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COVID-19: Community Q&A with two former CDC Epidemiologists working in NYC's Emergency Departments

On March 11, we decided to take precautionary measures to postpone all upcoming events hosted at Lightning Society. Our decision was not made lightly; it was in response to the guidance of social distancing from the CDC and conversations with several doctor friends who are actively working on the outbreak. On March 12, Lighting Society founder, Timothy Phillips, hosted a Live Stream with Dr. Saleena Subaiya and Dr. Rupa Narra to answer our community's questions on the pandemic.




Saleena Subaiya, MD MSc is an epidemiologist and physician based in New York City. She has two decades of research experience including behavioral work, disaster medicine, vaccines, and outbreak management. She received a minor in research at the University of Maryland, a Masters in Science at the London School of Hygiene and Tropical Medicine, and completed the Epidemic Intelligence Fellowship (EIS) at the Centers for Disease Control and Prevention. She has worked as an epidemiologist during Hurricane Sandy in New York City, cholera in Haiti during Hurricane Matthew, and measles in Kenya during their largest vaccination campaign to date. She is currently employed as an emergency department physician at an academic center in NYC. She is passionate about wellness, emergency response, epidemiology, and service to her community and city. In addition to her work as a physician and researcher, her husband and her run a Kombucha company (BKE) that services 70 stores, and holds wellness and mindfulness events in Bushwick, NY.




Our goal in this Q&A was not to provide specific medical advice but to talk about responsibility and what that means within an intentional community-- a group of people who are committed to contributing to each other's lives.


Ultimately there is a lot we don’t know, but this is the time to support each other and make wise decisions that we’ll be grateful for in the long-term.



Please read the Disclaimer at the end of this post.




TAKEAWAYS:

  • Be considerate of high-risk individuals when you decide to gather. If you live with someone who may be at risk, keep in mind that you may be bringing the disease home with you.

  • Practice hygiene. Regularly wash and wipe down surfaces. Have hand sanitizer on hand. Hand sanitizer should be 60% minimum alcohol.

  • This is an emergency and things are going to be unclear and hard and this is just how they evolve. We can’t predict anything more.



Q: What is the Corona Virus and why is it a pandemic?

A group of viruses predominantly found in bats. There are a few hundred species. They cause a range of symptoms in humans, from a mild cold to more severe outbreaks, like Mers and Sars, and now COVID-19. The main method of spread is from human to human.


An Epidemic is a disease that occurs in a certain circumscribed area that you get more cases than you expect for the normal seasonality (Ebola, measles, cholera).


A Pandemic is an epidemic that occurs in multiple countries possibly worldwide (novel strains of viruses, such as the flu).


Q: Why is this concerning?

Because it's a new disease in a community without immunity (humans!), the disease will spread and it's hard to anticipate what is coming.


Up to date information on the scope can be found on the CDC’s website.


Q: How are the Emergency Departments that you work with responding?

  • We are ramping up their ability to service the public, while still providing everyday care to patients as usual.

  • Some ER areas have been turned into isolation areas (masked and contained).

  • We are hiring more doctors for virtual urgent care (visits without leaving home).

  • We have banned all (nonessential) gatherings of 25+ people.


[Here at Lightning Society, we canceled all events over the next 2 weeks. We were also days away from announcing our biggest event ever. It’s not an easy decision to say we’re not going to gather, but it’s better to be responsible now and hope that we will be able to meet in a relatively short time on the other side. When there is this much confusion, it’s better to be wise than optimistic.]


Q: If we have a small gathering (100 people) and no one is symptomatic, is that ok? And am I a vehicle of the virus if I go from point A to B?

You can be asymptomatic and still test positive with the disease. With that information, all gatherings of 500+ people in NY have been banned.


On a small scale, it’s an individual's choice. Keep in mind that there are high-risk populations, such as people who are 70+ and with chronic medical conditions. Be hypervigilant about what you plan to do.


When you decide to go to an event, ask yourself-- do you live with a high-risk individual who will be in danger if you bring the disease home?


Q: If you are asymptomatic, can you still spread the disease?

We are not sure yet. Which is why we need to be careful about the messaging.


There are some instances of “shedding”- you can infect other people even if you don’t show symptoms. We know that the main method of spreading has been close person to person contact (within 6 feet).


Some people who test positive can develop symptoms 2-8 days later but some asymptomatic people may never show symptoms.


If you have been in contact with someone who has tested positive for the disease, the recommended quarantine is 14 days. Meaning you can develop symptoms UP TO 14 days since exposure.


Q: Is laughing a method of spread?

No, spreading mostly happens by coughing and touching infected surfaces.


Q: What do I do if I get sick?

Firstly, what are you sick with? The majority of people infected with Covid-19 have a fever and most have fatigue. Many have a cough and body aches. Asess how sick you are. In young people, it’s usually mild.


Isolate (different than Quarantine). This includes:

  • Make sure your distance from people is 6 feet.

  • Disinfect surfaces constantly and don’t use the same towels or linens.

  • Don’t share blankets or cups.

  • Pets can also be risky as germ carriers


If your symptoms get worse and last more than five days, seek medical help.


If your fever persists (100.4+) or if you feel like you’re developing a fever (very cold, drenched in sweat) and you start to have shortness of breath, feel dehydrated, lightheaded, not able to eat or drink, or confused, call your doctor and describe your symptoms.


If you need to go to a doctor or ER, wear a mask and do not use public transport. If you need to call 911, describe your symptoms so that they are prepared.


Q: What is the difference between Covid-19 and the flu?

