What's the New Normal Under COVID-19: Expert Q&A
May 4, 2020
UChicago Medicine infectious diseases experts Dr. Emily Landon and Dr. Allison Bartlett discussed our “new normal” – how we can stay safe as restrictions begin to lift as the COVID-19 pandemic stretches on. Are fabric masks effective and when should we be wearing them? When can we safely see our friends and family members again? What has changed with the updated Illinois stay-at-home order?
And welcome to At the Forefront Live. This is another episode where we are dealing with COVID-related questions from our experts. And as you can see, we are practicing social distancing. Our experts will be joining us from remote locations today. Now today, we will discuss the new normal as we live with COVID-19. We'll talk about effective masking and how you can keep safe while working and going to the store. How will the relax quarantine rules impact you. And our experts will answer all of these questions and much more that you will ask. That's coming up right now on At the Forefront Live.
Dr. Emily Landon and Dr. Allison Bartlett are both epidemiologists here at UChicago Medicine. And let's start with each of you introducing yourselves to our audience and telling us a little bit about what you do at UChicago Medicine. And Dr. Landon, we will start with you.
Hi. I'm Dr. Emily Landon. I'm the hospital epidemiologist and the executive medical director of our infection control program. I'm an adult infectious disease physician and specialist.
And Dr. Bartlett?
Hi. I'm Dr. Allison Bartlett, and I'm a pediatric infectious diseases specialist. And I work with Dr. Landon as the associate medical director of hospital epidemiology.
And you two have been very, very busy these last couple of months, so we appreciate all of the work that you've been doing to keep our patients safe here at UChicago Medicine and also, just keep the general public safer. So let's just jump right into the questions, because we're getting a bunch of them already. And we saw that today-- today's Friday-- the governor's new quarantine orders, I guess-- I don't know what the exact title would be for it. But the new orders are coming out as to what we can do and how we can go out safely in public. And if we can, just talk a little bit about what kind of an impact-- and when Dr. Landon, we'll start with you on this one-- what kind of an impact will that have on the public. And what things do people really need to know before they go out?
Well, this is going to need to be a cautious time. The virus hasn't changed. We don't have any vaccines or antivirals that are going to be able to keep people out of the hospital. And so it's really important as we open things up that we do it safely. That said, we've been doing a lot of work in hospitals like University of Chicago Medicine, where we have learned a lot about how to conduct business and how to keep our essential workers safe and our patients safe even through this COVID epidemic.
And so we think that some of these businesses are now safe to open. We agree with the governor that it's time for people to be able to come back and get the regular medical care that they need. And to be able to pick things up curbside from some retail facilities. And things like fabric masks are going to make that safe and possible for us to do. But fabric masks do not make up for social distancing, so we need to keep our distance.
And in order to make that work, we still need to stay home most of the time. You can add a few activities to your life, get out a little bit more. But really, this is about moving judiciously and carefully and watching what happens with the virus and we still need distance and masks in order to stay protected.
Dr. Bartlett, can we talk about the mask just a little bit? Because I think that's top of mind for a lot of people, particularly as they do get out a little bit more. A lot of people wearing the cloth masks, some folks are making their own, some of the people are buying them online. What's a safe mask, what's a proper way to wear that, and how much does it protect you?
Sure, I think the thing that I want to start with is first and foremost, a mask only works when it covers your nose and your mouth. Wearing a mask around your chin doesn't help provide any protection. So and that's my number one important part. The other thing about fabric masks is it depends a little bit about what it's made of. So the tighter the weave, so the higher the thread count, the more protective it is. So sometimes, elastic material like t-shirt material or other stretchy material isn't quite as good because you can have droplets that slip through the gaps in the fabric.
And again, because these are not form-fitted masks like sometimes we'll use in a hospital, there are going to be gaps around your nose and your chin. And so anything you can do to help minimize that will help provide protection. Masks are really helpful in preventing your germs and your droplets from getting onto surfaces and people around you.
Great. And I want to remind our viewers that we are taking your questions live on the air. So just type them in the comments section, we'll get to as many as possible over the next 20 to 25 minutes or so. We've had some interesting questions. And one that we got-- actually, I think it was yesterday-- dealt with food that you buy. You go to the grocery store-- still got to eat, obviously-- you bring back fresh vegetables and things like that. How do you make sure that fresh vegetables, your lettuce, your things that you get from the produce section is safe to eat? And Dr. Landon, can you take that one?
