Readers asked about masks, reinfection, Florida and quarantining; Here’s what how the experts responded

Three healthcare experts answered reader questions about the ongoing pandemic. All three physicians are members of the Acadiana Physicians Leadership Council, representing hospitals in the Acadiana region.

The Experts

Dr. Tina Stefanski is the regional medical director for the Region 4 Office of Public Health. In that role, she leads the local response to the pandemic.

Dr. Robert Aertker is an internist at Acadia General in Crowley. He has a background in immunology and virology.

Dr. Henry Kaufman is the interim chief medical officer for Our Lady of Lourdes Regional Medical Center. He is a surgical oncologist.

Here are some highlights

LindseyBuckley asks: Scientific evidence has shown that masks can greatly help slow the spread of Covid-19. I’ve encountered many people who say they cannot safely wear a mask in public. Can you please clarify for the public the instances in which wearing a mask would be contraindicated?

Dr. Kaufman: There are no circumstances that come to mind where it would be unsafe for an individual to wear a mask. This includes individuals with asthma, emphysema and other respiratory diseases.  Individuals with respiratory disease may feel as though it makes it more difficult to breath but gas exchange through a thin mask or fabric covering as advocated by the CDC is only minimally affected if at all. The first thing that happens to every COVID patient who comes into the hospital is [we] place a mask on them. In the healthcare setting we do not consider pulmonary (breathing) diseases a valid contraindication to the wearing of a mask.

alt8331 asks: Does the current testing method identify other viruses which can result in a positive COVID-19? i.e. If someone has another virus like Strep Throat or Influenza, would their swab come back positive for COVID-19 also?

Dr. Kaufman: The test for the SARS-CoV-2 virus (which causes the COVID-19 illness) are highly specific and very sensitive. High specificity means that it does not falsely report COVID when the underlying illness is another virus like influenza or bacteria like Streptococcus.  Very sensitive means that it misses very few cases when the SARS-CoV-2 virus is present and being shed (which is the case in most symptomatic individuals).

Dr. Stefanski: There is cross reactivity with the IgM antibody test – the “finger stick” test. It will not detect flu or strep. But, it can detect other, common coronaviruses. Not just COVID-19.

Dr. Aertker: The technical PCR test is so specific, it nearly reaches 100%.  I have not personally seen a False + since I’ve been testing. False negatives are also very low.: less than 1%. But in common practice it can be higher depending on the skill of the person doing the swab.

Vekellner asks: Do we have a testing shortage? If so, do you see us going back to the protocol in March where only symptomatic hospitalized patients get tested?

Dr. Aertker: Yes, there is a significant community shortage of tests. We have had to shift back to testing symptomatic patients only. Even if you were “exposed” to a known positive patient. We are now advising to quarantine for 14 days and test only if you get symptoms (because there is such a testing shortage and backlog). 

harmonkris asks: New reports are implying that this virus may be airborne, not just droplets from someone coughing or sneezing, that when someone speaks it becomes airborne and can travel across a room, especially one that is enclosed, What would be the precautions to take – would they be the same as we are doing now? 

Dr. Stefanski: That is another tough question. Unfortunately, there is still so much to be learned about this virus. Best evidence at this moment is that the main source of transmission is through droplet spread (viral particles traveling via respiratory droplets), and could be spread when a person has no symptoms, which is why it is so important for people to wear face coverings when in public. Face coverings/masks stop the spread of respiratory droplets expelled when a person talks, sings, coughs, sneezes. Airborne transmission might be possible but is not likely to be the main source of spread (it might occur during certain types of procedures, usually in a hospital setting, during a nebulizer treatment…etc.)

Dr. Aertker: I made up TIME SPACE AND FACE. It’s my common sense adaptation of the CDC guidelines:

1. Time — All encounters outside of home less 15 min
2. Space — Greater than 6 feet social distancing
3. Face — Wear a mask. This creates good hygiene habits so you don’t touch someone or something that allows the virus to enter the only 3 places it can enter your body and infect you: your eyes, nose and mouth.

