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COVID-19 Pandemic: Lessons for All of Us

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As all of us continue to follow the progress of our fight against COVID-19 in America and the world, there is no doubt that statistical data takes center stage in the reporting and understanding of the pandemic. For some help in understanding this information, we turned to Dr. Allan Feingold. He is a pulmonary specialist and medical director of Occupational & Environmental Medicine at South Miami Hospital, which is part of Baptist Health South Florida. Dr. Feingold and his team have been actively tracking daily information on the COVID-19 pandemic. He recently shared his perspective and data during the third “Back to Boca” Grande Rounds webinar, hosted by the Boca Grande Health Clinic, Boca Grande Health Center Foundation and Health Network Foundation on Oct. 21. This webinar is archived and can be viewed at https://vimeo.com/472401784/4bfdc756d2.

What does the COVID-19 positivity test rate tell us? The positive test rate is of interest and gives us an overview of the presence of the virus in our population. On an individual basis, a positive test helps in the clinical management of the patient and in appropriate epidemiologic/quarantine planning and contact tracing.

What data matters most? The hospitalization rate and death rate are powerful indicators of severity of disease. These numbers are not greatly influenced by the number of tests given.

Determine your person risk level if your develop COVID-19 (graph updated Oct 20, 2020) - Risk category: Very high includes age 75 or older or: BMI 35 or greater, diabetes, kidney disease, hsitory of kidney transplant, chronic congestive heart failure, chronic obstructive pulmonary disease (COPD, emphysema), autoimmune disease, malignancy on chemotherapy, immunodeficiency; Risk category: High includes age 65-64 or: moderately severe obesity BMI 30 or greater to less than 35, hypertension; Risk category: Moderate includes age 55-64 or: regular cigarette smoking; Risk category: Low includes age 25-54 and generally preserved health; Risk Category: Very Low includes age 25 or younger

What is the timing sequence of these data points? In the general population, a spike in positive test rate is often followed in two to four weeks by an increase in hospitalizations, which is followed in three to six weeks by an increase in mortality.

How does age factor into patient risk? Only .82 percent of Florida COVID-19 deaths have occurred in patients less than 34 years old. If you are in the 75-84 age range and require hospitalization, your mortality rate is 50 percent. If you are over 85 years old, your mortality rate is 80 percent. There are other health and behavioral factors to be considered.  

What is our best strategy now? Safe and effective vaccines are on the way. There are valid reports in the peer-reviewed medical literature that at least four vaccines are in the final phases of testing. These vaccines are being developed by Moderna, AstraZeneca, Pfizer and others in the United States and abroad. Until these vaccines have been approved by our FDA and are widely distributed, our best efforts to prevent viral spread lies in our own hands. We should use the proven behavior modifications of appropriate mask wearing, social distancing and frequent hand washing in addition to staying home if we are ill.

There are several important facts about future vaccines which are as yet unknown. We do not know how effective they will be in imparting immunity and how long the immunity will last. Importantly, we do not know how widely vaccination will be accepted by our general population. For these reasons, we are likely to be practicing the current U.S. Centers for Disease & Prevention recommended virus control measures for some time. We are all in this together and this guideline practice should allow for meaningful and productive reopening of our society. “Back to Boca” is a four-part free webinar series to provide sound facts about COVID-19, including recommendations for safe travel and safe living on island this season. Recordings of all webinars in the series can be found at https://bghcfoundation.com/webinar-series/.

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