‘You can revive a cafe, but you can’t revive someone back from the dead’

‘You can revive a cafe, but you can’t revive someone back from the dead’

Kent State epidemiologist Dr. Tara Smith breaks down the Covid-19 crisis in Portage County

Image of Dr. Tara Smith
Photo submitted by Tara Smith

Last week I talked with Dr. Tara Smith, a professor of epidemiology at Kent State. She specializes in infectious diseases transferred from animals to humans. At Kent State, her lab studies the transmission of staphylococcus aureus, staph, in communities.

Smith and I talked — at a socially safe distance of dozens of miles away over the phone — about coronavirus, its potential impact on our most vulnerable communities, government efforts to curb the spread and what residents can do to stay safe.

This is the whole conversation, but edited for length and clarity.

How concerned do you think residents should be that this virus is going to spread in Portage County?

I think it already is. My daughter had symptoms consistent with this about two weeks ago, and she was unable to get tested because they weren’t serious enough. I’ve heard that from several students as well, some that were at Kent State before we shut down, others that are still here in apartments or things like that. I think it’s already spreading. I haven’t checked our current case count, but I know it’s pretty similar as far as numbers per 100,000 of the population to other areas around us, like Summit County.

So, I think it’s here it’s spreading, we’ve had patients but a lot of them are going to go undetected because we don’t have those tests to give to everybody who has symptoms consistent with Covid-19.

That’s a good point on the tests. I guess it is going to spread regardless — the severity of the spread is what I mean to ask about.

Right, yeah and that’s one of the things of course we’re trying to stop right now is the rapidity of the spread at least. The whole idea of flattening the curve is to stop it from spreading so rapidly that it would overwhelm our healthcare systems and have too many people in the hospitals and in the ICU beds and using ventilators — it would increase the risk of death for those in Portage County or anywhere else.

What we’re hoping to do is slow down that spread, and it seems like Ohio is doing better than a lot of its neighboring states, especially Michigan. But it’s really hard to know the details because of the lack of testing.

I was reading that you’re a pioneer in research into MRSA and staph, things of that sort. How does this virus differ from things, like you were saying, things like H1N1 and MRSA on the bacterial side and those infections?

It’s similar to influenza in that they’re transmitted the same way and they cause somewhat similar symptoms. Both are viruses, both are transmitted primarily through small droplets. Those droplets that you release when you cough and sneeze and sometimes even when you talk. But they’re different in that they’re two completely different types of viruses.

The Portager reported that one person has already died of coronavirus. It’s suspected, not confirmed but suspected, that they lived in an assisted-living facility. If that’s the case, what risk is there to the others in that facility and similar facilities to become infected? [There are now six deaths in Portage County, with at least two of them in nursing homes.]

Assisted living, nursing homes, any of those are huge risks right now because you have a population that is very vulnerable due to age and other comorbidities: heart disease, high blood pressure, any of those issues.

I have friends and relatives in Hancock County, across the state, and they have completely shut down their nursing homes. No visitors are allowed, nurses and other healthcare workers have to come in through a certain entrance and wash their hands, get all their PPE on and try to prevent any spread within the facilities. I’m sure the ones around here are doing that as well.

It’s so hard because we do know now that this virus can spread before people develop symptoms. That was one way we could screen people out before was, ‘You can’t come in if you have a fever,’ which makes sense. But now there’s no way to test for those who may be infected but are what we call “pre-symptomatic.”

They’ve been infected, they’re incubating the virus, they may be able to spread it, but they’re not yet showing a fever or a cough or something like that. That has made it really more difficult in places like nursing homes and assisted living where you obviously need your workers to come in and help these people, but at the same time, they may be inadvertently carrying the virus into those facilities.

Do you think there are measures that these assisted-living facilities, nursing homes, can take to prevent these infections and subsequently more deaths?

I know some have instituted mechanisms so that basically residents there are not allowed to group. Even if you have one resident who is infected, it stays with that resident and it doesn’t spread further within the facility if they’re all eating together or playing cards or having a movie night or something like that. Many have gone to using social distancing within the facilities as well and then having workers wear masks.

So, there’s been some pushback from people about stay at home orders and, at least in Ohio, the shuttering of dine-in restaurants and bars. Could you tell me about why those types of measures were taken and why they’re necessary if there are only a few cases here?

We talked a bit about how Ohio’s spread compares to those states who did these interventions a little bit later. Ohio is faring much better, and I think that’s why. What happened with these orders to shutdown restaurants and close down schools and eventually have the stay at home order is that they have enforced some of that social distancing, so people are not mixing as much.

There are fewer opportunities to spread the virus. Again, especially now that we know about pre-symptomatic spread, you can’t just take it on faith that because someone looks OK and they’re not coughing or sneezing yet — you don’t know that they’re not spreading the virus because they could be. So, I think that’s been really important that these measures have reduced spread of the virus even from people who may seem well.

I have an uncle in Toledo who may be losing his cafe. They just shut down realizing that they weren’t making enough money even from take-home orders. So I know how devastating it can be to some of these small businesses, and I hope they’ll be able to get grants or loans or things like that to stay on their feet.

