By Nancy Pietroski, PharmD, WEMT, FAWM, CTH
Memorial Day weekend 2020 is here. Obviously, this one is different from other years.
Let’s face it. Even though there is some encouraging news about a “flattening of the curve” in COVID-19 cases in many parts of the US, the decision to continue to stay at home or to plan that next trip depends on a number of factors. First, let’s look at some scientific data.
COVID-19 Medical Facts
These are important medical facts about COVID-19:
Continuing to stay at home can save lives, but it will not kill the virus, because COVID-19 has not been eradicated (like smallpox has been). It is still around, and is willing and able to cause more infections.
COVID-19 is going to be around for a while because herd immunity has to develop. Herd immunity occurs when the majority of a population becomes immune to an infectious disease and indirectly protects those who are not immune. For COVID-19, this is estimated to be 70%. One way to achieve this number is for an effective vaccine to be developed (and for people to receive it!) which may take as long as 12-18 months until approval (more rosy predictions about this time to approval have been suggested). The other way is for a large percentage of the population to become infected and develop antibodies to the virus. This could take more than a year if it occurs naturally. Or a combination of both. https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html
We need to track the R0, or transmissibility of COVID-19. The R0 of COVID-19 is estimated currently to be 2.5-3, which means that one infected person can transmit the disease to 2.5-3 unprotected people (measles has an average R0 of 12-18). As the country reopens, this important number could get worse if appropriate safety measures are not followed. Widespread testing is extremely important to track the number of people who are infected.
So how will we know when herd immunity is achieved and we can go back to “normal”?
As reopening of the country occurs, the precautions that are currently in place still need to be maintained: social distancing, face masks, disinfecting surfaces, etc. If they aren’t, the number of infections and deaths could rise dramatically, overwhelming the healthcare system. If everyone is diligent, the number of infections could stay the same or decrease until a vaccine is ready for distribution, but this means at least a year or longer. The likely scenario is what is happening now - infections will rise, will fall when precautions are followed, and rise again when they are relaxed.
So the bottom line is, everyone needs to do their part to try to keep this thing under control until we get a vaccine. The alternative is to wait for 70% of the population of the US (>300 million) to get infected, and that is a big number. Some have suggested that why don’t we just expose everyone to the virus and get infected to achieve herd immunity? COVID-19 has a higher death rate than the flu, and attacks certain groups more viciously than others, like the elderly and immunocompromised - so not a great plan. One of the scariest things that is not known at this point is that if someone has recovered from COVID-19 and has antibodies, whether they are protected from getting infected again.
Time, and widespread COVID-19 testing and tracking will tell.
Treatments for COVID-19
How about the treatments for COVID-19 that we are hearing so much about in the news? Remember, treatment for COVID-19 can help to shorten the severity and length of the disease course, but it cannot prevent it.
Despite the media hype, this old drug has been studied carefully in multiple studies and has not been proven to decrease severity of COVID-19 disease or death. (See this very recent study published in the New England Journal of Medicine)
Furthermore, the irresponsible use of hydroxychloroquine for an unproven indication has decreased the world’s supply for the treatment of the diseases for which it is indicated: malaria, lupus, and rheumatoid arthritis. Hydroxychloroquine also has serious toxicities, including cardiac. The drug has been studied in combination with azithromycin, an antibiotic widely used for a variety of bacterial infections, but again, efficacy for COVID-19 has not been definitively proven.
There is very encouraging research on the effectiveness of this antiviral drug. Recently released data on a trial conducted in >1000 patients showed that patients who received remdesivir had a 31% faster time to recovery than those who received placebo; the median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who received placebo. Results also suggested a survival benefit. See announcement here: https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19
A study reporting the effectiveness of the heartburn drug famotidine in improving clinical outcomes in COVID-19 patients caused a stir and a run on the drug. The research has not been peer-reviewed yet, so this should not be an accepted treatment to be used in clinical practice at this time.
So, with all of this in mind, should you travel now since restrictions are being lifted, you just have to escape from the house, you feel perfectly fine, but COVID-19 is still very much around?
If you plan to travel somewhere in the US, it’s very helpful to take a look at what is happening with the coronavirus cases where you live, and where you are going. The CDC (and other sites) have detailed maps that are updated daily. If you live in an area with a high number of cases and you travel to an area with lower numbers, you could be putting others at risk. Remember that up to 50% of people infected with COVID-19 may be asymptomatic, meaning they could be transmitting the disease to others without knowing it. Look at the maps carefully to see if cases have been rising, falling, or staying stable in the area(s) where you are going to visit. However, bear in mind that with reopenings occurring, infection rates may rise if precautions are not followed, so the maps must be checked often.
