Coronavirus evokes hope, despair, and certainly confusion, all states of mind that a trio of “friendly, local, community, Santa Barbara neighborhood ER docs” attempt to level out about once a month. This Thursday evening’s webinar delivered experienced insights into COVID vaccines, airline travel, opening schools, mental health, and the wearing of masks. And the doctors also gave the basics on reducing infections: Wash your hands, stay home if you’re sick, avoid unnecessary crowds, and continue with your social “pod” if you have one.
“COVID numbers are still creeping upward, and hospitalizations are also moving in the wrong direction,” said Dr. Jason Prystowsky, who has organized several of these information drops with his colleagues Dr. Morgaine Daniels and Dr. Kristin Fontes. Prystowsky, who’d just returned from a spell with the Navajo Nation, has become known in Santa Barbara for his commitment to medical communication and education as well as his work with Doctors Without Walls (a k a Santa Barbara Street Medicine), the area mobile homeless health clinic.
But fatalities in Santa Barbara County were stable, he said, possibly due to earlier medical care. And from wearing masks, he added, which reduced the amount of virus people inhaled and made the disease “less fatal.”
“When people wear masks, they get less virus,” Dr. Daniels continued, taking up the lecture from Prystowsky. A curiosity of COVID is that infected people without symptoms actually shed a high amount of the virus, she said. When exposed to a person or place with a lot of virus, people wearing masks were less likely to have symptoms or bad symptoms, she said, citing a study published in The Lancet that reviewed 172 observational and 44 comparative studies of SARS, MERS, and COVID-19. Death rates were higher in countries before they knew to protect themselves, and lower in those whose residents consistently wore masks, the studies found.
“We can’t say we don’t know this anymore,” Daniels said. “So many studies like this are coming out.” She went on to outline the reasons to forego an exemption from the mask order. For those who became anxious and felt they couldn’t breathe wearing a cloth face covering, that was nothing compared to wearing a tight-fitting breathing mask or being intubated for oxygen in the hospital. “If I had to choose between that and a surgical mask,” she said, “the surgical mask is the way to go.”
COVID was to be avoided, Dr. Kristin Fontes made clear. “People are certainly not bouncing back from this and living normal lives,” she said, pointing to the fatigue, difficulty breathing, and body pains patients reported as long as 60 days after recovering from coronavirus. As well, studies of pandemics caused by SARS (2003’s severe acute respiratory syndrome) and MERS (2012’s Middle East respiratory syndrome) indicated similarities to a feeling of disorientation, or an effect on the brain’s executive function, from SARS-CoV-2, the virus that causes COVID-19.
Dr. Fontes gave a quick crash course in the body’s immune response, which can best be appreciated by reviewing the recorded seminar here, before describing two vaccine trials. In essence, the two trials — by Moderna and Oxford — were using strategies that had yet to be proven for humans. They hoped to stimulate not only antibodies (produced by B cells) but also T cells to induce a greater immune response to SARS-CoV-2. Study participants had some viral symptoms, but not serious ones.
Fontes raised the concern that both studies had almost entirely white participants. The virus was affecting more Black and Latinx individuals, including in Santa Barbara County, she said. If white participants had few negative reactions, it remained unclear how a vaccine against SARS-CoV-2 would affect people of other races.
The question of mask etiquette came up when Fontes described the flights she’s taken to a rural practice she attends four days a month. Early on, the airplanes were relatively empty, but now the empty center seats often hold passengers who’d been on stand-by. Worse, once in the air, a handful of passengers on every flight removed their mask and refused to put it back on. “Now, I drive when I can,” Fontes said.
The difficulty accepting masks is an example of the cognitive dissonance — or the pairing of contradictory ideas — that COVID is causing in so many aspects of normal life, Prystowsky said. Masks are necessary for health reasons, but they infringe on personal freedom. There’s a deadly virus going around, but children need to go to school.
Not only must kids learn, but working parents are facing another year of homeschooling — “almost mutually exclusive concepts,” said Prystowsky, who has a 5-year-old. We all wish we were back in 2019, he said, but we have to look at the factors we can control. Added air circulation from open doors and windows is how many third-world countries dilute the air for tuberculosis control in hospitals, Daniels noted.
The doctors didn’t have a solution for schools, where the risk to teachers from short 2nd graders would be different from that of tall high schoolers. But it seemed likely they would open and close and operate from a distance as the community infection curve rose and fell. “This is a marathon, not a sprint. The virus is not going away next month,” Prystowsky said.
The confusion among parents is a universal feeling, Prystowsky cautioned. Everyone is under some emotional stress. “What we used to do for mental health — going to the gym, to the church or synagogue, having big parties, doing hot yoga — those are closed to us now.” We’re all tired and anxious and grieving the losses, he said. “People snap at each other, snap at clerks” in grocery stores. “We’re all in this together,” he said. The more we support our community and neighborhood, the more we’re going to get through this.”
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