Health Officer and Chief of Public Health Services for Montgomery County, Maryland. We're talking about how to protect yourself during this pandemic. I want to transition Dr. Gayles to schools. Montgomery County is actually now allowing private schools to offer in person classes, because it's under pressure from state level Republicans in Maryland and a lawsuit that was filed by a group of parents.
SIMONSNow this comes after originally shutting down that possibility. Now I know that you can't discuss that in too much detail for legal reasons. But as a mom I'm personally wondering if you can talk more about -- more generally about the risks of in-person education right now.
GAYLESSure. And thank you for that disclaimer related to my answer. You are correct. So anyone listening don't take the lack of specificity due to a lack of desire to comment. But we are due to the lawsuit that is in place are limited in terms of what I can say. But what I can say is this, you know, the guidance that we've put forward is that in order for schools to open safely following the guidelines that have been put out by CDC and a number of places and we are still waiting for guidelines from the state to provide guidance for non-public schools to reopen safely.
GAYLESThe message that we've said is that even in the setting of having contingency plans and safety plans all of that is dependent and contingent upon there being low community transmission within the different jurisdictions within which the schools are housed. And that's what we've been emphasizing is to say that, yes, we do encourage and are working to support schools in that effort, as we await guidelines from the state to help guide that conversation.
GAYLESBut we also are emphasizing that in order for those plans to be fully effective we need to be able to have, again, lower daily caseloads and lower viral loads secondary to community transmission to feel comfortable and confident that those safety plans that are put into place once the kids and teachers and staff arrive at school are effective, because the concern is that, you know, everyone is in that environment within that seven to eight hour period. So all of the safety mechanisms that have been put into place address the time within which they're in that setting.
GAYLESBut people leave and everyone doesn't operate in a bubble. And so that's why we are emphasizing getting a better handle on community transmission and the level of viral load within our community to try to, again, decrease the probability and likelihood that someone would show up into that school environment positive for COVID-19.
SIMONSCan you give us a 20 second response to this email from Dave? "How is the county going to handle contact tracing of COVID cases when they break out in the private schools?"
GAYLESWell, I hope that doesn't happen, but we are well prepared to handle that. And contact tracing for schools would be handled much in the same way that we handle anytime we get information about a case. So anytime there's a report of a positive case there's a contact investigation that happens. And within that investigation there's a discussion of, you know, who is the patient who has tested positive, who else have they come into contact with, where have they been, where have they gone, what was the type of interactions that they had with those different individuals. And they would be identified for necessary follow-up whether it's testing, quarantine and isolation.
SIMONSWe'll have to leave it to leave it there. Thank you, Dr. Travis Gayles. Stay with us.
SIMONSWelcome back. I'm Sasha-Ann Simons in for Kojo Nnamdi. We're joined now by Dr. Leana Wen. She's an Emergency Physician and a Professor of Public Health at George Washington University, also a columnist for "The Washington Post," and she formerly served as Baltimore's Health Commissioner. Hi, Dr. Wen. Welcome back.
DR. LEANA WENThanks so much. Glad to join you.
SIMONSDr. Wen, we're five months into this and if people weren't feeling quarantine fatigue before they definitely are now. It's summertime. It's hot outside and we're really desperate to get out there and socialize and have gatherings. How do we navigate these interactions with friends and family safely?
WENYeah, I think actually it's great that it is summer and it's beautiful outside, because it means that we can socialize outside and take those indoor interactions that actually have a much higher risk and take them outdoors. So we now know based on research that being outdoors versus indoors reduces your risk of transmission by 18 to 19 times. And so whatever it is that you can do indoors take that outdoors. If you're going to be seeing friends and family know that actually one of the highest risks of transmission or at least the largest numbers of transmission have actually occurred among extended family and friends.
WENSo really important don't host dinner parties indoors for prolonged periods of time. Take it outdoors. See people outside spaced at least six feet apart. If there are going to be young kids around make sure that you're also keeping kids from different families different household units apart. Don't share food or utensils with others. You know, quarantine fatigue is real and we have to acknowledge it. But there are ways that we can keep ourselves as safe as possible while also seeing our loved ones too.
SIMONSLet's hear from some callers. Mark's been waiting patiently. Mark's in Silver Spring. Hi, Mark.