Source: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html [accessed 5/20/2020]
Before you go, check with the state’s health department at your destination(s). Here's a directory of state health departments from the CDC. These websites are full of useful information on travel, outdoor recreation, healthcare facilities, etc.
You can also check the number of COVID-19 cases in the area of the US where you'll be traveling.
Traveling internationally right now adds a whole other layer of complexity. Airline travel in the future will look very different than it does now. The International Airline Transport Association (IATA), in addition to providing guidance to the airline industry, has a very useful site for travelers. https://www.iatatravelcentre.com/iata-travellers-faq.htm
Changes that have already taken place include pre-flight temperature screening; masks or face coverings have to be worn during boarding, the flight, and upon disembarking; distancing between passenger seats; changes to in-flight meals; more frequent cleaning of lavatories– and the list goes on. Some of these are definitely a plus! The CDC has created in addition to their usual travel advice site, one specifically for COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
Factors to Consider When Deciding to Travel
Type of travel
Do you really have to travel for work, or can meetings or conferences be conducted via Zoom or another video conferencing platform? (this may not be up to you to decide, however)
Leisure – do you really need to take a trip now, or should you just continue to lay low and enjoy a longer “staycation”?
Method of transportation
We’ve all seen the videos of some crowded domestic flights – even though airlines are claiming they are implementing the guidelines for protecting passengers, in reality, they’re not – and putting travelers, the flight crew, and ultimately the population at risk. Do you really want to fly now?
Traveling by car seems to be a safer alternative to flying, but if you are taking a longer trip, are you exposing yourself and others at all the rest stops, gas stations, restaurants, and hotels you will be patronizing? You may be safe, but are they following all the rules?
Train travel may be a good alternative to flying or driving, but are railway cars and stations any safer than flying? (long lines to board, closed quarters, lengthy trips)
Destination – international, city, rural
As asked above, are you willing to fly now, while things are still in flux, especially overseas?
If traveling in the US, will you be traveling to a city, where the number of COVID-19 cases are likely to be higher, or to a rural area, where the numbers are lower, but where you may be putting the citizens of that area at risk, as well as their healthcare resources if you should become sick?
It’s Not All COVID-19, All the Time
As noted above, you don’t want to become sick in a smaller town or rural area that does not have as robust a healthcare system as a big city. You may not come down with COVID-19, but if you have other health issues, you could end up in the emergency room with a heart attack or acute abdominal pain, or maybe not as serious, you could break a collarbone while mountain biking on those awesome trails in the desert, and end up needing to be treated in the hospital.
If You Do Go
If you decide to take a trip, remember that all of the precautions to protect yourself and others that have been in place for months still need to be followed, even though there are those who don’t think these things apply to them. These are:
Social distancing – stay at least 6 feet away from others. Avoid contact in groups that lasts longer than 10 minutes if you cannot distance. Do not go to crowded places (if you get somewhere and it’s crowded, leave and go someplace else). Do not gather in large groups – some states and local municipalities have specific guidance on the amount of people. You don’t want those at most risk for serious illness to get sick – and this could be you!
- Greater than 65 years
- Residents of nursing home or long-term care facility
- Underlying medical conditions including chronic lung disease, moderate-severe asthma, are immunocompromised, severe obesity, diabetes, chronic kidney disease (undergoing dialysis), liver disease
Wash your hands with soap and water for at least 20 seconds after you have been to a public place; also after blowing your nose, coughing, or sneezing
Use a hand sanitizer that contains at least 60% alcohol if soap and water are not available
Don’t touch your face! This includes eyes, nose, and mouth
Cover your mouth and nose with a cloth face cover when you are around others and cover your mouth and nose when coughing and sneezing
- The CDC has recommendations for making cloth face masks, although by now, these are pretty widely available https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
- Certain types of masks can be used and are becoming more available , but they should not be the ones that healthcare professionals need, like N95 masks
Clean and disinfect the following frequently touched surfaces every day, if not more often. This should be done especially when you are traveling: tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
Don’t Go If You Have Any of These Symptoms of COVID-19
- Shortness of breath or difficulty breathing
- Muscle pain
- Sore throat
- New loss of taste or smell
These symptoms may appear 2-14 days after exposure to the virus.
The next blog post will give you advice about precautions to take while traveling, and medications and supplies you will want to bring with you on your trip. Happy, healthy, but heedful trails!