December 2020 COVID Update

Dear Friends,

We are now nine months into the marathon. I am not sure what I really imagined about this journey that began on March 13th. We can all look back. I was in D.C. running an FAA/Industry US Helicopter Safety Team Infrastructure Summit which we took virtual overnight before returning to Maine. 

In the months since, we have learned a lot about managing SARS CoV-2 , aka COVID. We have learned a lot about adapting while in motion and the need for rigorous safety work practices. We have made it through the last nine months. Not always smoothly but, more often than not, gracefully with a bit of luck, routine high performance, and the constant willingness to show up. The journey is far from over, despite the bright light of vaccines.

As with all provider entities LifeFlight is deeply attuned to highly infectious diseases including COVID. We are taking care of these critically ill patients every day. Through close and rigorous work practices we had not had any staff become ill since our first COVID patient transport on March 16th

Post the Thanksgiving holidays, this changed. Early last week three of our aviation team and several days later one of our clinical team became ill and tested positive. A second clinical team member tested positive last evening. With widespread community transmission there is no way to determine the original source despite everyone’s best efforts and we are uncertain if the clinician case is tied to the aviation cases. To our knowledge, the exposures and transmissions were neither the result of, nor tied to patient care.

As with everyone at home, we are a family and despite universal masks and rigorous precautions we are not immune. As we have noted earlier, LifeFlight made the decision in early April to care for every patient as if they were COVID positive regardless of current test status. We did this to protect our crews but also to protect patients. As such, the recent exposures and cases we have incurred do not impact our ability to perform safe patient care. 
Spread can be rapid. With five cases we are treating this as an outbreak, adding new controls and testing to further limit potential spread. Due to our shift schedules, ongoing major aircraft maintenance work and flight training, four additional mechanics and five more pilots were noted to have close contact exposures along with 18 clinical staff. We are working closely with our Infection Prevention specialists at Central Maine Medical Center and the Maine CDC on containing additional exposures, supporting our workforce and, as people recover, bringing our crew members back to work. This is a bump in the road, but thanks to a lot of stepping up and stepping in by our crew and staff, LifeFlight is continuing to care for Maine with all of our teams, 24 hours a day, 365 days a year.

With Thanksgiving behind us and Christmas, religious holidays and New Year’s Eve beckoning, we are about to hit the most difficult stretch in a no-easy-answers pandemic. The first rounds of vaccines are here and there is light at the end of the tunnel, but the tunnel is long. The good news is we know what to do while vaccines are being rolled out to the front line. Our clinicians are getting vaccinated starting today. 

The challenging news is we are just seeing the effect of individual choices over the Thanksgiving holiday and we are already maxing out available hospital beds. Recent studies highlight the risks of household transmission which can be rapid, regardless of age, children or adults, due to asymptomatic and pre-symptomatic transmission. (1, Journal American Medical Association JAMA, and CDC)

The projections for Maine over the next few months are unsettling. Expansion has taken us from around 25 cases a day in August, to currently over 200 a day with projections of 500 new potential cases a day by the end of December. This can result in a doubling of hospitalizations and deaths which lag new cases by 3-6 weeks respectively. At current pace, we are on track to overwhelm our healthcare system by mid-January. We have seen the pictures of what this looks like from Italy, from NYC, from El Paso.

Further, and much more troubling for Maine, the current death rate in rural locales across the country is more than double urban areas. From our current 265 total deaths we could reach 700 total deaths by March. (2, Pew Research Center, CDC)

We have to make sure it does not happen in Maine and we cannot do it alone.
What will happen or not over the next twelve weeks is the sum of every individual action either reducing or increasing risk. (3, CDC) So, what can we do individually and collectively? The single most important action we can take is to lead by example with our colleagues at work, our extended families, friends, our social networks, and every time we are in public.

The next thing is to share good information and help everyone around us work through a difficult time when we all want to be together during the holidays.
Dr. Ellie Murray, an epidemiologist from Boston University recently was interviewed about the trajectory of the next few months. From the interview on what we can do individually and collectively:

First, there’s the risk of getting infected and transmitting that infection to somebody else. I still don’t think it’s widely understood that you can transmit infection even if you feel totally fine. A lot of people think, “If I feel sick, I’ll just stay home.” But you can feel totally healthy, infect grandma or your neighbor, and realize a couple of days later that you were sick. We need people to get more comfortable thinking about that.

Second, which activities are risky, and how risky are they? This is where the idea of a continuum comes in. There’s a rhyme that [epidemiologist] Bill Miller from the Ohio State University came up with for the four dimensions to think about: “Time, space, people, place.”

Time: How much time are you spending doing this activity? The more time you spend, the more chance there is for transmission. The less time you spend, the less chance.

Space: How much personal space do you have? Are you able to get a distance from people? Is it 6 feet or not? If you’re singing or cheering, you’ll need more space because your respiratory particles can travel further than 6 feet. The more personal space, the better. If you’re out in the woods by yourself with no one around, you don’t need that mask on, because there’s no one to transmit to or get infected by.

People: How many people are there? Are these people you see regularly? Are they part of your core bubble, or strangers? It’s safer to spend time with mostly the same group, and safer to have fewer people in that group.

Place: Where is this? Certain places are more conducive to transmission. A small room where everyone’s packed in together is riskier than a large space. A museum is typically a much larger space than a bar, which is generally smaller with a low ceiling. Outdoors is safer than indoors. Indoors with the windows open is safer than indoors with the windows closed.

Think through all of that. What are the activities that I must do? What are the activities I just want to do? How risky are they? How can I make them a little bit safer?Thanksgiving is behind us. Christmas and New Year’s Eve are ahead. Next year can be different.

In the meantime, at the height of nightly bombing during WWII, Winston Churchill noted “If you’re going through hell, keep going.”  And every day, as Churchill noted, we just need to keep going. We know how to do this, we did it all summer. Practice the 4 W’s: Wear my mask, Wash my hands, Watch my distance, What are my symptoms. If we all work together next year’s holidays will be different. We can make it through to the other side. A huge thanks to everyone who helps us take care of Maine, every day, when you show up.

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

1. In home transmission. A new study published in the Journal American Medical Association on in household transmission and the CDC Weekly Report on Morbidity and Mortality
2. The changing geography of COVID: Rural Impacts. The Pew Research Center and the CDC Weekly Report on Morbidity and Mortality.
3. What we can do to reduce transmission. CDC Weekly Report on Morbidity and Mortality.