MARKHi, good afternoon. First I want to bring support for this program, this doctor and the prior doctor. I have to quick points. The first is I wanted to support the prior doctor in his wanting all schools closed, and if governor -- and I sent email to my councilman and the governor in Maryland. And if the governor or secretary of ed or whomever think it's safe for children and safe to go into the school they could meet the children at the school door and walk the halls with the children and staff.
MARKIf it's safe for the kids, why can't it be considered safe for the governor? And my second point is if you think of the old government anti-smoking campaigns comparing a cancer ravaged lung to a normal lung, I don't see anywhere flyers comparing a COVID ravaged lung to a normal lung. Flyers need to confront, educate, motivate and direct people so they not only know what to avoid, but know how to avoid it.
SIMONSThanks for your call, Mark. Let's work on both of those questions, Dr. Wen. So the second one Mark says why aren't we comparing COVID-19 lungs to healthy lungs.
WENYeah, I mean, I actually think that Mark brings up a really good point about the public education that we should be doing around COVID. I mean, there is a lot that we're still learning about this new coronavirus. But we also now know a lot including that even though it's a respiratory virus it doesn't just affect the respiratory system. So you can have permanent lung damage as a result of this. But this is a disease that could also affect other organ systems as well. It could affect your heart, your nervous system. It could end up causing strokes, could cause blood clots. It is important that we emphasize this is not the flu. This is an extremely severe and dangerous disease that's also very contagious. So I think that's important to keep in mind.
SIMONSMm-hmm, and Mark also brings it back to our conversation about schools. And says that he supports schools staying closed. And, Dr. Wen, I know that you have a lot to say about reopening schools. I saw your tweet earlier today. You said, you know, this new guidance on reopening schools from the federal government is not even close to being enough. Tell me what you meant by that.
WENRight now the federal government and the Trump administration has been set on justifying why it is that schools should be reopened for in-person instruction. And you know what? Of course, I agree with them that students belong in school. I'm the mother of two young kids. I oversaw school health in the City of Baltimore. Of course, we know that there are so many reasons educational health, etcetera, for kids to back in schools. But we have to be able to do it safely not only for the children, but also for the staff, for the teachers and for all of their families as well, because kids do not exist in a bubble.
WENAnd so the single most important determinant of whether and when it's safe for schools to return is what is the level of COVID-19 spread in the community. You just can't keep a school and the people inside the school safe COVID-19 if the community is a hotbed of infection. And in many places around the country the level of COVID-19 infection is simply too high. So we need to work on suppressing that level. And I think we as a society have to think about our priorities.
WENIf the priority is going to be safe school reopening in a month or sooner, then the most important thing we can do is to reduce the spread in the community by potentially closing down bars, not allowing indoor dining, not having night clubs, restricting other activities, because you can't do it all. We can't have our cake and eat it too.
SIMONSCan you help set the record straight when it comes to kids and COVID-19? You recently wrote a column for The Post that asks, you know, "Can people please stop saying that children don't get sick from the coronavirus and don't spread it?"
WENYeah, because, again, I want us to be using evidence and science in our decision making. I know that people are eager for kids to be back in school, but we can't do it based on false information. Kids do get sick from coronavirus. Kids in fact do get coronavirus. In the last two weeks of July alone 97,000 children were diagnosed with coronavirus. Imagine if all of these kids were in school. How many outbreaks could we be dealing with? Even though kids don't get nearly as sick as adults do from COVID-19, they can be hospitalized.
WENAnd of the kids who are hospitalized, one in three end up in the ICU, which is the same ratio as adults. Now there is conflicting research on the degree to which kids can spread coronavirus. There was a large study done out of South Korea and that found that kids 10 and older can spread coronavirus as much or at least as much as adults can, but that kids under the age of 10 maybe spread it less.
WENBut that's contradicted by another study in the Journal of the American Medical Association that found that kids under the age of five can harbor up to 10 to 100 times the amount of virus in their nasal passage ways than older people. So we know that kids can spread it. We don't know exactly how much. And this is the key that we need to be watching out for their safety as well as the safety of their caregivers and the adults that are in these schools too.
SIMONSLet's just back to the phones. Laverne is waiting on the line. Laverne is calling from Washington. Hi, Laverne.
LAVERNEYeah, hi. Thanks for taking my call. I actually have two questions. One about two days ago I stepped out of my house and I had my mask in my hand. I was going to put it on when I got into the car. I took a breath and inhaled a whiff of smoke. The smoke was coming from my neighbor across the street at least 6-0, 60 feet across the street from where I am. And my thought is, "If I can inhale this smoke and I definitely know that it was from the cigarette he was smoking, is it possible, do they have any studies to show whether or not the particles of the virus can travel this distance?" And if there is need to be concerned if someone had tested positive for COVID.
