February 2021 COVID Update

Dear Friends,

With yesterday’s snow it finally seems to be winter in Maine. Yesterday was also the first anniversary of the death of Dr. Li Wenliang, the physician in China who first alerted the science community about a potentially new dangerous virus before being silenced and then succumbing to the disease he was treating, and Ms. Patricia Dowd, the first person in the US to succumb to COVID-19. It has been an extraordinary year in which the pandemic has raged and science has responded with new hope and light at the end of this long dark road.

Nationwide, there is some good news between declining new infection rates, positivity rates, and vaccines. In Maine we are finding the same which is hopeful, but we must remain cautious. The early disease models accurately predicted both of the second wave surges we’ve seen. They also predicted the sawtooth pattern of rapid rises in disease followed by decline rates as we embrace mitigation measures—physical distance, avoidance of indoor gatherings of large numbers of strangers, hand hygiene, improved ventilation, and most importantly the use of masks
 to reduce aerosolized viral exposure from others to us and their exposure from us in asymptomatic transmission.

The battle between science and politics remains troubling. And at the top of the list are masks, which remain the single most important step we can take in protecting ourselves, our loved ones, and the community we share.

Mandating masks has never been about personal liberty or government overreach. It is simply what each of us must do as citizens. We have all had to compromise our individual liberties for the greater good in this pandemic. Mandatory mask wearing is the single most effective tool we have on the frontline defense to keep our hospitals ready to care for all diseases, our healthcare workers safe, our schools open, and our economy recovering. 

Wearing masks in public is our social responsibility as citizens and is even more necessary as new virus variants take hold with much higher transmission infectivity rates and worrying hospitalization and death rates. The new variants will likely be predominant in the US by mid to late March with a 35-40% increase in transmissibility. While the overall new case numbers in Maine and the US are declining at the moment, we expect another surge in the third week of April.

With the new variants, masks in public are even more important and recent guidance asks us to consider double masks when in higher risk indoor situations with many people not from your household. As we continue to learn how to better manage SARS Co-V-2, the science of masks is ever more clear in a recent CDC study showing a significant decline in hospitalization rates for ages 18-64 years comparing pre and post mandatory mask policies issued in ten different states. i

What we need to do: We need to double down on good masks worn properly (more science on masks is on our website under “Research to Understand COVID-19”).

While positivity rates, new cases, and new hospitalization rates are currently in decline in Maine, our ICUs are still challenged with COVID-19 adding to what is typically the busiest time of year for ICU admissions. Unfortunately, deaths, which lag hospitalizations by three weeks, continue. Overall, the news is mixed and we cannot become complacent. While the newest numbers are declining, as compared to early November our new case rates remains doubled, our hospitalization rates remain 2.5 times greater, and our deaths are 3 times greater. While the light of vaccines beckons, we must not become complacent. We are not out of the woods on this dark road. ii iii

As noted in another CDC rapid study published in their weekly Morbidity and Mortality Weekly Review:
“COVID-19 pandemic control requires a multipronged application of evidence-based strategies while improving health equity: universal face mask use, physical distancing, avoiding nonessential indoor spaces, increasing testing, prompt quarantine of exposed persons, safeguarding those at increased risk for severe illness or death, protecting essential workers, postponing travel, enhancing ventilation and hand hygiene, and achieving widespread COVID-19 vaccination coverage.”iv

What we need to do: For the next few months we need to make a focused effort on each of the mitigation strategies noted by the CDC while we engage in the race between the new variants and vaccines. 

But as noted earlier there is good news and reason to hope on this difficult journey. Vaccines, while still bumpy in the roll out, are beginning to expand to our priority populations as we finish vaccinating the frontline health workers. While implementation is frustrating Maine is doing well and we have built a system to mass vaccinate those who want vaccines and, as the supply catches up with delivery, we will meet the demand. Patience is needed and our mitigation strategies remain critical in the interim in the race between the new variants and vaccines. 

The early good news comes from Israel which leads the world in vaccination with over 80% of their elderly now vaccinated. Within weeks the early effects are visible. Dr. Eran Segal, a computational biologist at the Weizmann Institute of Science, has published early results showing an overall 34% reduction in hospitalizations among those vaccinated, along with some particularly important early signals.

Those most at risk, greater than 60 years of age, experienced a reduction of serious disease requiring hospitalization of 46%, while in the younger population hospitalization rates are down modestly due to the third complete national lockdown.

Graphic courtesy of The Financial Times. The full graphic of Dr. Segal’s work courtesy of the journal Nature is on our website COVID section under “Research to Understand COVID-19.”
What we need to do: Be patient with the roll out. It is getting better day by day. In the interim, wear a mask and consider a double mask when in crowded indoor public spaces, continue mitigation strategies, and register to get vaccinated as the phases move forward. 
On this anniversary of the deaths of Dr. Li Wenliang and Ms. Patricia Dowd due to COVID-19, we worry about the Super Bowl effect on transmission. These are challenging times. Our safety and our loved ones’ safety and health are tethered to our individual choices. There is light ahead on this troubled road but there are going to be bumps and challenges.

In our practice of medicine in aviation/transport, complacency is our single greatest risk. If we lose focus, even for just an instant, catastrophe is possible. In facing COVID-19 it is the same. Discipline in the mitigation measures we bring to our practice have kept us and our patients safe. We can continue to make our way through the pandemic if we all work together.  
Stay safe and healthy.

On behalf of the LifeFlight team, 
Thomas Judge, Paramedic Executive Director
Norm Dinerman, MD, FACEP Medical Director

Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates — 10 States, March–October 2020
ii https://covidtracking.com/
iii https://dsd.c19hcc.org/
iv Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020