Bob4165 asks: In March, we shut down to flatten the curve and allow healthcare facilities and professionals to prepare. This was done at a huge cost to the economy. Therefore our leaders realized this and have slowly opened the economy. Why does the medical profession seem shocked that cases of Covid are rising?  Wasn’t this expected especially since we cannot “stop” it?

Dr. Kaufman: No one in the medical community that I know has been shocked by the resurgence in cases, in fact I think most were waiting for it. I personally expected a small surge earlier and a larger surge in the fall. We were following multiple mathematical models, one of which early on showed a very similar spike in cases like we are experiencing now. We were however surprised by the rapid rise in cases that occurred in the last two weeks, especially the phenomenal outbreak in Lafayette Parish amongst the 18-29 year old population. The medical community is much better prepared to weather the current surge but all healthcare facilities have a limit to their capacity, and once that capacity is breached, significant inconvenience and delays in care are inevitable. This is the scenario that we must all work to avoid.

Bert asks: Is there any credible evidence that the antibodies produced from being infected with COVID-19 do not last very long and you can become infected again? If so, would it be possible to reach herd immunity?

Dr. Kaufman: There are recent reports in the media, not yet in peer reviewed scientific publications, which suggest that antibodies to the SARS-CoV-2 virus are not durable and may clear rapidly from the circulation. It is too early to give much credibility to these limited reports. There is good evidence that those who acquire COVID and recover, can be re-infected. The numbers regarding this phenomenon are unknown. In general I can say that a scenario where re-infection occurs, will negatively impact the ability to reach herd immunity. I must also say that herd immunity will not likely be attained until over 90% of the population has been infected, this is unlikely to occur anytime soon and is not an effective pandemic management strategy.

Erin asks: I’m hearing conflicting information about the quarantine period. Should a person who’s been exposed quarantine for 10 days or 14?

Dr. Stefanski: A person may return to work 10 days after symptom onset (or, 10 days after the date of testing if they had no symptoms and, remained asymptomatic) as long as they have been symptom free for the preceding 72 hours. However, if the person works in a congregate setting – like a nursing home, jail or shelter – we extend that to 14 days just out of an abundance of caution. Fourteen days is [also] the quarantine period for people who are exposed but not sick themselves.

wlyn628 asks: Is there any new information out there regarding reinfection? I am currently getting over Covid19 and am curious about being able to get it again. Thanks for all that you are doing!

Dr. Aertker: Only that re-infection is a real phenomenon. I’ve had two patients who got re-infected. They were older and with medical problems. But they got worse the 2nd time around. It’s too soon to know about re-infection side effects specifically because the diesease is so new and still in its first wave. Immunity may be better judged in the younger patient.  Re-infections are likely harder on the older patients. 

kevinstephan asks: I am a local business owner that employs 30+ employees. A few of my employees are planning vacation trips to the panhandle area of Florida within the next few days. Since Florida is now considered a “hotspot” for an increase in COVID infections, should I require these employees to self quarantine for 14 days following their return before allowing them to return to work?  Your answer will be much appreciated. 

Dr. Kaufman: Florida is definitely a hot spot but Lafayette Parish is currently the hottest spot in the state which, in turn, is one of the hottest spots in the country. That being said I can not say that it’s any worse to physically be in Florida, than Louisiana. If your employees are conscientious, practice good social distancing and report no high risk exposure (being within 6 feet of an infected individual for 15 minutes or more), I think that you as an employer are OK with not mandating quarantine. If however your employees include individuals in the current highest risk category for community spread (18-29 year olds) and you suspect they are engaging in high risk behavior (large social gatherings) it might be prudent to quarantine them. Regardless we would advocate your employees practice good social distancing, masking and personal hygiene.

Dr. Aertker: Encourage all your employees to social distance greater than 6 feet from unfamiliar contacts, preferably outdoors, and do not remain in the space/company in/outdoors for more than 15 min. And above all, whether you’re on Bayou Teche or Orange Beach TELL ALL YOUR EMPLOYEES TO WEAR MASKS

Check out all the questions and answers below!