Pinellas County docs tackle COVID-19 myths

There are more positive COVID-19 cases simply because there are more tests. Young people won’t suffer serious consequences if they get COVID-19. “Herd immunity” is the best way to approach the virus.

Two top Pinellas County public health officials debunked those statements and others during a 45-minute Facebook Live discussion Tuesday morning. Both physicians — Dr. Angus Jameson, medical director, Pinellas County Emergency Management, and Dr. Jon Thogmartin, Pinellas County medical examiner — emphasized their concerns about the growing number of COVID cases, the strain local hospitals are starting to feel as a result and the serious consequences of the disease on public health and the economy.

“We are seeing significant numbers of COVID patients. We are finding them in nursing homes and in the community and taking them to the hospitals,” Jameson said, expanding on his comments to the St. Pete Catalyst on Monday. “We’re also seeing significant increases in the number of folks coming for testing and the number of folks testing positive. Our hospitals in Pinellas County today have more COVID patients in-house than they have had at any time previously.”

Related: Pinellas County hospitals preparing for a surge in COVID-19 patients

As of Tuesday morning, 4,033 Pinellas County residents have tested positive for COVID-19 since the Florida Department of Health began reporting case counts by county in early March. That was an increase of 179 cases from Monday.

Also as of Tuesday, there have been 129 deaths in Pinellas attributed to COVID-19, a one-day increase of 12 deaths.

Some skeptics have questioned those death counts, suggesting that some people are incorrectly counted as COVID deaths if they are in the hospital for reasons unrelated to COVID and also test positive.

“That is not true amongst my colleagues in Florida. Medical examiners certify in Florida all COVID deaths. If there’s a COVID death, we’ll do an autopsy and examination or investigation. None of my colleagues are just calling it COVID just because they’re positive,” Thogmartin said. “We do an autopsy or exam and for the complex cases we do a very detailed autopsy to figure out what’s going on. So if you are looking at Florida’s numbers  — and Florida has the best medical examiner system in the country, if not the world, with more forensic pathologists per capita than any place else — so if you’re looking at Florida’s numbers of deaths, they are as correct as humans can possibly make them.”

Both physicians addressed other unsubstantiated public comments that have been made about the COVID-19 pandemic.

• Public comment: “There are more positive cases because testing has increased.”

“The numbers of tests are up substantially … but of those looking for tests, we’ve gone from 1 or 2 percent coming back positive to a much higher percentage coming back positive, 10, 15, some testing sites have told me 20 or more percent of the tests are coming back positive,” Jameson said. “I don’t think you can explain away the increased cases based upon the testing and I certainly don’t think you can explain away the increased number of patients in the hospital, the increased number of patients in the ICU and the increased number of people that Dr. Thogmartin is seeing come through his office based upon testing.”

• Public comment: “Young people are less likely to suffer serious consequences.”

Even though a young, healthy person most likely will come through OK, there’s no guarantee of that, Jameson said.

“This is a new virus and we’re still learning about it every day. The further we get into this and the more people that have had this disease, the more we learn that there may be long-term effects we don’t fully understand yet,” Jameson said. That includes inflammatory syndrome in young children, a condition where different body parts become inflamed, according to the Centers for Disease Control.

“That’s just one piece of it. We’re seeing people who have significant lung damage after pneumonia. That’s going to really change your life if a year from now you can’t exercise or have to wear oxygen all the time. We’re seeing early reports of neurologic complications that could be long term,” Jameson said. “We know there’s a couple of important risks, like the virus seems to make your blood more prone to clotting, so we’re seeing people come in with pulmonary emboli, or blood clots in the lungs. We’ve also seen case reports of people presenting with heart attacks or strokes, because the blood is clotting more easily.”

• Public comment:  “‘Herd immunity’ — when most of the population is immune to infection – will eventually take place.”

Herd immunity generally means that about 70 percent of the population has had an infection, Jameson said. Currently the percentage of people who have had COVID-19 is in the single digits, he said.

