Deconstructing Covid

Dr Ghalib Mannan is an Infectious Disease Specialist in Shelby County with more than 20 years of experience in the management of patients with infectious diseases. He graduated from Medical School from the University of Wales College of Medicine in the United Kingdom in 1992 and he has almost 30 years of experience in clinical practice.

Due to the recent increase in Covid-19 cases, the PVS Newsletter wanted to ask Dr. Ghalib Mannan on his professional opinion and advice regarding the pandemic.

1.Will there be a second wave of COVID-19?

Dr. Mannan: There have been three peaks since the beginning of the pandemic. The first peak was in April, when the cases first started; then there was a second peak in August, and things were improving quite a bit in September. What we are going through right now is the beginning of a third peak. In the last two weeks or so, we have been seeing an increase. We are on the upwards curve right now and we haven’t reached the new peak yet. There are two main ways we can determine whether we have reached a new peak or are reaching a new peak. The first way is the number of new cases a day and the second way is through the positivity rate. For example, during Shelby County’s peak in July or August, the number of new cases was up to 300 or 400 a day. Right now Shelby County is averaging 100 to 200 new cases a day. A low number of cases a day would be anything below 50 cases a day. The number of new cases is trending upwards right now. The positivity rate is what percentage of coronavirus tests come back positive. Anything above ten percent is considered a high positivity rate. Our positivity rate is averaging 8 to 10 percent right now. In July and August the positivity rate was as high as 15 to 18 percent. When our numbers in September came down our positive rate was as low as 4 to 5 percent. Because the number of new cases and the positivity rate are both trending upwards scientists can predict that we are heading for a new peak.

2. There are reports of vaccines being developed. When do you expect a vaccine being released to the public?

Dr. Mannan: There are currently a lot of vaccines being developed around the world, with around 4 or 5 making the most progress in the development. These 4 or 5 vaccines that have been progressing the most are in China, United States, and Britain. The estimated time of availability and first release of a vaccine will be around the end of November to mid- December. The logistical problem is that not everyone will be granted access to the vaccine, as the global population needs to be vaccinated. There will be a prioritization of who gets access to the vaccine first, with those who are in the frontline of dealing with COVID-19 every day, like doctors, nurses and hospital workers getting the vaccine first. Another group of the population that will be prioritized to be vaccinated, are the ones with high risks such as the elderly, those with chronic medical problems that can lead to higher medical complications specifically people with diabetes, lung problems, obesity, chronic heart problems, and those who take medication that can suppress the immune system. After vaccinating the initial group at risk, they can begin vaccinating the rest of the population: healthier or younger population. It may take until spring or the summer for the whole world to be vaccinated.

3.Can families go out at this time? Can friends meet up?

Dr. Mannan: I think it is important that families get out occasionally. But the important thing is to do it safely because the amount of community spread is increasing right now. So families can go out, but they should take precautions. They should choose to go places where the rate of transmission is low. One option is to go to a park, hiking, or any place where you are not too close to other people and are in open air. You don't want to go to a packed cinema hall, for example. Anytime you go out you should wear a mask to reduce the risk of transmission. You want to make sure you are protected by wearing a mask. As far as gathering with friends, you have to be careful with meeting up with your friends. The only guarantee that it is safe to mix with others is if they have tested negative for COVID-19 recently. It has been shown that a lot of spread is occurring in small gatherings with friends and even families. Try to restrict gatherings to 10 or fewer people, wear masks and try to keep gatherings in open air.

4. Do you think cases are low enough for institutions to begin opening up?

Dr. Mannan: We're probably going to be watching the community spread and the cases until the end of next year when it comes to terms of reopening institutions like schools. The CDC has provided a set of guidelines for how to open up schools, business, etc. properly during this COVID-19 crisis. Whenever you have a group of people together in the same area, it brings the risk of spreading or contracting COVID-19. The question is how to minimize this risk of people getting infected in these large spaces while continuing the daily activities and obligations. Some solutions for reopening institutions like schools would be to open up gradually, utilizing smaller groups slowly coming in, and practice cohorting. Cohorting is the practice of separating the total number of people into groups, and each group stays isolated and only interacts with the people in their own group. This prevents people in other groups from possibly getting the virus from anyone but their own individual group if that situation would occur. Another solution we are looking at when it comes to reopening, is the enforcement of masks in the workplace, as wearing masks is a very strong way of preventing the virus from spreading. Handwashing stations are also crucial to preventing the spread of the virus, as the virus can spread through touch. Also, regular testing of everyone in a school or business can help pinpoint the virus quickly before it spreads and causes places to shut down.