COVID-19 Q&A WITH DRS. KIRTON AND HAFIZ

It has been nearly five months since South Dakota reported the first COVID-19 case. Our knowledge of the virus has dramatically changed over this time and advice on how we should respond has continued to evolve. This week we asked the outgoing and incoming Chief of Medical Staff at Freeman Regional Health Services, Ken Kirton, MD and Shakil Hafiz, DO, to answer questions to help us understand the current COVID-19 situation.

What have we learned about COVID-19 illness?

Dr. Kirton: While COVID-19 can easily infect anyone, older individuals (60 and over) and those with underlying medical problems (diabetes, overweight, heart disease, respiratory disease) are more likely to become seriously ill and die if they contract the virus. Many carry the virus and spread it to others despite having no symptoms. This makes it very difficult to know who could spread the virus. COVID-19 primarily affects the respiratory system, but can cause problems with any system. Some have minor cold symptoms or simply the loss of smell. Others have significant symptoms that cause severe illness such as respiratory failure that require hospitalization. A small percentage die from the infection.

Dr. Hafiz: Even if you are confident that you will not get very ill if you contract COVID-19, we need to realize that parents or grandparents may not be so fortunate. If we become an asymptomatic carrier and pass it onto grandma, then life will not be the same ever again. Worst case scenario, she will die, making grandpa a widower after being married for 60 years. Best case scenario, she will survive, but her quality of life may never be the same. We see it all the time, when elderly people contract influenza and years later they are still saying that they are rundown, fatigued and easily lose their breath. COVID-19 is worse than influenza.

How has treating COVID-19 patients changed?

Dr. Kirton: Our ability to test and determine who is infected has become better and more widely available. Slowly doctors and nurses have become more effective in helping support and successfully treat infected individuals. However, the options to provide significant help is still quite limited and of variable effectiveness. We have learned that many who become ill, may survive, but have to live with the residual effects from the virus.

Is COVID-19 no longer a concern for our community?

Dr. Kirton: All of us have been living with the impact of COVID-19 for almost five months. The effect on all of our lives has been significant. It is very understandable that each of us might have our own unique perspective on what has happened in our country, state and local community. I am sure we have all felt a wide range of emotions during this time including frustration, concern, anger and disbelief. Seeing the number of COVID-19 cases steadily increase across most of the country has created a concern about what is to come.

Dr. Hafiz: I am worried that it is actually about to begin for our community. In the beginning, our community and our state did a great job taking preventive measures, such as discouraging noncritical business, encouraging social distancing, home isolation, frequent handwashing / sanitization and masking. We started off being hypervigilant and extra cautious. This did a very good job to freeze the spread of COVID-19. This was also critical because it gave our medical centers a chance to learn about the disease and to prepare as best as possible. But over the past several weeks, we have all grown fatigued and maybe annoyed of being so careful. More and more businesses have relaxed their COVID-19 precautions and we are certainly seeing the attitude of the general public returning to “business as usual.” This combination will allow the COVID-19 virus to resurface and spread very quickly.

How should our community respond?

Dr. Hafiz: It is not a viable solution to shut everything down again. As a community we need to keep moving forward. We need to resume our businesses, jobs and livelihoods. We need to spend time with our family and loved ones again, because mental and emotional health is just as important as our physical health. But as we return to our day-to-day activities, it is especially important to preserve the good habits that were encouraged – social distancing, hand washing/sanitizing and masking. If we increase our interactions and decrease our personal protection, then this will not end well.

Dr. Kirton: I still believe those of us that have made Freeman and the surrounding community our home, are blessed to live in a place where people truly care about each other and are concerned about the welfare of their families, friends and neighbors. These social interventions are not new. They are the same principles that have been used in the past to slow and eventually eliminate outbreaks of respiratory viruses. These measures have been shown to be effective by our ancestors. The places that have effectively adopted these principles have been effective in changing the impact of COVID-19 on their community.