You can revive an organization, a cafe, a store, but you can’t revive someone back from the dead.

That’s what we have really seen here: We are slowing down that transmission, keeping our hospitals afloat without an over burdening of cases so far. And it’s tough on everyone, but I think we’re seeing it make a difference and flattening the curve as everyone has tried to do.

I’m sorry about your uncle’s cafe. That must be very difficult.

It is, he’s spent the last 15 years or so on this place, and in a couple weeks, who knows? Again, hopefully he’ll be able to reopen after this is all done, we’ll see. Lots of people are in that place. I mean my brother-in-law works for a factory; it’s closed right now. He’s getting unemployment, but no one knows what’s going on with health insurance, and he has all kinds of health issues. There are a lot of things that still need to be ironed out from some of this that we’re kind of figuring out as we go, but I do think that our government officials have everyone’s best interests in mind and are trying to do what they can to minimize some of those economic losses in order to save physical lives.

You’re going to have to forgive my ignorance on this, but a lot of folks are sort of even pushing back on what we were just talking about, they’re talking about herd immunity and things like that. Could you talk about the validity of that herd immunity argument?

For herd immunity for this virus on average it transmits to about 2.5 people. Every person, on average, will spread it to two or three others. You need to have somewhere to about 50–75 percent of the population immune to the virus in order to stop that spread through the population. That’s a lot of people, right? So, if you assume that 50–75 percent to the population gets infected — let’s make the numbers easier. Let’s say there’s 10 million people in Ohio. You would need up to seven million people infected to reach that herd immunity, and even if you’re talking about 1 percent rate of death, that’s a lot of death.

I think people think of that as a logical common-sense solution. “Oh, it’s only maybe 1–2 percent fatality, just get it over with.” But what if you or your family, someone in your family, was one of the people who died? And you just said — you were the one who supported getting everyone infected and had a really tragic result from that.

I can’t support that, I’m not going to be a sacrificial lamb for this, and I don’t think a lot of others would be either, even if their risk is, in theory, relatively low.

Yeah, people should not have to be sacrificial lambs for the sake of economic stimulus, as some folks recommended.

I think it’s being kind of dichotomized, too. As if, we can just open up and things will be fine, but that’s not going to work either because you’re still going to have employees who are sick, employees who are potentially getting very ill, maybe needing ventilators. It’s not like everything is just going to run business as usual and then people are going to be getting sick.

I think the people who are kind of saying it’s either the virus or the economy aren’t taking into account that the virus isn’t going to go away just because you reopen things. In fact, it’s going to spread even more.

I’ve seen folks openly muse about the validity of social distancing and if it actually works and “if I could have a glass of wine with my friend for an evening if that would be fine.” What social distancing measures do folks need to take? Is that glass of wine at your friend’s place OK, or should folks really be at home except for these essential trips the state’s been recommending?

We personally have to stay at home, besides going out to get groceries and things like that. You have to think basically whoever you are socializing with, you are one unit of potential infections. When my partner goes out to get groceries, he comes back, he could be infected from touching something in the grocery store and he could infect the rest of us.

If I go out and I mingle with a friend, they and their family are also in that infectious unit. As you expand that more and more, then you have more chances for more individuals to become more infected. Really the best thing is just to lock down as much as you can. Have that glass of wine with your friends, but do it over Skype or something instead of doing it in person. Really, that just increases the risk of transmission.

For folks who are getting groceries for their families, are there extra steps they can take to mitigate the risk of infection?

I’d caution against gloves because I think lots of people see gloves as a panacea but they don’t know how to use them properly. Any time you touch anything with your gloves, that’s potentially contaminated and your gloves are potentially contaminated, too. If you touch the store shelves and touch your money wearing the same pair of gloves, now your money’s contaminated.

I just prefer handwashing. We do a lot of handwashing; we use a lot of hand sanitizer

We’ve left our mail sit for a day just in case and put all of our groceries on the floor out of the way rather than usually we would put them on the counter right by the fridge. Just being cautious of some of those things that could lead to environmental transmission of the virus into your home. And just touching the minimal things you can in the grocery store. Don’t be, I don’t know, shifting through boxes or something. Pick one and go, clean off your carts, try to stay away from people as much as you can.

There’s a lot of misinformation out there, some from the federal government. With that, are there any particular resources you recommend folks go to online, things of that sort for proper information about this?

WHO (the World Health Organization) is a good site, and they actually have a whole page on myth busting for some of the things they’ve seen spread around that are wrong or potentially not confirmed yet.

Johns Hopkins has a really good site for information. Even Kent State has been keeping up a Covid-19 information page for students but is certainly applicable to others in the community. So those are some sites that I would trust. Keep in mind everything is changing so fast that something that’s on there one day may be switched around the next as we get new information.

Are there any last bits and pieces we didn’t cover that you’d like to talk about?

I think the one thorniest issue we have right now is the mask issue. I would just make sure that anyone who is thinking of using those — again you realize for the most part those are about protecting other people and not necessarily protecting yourself. But those masks are not really good at keeping viruses out. So, you still could get infected while wearing those. Still keep up the hand hygiene, keep up the distancing, keep up all those other things you’re doing if you’re wearing a mask.

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