The power of the mask! I learned a lot about Covid this week.

Earlier this week we had a patient in the office whom I have taken care of for many years for a variety of ENT issues and he was in for a routine exam. He mentioned that he has had a cough for a week, no fever but, by the way, also felt really, really tired. Although he filled out the Covid pre-screening questionnaire everyone gets and mentioned these symptoms, he somehow still made it back to the exam room. Normally, those answers would have resulted in “Do Not Pass Go”and head straight to get tested for Covid-19. Chalk that big miss up to the fact that everyone is stressed and sometimes Sh&^*T happens. I sent him to get tested and it turns out he was positive for Covid. We assume everyone has Covid but when you actually know someone does, it raises the anxiety level quite a bit.

He was wearing a mask the entire time (we won’t see anyone without it). Our staff is masked up all the time. We have glass and plexiglass shielding at the desk. Personally, I wear an N95 all the time and was in the room with him for only about 15 minutes. After some initial panic cleared, and all those factors were taken into account, and after discussions with 2 separate infectious disease specialists, no further testing of staff, including myself, or other measures, were needed to be taken. Our exposure risk is low.

I want to reiterate some new things I learned and some well established facts:

1. The incubation period (time from exposure to developing symptoms) of this virus is anywhere from 3-14 days however the majority of people will become symptomatic within 4-5 days.
2. The most contagious phase are the 48 hours before someone develops symptoms. You continue to be symptomatic after symptoms develop, but the degree slowly diminishes. Studies have shown that 40-50% of infections come from asymptomatic people.
3. If you are diagnosed with Covid, you need to isolate for 10 days after symptom onset, not the date of the test, unless you are asymptomatic, in which case you do it from the test date since the probable date of infection is not clear. Other symptoms might persist for weeks if not months after infection but you are no longer infectious however if you have a fever, isolate until 10 days plus 2 days of no fever. The urgent care where my patient went told him that he no longer needed to isolate. At that stage, his symptoms had only  been present for 7 days so they were giving him the wrong advice. Maybe they were taking into account the 3-4 days of asymptomatic infection before? Who knows but that just shows you the degree of confusing information there is out there, even in medical facilities.
4. Significant Covid exposure consists of 15 minutes of unprotected exposure to a covid positive patient in an enclosed space. One of the parties wearing a mask is good. Both masking is better. Both masking with distance the best. If you pass someone who has Covid in the park, street or supermarket, the chances are remote that you will contract it.
5. If you have been exposed to someone with Covid and are asymptomatic, you should not get tested for at least 7 days. Your test is likely to be false negative. If symptomatic, get tested anytime.
6. If you got the first vaccine and then somehow got Covid before the subsequent shot, you should still get the subsequent shot, just wait 2 weeks after you are feeling better. After the second shot, you are much more likely to have side effects because of the first shot and the infection “priming” your immune system.
7. I posted earlier this week about a British study of healthcare workers showing that immunity lasts for at least 5 months after infection. I was schooled on that also. Although some protection exists after infection, the degree and duration depends on how sick you were. Asymptomatic or mildly symptomatic infection is felt to render only 2-3 months at most and more significant illnesses, 5-6 months of protection. In either case, you should still get a vaccine ASAP. There are some places telling patients who have had covid to wait 6 months. RUBBISH!!!
   
   

The studies show that the immune response to the vaccine is actually more robust that what is seen with actual infection so even if you’ve had it, get the vaccine.

The reality in our office is that we have probably been exposed to many unsuspecting and asymptomatic Covid positive patients. Knock wood, we have not had a single employee contract it from the office and I attribute that to rigid rules about mask wearing and distancing. We also really reinforce the need to be careful outside the office since most infections occur there. In fact, since the start of the pandemic, 90+% of all the workers at one of the larger local hospitals I work at who contracted Covid were felt, through contact tracing, to have been infected outside the hospital, not from infected patients. I know of many other offices where there have been outbreaks leading to shutdowns and they were all loosey goosey with mask wearing when patients were not around.

THE DISEASE IS REAL!

WEAR A MASK AND DISTANCE.

GET VACCINATED WHENEVER YOU CAN, ASAP.

Stay safe and be well. 

AC