LAVERNEMy second question is as a healthcare worker is there a double standard that the nation or the organizations have setup with regards to who gets quarantined and who does not. Healthcare workers in ancillary departments, for example, the pharmacy, the lab, dietary, they have individuals there, who come down with COVID. They have to go home because they're sick. And they're quarantined until they get over the illness.
LAVERNEThe co-workers, one, we're not told that they're ill. And we can understand the HIPPA requirements, but we are not informed. And we are expected to come to work. We are not quarantined. We can go home to our loved ones with any kind of infection.
SIMONSWe're almost out of time. Let me just get a response for you. Thanks for calling. Dr. Wen, can you at least just address that first question about the smoke before we take a break?
SIMONSAbout 30 seconds.
WENSure. We're learning a lot about transmission. We do know that these aerosols, these much smaller particles can also transmit coronavirus. But at a level of 60 feet that far, even if the particles can travel potentially that far, they probably will not be infectious at nearly that length. But this again why being outdoors versus indoors is so important, because when you're outdoors those virus particles are defused into the air and then they are not going to infect you from that type of distance.
SIMONSAnd she asked about a double standard for healthcare workers. We'll get you to address that once we return. We are talking with Dr. Leana Wen. She's an Emergency Physician, Professor of Public Health at George Washington University and a columnist for "The Washington Post." You're listening to The Kojo Nnamdi Show. I'm Sasha-Ann Simons sitting in for Kojo. There's much more to come. We'll take your calls and emails when we return.
SIMONSI'm Sasha-Ann Simons, sitting in for Kojo Nnamdi. Dr. Wen, let's pick up where we left off. Our caller, Lavern, was asking about expectations on healthcare workers and whether or not there's a double standard here. Can you address that?
LEANA WENThere should not be a double standard, not only among healthcare workers, but also between healthcare workers and the general public. Because we know that this is a highly contagious disease, and that if you have substantial exposure to someone with COVID-19, that you should be placed within quarantine and obtain testing accordingly.
LEANA WENSo, I agree with her completely that it would be a problem if that's not occurring, especially given what we know about asymptomatic transmission, that 30 to 40 percent -- up to 30 to 40 percent of cases can be transmitted by individuals who show no symptoms at all. And so that type of isolation for those who are ill and quarantined for those who are exposed is really important, as is widespread testing, as you were discussing earlier in the program.
SIMONSWe need to talk about masks. I've got so many questions for you. First, you know, public health officials have been very adamant, Dr. Wen, wearing masks saves lives. But there's a new report from Duke University that finds that some masks are significantly less effective than others, and some may be even worse than actually not wearing a mask at all. What can you tell us about this study?
WENYeah, so I found this to be very interesting. They did a -- the researchers at Duke did this study looking at what kind of particles, how many particles, what percentage of particles are going to be passed through, depending on the type of mask that you're wearing.
WENOf course, we know that the gold standard mask is the N95 respirator mask. This is the one that healthcare workers wear, although I will tell you, as someone who wears a lot of N95 masks, that they are really uncomfortable. They can filter out, of course, at least 95 percent of the particles. This is where the phrase N95 comes from. But what the researchers emphasized is that there is a tradeoff between breathability and protection.
WENThat comfort is going to be really important, too, because, otherwise, if you have a mask that's just so uncomfortable, you might not be wearing it, and then that defeats the purpose of the mask. And so what they're finding is that the neck gator masks that are made of the polyester very thin materials, while they are pretty comfortable to wear...
SIMONS(overlapping) And I see them a lot.
WEN...it's really easy to breathe -- yeah, that's right. And important to know that they only tested one type of that neck gator, the one with the very thin polyester. But because it's so comfortable, you can see how it allows a lot of particles to come through. And so the best recommendation is cloth masks are just fine. Surgical masks are just fine. But the important thing is to consistently wear them.
SIMONSFor those of us who are unsure about the proper way to wear a face covering, can you explain, because I see a lot of people wearing it just below their nose, only covering their mouth. It drives me insane. (laugh) So, I need you to clarify. How should we be wearing these?
