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Reopening From COVID-19 Safely

Published in Family Medicine, For the Health of It Author: George Morris,MD

Dr. George Morris, vice president of performance excellence and physician lead of the CentraCare COVID-19 Incident Command, recently was interviewed by Jay Caldwell of WJON to discuss the current status of the pandemic.

Among the topics discussed include where are we seeing the new COVID-19 cases, why it’s important to wear masks and if the local reopening can take place without it resulting in spread of the illness.

Some content has been edited for length and clarity. You can listen to the full interview here.

Q: We’re starting to see more confirmed COVID-19 in surrounding counties. Are those cases turning into more hospitalizations at CentraCare?

Dr. Morris: So far, this increase we are seeing lately is all in the outpatient setting. We are still low on our inpatient cases. So, the most seriously ill patients are being protected and are staying safe. We still have patients in the hospital. We still know our vulnerable elderly and people with chronic diseases are getting sick. But right now, it really seems like the younger groups that are getting the positive cases.

We are seeing many people with symptoms that are COVID-related. We know that there are asymptomatic positive cases, there are pre-symptomatic people (meaning they haven’t developed COVID yet) and the ones with symptoms. That ranges from cough, headache, fever, even some GI symptoms. There’s lot of different ways this shows up. Many of the people we are testing are having symptoms. Our concern is that this is another group of people that now can spread it widely throughout the community or into those vulnerable populations.

Q: Is fair to say that we are seeing a surge in 20- to 30-year-olds getting COVID-19 in Minnesota?

Dr. Morris: I think we are. Some of these waves and peaks are relative in size. We were, as a state, seeing 800 or 900 positive cases a day. Our lowest was in the 200 range. We are still having a surge. We are in the 300 to 400 range of new cases per day; however, it’s not zero. We were really hoping when we powered down slowly, it would lead us to a count of zero.

Q: When do you suggest that people wear masks? And why are they important to wear?

Dr. Morris: Masks are very important to wear when you are in an enclosed setting — inside a public building — especially if you are going to be there and there may be prolonged contact. Some examples include churches, bars, restaurants, family events, etc.

They are also helpful if you are going to be in an outdoor space where you can’t maintain that six-foot distance from others. And especially if you will be doing things for a prolonged period of time in a group.

We had discussed protests and the memorials for George Floyd where people were outside in large numbers, but many people wore their masks outside to minimize the spread. I think that’s a good way to view this.

The times when a mask is not necessary is if you are in your own home, with your own family members and everybody is healthy. If you have a positive case in your house, then you should think about how to keep that person separate.

If you are doing small gatherings, such as a walk, hike, an outdoor activity where you know the people you will be in contact with — then the masks are less important. That’s why golf is a safe activity. Biking, walking, running — those things are safe.

Q: People wear masks for the protection of those around them, correct?

Dr. Morris: Yes, that’s where it really has the most benefit. And there is some recent research suggesting that it can protect you.

N95 masks worn in the hospital setting filters out 95 percent of possible contaminants. Other traditional masks, such as a hospital-grade mask or a cloth mask might give 40-60 percent projection. No mask gives you zero.

Even wearing a cloth face covering or a bandana protects you from what others are breathing out. But remember, the best protection is six feet apart and both people wearing a mask.

Q: Lots of states are seeing surges. In some states — like Arizona, Florida and Texas — it’s becoming serious. What did they do there that led to this? What have they done that we in Minnesota can learn from?

Dr. Morris: That’s a good question. As we open up, we run the risk if our numbers spike or peak again, we could be closed down again. If we can open up safely, that’s where we can keep on the current path of increased activity and interactions.

What other states and regions are seeing is as they opened up, they did so while having lots of gatherings, minimal mask wearing and little social distancing. There was lots of a high demand and desire to get out and see people. Well that led to these outbreaks. Then one becomes two, then four, then 16 and 64 and it spreads like wildfire very quickly.

That’s a big risk. I could anticipate our state having to dial it back, unless we take these measures to heart. Wearing a mask when we are out. Stay home if you are sick. Use good hygiene. And maintain social distancing and staying in small groups. We are still in a risky situation now that I want us all to be very careful about.

Q: Can we keep bars and restaurants open and do some sporting events? Can the reopening still exist without a spread of the virus?

Dr. Morris: I believe we can have the hope that we can keep opening — if we do it in safe ways.

At bars and restaurants, do the outdoor seating. I understand many have gone to indoor seating. The challenge is to wear your mask when you do everything but eating. And expect the people working there keep their masks on the whole time. That should be a normal expectation.

The people and tables should be at least six feet apart. That should help us keep the bars and restaurants open. Inside a bar it may be harder to do this — and that’s going to increase the risk.

The sports events can continue to progress understanding that there may be exposures. To minimize that — it’s sad, but — no high fives, no hugs, no chest bumps, no spitting. Don’t share golf clubs or baseball bats. Think of what you can do to minimize exposures to others. That will allow us to continue this reopening in as safe a way as possible.

Q: When will it be safe for people who are older or at high-risk, when can they get outside and do things? How can they live and do it safely?

Dr. Morris: I think there will always be a little bit of a worry. Even in younger populations, we’ve had people really sick and on ventilators. There isn’t a zero risk, even for younger people.

For older people who do have chronic conditions, the way to decrease that risk is to stay outside, do curbside pickup for shopping, go for a walk, sit outside, maintain your distance, wear your mask and expect others to wear theirs. That’s the way to slowly ease our way into this.

We’ve even started to have outdoor visits at our nursing homes and skilled nursing facilities. We know that social interactions are important. We are just setting it up with rules, so we can do it as safe as possible — understanding that nothing is 100 percent.