Two of Pinellas County’s top medical experts with very different jobs came together June 23 to talk about COVID-19 and the importance of learning to live with it, using social distancing and wearing facial coverings.
Dr. Angus Jameson is the county’s emergency medical director. He is responsible for all paramedics and emergency medical technicians. He also is an emergency medical physician.
Dr. Jon Thogmartin is chief medical examiner for the District Six Medical Examiner’s Office. He’s responsible for death investigations in Pinellas and Pasco counties.
Jameson sees COVID-19 patients when they start getting sick enough to go to an emergency room. Thogmartin sees them after they have died.
Jameson said with the uptick in cases, more calls were coming in to emergency medical services and hospitals were feeling the effects. He said local hospitals have been busy with a significant number of people coming in for testing. And, hospitals have more COVID-19 patients in house than at any time previous.
“From my end, we were seeing quite a few referrals for deaths from COVID,” Thogmartin said. “It flattened out with the lock down, and now we’re getting a little increase.”
He added that there is a delay between when people get sick and when they become his responsibility.
He also said 85% to 90% of the deaths thus far had come from various long-term care facilities and have been in people that make up the vulnerable population.
However, Jameson pointed out that the rise in cases in the past two weeks has been in younger people, and that has translated into an increase in cases in the hospital and intensive care units.
He said a spike in young people, who may not even know they have COVID-19, results in more danger to those who aren’t as healthy and young.
But, younger people aren’t totally without risk, since COVID-19 is dangerous for people with obesity, diabetes, hypertension, heart disease and other chronic illnesses, Thogmartin said.
“Younger people probably will get though it and hopefully, you’ll get through it intact,” he said. “Hopefully, you won’t have a stroke or lose a limb and hopefully you won’t go into renal failure. But, if you’ve got a relative that you love that has one of these co-morbidities, and you contact them, even if you’re asymptomatic, they could get sick and die.”
Jameson pointed out that the novel coronavirus is a new virus that still has a lot of unknowns. He said it has effects that aren’t understood yet, such as inflammatory disease in young children and very significant lung damage.
“It could really change your life,” he said, adding that it could mean that “a year from now, you can’t exercise or need to wear oxygen all the time.”
He said reports were coming out about neurological damage and other complications that could be long term. He said blood is more prone to clotting with COVID-19, meaning a higher risk of strokes or heart attacks. He said even if a younger person came through the illness OK, the long-term effects were unknown.
“Our community came together and did an amazing job of flattening the curve,” he said. “We all sacrificed a lot,” adding that it had looked like it was under control. “But unfortunately it has rebounded and that curve is not flat, it is the opposite of flat.”
He said all the concerns from a few months ago are back. He is really worried about hospital capacity and health care workers themselves.
He said the danger is if hospitals get overwhelmed, people may not get treated for a heart attack or stroke as quickly as they would otherwise.
Thogmartin said soon after businesses opened, the uptick began. He said people thought “COVID was fading in the past.” Others thought it was just a hoax or it was only as bad as the flu. He said he had relatives that believe it is a hoax.
“Look at the overall death rates,” he said. “There’s a giant spike in deaths. This is actually killing people.”
He had a message for those who don’t believe the deaths are related to COVID-19. He said Florida had the best medical examiner’s system in the world. He said they are as correct as a human can possibly be.
Personal protection measures
The doctors were asked what they did personally to minimize the possibility of infection.
Jameson talked about the risk healthcare workers pose to their families. He and his wife both work in the health care field and have about the same risk of exposure. He said they aren’t staying apart, but he knows plenty of colleagues that are staying away from their families because they’re worried about bringing it home.
He said when he goes out in public, is indoors or can’t be socially distanced, he wears a mask. If he’s outside with no one around him, he does not.
“If I’m going to be around other people, I’m wearing a mask,” he said. “It’s important to recognize, that a mask is not for my protection, it’s for their protection. I don’t want to be the person who transmits it to somebody else.”
Thogmartin said he started wearing a face covering when he went out in public as early as February.
“It was funny. I got some strange looks,” he said.
He said in early March one of his employees had attended a conference in Tampa and had gotten sick. He did not have COVID-19.
“But it gave us a little reality check and knowing respiratory droplets spread the virus, I had all my employees start wearing masks unless they are isolated in their own office,” he said.
Thogmartin had planned to pull his kids out of school after spring break, but “schools were wise enough to go to digital learning, which was smart,” he said.
He stressed that people can be safe in their homes with the people you live with.
“But if they don’t live with you, there needs to be either a great amount of space between you and that person, or there needs to be a material between you and that person,” he said. “You don’t know where they’ve been.”
He said it was “crazy” not to wear a mask in indoor places, including in the workplace.
“You don’t know your co-workers or where they’ve been. You don’t know if they have a 21-year-old that was recently in all those Pinellas County bars and restaurants whooping it up and may be positive and not even know it.”
Thogmartin believes the best way to stop the spread is to put space or a barrier “between every human being that does not share a residence.”
“If we do that, we’ll beat this thing,” he said.
Jameson put another spin on it.
“Take a step back and don’t think about yourself,” he said. “Think about your coworker who has a family member at home who is on chemotherapy or has another medical issue going on or lives in a home where there’s an older family member. Think about them for a second. … Wearing a mask is about protecting other people primarily and then protecting yourself. This works when everyone wears the mask.”
They also answered a question about herd immunity.
According to information about COVID-19 on Harvard University’s website, “Herd immunity occurs when enough people become immune to a disease to make its spread unlikely. As a result, the entire community is protected, even those who are not themselves immune. Herd immunity is usually achieved through vaccination, but it can also occur through natural infection.”
Jameson said to achieve herd immunity without a vaccine around 70% of the population would have to have the infection. Some online sources say the infection rate would need to be as high as 90%.
