The Dance Floor

As we discussed in my previous blog, West Virginia is moving from the hammer to the dance (in Tomas Pueyo lingo). In other words, we have moved from staying at home and suppressing person-to-person spread of the virus, to opening the state, and learning to live with the coronavirus.

To date, we have done extremely well flattening the curve of COVID-19 in West Virginia. By these actions, we have saved lives, protected our healthcare assets and achieved some of the best metrics in the United States. We have reduced our R0 (R naught) or reproductive index to below 1 for the past few weeks. In addition, our rate of positive tests to around 2%, which is amazing given our neighboring states, which are four to 20 times higher and have less than 100 total deaths from coronavirus to date.

Now the tricky part, which we call "The Comeback."

We are starting the dance with COVID-19 - where we learn to move in harmony with the virus, versus shelter to protect against rapid spread, as we reopen West Virginia.

As we test more, we'll begin to see more cases. As we resume more normal activities and open back up, we'll see more cases. But as we shift from acting statewide to a more localized operation, we'll be able to act more precisely to stop outbreaks or resurgences. That is the dance. Moving forward. Moving backward. And, if the situation gets worse, we'll leave the dance floor altogether.

So how do we restart safely and position ourselves to balance the need to restart our economy and keep us safe?

If we look at other countries that have reopened, there is cause for caution.

Singapore, a country that did amazingly well when COVID-19 first challenged Asia, opened back up and had an outbreak. This was caused by workers entering Singapore from other countries. 

Hong Kong also did well in the initial phase of COVID-19. As they reopened their borders, they received many of their citizens that were stuck outside of the country during the initial outbreak. The country also opened itself up to European visitors, and again, suffered outbreaks.

So how do we keep from having these setbacks and protect our population? As a reminder, Kaiser Family Foundation identified West Virginia as the most vulnerable population. A large outbreak in West Virginia could cost many lives and force us off the dance floor.

We also know that states opening early have a mixed set of experiences. Texas suffered the highest single-day number of COVID-19 cases last Saturday. Georgia is redoing its data reporting to more accurately indicate COVID-19 spread.

Let's look at other places that did not close their economies during the early stages of the pandemic and let's see what worked and what did not.

Let’s look at Sweden and Japan.

Sweden's lead state epidemiologist, Anders Tegnell came up with the approach of leaving Sweden open for business, counting on them to maintain social distancing and protect the elderly in nursing homes. Others have labeled this approach as one that gains herd immunity.

Remember, herd immunity is population protection against infectious disease that requires a large component of that population to become infected and develop an immune response against the infection. Depending on how infectious the spread of the agent (R0) is, it takes between 60 to 80% of the population to have immune responsiveness to stop the viral spread.

Swedes are generally healthy and their healthcare enterprise is very good. They were encouraged to be personally responsible for their well being, given general guidelines to stay distanced. They did not wear masks or face coverings around each other. They focused on protecting the elderly in nursing homes but did not have other specific interventions to start.

Their results?

Sweden has the highest per capita death rate in Europe and, today, the rate is greater than the United States. A majority of those deaths are in the elderly (the group they committed to protect.) This is a key finding. Without intervening in some way, it is difficult to protect a vulnerable population from COVID-19, which is omnipresent.

This is a pandemic.

As their numbers got worse, they limited large scale events. They did encourage mask-wearing or face covering.

Sweden has approximately 10 million people and 3,800 deaths for a rate of 38 per 100,000 population.

US has approximately 328 million people and 94,000 deaths or rate of 28.5 per 100,000 population.

How about Japan?

Japan has a population of 126.5 million, and 784 deaths, or a rate of 0.61 per 100,000 population. They never stopped their economy. Their children are still in school. And they protected their citizen’s health.

They are dancing well with COVID-19.

What is their secret and how did they accomplish this?

The major weapon that Japan has unleashed against COVID-19 is the countrywide mask-wearing. And, by wearing masks, the population-adjusted risk of a person dying of COVID-19 in Japan is 2% of that in the US. Wow!

This insight is key in helping us understand how we can dance safely and most effectively with COVID-19 as we reopen West Virginia.

Maintain what we have learned:

• Keep physical distancing at 6 feet between yourself and others.
• Wash your hands regularly with soap and water for 20 seconds, especially if you touch public-facing surfaces (remember to sing Country Roads!)
• Avoid touching your mouth, nose or eyes.
• Cover coughs and sneezes.
• Stay home if you can.

But, it appears we have another secret weapon to deploy -- masks and face coverings.

A new study coming out shows that if 80% of us wear masks and face coverings and maintain our safe distancing, we will more safely coexist with COVID-19 in West Virginia until we can get more effective therapeutics and a vaccine. We will protect ourselves and our most vulnerable. We will protect our healthcare resources. We will continue to keep the curve flattened.

Remember, the mask is meant to keep the person who is infected safe - the person who doesn’t know or realize he or she is infecting others. A recent study shows that normal talking can distribute droplets that stay airborne for up to 14 minutes without a mask. A single super-spreader at a choir practice in Washington state infected 52 people of a 60 member choir from aerosolizing COVID-19 droplets.

Masks reduce droplet aerosolization amount, distribution and length of time airborne. And, the mask doesn’t have to be medical grade, two-layered masks made of T-shirts, bandanas and dishcloths all work.

Remember, the mask is not to protect the uninfected. It is meant to reduce droplet spread from the presymptomatic person with COVID-19, which occurs 0.5 to 2.5 days before any symptoms may show. Masks also reduce spread to surfaces where infected people introduce the virus from these droplets.

That is why it is so important for all of us to wear masks.

These are our new weapon against COVID-19. They are our newfound power and will help us dance successfully until we find a vaccine or drug regimen.

Let’s continue to lead in this pandemic response and show others what #WVStrong means.

What does leadership in COVID-19 response mean to West Virginia?

Lives saved.

Freedoms regained.

Safety to come together.

A beacon for others.

A bright future for the state.

Wearing your mask or face covering.

Building the future we deserve.

Together.

Almost Heaven.