Once a month, The University of Nebraska Medical Center holds an event called a 'Science Cafe' - where doctors from Nebraska Medicine talk about scientific advances in the community. These events were normally held in the afternoon at The Slowdown, but in the wake of the COVID-19 pandemic, these cafes have been broadcast virtually.
This month's Science Cafe covered the COVID-19 pandemic, with UNMC Doctors Dr. Kelly Cawcutt, Associate Medical Director of Infection Control and Epidemiology, and Dr. Mark Rupp, Chief of the Division of Infection Diseases.
UNMC cosponsored this event with the Nebraska Coalition for Lifesaving cures. Social Distancing and Mask wearing were strictly enforced.
Their first topic of conversation was how the number of COVID cases and deaths have escalated since the pandemic began last Spring. Dr. Rupp began, "we started seeing some initial reports coming out of South Central China - and the Coronavirus has since exploded around the world with over 30 million cases and a million deaths. We have seen a quarter million deaths in the United States."
"You look at the number of deaths in the country, and we're coming up to a number close to the world wars. We haven't seen this mass death in decades. We are nowhere near the end yet. We don't have control (of cases), and we haven't flattened the curve. Its really been a challenge to get the curves to come down," said Dr. Cawcutt.
Both doctors say the re-opening was too lax, which has led to a resurgence in cases.
They reviewed what all we know about how the Coronavirus is spread and how to restrain the virus. Mask wearing, hand washing and social distancing were the chief recommendations. "We know how this virus is spread, we know this is a respiratory virus spread from person to person in close quarters. There is some evidence for airborne spread, but we know for sure that the virus is spread through droplets and close contact," said Dr. Rupp.
"Six feet is great, eight feet or ten feet or twelve is even better," Dr. Rupp said on social distancing.
"The spread is in the community," said Dr. Cawcutt. "We know the masks protect everyone, we know that large gatherings spreads the virus. Social distancing becomes a difficult task when we go to bars and restaurants."
They criticized the politicization with regard to wearing a mask. "We know that masks work," Dr. Cawcutt said. "We have good data, we know that the masks protect everyone. We know when everyone gathers in a bar and is watching a football game, that projection of droplets and aerosol increases when you're yelling and screaming."
"There are many reasons you should wear a mask, it provides filtration, it protects you, it protects the people around you by guarding your respiratory secretions, its a strong visual clue that we're in the middle of a pandemic," Dr. Rupp added. "The fact that this has become politicized and been framed as an encroachment on personal freedoms is really disappointing."
Dr. Cawcutt agreed, "the politics involved with mask wearing have put a negative light on something that's aimed to decrease the load on the hospitals, the number of people who are getting sick and the number of people who are dying, which is not a small number." Dr. Cawcutt criticized people who have not avoided large gatherings.
Staff from Nebraska Medicine put out an open letter that urges people in the Omaha metro to more adamantly follow the mask guidelines, adding that UNMC has 10 units filled with COVID-19 patients.
Both Dr. Rupp and Cawcutt preach caution when planning for Thanksgiving and Christmas and even cancelling if the risks are too great. "The worry is getting together and someone (extended family) doesn't think they're sick," said Dr. Cawcutt.
"The ripple effect is a concern." Dr. Cawcutt is referring to an instance when someone going to a gathering believes they are well, but is carrying the virus. This person then passes the virus on to their friends and family.
Dr. Rupp recommends increased ventilation for any holiday gatherings, having smaller gatherings, and planning well in advance. "As much quarantining as you can would really be helpful," he said.
They remind everyone that a COVID test is not a 'get-out-of-jail-free card.' "It is a snapshot, an indication that you don't have the virus at that instance. The test doesn't account for the 14 day incubation period," Dr. Rupp said.
"A test without quarantining still means you could be positive arriving at a family gathering," said Dr. Cawcutt.
They say that most people who get infected and recover from COVID-19, although that's not a guarantee either. "We have seen cases of people getting reinfected, although we think you'll be safe for a couple of months," Dr. Rupp said.
"The amount of antibodies you develop after getting COVID decrease the further away you get from your infection," Dr. Cawcutt added.
Dr.'s Cawcutt and Rupp addressed the debate over herd immunity. "We don't know a lot about the science about how long it lasts, herd immunity is not something we've advocated from a public health standpoint for a variety of reasons, not just whether or not it would work" Dr. Cawcutt said. An instance from Brazil, reported by Nature.com, talks about how the city of Manaus concluded that, since the city saw 66% of people infected, the pool of those who could get reinfected was too small to sustain a new outbreak, only to see cases rise again later in the fall.
"Herd immunity is the name of the game, and we can get there in a smart way," Dr. Rupp added. "We can blunt the curve down, buy some time for a vaccine to vaccinate enough of the population to gain more immunity, or we can let nature take its course. We are unfortunately letting nature take its course, which has led to a swelling of cases." Dr. Rupp suggested we'd need 40% to 70% immunity to slow the spread of the Coronavirus. "Most of the estimates I've seen, even in areas that have been hit hard, only about 10% of people are immune, meaning 90% of Nebraskans could get reinfected."
They warned against hospitals in Nebraska reaching capacity. "We can do a better job," said Dr. Rupp with regard to containing the virus. "We've become somewhat numbed to looking at these numbers - these are all human lives."
"There's a cost to herd immunity, human lives. We're seeing cases rise and hospitals reach capacity. Our teams are stretched thin, this would be a devastating and unnecessary loss of life when we have such simple solutions to reduce the spread while waiting for a vaccine," Dr. Cawcutt added.
Nebraska has moved up to fifth place on the New York Times COVID Map and Case Count, which gauges most COVID-19 cases per capita.
They talked about the long term risks of even contracting COVID. "Even young, healthy people are left with lingering symptoms for months after infection. We haven't had the longevity with this virus to know if these impairments are going to be permanent," said Dr. Rupp. "People can feel malaise or fatigue for months after getting COVID."
Dr. Cawcutt and Dr. Rupp expressed hope over the vaccines. "If we can just buy a couple more months, we can roll out these vaccines," Dr. Rupp said. Both Pfizer and Moderna have begun testing COVID-19 vaccines with a 90% effectiveness rate reported from Pfizer and a 95% effectiveness rate reported from Moderna. Pfizer wants to roll out its vaccine by the beginning of next year.
Both doctors remain hopeful that these changes will be contained to this year.
You can watch the livestream from Tuesday here.
Future Science Cafes will be announced on their Facebook page. You can see an archive of previous Science Cafes here.
(Credit for Photo goes to UNMC)