- January 20, 2025
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How does the county seem to be doing at this point, in terms of testing and things like social distancing?
Cases are steadily rising. They're still a relatively low number, but it's following the exponential growth trajectory that we all worry about. We've gone from one case to 31 in three weeks. The typical thing is it doubles every four or five days, so we're right on that trajectory. So that's expected, but worrisome. Plus, we still have had limited testing facilities, so we could be significantly underdiagnosing at this point.
The selection criteria for testing has been changed — partially because of test ability, but also, very importantly, because we have now reached the second phase of this pandemic locally, which is we're experiencing community spread. Now, we're testing basically anybody with significant symptoms, all healthcare workers with symptoms, anybody with significant symptoms over 65, anybody with comorbidities that put them at risk; we're testing all those people even with mildish symptoms now.
Testing kit availability is ramping up; there's private parties making this stuff. The Health Department is working to increase the availability. ... Testing availability in Flagler should increase dramatically.
On the mask front, there's been a change. Not so much the data on masks, more on how they're interpreting it, and also that there's probably more people walking around asymptomatically with this that could be spreading it to others. ... They [masks] are for the people who have it, to wear to prevent them from expelling droplets into the air that other people then touch or they land on their clothes or other things, and they get it that way.
That hasn't changed, although there's a little bit of research suggesting this may spread by aerosol more than we thought. If the whole community wants to be wearing masks, it would probably help a little. But people shouldn't interpret that as they should have been wearing them before. This is one added protection.
In terms of policies, the last two weeks you've seen a steady increase in the intensity of the isolation measures. Usually, communities have trouble ramping up as quickly as they should have, in retrospect. It wouldn't shock me at all if we end up with 1,000 or 2,000 patients. In fact, that would only be 1% or 2% of the population, and a lot of the projections are 10%, 20% or more of the population. I think we're doing pretty well, but I'm not at all convinced that we've done enough; we may get into more significant lockdown measures, more strict interpretations of the exclusions.
What would you imagine might be an improvement?
A lot of it is just how strict; so far it's pretty voluntary. Italy got to the point where people couldn't even go out of their houses unless they had a bonafide reason. I think they had to in advance register, "I'm going out to the store;" they'd sign up on the internet.
You still see a lot of people at the grocery store, moderate amount of traffic, trying to support our local businesses to some degree, practicing social distancing. But practicing social distancing is a relative thing; it's impossible to do it perfectly.
Could you speak a little bit more about the extent of the protection, for instance, with different kinds of masks?
The first thing people should keep in mind is that there's been no dramatic new data on this; it's mostly just reinterpretation of existing data which is pretty scanty. ... The idea with the masks was that the people who have it should wear them to keep from spreading it to others, but that it offers little protection to people who didn't have it, because they weren't going to be inhaling it anyway.
That's still true. It changed a little because there's a little evidence that ... there's a little bit of aerosol [spread]. All these things are relative. They say 6 feet is the barrier for people. It doesn't mean if you're 7 your'e totally protected or if you're 5 you're high risk. There's a gradient.
In terms of the masks that people should wear; if you're a health care worker, with close contact with known patients, that's high risk, so they need the full protection, they need these N95 masks.
But those are known patients, close contact. What most people are going to have is unknown patients and not close contact, so the risk is just way less. The thought is more — let's say instead of 30 cases, you've got 100, you just haven't diagnosed 70. They're asymptomatic. Somebody shopping next to you in the store could have it and not be wearing a mask because they don't feel sick, and they could be breathing it onto you and you could get it that way.
If anybody wants to contribute, there's a number of charitable organizations around the country trying to get these N95 masks to any health care workers in jurisdictions that are not getting them. I applaud that effort; I've done it myself.
So if people are wearing something like a bandana that's folded over or something made out of a T-shirt, that should be fine to keep you from breathing it out onto somebody else?
Ideally, you'd want the people who have it to be wearing better masks, but they may not know who they are. But even that would help. If somebody is considered to be high risk, like elderly or other medical conditions, and they wanted to get more gung ho about the mask, get a better mask — that's fine.