They have similar symptoms of fever, cough, body aches. And the care is similar-- stay hydrated, take medicines to reduce the fever, rest, etc.


But we know the flu, we have a vaccine for it, we know the dangers of it and how to treat it. We know that it’s predictable and that it’s not heat stable (doesn’t occur often in hot weather).


Compared to the flu, Covid-19 spares the younger population. We don’t know if it is heat stable. But we know how it transmits. Treat it with supportive care similar to the flu.

Call your doctor or the ER if you have:

  • Fever for 5 days

  • Shortness of breath

  • Dehydration

  • Feelings of confusion

You know your body. If you are getting sick and can’t take care of yourself at home, seek medical care.


Q: I have been sick for several days and self-quarantining, have had mild symptoms and are starting to feel better, how long do I isolate myself for?


They still don’t know how long people will be shedding after they’re sick. If you have the above symptoms, isolate at home for 24-48 hours after your fever has ended. If your symptoms have not abated, stay isolated.


Treat it like the flu. If you’re feeling profoundly ill, make arrangments to seek real help


Q: After I recover, can I be immune? Can I help others who fall ill or will I get sick again?

We don’t know yet because we need time to check the data. If you present again with new symptoms after you were ill, treat it the same. Vigilant caution.


Q: People are sick around me, what advice do I give them?

If you’ve been exposed to someone who has tested positive, quarantine for 14 days.


This is a community of friends and family. There’s a lot of stigma, panic, and denial. It’s our responsibility as friends and family to be supportive and repeat these same messages. People are scared. Repeating these messages is important.


Just because someone coughs on the subway, it does not count as exposure. Don’t panic.

We are quarantining ourselves for social responsibility, to protect the more vulnerable in our community. Think about our city, country, world. If we do these things and we do everything properly, we’ll be able to do our part to stop this.


Q: Are there any surfaces the virus survives on in particular?

Towels, bedding, dishes, countertops, hands, clothing. Wherever droplets of particles can go are likely to be infected. Regularly washing and wiping down surfaces is the best mode of caution.


Q: What is proper mask usage?

You don't need to wear a mask out in the public regularly, only if you’re not feeling well and don’t want to spread.


There is no evidence that wearing a mask limits the spread of Covid-19. People who are wearing masks and they don’t have symptoms can cause a shortage for those who need it. You can also oversaturate the mask, then touch it and spread the germs.


Q: When will there be Covid-19 testing?

Good news! Testing is going to expand. They are close to launching an in-patient test and are currently training people and making sure the labs are FDA compliant.


The wait for testing is frustrating, but the recommendations will still be the same whether you test positive or not: isolate and quarantine for 14 days.


Tests are not the answer to a lot of things, but it's an important aspect. Be patient above all else. It’s coming.


Q: My friend is pregnant/ my parents are elderly/ my friend has an immunity disorder, should they be going somewhere with less danger of exposure?

Don’t take vulnerable people away from the healthcare that supports them. Make sure they have the resources they need, including their prescriptions and emergency numbers.


Q: Should I still travel?

How important is the trip you’re taking? Some countries are rated different levels and you may be quarantined. Know which countries will put you at risk.


Vigilance in personal health and hygiene, social distancing: it sounds simple, but these are the measures that work. The small things ARE important.


Procedures that worked for Ebola are being put into place now. When they started doing social distancing and personal hygiene, the epidemic curve began to fall.


Q: What happens when the healthcare system gets overwhelmed and why is it important to slow the spread of the disease?

The healthcare system is still doing business as usual. They’re preparing as much as they can, but there will be deficiencies. They have to balance doing their regular work as well as being prepared for this.


This is an evolving situation minute by minute. We don’t know what is going to happen.


Q: What are the best places to look for the most current and reasonable updates?

NYC Department of health

The CDC website

Good information about cleaning materials and guidelines-- a lot of practical information.


Q: How can we best support our mental health during this time?

It is normal to feel anxious and scared. We have to be there for each other. In the long game, it's important to take care of your mental health and stay on top of what's happening from a reliable and trusted news source.


Ask yourself:

  • How can we support each other within this community?

  • How can we support each other virtually?


There is no single more unifying issue the world is facing right now. The restrictions and vigilance that we put in place now are proven measures that have WORKED and are going to help us get to the end sooner.


We’re really tough, we’re fighters, we love this community and we love this city. This doesn’t seem like such a big of an ask. And we have a lot of fun the rest of the time and there will be more fun!



Disclaimer:


Lightning Society, Timothy Phillips, Saleena Subaiya, and Rupa Narra are presenting this discussion for informational purposes only. Some of the participants have medical expertise but this discussion should not be considered a substitute for consulting with your physician.

Always seek the advice of your physician or other qualified health provider with questions you have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard here or read through Lightning Society communications.


If you think you may have a medical emergency, consult your doctor immediately. We do not recommend or endorse any specific tests, physicians, products, procedures or opinions and reliance on any such information is solely at your own risk.


As a community, Lightning Society always encourages individuals to share and collaborate. However, Lighting Society makes no guarantees as to the accuracy of information shared by the participants in this discussion. We ask that individuals consider and vet any media, content or information shared here. Further, please ensure that anything you transmit does not violate trademark, copyright, privacy, or any other rights of any other person.


You are solely responsible for your own communications, the consequences of posting those communications, and your reliance on any communications.


Thank you all for time and participation during this difficult time. If we adhere to our supportive and collaborative community values we can emerge from these difficult times stronger than ever.

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