What is our current understanding of how the COVID-19 virus spreads?

Dr. Kirton: The major means of spread is thought to be contact with infected airspace. An airspace becomes contaminated when a person breathes, speaks, coughs, sings or sneezes. The virus moves from the infected person’s nose, throat or lungs into the air surrounding them. A non-infected person can become infected through breathing in the virus in that contaminated air space. The secondary means of spread is through contact with the virus on a surface and touching the nose and face. We have learned that frequent hand washing or sanitizing effectively lessens the likelihood of spread of the virus through contact with contaminated surfaces.

What are the factors affecting COVID-19 spread?

Dr. Hafiz: My first recommendation would be to keep your distance. If “6 feet” is too cumbersome to remember, then simplify it and remember to stay more spaced out than what you would typically do. Instead of having people over and sitting around the dinner table, why not move the meal outdoors on the patio and keep a little bit more space between each other? When we see each other in the parking lot and we visit, instead of standing shoulder to shoulder, take a few steps back and then visit. Instead of hugging and shaking hands, we can fist bump or elbow bump each other. We can still do the important things, but we need to be creative in keeping each other safe.

Dr. Kirton: COVID-19 is primarily spread by coming in close contact with someone who is infected with the virus. Airborne spread is significantly affected by time, space and place. The greater the length of time spent in close contact with an infected person shedding the virus increases the potential for spread. The greater the distance (at least six feet) between an infected person and a non-infected person lowers the likelihood of spread. An encounter occurring outside is dramatically less likely to spread the virus compared to an encounter inside or in a closed space.

Are hand washing and sanitization necessary?

Dr. Hafiz: Keeping our distance does a good job to ensure that we do not share the virus between each other. But if somebody touched the door handle, the shopping cart or the pen that you are using, then you may have picked up the virus on your fingertips. Surround yourself with hand sanitizer and make it second nature that every time you pass a bottle, you sanitize your hands. Keep it on your work desk, in the breakroom, in your car (or tractor), at your front and back doors of your house, then you will help reduce any virus that you may have passively picked up.

Are masks effective?

Dr. Kirton: The topic of masks has become a very emotional topic. Masks have been clearly demonstrated to decrease the spread of the virus. They provide the greatest benefit when worn by an infected person shedding the virus. The mask significantly lessens the amount of virus sent into the air when they cough, breathe, talk, sing or shout. Masks also provide some degree of protection to non-infected people when they come into close contact with a person shedding the virus.

Dr. Hafiz: My advice would be to wear a mask. Once the virus is on your fingers, the next place it will go is in your eyes, nose or mouth. We scratch our eyes, rub our noses and lick our fingers. Many people argue that wearing a cloth mask may not block airborne virus particles. But there are other benefits to the mask such as reminding you to not touch your face or mouth. I personally am reassured when I see others wearing a mask. It tells me that they are well aware of the threat of COVID-19. When I see others in close proximity to me, in indoor spaces, without a mask that makes me very nervous. When I see people wearing a mask that is reassuring and communicates to me that they are making a conscious effort to be cautious.

Any additional messages that you would like to share?

Dr. Kirton: Wearing a mask is really about showing concern, care and respect for others, since each of us could have the virus without having symptoms and give it unknowingly to someone else who might become seriously ill. A mask can greatly decrease the likelihood that a person shedding the virus could spread it to many others. A mask helps to protect you. But even more it helps to protect others and sends a powerful message of care and concern to our friends, family and community.

Dr. Hafiz: We need to move on and learn how to resume life, while still maintaining a high respect for COVID-19. The difference between life and death is very small. Keep a few extra feet of distance between each other. Instead of spending ten minutes with each other, spend five. Instead of sharing a meal indoors, do it outdoors. Do not sit so close to each other when we are at the ballgame. I think it is absolutely doable for us to enjoy a high-quality life, while doing the small things that will go a very long way in keeping all of us safe.