Yeah, I think this is a great question. The first thing that we can do to help protect the produce and everything that we're bringing home from the grocery store is again, to where our fabric masks when we're out and about. They're going to keep your respiratory droplets in the mask and not on the vegetable. If everyone is wearing them, then we can trust our produce, the boxes, and everything that comes from the grocery store a lot more.
Now that said, there have not been any outbreaks associated with contaminated products from stores. Now some of that is because there's so much transmission in the community, we can't really tell exactly where it's coming from every single time. But also, there are some common sense measures that you can take in order to protect your family and yourself.
First of all, if you're ordering food from somewhere, hot food is probably safer. Heat kills the coronavirus. And so I always opt for hot food in order to help support my local businesses. Then if I'm going to the grocery store, when I bring stuff home, things that can be wiped down can be wiped down with a disinfectant if you're concerned about them. But fruits and vegetables, you just sort of have to wash before you use them is the best advice I can give. And always clean your hands after you've been at the store and after you've handled things that came from outside the house.
Now after a few days, the virus will be dead on the surface of those products, even if you couldn't wipe them down. And so you probably don't need to be as concerned about them. But if you're bringing home broccoli or something-- those little nibs are really hard to keep clean-- raspberries, strawberries, same sort of thing-- you got to just rinse them off before you use them with hot water, if you can. Or if you're going to cook them, that's even better. But I think the risk is pretty low.
Great. And Dr. Bartlett, I've got a question about children, actually. Somebody wrote in and asked, they've got a lot of kids that are climbing the walls right now, as most people are, and particularly little kids, I would imagine. They want to be able to get them out and enjoy the nice weather. Is that safe to do?
It is absolutely safe and important to do. Mine are out there right now enjoying the sunny day so that I can have a moment's peace and quiet though so I can do this uninterrupted. The best and safest place to be with regards to risk of transmission is outside. That's really the lowest risk place to be.
That said, we do need to be mindful of keeping our social distance. But it's important for kids to get out, and run around, and play in an open space. Playground equipment is fine to play on and they should wash their hands when they come back inside. But really, a little bit of exercise goes a long way keeping the kids from climbing the walls.
So Dr. Landon, I have what may be the most bittersweet question for you today from one of our viewers. When will it be safe to hug our family members that we don't live with?
I think that's so hard right now, especially with Mother's Day coming up. You know, really, the more that we stay home, think of it as banking up. We're saving up by decreasing the number of contacts we're having with other people. And the more you decrease your contact with people that you don't know, people that aren't as important to you, the safer it is for you to have contact with some of your loved ones. So I'm not suggesting that everyone in the family should get together for a big reunion right now.
But if it's really important to you and mom, and this is something that you really want to do, and you really are sick of standing at the end of the driveway and waving at grandma and grandpa, then when if everyone's been very careful everyone's very low risk, and if it's OK with everyone involved, maybe now's the time that you put your fabric masks on, you wash your hands, and you give everybody a hug on Mother's Day. And then you can maybe keep your distance a little bit more again.
But I think what the recommendations are really saying is that it's kind of OK to start broadening our quarantine families, so to speak, just a little bit. But you have to remember that every person in your quarantined family, you're also having contact with all the people they've had contact with and all the people those people have had contact with. So while it may feel like no big deal to add 6 people to your quarantine family, that's really adding all of the people that they've had contact with.
And if you're letting kid that are running around playing at the playground, it's great if you're the only family there. But if there's a bunch of other kids at that playground, then maybe you're adding them to your quarantine family, too. So think very carefully before you start adding people to your quarantine family. But I think a hug or two done in a safe way with your fabric masks on your hands clean after you've been so careful, maybe OK. I can't promise it's going to be OK for everyone, but I can tell you that for me, it may be worth the gamble.
And wash your hands, wash your hands, wash your hands, as you just said. That's so important just to mitigate the potential danger. Lots of questions about masks coming in. And so clearly, people are thinking more and more about this. And we've got some of our testing video that we could run, too, because we are doing we're testing and we're getting questions about tests, and whether or not they're effective. Let's do the testing questions first.