But there's one caveat to this. People should not think that wearing the mask means that they don't need to wash their hands and practice social distancing. They still need to do that. In fact, the mask could be almost counterproductive if they stop doing that. I think the masks kind of play a role in signaling to people that they're being careful, and to others to be careful, that we're not in typical conditions anymore. In a way there's a kind of social signaling impact to the mask.
For the people doing essential jobs where it's not easy to be six feet away from other people — like cashiers at a grocery store, where they're often really three feet or so from someone going through the checkout line — would you recommend for those folks that they wear some kind of a mask?
Recommend may be a strong word, but I certainly wouldn't think it's a bad idea — same thing with gloves. Yes, people who have close exposure, it's kind of a different animal. And they should be washing their hands regularly.
Do you know where we are right now on test kit availability within the county?
It is increasing dramatically. In the next week or two ... there will be a lot more test kits available. The Health Department's been working on this, the city of Palm Coast's been working on this, the mayor herself, the Emergency Operations Center ... [Florida Department of Health-Flagler Administrator] Bob Snyder was working on it all weekend.
I understand there's an effort to get a drive-through testing site. Can you speak to that?
We hope that will be available very soon. If it's not available — I don't know if it will be a full drive-through or a partial drive-through, but there's definitely a lot of work going on in the area of the testing sites.
Anybody who wants to volunteer, anybody with health care experience — the Health Department can't do this itself; they need volunteers to help them. It's a huge undertaking. Anybody with any health care experience.
We also need anybody with any general clerical skills, because everybody who's tested positive, we have to track them; we have to track all their contacts. That involves a lot of phone calls. If you have 30 people and they each have 10 contacts, that's 300 people that we track. [To volunteer, call the Health Department at 386-437-7350].
What about medications or treatments?
There are a number of drugs that seem to have antiviral activity that are being looked at, and some of them are HIV drugs. Some of them are other drugs that have been found to have antiviral activity, like these malarial drugs — chloroquine and hydroxychloroquine. ... And then there's a group of anti-inflammatory drugs.
In general in the past, these antiviral drugs, the effect is usually not dramatic; it's usually modest. But let's say you have a drug that you could give to people, and it would decrease the number of serious patients by 25%. ... Well, if that took from 20 patients out of 100, down to 15, these are people who would be in the hospital for 10 days — that could have a pretty dramatic effect on your hospital infrastructure, and also people dying.
I think within the next month or two, we'll see a number of study results, and hopefully something will have some significant effect, and then they'll just start using that for everybody. That also changes the testing strategy, because if you have a drug that works — like with influenza, you have to give it within two days of the symptoms developing. So that would mean we'd have to start testing everybody with symptoms aggressively, right away.
People shouldn't be shocked if, in a month or three weeks, we want to test everybody with a cold, because now we've got something and we're just pouring meds out.
If you were to get this thing now and you were hospitalized somewhere in Florida, are these medications actually being trialed on patients at this point, in local hospitals?
They are being used. Some of it's under what's called "compassionate use," where they're allowed to be used under exceptional circumstances. But a lot of it's under studies. ... If you have a serious illness and you've got a drug, even if it's investigational, that might work, it's probably worth trying. At AdventHealth, they have a protocol for this.
Is that fairly consistent across hospitals, so that you know that if, say, you go to Advent versus Halifax you have a roughly equal chance of getting an opportunity to try these meds? Do you know if that's standardized at all?
I can't speak to that. I've seen the protocol for Advent. And I know of one for Chicago. ... It's the same drugs. They're all based on little studies around the world. But everybody's going with the same drugs, the same studies. And they're putting together decent studies using multiple institutions to get enough people to draw conclusions, so it's happening really quickly.
Is there anything else that you would like to add for the community?
I think people should just stay very aware of what's going on, and trust the leadership. I think there are a lot of people working really hard on this, and they're learning from other people. And it's something we'll just have to deal with. It's a war. We're going to succeed, but we want to minimize the casualties.
