Dr. Nicole Saphier: COVID-19 — From goggles to testing, this is what we need to do next to beat coronavirus

16 days — just over two weeks is how long it took for my son’s COVID-19 test results to be reported.

My eldest son had to travel to his college to empty contents from his dorm, and since his college is amidst a spike in cases, he was required to quarantine when returning to New Jersey unless he received a negative test result. 

Upon returning he promptly got tested, isolated from the family and did not go to work while waiting for the results. After several attempts to contact CityMD/Summit Medical Group and the lab that performed the tests, we were repeatedly told that “results are taking 10-14 days given the increased demand.”

MAJORITY OF AMERICANS EATING MORE OF THESE COMFORT FOODS DURING PANDEMIC

Here is the problem with that scenario — most people can’t afford to strictly quarantine for 14 days while awaiting a test result. That means people are not adhering to the quarantine recommendations and asymptomatic/pre-symptomatic transmission continues.

The entire testing mindset needs to change from diagnosing someone with the virus (for little other than to add to the daily case count) to determining whether someone is actually infectious because, as we have learned, there is a window of infectivity. That window is what needs to be targeted to lessen community spread.

A positive test result (or negative for that matter) does very little in terms of management 16 days after the fact. My son had already cleared himself with the quarantine recommendations by the time his test results were posted, so resources and funding used for his test were wasted.

In a time of economical strain like we are in now, the last thing we need is wastefulness. Testing results must be available within hours, even minutes. Not days. And certainly not weeks.

Undoubtedly, widely accessible rapid testing (such as rapid flu, pregnancy, etc) is a critical component to lessening community transmission of coronavirus.

The deaths attributed to COVID-19 in the U.S. are now over 150,000 with the daily death rates highest since May 15. More than half of the recent daily deaths reported have occurred in California, Florida and Texas. 

The glimmer of hope is that across the country, including these three populous states, new cases are beginning to decrease despite the daily deaths tolls slightly increasing. This perhaps may represent the lag between a rise in cases and deaths that we experienced in the northeast.

However, the case fatality rates are much lower now than several months ago as a result of protecting the elderly, improved treatments and earlier intervention.

While the country continues to battle with COVID-19 and as our testing capacity has ramped up, there is a growing conversation about the possibility of aerosolized transmission and even wearing goggles to protect the eyes.

The concept that this virus may become aerosolized is not new. In fact, it has been mentioned many times over the last six months after the outbreak occurred during choir practice in Washington state and after a small study suggested an air conditioning unit spreading the virus from one contagious individual to multiple others in a restaurant.

Further, a study from the University of Nebraska Medical Center reported detection of viral genetic material in air samples collected from rooms of COVID-19 patients suggesting the virus may be transmitted through HVAC units. In a similar study, not yet peer-reviewed, researchers from Oregon Health and Science University in Portland swabbed three different HVAC units at the hospital with 25 percent swabs testing positive for coronavirus genetic material.

The growing evidence of aerosol transmission has led to a cohort of 239 scientists writing commentary in July to the World Health Organization to recognize this potential for airborne spread.

While the direct routes of transmission remain the same (via mucosal surfaces), whether coronavirus is suspended in respiratory droplets or freely in the air makes a difference. Aerosolized virus tends to transmit easier and remain lingering in the air for a while after the infected person leaves a room. 

Think of the disaster that would be seen with elevators, public restrooms and other small indoor spaces if an infected person was simply breathing without a mask on. Granted, not all masks are created equally and certainly no mask is foolproof, but they can lessen the transmission of a virus. If two people are wearing a mask appropriately, the risk is reduced even further.

How long the virus can linger in the air, we don’t know.  But “we don’t know” is a recurring theme with this novel coronavirus – that is the thing with a novel anything; it’s unknown. We are gathering piecemeal information and trying to put it together, learning something new every day.

While the most likely way to become infected with coronavirus is by inhaling through the nose or mouth nearby respiratory droplets from someone who is sneezing or coughing, there are other ways the foreign pathogen can invade and wreak havoc.

The heavy respiratory droplets filled with virus tend to fall quickly to the surface so if someone touches the item and then puts their hands in their mouth or nose (we all do it whether we realize it or not) then that is another way, albeit less frequent, of contracting the virus. Fortunately, that is easily remedied with proper handwashing and re-training yourself and children to avoid touching your face.

However, while the virus is known to invade via the mucosal surfaces of the mouth and nose (which is the concept behind wearing masks); the eyes are another susceptible mucosal surface on the face. The eye serves as a potential site of virus replication and a way to establish a respiratory infection through the nasolacrimal system, providing the anatomical bridge between ocular and respiratory tissues

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A small-scale study published in March 2020 in the journal JAMA Ophthalmology suggested the coronavirus may be transmitted through the eyes. This is not entirely surprising since evidence demonstrated that lack of proper eye protection was associated with an increased risk of SARS (caused by a similar coronavirus) transmission.

This week our nation’s top experts Drs. Fauci and Birx suggested adding goggles to our self-protection gear. Albeit this is the least likely mode of transmission, when we are discussing a highly contagious and virulent novel virus, doesn’t it make sense to arm ourselves the best we can?

So, does this mean we should all walk around wearing goggles like a member of the ski team or the next space crew? Well, I do when I am in the hospital doing procedures on patients that require close face-to-face interaction, but that is a far cry from the general public walking around in goggles.

The reality is, there is no such thing as being over-prepared for a health crisis, but there is certainly the possibility of being under-prepared for one. An acceptable solution lies somewhere in between the extremes.

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For me, I will continue to take the knowledge we have learned about how this virus acts and do what I can to protect myself, my family and my community.

We will be dancing with this virus for a while so life must go on.

We should all continue to protect the vulnerable, encourage some level of general physical distancing, wear a mask when we are around others (maybe even glasses or some other level of eye protection if inside a public space), and do everything we can to limit non-essential indoor gatherings.

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If our fundamental goals are to keep businesses open and get our children to in-person school, we have to work together as a community to make it happen. Without these measures being adopted by the majority of people, it will be quite difficult to control clustered outbreaks and will be nearly impossible to overcome this pandemic.

While the public continues to care for one another, there needs to be further collaboration with governmental and commercial laboratories to improve test turnaround times. We’re doing more tests than ever, but testing alone isn’t enough when the delayed results are useless and people are not adhering to quarantines while waiting for them.

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