WENSure. So, where you should not be wearing it is around your neck, (laugh) because, obviously, that's not going to be effective. The mask should cover your entire -- your nostrils. It should absolutely cover your mouth. And there should be not much space between your cheeks and that mask, because you can imagine wherever it is that there is space, that is opportunity for the virus to escape you.
WENAnd also, now, we are getting additional information about how masks -- it doesn't only protect other people from you, as we've been saying. There's also evidence to suggest that it protects you, the wearer, from others around you, as well, even in terms of decreasing the level of exposure. So that even if you are exposed to some virus, by reducing the amount of virus that you're exposed to, that could also prevent you from getting ill, too. So, cover your nose and your mouth with a mask.
SIMONSThere was an incident that occurred at a Montgomery County restaurant when an employee asked a patron to wear a mask, and the situation escalated. Now, we've seen many examples of this play out across the country, lots of viral videos. What do you recommend, Dr. Wen, in that scenario? If a stranger is making you feel unsafe, what do you say to them?
WENI think it depends on the situation. If you are an everyday person, you're not an employee at a restaurant, you're just passing someone on the street and they're saying something to you about the fact that you're wearing a mask, I think it's better to deescalate and walk away. Because we don't know what this other person's intention is going to be, and I certainly would not want you to be put in harm's way if they are escalating the situation further.
WENIf you are an employee and there's a policy about mask wearing, it's always good to fall back on that policy and explain calmly that that is the policy of that particular establishment. There should also be protocols by your employer about what the best practices are, too. I think there's another situation, too, which is many of us may have family members or loved ones who, for whatever reason, think of masks as a political symbol or don't agree with the idea of wearing masks. And I think...
SIMONS(overlapping) Or they're just skeptical sometimes. Yeah, they just don't take it seriously.
WENRight. That's right. And I think it's important, especially if we have a relationship with that person already, to approach them with empathy rather than with shame and judgment, to understand where it is that they're coming from. And then to see what it is that we can help with. Maybe we can help explain the science. There's science showing, for example, that wearing a mask reduces your risk of transmission and of getting the virus by up to five times. So, we can explain the science.
WENWe can also enlist other trusted messengers. If they will trust somebody else around them that may be willing to explain to them, too. So, I think that that open conversation, though, and approaching with compassion and empathy is really important.
SIMONSLet's hear from Megan in Alexandria. She's got a question about testing. Hi, Megan.
MEGANHi, Dr. Wen. So I had an escalated situation a couple of weeks ago. More unfortunately, I was in contact with someone who tested positive for COVID-19. You know, I tried to be responsible about it and I scheduled a tele-health appointment with one of our local clinics. The doctor thought it would be beneficial for me to go and do a drive-up test. Did the drive-up test, tested negative, continued to quarantine for the recommended two weeks.
MEGANA couple of weeks ago, I found out that my insurance, unfortunately, was billed incorrectly, and I actually ended up with a bill of over $400. Itemized, it was actually $300 for the telephone visit, and then $50 for the drive-up test and then $50 for the actual test.
MEGANI was just wondering, you know, we have -- there's 20 million uninsured Americans, you know, in the entire country, like, what can I do, you know, as a person, like, who encountered this issue do to make sure that everyone is being tested and, you know, making sure that they can even afford to be tested?
SIMONSThank you for sharing that story, Megan. Dr. Wen, why isn't testing free?
WENThat's a great question. I cannot agree with Megan more. That testing and all the related healthcare costs around COVID-19 absolutely should be free. Because, otherwise, we are disincentivizing people from doing the responsible thing, as Megan has done. I mean, Megan, I'm glad that you got tested. I'm glad that you tested negative. And it's so great that you quarantined for the recommended 14 days.
WENI mean, I just -- you know, there are so many people who may not be able to do that. Not because they don't want to, but because they're prohibited from it because of financial reasons. I mean, not being able to go to work, for example, for 14 days is already extremely difficult. Or if you live in a house with many other people and trying to quarantine yourself away from little kids or if you're the caregiver of elderly parents, that would be really challenging, too.
WENAnd so I think there are a lot of systemic issues that we need to address very urgently, starting with the concept of providing free testing. And, right now, insurance coverage is for testing -- supposedly for testing for individuals who have symptoms or who have exposure, as Megan does. But it should also be free for individuals who need it, for example, for going back to work.