“Just letting it burn through the population is not a good strategy for a lot of different reasons,” he said.
His No. 1 reason was that people will get sick and die. The second was that the healthcare system would likely get overwhelmed and “people who need care who have nothing to do with COVID will also unnecessarily die.”
The third is that between the infection rate, which Jameson says is now in the single digits, to the point of herd immunity, “is a lot of pain and suffering.”
“That’s just not a pathway we want to go down,” he said. “So the goal is to learn to live with this safely. Keep infections as low as possible until we can come up with a vaccine — that way we can skip all that pain between here and herd immunity.”
“This is a novel virus we don’t know anything about,” he said. “It has significant morbidity and mortality. Looking at the numbers, we cannot let it burn through, because it will be a disaster. It would break us and it would take us a decade to climb out of it.”
Thogmartin said if people would social distance and wear face coverings to help re-flatten the curve and protect the hospital system until at least the end of the year or maybe into January, a vaccine might become available.
He said he had heard about three of four “really good” vaccine candidates with new technology “and they’re just amazing. They’re doing in months what usually takes years and they appear to be making great progress — although, we have to wait. The worst news possible would be none of them work. I would be happy with a vaccine that just prevented severe disease.”
Jameson agreed; however, he added that “coronavirus is notoriously difficult to get a vaccine for. We tried with SERS and MARS, both coronaviruses, and were not successful. But maybe this time, with all the resources focused on it, we will be successful.”
Meanwhile, Jameson said, “We need to act as if that’s not around the corner.”
He said even if there was a vaccine that works by the end of the year, it will take time to get enough of the population immunized to create herd immunity.
“It’s still going to be months,” he said. “So we need to be smart about what happens between now and then.”
Neither doctor believes a lockdown is a viable solution. They say some things are essential to keep a functioning society.
Thogmartin said some businesses are riskier than others, including restaurants and bars. He said they needed to modify how they work “otherwise they’re going to be the epicenter of super spreader events.”
He said any business that has a product of food or drink needs to modify how they operate. He believes the steep rise in cases is due to those businesses. He pointed out that even their workers were getting sick.
“They’re going to have to up their game while they’re serving customers,” he said.
He said he was talking to a friend about the loud music, which is typical in a bar, and how people have to get in each other’s faces and shout, just to be heard.
Thogmartin also brought up singing in churches, which he said is high risk, as is exercising in a gym or any other activity during which people take a deep breath and then expel it.
He said all those activities need to be modified until there is a vaccine and the disease is no longer a problem.
Social distancing and wearing facial coverings are two ways that work to reduce transmission, both doctors said.
Jameson talked about a publication in The Lancet, which he said is a well-respected medical journal. He said the journal took the best evidence they could find from 172 studies from across the 16 countries covering six continents and found that distancing and masks are both effective ways to reduce the risk of transmission.
He admitted that different kinds of masks perform differently. He offered advice on how to make a mask work as well as possible.
First, don’t wear it on your chin. Wear it right over your mouth and your nose all the time. A mask over your mouth while your nose is out is not effective, he said. And, you should also social distance when wearing a facial covering to better reduce the risk of transmission.
He said N95 masks, which are used in health care settings, are really respirators. They require the wearer to be “fit tested” to ensure they have a good seal. He said for that reason, they weren’t good for the public to use unless they can get a test to make sure it fits properly.
He said based on all the evidence available, surgical masks, also known as procedure masks, and cloth masks all provide some benefit.
Flattening the curve
The doctors were asked why measures were needed now, since the curve had already been flattened.
“If you asked me that three weeks ago, I would have agreed,” Jameson said. “But the curve is not flat. It is growing exponentially. It is the opposite of flat. There are more people hospitalized and in the ICU than at any other point with COVID-19 and that’s going up very fast.”
Jameson added that local hospitals were saying that if something doesn’t change in the next couple of weeks, they’re going to be very strained. He said health care workers had been “working nonstop, around the clock for months now, not only taking care of individual patients but also making sure we as a community are as prepared as we can be for this.”
He said for a few weeks, he was optimistic. The community had done a good job flattening the curve. The hospitals were prepared and had plans for when the surge arrived.
“And we were kind of sitting going OK, we’re ready, where is it,” he said.
From his colleagues in New York, he had heard what to expect, which was a couple of weeks of increases in mild disease, then “somewhere around week three or four, it’s going to hit you like a wall with the people with severe disease.”
“And we were all sort of waiting for that to happen, and it never happened all through April and May,” he said.
Health care workers kept asking when is it going to get here, and everyone thought that the community had done a great job — and we did, he said. People began to think it was all over.
“Now, here it comes,” he said.
Three weeks ago, elevated activity was detected and even more two weeks ago, and health care workers began to get worried, Jameson said.
“A week ago, it was uh oh, this is not looking good,” he said, adding that the daily case counts have doubled every five-seven days over the last three weeks.
“Now, we’re seeing the next lagging indicator and that is hospitalizations and ICUs in use is increasing significantly this week, and I am really scared that Dr. Thogmartin’s work is going to get busy in another week or two.”
Testing and more cases
The doctors were asked about the relationship between testing and more cases.
Jameson said regardless of the number tested, the issue was the percent of those tests coming back as positive. He said before when it was hard to get tested, only 1-2% of tests were positive, and now that it is easier to get tested, the positivity rates were as high as 10-15%. He said some testing sites were reporting positivity rates of 20% or more.
“I think, you know, that some mistakes were made amongst our fellow citizens with their personal choices right around Memorial Day,” Thogmartin said. “I think we need to remember that it’s not gone away and it’s not fake. You can ignore reality but you can’t ignore the consequences of ignoring reality, right?”
Suzette Porter is TBN’s Pinellas County editor. She can be reached at email@example.com.