Thomas S. Bottiglieri, D.O.

No communication at this time can go without mention of the current national crises. While we have been focused on re-opening and getting back to normalcy a different kind of plague reared its ugly head – that of racism & police brutality.  To stay within my lane I will simply say that if our nation is ever to heal from past, current & future evils, whether they be the disease caused by coronavirus or be it the broken ideology and misuse of a badge and uniform to murder a citizen, we must find a way to look deeply within ourselves and open our hearts to trusted and venerable leadership. We must tune out of the vicious cycle of opinions and noise that drive the insanity.  Of course, this is my opinion. I hope that my use of this platform to share my concern regarding the ability of us all to be critical thinkers and compassionate citizens is empowering and within the level of trust you grant me in allowing these communications to you. My deepest sympathies to the family of George Floyd. May his death not be in vain as we put compassion and humanity at the forefront of our minds. Change is possible.

As states throughout the United States begin to lift stay-at-home orders, re-open businesses, and relax social distancing measures, the question remains – are the numbers really decreasing? At this time, even though the greater New York City area has long been listed as a hotspot, the numbers in this area continue to decrease. However, in some parts of the country, the numbers seem to be reflecting less methodical and abrupt openings.

Early on we were told to “flatten the curve.” Social distancing and the stay-at-home polices did slow the spread. Our capacity for treatment was not overtaken, which very likely saved many thousands of lives. A patient who tests positive for COVID-19 today, has a better chance of surviving today than they did 3 months ago as our treatment algorithms improve.  However, we must also keep in mind that the deaths may persist for months beyond our peak, as we are seeing in both China and Italy.

It is postulated that 65 to 70%, 2 out of every 3 people, will need to have had the virus before heard immunity is achieved. For reference, in New York City, one of the hardest hit areas of the country, those with antibodies sits at approximately 25%.  There are some mathematical models that suggest we are closer to the end of this viral pandemic, with only 10-20% population exposure needed for herd immunity, but without solid evidence of that reassurance, the best way to insure that we minimize the risk of a second wave is to proceed cautiously and with appropriate SCREENING, CASE RECOGNITION, & TRACING game plans.

On his 100th birthday, in the hospital, my patient said to me, “every day above ground is a good day.“ As doctors we recognize the limitations in all strategies as ultimately fate has it that nature wins – every time.  But we push back against the fray in hopes to improve quality of life and to extend that life for as long as possible. By taking appropriate action we are slowing the virus down and solidifying treatment strategies so that we can give as many people a chance to avoid infection or overcome its deleterious impact if infection occurs. As we reopen, we must remain aware of the potential for rapid changes in strategy, and avoid cavalier actions that can unwittingly give this virus a second wind.

For those interested in learning more or receiving certification in contact tracing:

Many organizations including public health departments and universities are offering contact tracing courses, some following the CDC recommendations and some generated from internal content. Johns Hopkins and Bloomberg Philanthropies have created a set of courses designed for the prospective state-hired contact tracers; however, have made it available to the general public as well. The course is free and estimated to take approximately 6 hours.

The five modules include content on:

1. Basic COVID-19 information including symptoms how the virus is transmitted;
2. Fundamentals of contact tracing, including how to define a case, identify contacts, and calculate isolation;
3. Steps involved in investigating a case and tracing contacts;
4. Ethic of contact tracing, including balance privacy and public health considerations;
5. Sills for effective communication in the process, including being an ‘active listener’ and how to deal with common challenges that may arise.
   

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   by: Andrea Happli, ATC, O-PA & Thomas Bottiglieri, DO