WENOr, ideally, we have widespread antigen testing, this rapid testing that can be done within 15 minutes at home, so that everyone can obtain that test. How much of a game-changer would it be if we could all have a test before we go to work or before we go to school? That would really, I think, change the way that we understand COVID-19, that we're dealing with it, and would make such a big difference in our fight to control this disease in our country, too.
SIMONSIf you're just tuning in, we're talking with Dr. Leana Wen. She's an emergency physician, a professor of public health at George Washington University and a columnist for the Washington Post. She's here answering questions about protecting yourself during this pandemic. We're five months in, and we still have lots and lots of questions. And, Dr. Wen, many of us eying possible family reunions, weddings, other events. Jenny emailed us and said: My friend is planning for a wedding this fall. It's going to be small, hopefully outdoors but possibly in a tent, if it's raining. No masks. Is this safe?
WENI guess it depends on a number of things. One is what part of the country...
SIMONS(overlapping) How small?
WEN...this wedding's going to be taking place.
SIMONSHow small is small? Yeah.
WENRight. Exactly. And also where is this happening? Are people going to be flying from all over the place? Even if it's a small wedding, are people still going to be -- it depends on the space, as well. You could have a relatively small wedding of 50 people. But if 50 people are going to be crowded together, that's not necessarily safe, too. And no masks also really concerns me.
SIMONSYeah. What can you tell us about contact tracing? It's come up quite a bit with some of these questions.
WENWell, contact tracing is the bread and butter of local public health. It's what we, in local public health, do all the time. We know how to do this, but we also know that it is very time-intensive, extremely resource-intensive, and that it can't just be tracing alone. It also needs to be done in combination with testing and then with what happens. If somebody tests positive, they need to be able to do isolation and quarantine, as well.
WENOne major issue with contact tracing in this country is that we have such widespread virus, that it just completely overwhelms our ability, our healthcare system, our public health infrastructure to do effective contact tracing. So, before we can even do effective contact tracing, we need to -- in many parts of the country, need to substantially bring down the level of COVID-19.
WENThat, by the way, is also the key to our testing problem, as well. If you look at the number of tests we're doing, we're doing a lot of tests around the country. But we also have surging infections all over the country, too. So, we need to bring down that level of cases as we ramp up testing and contact tracing, too.
SIMONSLet's go to a call from Gary. Gary's in Sterling, Virginia. Hi, Gary. You're on the air.
GARYHi. I have a question. Will bacterial digestant metabolize a virus?
SIMONSThanks, Gary, for calling. Dr. Wen, bacterial...
WENI'm not sure I heard the...
SIMONSHe was asking if bacterial digestent will destroy the virus?
WENI see. So, viruses are different. They're a different type of organism from bacteria. And so antibacterials are not going to work against viruses. But, again, remember the best thing that we can do, still go back to the basics. Washing your hands with just plain old soap and water is extremely effective, wearing a mask and, really important, is keeping that social distance.
WENBecause now we know that the virus that causes COVID-19, that it is something that's not just transmitted through respiratory droplets. We used to think that it's something that, only when you cough and sneeze and you expel these bigger droplets, can you transmit the disease. Now we know that it can be carried through these much smaller microscopic aerosols. And that's the reason why keeping that distance and being outdoors is so critical.
SIMONSYou mentioned travel, as we answered the question about the wedding a moment ago. And Sharon messaged us on Facebook. She says: I need to travel to New York to move my mother, who is 88 years old. I'm apprehensive to travel by air and do not want to put her at risk. What are the travel restrictions currently in place?
WENWell, I would recommend, assuming that Sharon is local, that she drive up to New York. That's certainly going to be the safest, because you can control your vehicle, and you can even avoid potentially a rest stop along the way and really have no exposure between here and New York. I think that airports and airlines are taking some safety precautions, and this is a relatively short flight, but there is going to be some risk involved. And so driving is still going to be the safest.
SIMONSDr. Wen, our country doesn't have a national strategy to defeat this virus, which is quite scary. Instead, we have a patchwork of local strategies. What impact will that lack of unified response have in the long run?
WENWell, I think we're seeing what that means, even in the short term. We're seeing that there are states that came very close to overwhelming their hospital capacity, that were able to avoid that kind of catastrophe for the time being, but they have plateaued at a very high level. And then in the meantime, there are other states that are increasing to the point of overwhelming their healthcare system, and I hope that they'll be able to control it in time.
WENWe're seeing waves upon waves of COVID-19. We're seeing, at best, whack-a-mole where we're able to contain one place only to have another place come up as a problem. And this lack of national strategy has been our major fault as a country all along. And I think the devastating thing is it doesn't have to be this way.
