COVID 19 5-29-20

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The data in Arizona continues to show a high number of cases weekly. As I have mentioned in past messages, I average the number of new cases over 7 days to get a better idea of where the trend is. Today’s numbers show 702 new cases, which is the highest number thus far. However, that does not mean the number of cases is going up as the reporting of new cases to the state health department lags by a few days. We are still averaging over 300 new cases a day though, which to me is double the number I want to see. Unfortunately, the number of deaths reported daily has remains in the 20’s.

What this means is that the virus is still present in the community at approximately the same level as it has been for the past month. Even though recommendations to stay at home have relaxed, there is still significant spread of the virus.

It is estimated that up to one third of Covid 19 carriers are asymptomatic, which makes prevention so tricky. A lot of what we do in prevention is about probability, and our recommendations are designed to lower the probability of getting an infection. For instance, wearing a mask helps reduce the risk by decreasing droplets in the air, yet it is only effective if everyone wears a mask. Likewise, when the average daily number of new cases drops below 150, the chance of getting an infection will be lower since there will be fewer carriers.

Another key variable is air space and air circulation in a room. For instance, if you are in a standard size room, say 9 by 12 feet and there are 2 or more people in the room without masks, then there is a good chance any droplets or aerosolized particles will remain in the airspace of the room for an extended period of time, thereby increasing the risk of infection. Unfortunately, air conditioning or fans may just circulate or spread those particles more, which would not be desirable.

Proximity to others is also a risk. Staying at least 6 feet apart (and maybe even further) will help reduce exposure. Certain activities such as haircuts and nail salons and massages can not maintain this distance, and therefore represent a higher risk of exposure. Likewise, eating in a restaurant (or even walking into a restaurant where a lot of people are eating) also presents a higher risk, since the people dining in will obviously not be able to be masked. That is why I continue to recommend not doing those activities at this time.

Finally, when Covid19 was first being discussed 3 months ago, there was concern that certain blood pressure medications such as ACE inhibitors (Lisinopril and Monopril for example) and ARBS (Losartan, Valsartan and Olmesartan for example) increased the risk of having a severe case of COVID19. Subsequent research has shown this not to be the case, with ACE inhibitors possibly even being protective against a more serious infection. In addition, data is suggesting that cholesterol meds such as Lipitor and Crestor (the statins) are also potentially protective against a more serious infection. These drugs appear to reduce the inflammatory reaction that occurs with COVID 19. This data is not conclusive, yet it is very interesting. I will speak more about this in my next message. Take care.