That is one of the questions that came in-- are the test effective? And then there's also another question about antibody testing and whether or not that actually works. So either one of you can jump in and take that one.
I'll start and I'll let Allison cover the antibodies, because that part's hard. I want to let everyone know that the testing is so important, but it's not everything. We're pretty sure that a positive test means you're contagious. What we don't know, and what is really important for everybody to understand, is that a negative test does not mean that you're not contagious. In fact, the test is really good at identifying individuals who are sick when they're symptomatic who have COVID. However, we have no idea how good it is at identifying individuals who are asymptomatic, who are carrying COVID, and can transmit it to other people.
So you can't assume that a negative test means everybody is safe. In other words, I'm saying if you want to hang out with mom on Mother's Day and you guys have been kind of all over the place, you've got essential workers in the family, people who need to take public transportation, you can't just all go get tested on Saturday and then it's going to be safe for everybody to be together on Sunday. We have to keep acting like everybody could possibly have COVID, even people with no symptoms at all, even people who don't seem to have had any contact. We all know people who are sick with it and have no idea where they picked it up.
Dr. Bartlett, can you talk to us a little bit about the antibody testing and whether or not that is effective?
Yeah, absolutely. It's, unfortunately, a similar story to what Dr. Landon just shared. I would love for there to be a test that would let us know 100% for certain that you had COVID, and that you're immune, and you don't ever have to worry again. But that test does not exist. So the tests that are out there now can detect whether you've had antibody to coronavirus. But there are non-COVID coronaviruses that might cross react. So one of the common cold causes that happens every winter is a related kind of coronavirus. So not all tests are as good at distinguishing the two.
The other thing is that we don't know whether the antibodies that we're detecting is actually antibody that would protect you from becoming infected again, which really is important to eventually be able to know. And then unfortunately, the final part is this is a new infection. This is a new virus. It hasn't even been around for a year. We don't know how long the immunity would last even if you had it.
So the serology testing is important. It will give us a population idea about what percent of people we think might have been infected. But for each individual person who gets a serology test, it doesn't give us the information that we really wish it would be able to give us.
So we have multiple questions about masking and masks. I'm going to kind of bundle them together so maybe we can take a shot at answering these all at once. I'm sure we'll get more. But the questions are, can you reuse masks? What's the best way to wash a fabric mask? How long can you wear a mask during the day? And let's just take those right now.
OK, I'll start. Fabric masks are different than medical masks. Right now, medical masks should be saved for medical use. We still do not have enough masks in the hospital to meet the needs of everything that we'd like to use them for. But medical masks are disposable and should be disposed of as soon as they're soiled or after they are wet.
And to be honest with you, they may not be able to be replaced on the face afterwards. If they're contaminated, you could get yourself contaminated. It's pretty easy to get the outside the inside contaminated. So we don't reuse them in the hospital unless we absolutely are in a dire situation.
Now fabric masks are a little bit different. They're meant to keep your droplets inside. And you probably don't want to be wearing them-- we don't let our health care workers wear them around individuals that are sick with COVID are known to have COVID. They're best used when other people have a fabric mask on. They can be worn and taken off, put in your pocket if you need to eat something, and then put back on.
The most important thing about a fabric bath is that it has at least two layers. You can see that mine-- I made this-- I don't have a sewing machine-- I made it with some quilter's cotton, which isn't very good, actually. I would use something stronger, something more like a really high thread count pillow case. You might want to cut one of those up.
And then on the inside, I've cut of 100% silk scarf. And I put them together and sewed down the edges. I've also put a pipe cleaner in this part in order to hold it over my nose. Unused hair ties for the ears. Most important thing about this mask is that it covers my nose and my mouth, and then it seals as well as it can to my skin. So it needs to be pretty tight. So when I put this on, you can see that it goes way underneath my chin and it seals in. It's also tight against my face. And it's hard against my face here.
So that can be worn. And you can watch it any way that you'd usually wash the material. Silk is really good for masks, because it has a hydrostatic capability. And we're learning from some scientists here at the University of Chicago that silk makes a big difference and has much better filtering capacity than most cotton does. And so if you have an old silk scarf that you can cut up and put in there, you should. I don't know how I'm in a wash it yet. I think I'm going to probably just launder it as I usually would and see how the silk holds up.