WENWhen we look at other countries, other countries have not just bend the curve when it comes to COVID-19. They have crushed the curve. They have suppressed the level of COVID-19 and, as a result, their schools are open. Sports are now taking place. They are now able to get back to life, and their economies are up and running. Of course, it's not 100 percent. Many of these countries still experience surges, and then they have to dial back these -- or dial up these restrictions once again.
WENBut it doesn't have to be that we're losing more than 1,000 Americans every day. And we can still make a difference now by having a national coordinated strategy by letting public health lead the effort, instead of muzzling scientists and public health officials.
SIMONSWell, after an initial spike in July, some coronavirus metrics are ticking downward -- locally, at least. What could be behind the decline in reported cases? Are we just getting better at handling this thing?
WENYou know, I think that Maryland and our area, D.C., Virginia, they've done a pretty good job of being careful about reopening, messaging reopening not as, now everything's safe, but rather as, we need to do this carefully in accordance with science. But I also think that we cannot let down our guard. First of all, we are one country. What happens in other places absolutely will also affect us here in our region, also.
WENBut the other thing too is we need far more widespread surveillance testing. And as things like schools come back, we are going to see more cases. And we need to be on top of it and identify these outbreaks before they become epidemics.
SIMONSLet's jump to the phones. Lee is on the line from D.C. Hi, Lee.
LEEHi. Thank you, Dr. Wen, for all that you do. My question is about gloves. If you are not a healthcare worker, grocery store, transportation worker, when should you wear gloves outside?
SIMONSThanks for calling, Lee. Dr. Wen?
WENYes. So, Lee, I would not recommend -- actually, outside of the settings that you described, I would not recommend wearing gloves other than maybe the one instance of if you have a family member who's sick in your house and you are taking care of them and you're cleaning up after them, maybe you wear gloves in that instance because there's such high levels of virus around. Otherwise, I would not recommend wearing gloves to go to the grocery store or wearing gloves to go see your friends.
WENBecause the issue is, you're not going to get COVID-19 through your hands. The issue is what happens if you touch something and then you touch your face. Many people who are not used to wearing gloves actually take that as a type of false reassurance. And then they still touch their face, even after touching something with their gloves. And that ends up being worse. So, I would not recommend wearing gloves, but absolutely wear masks.
SIMONSSome of us were so focused on that at the beginning of this. Were we just misinformed or -- I know I was one. I had gloves on. I'd put gloves on my kids. We'd have masks, the whole nine.
WENWell, I think there are a couple of things. One is that I do think that there is kind of a false reassurance that we have with putting things on like gloves, because it makes us feel safer, when, in fact, it may not. But I think the other part too is we now know more than we did in the beginning about transmission. We know that the surface transmission is probably a small proportion of the transmission that's occurring. Not to say that it cannot happen.
WENCertainly with high touch surfaces like door knobs, elevator buttons, you should be careful and wash your hands after touching those surfaces. But we know that the in-person transmission, person-to-person in crowded areas, that's going to be much higher likelihood of getting the virus that way. And, again, don't just think about it in terms of strangers, that you're going to the grocery store, it's strangers who are going to give it to you. Actually, our studies show the opposite. That it's when you get together with your friends and your loved ones in bars and restaurants, at home. Those are the types of events that we should actually be much more careful about.
SIMONSEric is on the line, from Alexandria. Eric, you're on the air.
ERICYes, good afternoon. I'm part of the very small group of people who are claustrophobic. And when I wear a mask over my mouth and breath my own hot air back in, I start to have panic attacks. Most of my life, I've had this issue, so I've known about it and was very concerned when coronavirus started and they said, wear a mask, wear a mask. Is there another choice for me? I wear a bandanna and make sure that I can breathe straight down and breathe cold air in to try to stop that from me, but it doesn't sound like Dr. Wen approves of that idea.
SIMONSThanks for calling, Eric. Good question. Claustrophobic people, you know, how do they navigate the mask situation?
WENSure. And I appreciate what Eric said, and I think there are others who are in this situation, as well. I mean, I think a bandanna is certainly better than nothing. I certainly would recommend that people do what they can consistently do. And so if you cannot consistently wear a mask, but you can wear a bandanna, do that.