“Just letting it burn through the population is not a good strategy for a lot of reasons. First, some people, frankly a lot of people, will eventually get sick and potentially die. Two, the healthcare system will likely become overwhelmed at some point during that when you get one big spike, and then people [with conditions other than COVID] will also unnecessarily die. And three, between where we are right now and a level of infection in the community that would provide herd immunity is a whole lot of pain and suffering and that is just not a pathway we want to go down,” Jameson said.

The goal is to learn to live safely with the virus and keep infection rates low until there is a vaccine, Jameson said.

“I would agree with that,” Thogmartin said. “This novel virus that we don’t know anything about has significant morbidity and mortality. You cannot let it burn through us. It would be a disaster. It would break us. And it would take us a decade to climb out of it, as far as economic damage and just damage to the communities in general.”

• Public comment: “Vaccines will soon be available.”

Thogmartin said there are three or four good vaccine candidates.

“They appear to be making great progress, although we have to wait. The worst news possible would be none of them work,” Thogmartin said. “I would be happy with a vaccine that just prevents severe disease.”

Coronavirus in particular is a notoriously difficult virus to get a vaccine for, Jameson said, citing earlier unsuccessful attempts to develop vaccines for two other types of coronavirus, MERS and SARS.

“Now I hope that this time with the amount of resources that are focused on it that we will be successful, but we need to continue to act as though that’s not around the corner,” he said. “Even if we have one that works by the end of the year, by the time we get a big enough slice of the population immunized to give us that herd immunity it’s still going to be months.”

• Public comment: “Another lockdown is the answer.”

“You can’t lock down an economy for that many months without destroying your economy so we just have to be smart,” Thogmartin said. “There are  certain businesses that are high risk and those are going to  have to modify how they work, otherwise they’re going to be the epicenter of super spreader events … Bars and restaurants have to up their game while they are serving customers.”

• Public comment: “Face coverings aren’t effective.”

The Lancet, a well-respected medical journal, recently took the best evidence it could find from 172 studies in 16 countries covering six continents and found that distancing and masks are both effective ways to reduce the risk of transmission, Jameson said.

While different kinds of masks perform differently, there are some basic things a wearer can do to make the masks perform as well as possible.

“First of all, don’t wear it on your chin. Wear it over your mouth and your nose, both of them, all the time. A mask over your mouth while your nose is out is not effective. You see that sometimes, people walking around with a mask below the nose or on the chin and that seems more like a fashion statement than protective equipment. So wear the mask and stay apart from folks whenever possible. The risk of transmitting virus one to another in this review of all of this data substantially decreased with every meter you put between you and somebody else. And the risk of transmission substantially decreased if one – and more if both- people were wearing any kind of mask,” Jameson said.

Surgical masks, procedure masks with elastic earloops and cloth masks all provide protection, Jameson said.

Masks worn by healthcare professionals such as N95 masks have to be fit to a person’s face to work properly and have exhalation valves that protect the wearer, but not the people around the wearer, Thogmartin said.

• Public comment: “We took steps to ‘flatten the curve’ – slow the spread so that hospitals would have adequate capacity to treat patients – and now the curve is flat.”

“Three weeks ago I would have agreed with you but the curve is not flat right now. The curve is growing exponentially and it is the opposite of flat right now. There are more people hospitalized and there are more people in the ICU in Pinellas County than at any point previously from COVID-19 and that’s going up very fast,” Jameson said.

“Our curve is as steep as it’s ever been, if not steeper,” Thogmartin said.

Jameson said the community did “an amazing job” to flatten the curve initially.

“Three weeks, myself and other doctors were starting to see something. Two weeks ago, we said we’re definitely seeing something. One week ago, it was ‘uh-oh, this is not looking good,’” Jameson said. “I can tell you as of this week our daily case counts have doubled every five to seven days over the last three weeks and now we’re seeing the next lagging indicator, which is hospitalizations and ICUs are beginning to increase significantly this week, and I am really scared that Dr. Thogmartin’s work is going to get busy in another week or two.”