We know that with cotton, even 600 or more thread count sheet cotton, which would be ideal, two layers of 600 thread count cotton seems to act at least as well as the surgical mask does. You can launder it in the laundry, in the hot water, and then just dry it in the dryer just like you do any other sheets.
Yeah, it's interesting. This is what I got here at the hospital, actually. And it's a heavy cloth mask. And so I hand wash it just in the sink in my kitchen, and then hang it up to dry. I have run it through the washer once, as well, but it fits tight and it seems to work pretty well.
Dr. Bartlett, I have a question for you, and this is one that just came from a viewer. There was a recent story in the news about it being potentially a long time before there's a vaccine. Are there other potential routes to a normal life again?
So the two things that we can do to decrease the number of people at risk for COVID, which really is what we're looking for to impact our ability to return to a normal life, is immunity-- ideally, from a vaccine, and not from natural infection, which of course, can be severe. And then the other option is if there is a way to prevent transmission with antiviral use. So if we find that one of the medications that is being tried can be given to people who've been exposed to COVID and then prevent them from becoming sick and transmitting to others, we could use that as part of an intensive testing and contact tracing program to help limit the ability to spread the infection.
More questions from our viewers. What about not exposing ourselves to germs and bacteria? Doesn't that suppress our immune system?
Either one you grab that one.
Yeah, so not exposing yourself to germs and bacteria for a short period of time is not going to be a danger to your immune system. Of course, you do need to have illnesses over the course of your life. And we know that the kids who play more in the dirt are less likely to get asthma and have allergies, but that doesn't always pan out. I played in the dirt a lot and I have terrible allergies. But nonetheless-- I guess maybe it may have been worse. But the idea is that this is a short period of time in the whole lifespan, where we're really going to avoid all of these germs in order to protect us from one that's pretty bad.
It's important for everyone to understand that while younger people most vast far and away will survive this infection, a lot of them do need hospitalization and some even need ventilators. So please don't think that this is the same as influenza. People need the hospital a lot more with this than they do when they have influenza. So it's not just about dying. Half of our patients in the ICU have been under the age of 55.
And as long as everybody is able to get the oxygen that they need or the ventilator that they need or if they need remdesivir in order to help them get through it one of the other drugs that's currently being tried, we want to be able to have room for everybody to get it. And the only way we can have room in our health care system is if we continue to make sure that we limit the number of contacts between people who are susceptible to people who are infected. We have so many people who are susceptible still, because in the studies even in New York, less than a quarter of people were actually infected.
So everyone else, if there is immunity, which we have good reason to believe that you get at least immunity for a while-- everyone else is still susceptible. And if people can be infected without any symptoms whatsoever and be transmitting the virus to other people without anyone knowing it, then we don't know how to limit those contacts other than things like wearing masks, staying at home.
And so that is going to mean less contact with dirt, with soil. well, I mean, I suppose you could still go out and play in the dirt. I'm going to plant some flowers this weekend, so maybe I'll get a little bit of extra immunity that way. But yes, you are going to have less exposure to other colds and viruses. But I think it's going to be OK. It's just a little bit of your life. It's not forever.
So that was an interesting number you just gave us. 50% of our patients in the ICU are young folks. And people need to remember that-- this is serious business. Dr. Bartlett, so here's one from a viewer. My kid's summer sleep away camp said they're still running the summer. It begins at the end of July. What are your thoughts on me still sending them?
I think that July is a long time from now and a lot can change. But I also think that we're going to be seeing a lot more summer camps and summer programs that will be changing their minds and will be closing. I think that here in Illinois at the end of May, if the governor decides that we want to open things up, we'll have a better sense of what a second wave of infection could look like. I think there are things that can be done to manage summer activities better.
Obviously, we discussed being outside is better than being inside. But it's hard to self isolate and maintain social distancing when you're living in a cabin or a tent with someone. So I think time will tell, but I'm expecting to see more camps that may be closing.
So Dr. Landon, we talked a little bit about this on the At the Forefront Live that we had yesterday, but one of the things that really alarmed me-- I was talking with one of the physicians in our emergency department just a few days ago, and he mentioned to me that they are seeing cases where patients are not coming in for very much needed care. They're suffering at home and in some cases, with tragic results, because they're afraid to come to the hospital.