WENSomething else you could do, in addition to the bandanna, because bandannas are not as effective as a mask that completely covers your nose and your mouth, you could also wear a face shield. That's that plastic -- clear plastic that you can see through. A lot of people much prefer that. The problem with the face shield is it doesn't cover your nose and your mouth. There's certainly a lot of -- an air gap around it. But if you combine that with a bandanna, that might be able to get around the claustrophobia issue that Eric mentioned.
SIMONSSome people are wearing masks with valves on them. Is that okay? Can the virus escape through the valves?
WENYes. Please do not wear the mask with the valve, especially the one-way valve.
WENBecause what happens in that case is that everything that you are breathing out, that other people are being exposed to the virus that you are breathing out. And so, actually, the CDC and others have issued guidelines saying that you should not be wearing these masks with the one-way valve, for that reason.
SIMONSDarcy's on the line, from Silver Spring. Hi, Darcy.
DARCYHi. My question is, my daughter is flying here from California and she's planning to take a COVID test when she lands. Does she also need to quarantine?
SIMONSGood question. Dr. Wen?
WENYes. It depends on what your level of comfort is, assuming that she's going to be staying with you. And so if she takes a test as she's landing, that's only going to be looking at her exposures from several days ago. Because we know that there is an incubation period between two to 14 days, average five to seven days. But we're still looking at an incubation period where, even if the test is negative when she lands, we don't know about her exposures in the previous days, including on that flight.
WENAnd so if you are particularly -- if you are, you know, compromised with other medical conditions and that's the concern, she should still be quarantining for, I mean, ideally two weeks, as she sees you, but at least another five to seven days until she can take another COVID test after landing.
SIMONSAnother quick travel question, here. It's an email from Jill that says, my son will soon be driving from Northern California to Washington, D.C. He's planning to stay in motels or maybe sleep in his car in a campground. It is important that he get good sleep in order to drive safely, so the motel is probably his best option. Is that safe?
WENSo, hotels and motels have instituted a lot of provisions around ensuring safety. And I actually think that it would be safe to be in a motel or hotel, but he should still take additional precautions. Specifically, stay out of all these communal common spaces like lobbies, restaurants and so forth. It's not so much a problem to be in the room as it is to be in these congregate spaces.
SIMONSRussia is moving forward. We've been seeing this in the news. They're moving forward with their own vaccine for the virus. Can you tell how close we are to a vaccine?
WENSure. Well, first of all, the Russian vaccine, we really have no data for at all. And, to the best of my knowledge, it sounds like they have just started phase three trials, which is what we have started here in this country, as well, with several different candidates. And so the hope in this country is that we'll be able to have something, assuming everything goes as well as possible, I hope that we'll be able to have a vaccine that's shown to be safe and effective by end of this year, early next year.
WENBut that really depends on how quickly we can recruit candidates into these trials and whether -- again, I think safety and efficacy are so critical. Safety because we are giving this vaccine to otherwise healthy people. Efficacy because we don't want to give people the idea that they are protected from COVID-19 when, in fact, that they're not. And so I hope that our federal government, the FDA in particular, maintains its independence and does not let political pressure determine vaccine approval, as opposed to the science.
SIMONSWe've got just about 40 seconds before we've got to wrap up. Just a question here from Audrey in Alexandria about pools, indoor pools, if that's safe. You said before, you know, we're fortunate right now that we have this warm weather. Can we swim?
WENWell, any pool that's your own or that belongs to someone that you know and you won't be around others is absolutely safe, because you're not going to get it through water. But I am concerned about pools where there are a lot of people congregating around, because that's how you're going to get COVID-19, through that person-to-person interaction.
SIMONSDr. Leana Wen is an emergency physician, a professor of public health at George Washington University and a columnist for the Washington Post. And she formerly served as Baltimore's health commissioner. Once again, thank you so much for your time, Dr. Wen. It's so helpful.
WENThank you very much.
SIMONSToday's show on staying safe amid the pandemic was produced by Julie Depenbrock. Join us tomorrow for The Politics Hour. We'll hear from Howard University provost Anthony Wutoh about the significance of alumna Kamala Harris as V.P. nomination. Plus, the majority leader of the Virginia House of Delegates, Charniele Herring previews next week's special session addressing criminal justice reform. And D.C. Councilmember Charles Allen will talk to us about gun violence in the District. It's all coming up tomorrow, at noon. Thank you so much for listening. I'm Sasha-Ann Simons, sitting in this week for Kojo Nnamdi.
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