So can you talk to us a little bit about the safety of in-person care. We want people to know that we are open for business and it is important. It's safe for people to come here, but it's very important to come and get your care when you need it. Can you talk a little bit about that?
Yeah, I completely understand. And I've heard some of the same things and talk to some of my patients about the same things, as well. It's OK to kind of put off your chronic medical conditions for a few weeks, maybe, and say, OK, I'm going to just hold off on this appointment for now. But at some point, stuff does become urgent. And if you don't pay attention to it, it will become even more urgent.
And so now is the time. The case numbers are kind of coming down a little bit. Hospitals are confident that they're not going to have a big peak, a big surge of patients. We now understand how to care for these people. And all along, we've been taking care of patients that have urgent problems that are not COVID-related and successfully doing so without giving them COVID or causing other problems. And so it's time now for people to start going back to your doctor.
I have rheumatoid arthritis and it's time for me to go in and have my labs checked again. I went in yesterday for my allergy shots. You already heard we talked about that. These are not urgent or emergency problems, but there are things that if we ignore them, we're not going to be able-- I would get pretty sick if I didn't pay attention to those things. And I want to be able to keep doing my job helping protect everyone else and providing care. And the last thing anybody needs-- with all of the heartache and economic strain and medical strain from COVID-- is worsening other health problems.
So we have virtual visits at the University of Chicago and many things can be taken care of by virtual visits. I've seen some of my patients by virtual visits. And that can take care of a lot of things so you never have to leave the house. You can also talk to people on the phone. And we can also have you come in and be seen if you need to be seen. Oftentimes, that'll be started by a triage to make sure that it's really worth it for you to leave the house.
We're not so worried about you being in the hospital. We're more worried about all the things that come with getting out of the house and getting all the transportation and the effort that it takes for people to get places. But if you need to be here, we'll make it safe for you to be here. It is safe and you should definitely do that.
It's interesting-- one of the ways that this was explained to me-- actually, if you come to the hospital, it's a much safer place than probably any place else you'll visit during that day. And the way we have things set up here at UChicago-- again, I'll just touch on this-- fascinating to me. When we built our Center for Care and Discovery, which is our big hospital building here on campus just a few years ago, they designed that specifically for things like this. And they have negative pressure rooms and negative pressure floors, which makes it extremely safe for not only the patients that have COVID, but the rest of the patients and the workers in the hospital. It basically sucks the air out of those rooms, filters it, the exhaust it's outside of the hospital. So just it's really-- go ahead, I'm sorry.
Dr. Bartlett and I worked with the construction teams on this.
I'm so glad you brought-- yeah, perfect. Tell us about that.
Amazing facilities. Every single one of the clinics that our clinic building also has a negative pressure room where we can put patients with infectious diseases. But it's so important to know that we've been taking care of patients with dangerous transmissible infections forever. Since the beginning-- you may not have realized it, but you could be in a clinic room right next to somebody with tuberculosis.
And you know it's happening during influenza Season and we're keeping people safe all the time. This is just the newest thing that we have to keep people safe for. And Dr. Bartlett and I have spent decades studying and learning how to do that. And coronavirus is a big problem, but it's not that challenging for us. We know what to do. It's just a matter of setting everything up for the sheer number of patients that have it and the amount of PPE that we need. And the spaces that we just need to set things up appropriately and teach our faculty, and our providers, and our nurses, and our EBS workers. And we've got it taken care of.
We also need to make sure, by the way, that they stay socially distanced at work, because they can be a risk to each other. And not just patients or risk to them, but anybody could have COVID. So we need to provide a safe workspace for them. And that means that while we are offering clinic visits, they're not going to be that many of them. So when you come, you'll find a mostly empty waiting room to wait in. You'll find that you your doctors and nurses are keeping separated in their work spaces. It means that there's not going to be as much crowding. Hopefully, we'll be more on time. My patients will be thrilled.
But it means that I we're protecting our staff so that they can protect you. And that's what we should be looking for in all the businesses that are reopening. I know that I'm going to spend my dollars at the places that are taking care of their essential workers, providing them with masks, making sure that they're socially distanced, making sure that behind the closed doors when I come for curbside pick up. That they're doing what they need to do to take care of those workers, not just make sure that I'm safe when they bring it out to my car.
So Dr. Bartlett, we're getting a lot of questions about timetables, and I know this is probably an impossible question to answer, but I'm going to throw it to you, anyway. But timetables-- when can we see more easing of restrictions? When can we expect maybe a vaccine or that sort of thing? Any ideas on any of that?
My crystal ball is in the shop, unfortunately. I have to just emphasize patience. It's tough. I'm not a patient person-- just ask my family. But the vaccine development is years away or 18 months to two years. That's not going to be as soon as we want it in our immediacy age. I want food delivered, I pull my phone, and hit send, and it comes to my house. It's going to be awhile. Restrictions are going to probably be eased and tightened and eased and tightened as the virus continues to spread, as we learn more about whether infection confers immunity, and as we march towards potentially having some treatment.
So it's not going to be as soon as anyone wants. And we need to be prepared to maintain practices in the long haul. Like Dr. Landon mentioned, there will be some easing. Maybe increasing your circle of friends a little bit in a very cautious thoughtful way.
So here's an interesting one from a viewer. Should we change our clothes after we've been in public places?
It kind of depends on what you did in those public places and what it was. So if you're outside and you go into the grocery store, I don't think it's necessary to really change your clothes right away. But if you are working in a hospital, we've asked our health care workers-- we've suggested that they change their clothes, but they're having close contact with COVID patients. So I think it kind of depends on where you are and what you're doing more so than it does a blanket statement. I would hate to make something to blanket. I think you have to use your judgment and do what you think is best for you and your family.
If you've got high risk individuals living in your home, maybe that's something you want to do. If you're not wearing a coat when you're at the store, and you feel like you might have brushed up, and the situation was more crowded than you thought it was going to be, maybe you do. But if you go out and you really don't get too close to anybody, everybody's wearing their mask, you feel pretty confident, you're good, seemed like a pretty safe situation, you're probably OK.
Great. So we are about out of time. I just want to give you each an opportunity real quickly if he can, just leave us with a closing thought. And Dr. Bartlett, let's start to start with you.
Sure. I think I want to just build on a little bit of what you were saying about the need for in-person clinic visits and keeping some health maintenance opportunities going. Our infants, as zero to two-year-olds, come in frequently for vaccines. We certainly want to make sure that we're keeping their vaccines up to date. We don't want to run into a problem, where we're having outbreaks of vaccine-preventable diseases on top of COVID because we haven't been able to vaccinate our children.
So again, we can do it easily and safely. Things will look a little different for kids coming into the doctor's office. They'll see more people wearing masks. Sometimes, we might be wearing goggles or eye shields. But we can help prepare the kids so that they know what to expect. And we are ready and waiting to help keep everyone healthy.
And Dr. Landon?
It's going to be a long time before we can have our regular lives back again. And until then, the more freedom we get is going to be dependent upon how well we incorporate the importance of distance and personal protective equipment in our daily life. So the more we are, wearing those mask, and with keeping our distance, and finding creative ways to live our lives while we're still doing those things, the more of us agree, and abide by those rules, and participate in this important social contract, the more freedom we're going to be able to have. And the safer our community is going to be.
If we avoid the reality of this virus-- there is nothing Democratic or Republican, conservative or liberal about this virus-- it's biology. And we are not fighting each other. We are fighting a virus. And you can't negotiate with that. So wear your masks, keep your distance, and get on with it.
Yeah, I think this is a wonderful time to remind people to be nice to each other. We got to stick together. We will get through this eventually. Thank you both of you for doing this today. I think it was very, very valuable. Your answers were fantastic.
That's all the time we have for the program. We'll have another At the Forefront Live next week, where our pediatric physicians will discuss COVID-19 in children. Please remember to check out our Facebook page for our schedule of programs coming up in the future.
Also, if you want more information about UChicago Medicine, COVID-19, and other things, please take a look at our website at UChicagoMed.org. It's also a great place if you want to set up one of those video visits. You can do it there. You can learn all about it. In fact, there's a video there that shows you how to prepare for it and exactly what you need to do. Need an appointment, you can also give us a call at 888-824-0200. And again, you can schedule your video visits that way. Thanks again for being with us today. I hope you have a great week.
Allison Bartlett, MD, MS
Allison Bartlett, MD, MS, specializes in the medical management of acute and chronic infectious diseases. She also is working to improve the safety and efficacy of antibiotic use in children.Learn more about Dr. Bartlett.
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