StemCell Therapy

RALEIGH As North Carolina prepared to enter Phase Two of Gov. Roy Cooper's plan to reopen the state in the midst of the coronavirus pandemic, we talked to some local health experts in May about which Phase Two activities they considered safe or risky.

We asked doctors from UNC and Duke at that time about their comfort level in visiting restaurant dining rooms, barbershops and nail salons, swimming pools, malls and indoor church services.

For this follow-up two months later, we asked our experts how they felt about sending kids (or young adults) back to school in the fall; about patronizing bars, gyms and bowling alleys; and about attending outdoor protests.

The first thing we learned from checking back in with our experts is that their feelings about the activities we discussed in our first story haven't changed much. In fact, if anything, most of our doctors held stricter opinions now than they did in May.

On Saturday, North Carolina had nearly 1,100 people in hospitals with COVID-19 issues, marking the fifth consecutive day the state broke a record for hospitalizations, according to data from the N.C. Department of Health and Human Services. There were 1,093 hospitalizations on Saturday and the number of positive confirmed cases of coronavirus hit an all-time, one-day high of 2,462 since the virus reached the state in early March.

"Compared to May, the risk of being infected with this coronavirus has only increased," said Dr. David Alain Wohl, a professor at the Institute of Global Health and Infectious Diseases at UNC-Chapel Hill.

"There are more people infected currently out and about, and many are not mask-wearing or physically distancing either, for reasons that are not evidence-based or because they are being neglectful."

Dr. Amir Barzin, professor and director of UNC Family Medicine Center, has also become more cautious since May.

"A lot of what we talked about before still is very applicable to right now," Barzin said. "If anything, I'm understanding as a physician that this is a longer and longer course, and so my ethical responsibility as a doctor is to try to keep myself healthy and safe longer and longer. So if anything, maybe I've become a bit more conservative."

In addition to Wohl and Barzin, we followed up with Dr. Tony Moody, associate professor in the Department of Pediatrics at Duke University School of Medicine and member of the Duke Human Vaccine Institute; and Dr. Sallie Permar, a professor of pediatric infectious disease, immunology and molecular genetics at the Duke School of Medicine. In our first round, we also spoke to Regina Petteway, director of Wake County Human Services. Petteway retired on July 1, so for our follow-up, we talked to Chris Kippes, Wake County Public Health division director.

There has been much discussion about reopening bars and gyms, so we asked our experts if those are places they would feel comfortable visiting.

For our experts, it's a resounding "no" particularly in regard to bars.

Wohl told us "no way" when we asked about bars, and "absolutely not" when we asked about gyms. As for exercise, "I exercise out of doors with others who I stay a generous distance from," Wohl said.

Moody was also a "no" on bars and gyms.

"While I really like the socialization, the bar setting is exactly the kind of place where transmission may be easiest," Moody said. "People may have lowered inhibitions, and they are usually in tight quarters, often talking directly into each other's faces or ears, especially if conversation and music is loud."

Moody said that like bars, the activities in gyms are exactly those most likely to speed transmission.

"People are breathing heavily and may be much less likely to wear a mask, both of which would facilitate virus spread into the air," Moody said.

"Also, people may be touching their face more frequently and then depositing infectious particles on surfaces, and it is challenging to have people be scrupulous about cleaning surfaces after every use. Classes (spin, yoga, aerobics, etc.) where you have many people in a tight space are perfect for transmission."

Moody says for now he is working out at home and getting lots of outdoor exercise by biking and walking, making sure he can distance and avoid people.

"Even then," he added, "I've taken to carrying a mask so that if I have to approach someone, I can cover up."

Barzin told us that he would "definitely not" visit a bar right now.

"That is one of the absolute 'hard Nos' for me," he said, citing an atmosphere favorable to the "potential spread of contagion."

Barzin said he understands bar owners' desire to reopen, but worries about the long-term repercussions of opening too soon and then having an outbreak associated with a business.

But he said there is, in theory, a right way and a wrong way to reopen.

"If you have the opportunity to be outdoors, if you put tables outdoors, that would make it more attractive, I think," Barzin said. "It makes it more safe for the patrons. But right now, I'm trying to limit exposure in confined areas for prolonged periods of time. "

His feelings about gyms are similar.

"I think again this is one of those situations where you get a lot of people confined," he said. "Especially in a gym, people are exerting themselves, they are breathing harder ... that is not an area where I'd spend a lot of time."

Permar is in agreement about bars and gyms.

"The point of going to a bar, congregating and talking in a group of adults, is a high-risk setting for transmission," she said. "Moreover, drinking and universal masking don't mix well. But I would like to be able to order takeout cocktails!"

At gyms, the heavy breathing during a workout can be a high-risk setting for transmission, Permar said.

"And masking could be seen as a challenge and may be less effective in this setting. Outdoor, spaced group workouts seem like a way for group physical activity to continue."

Kippes said he would not visit a bar at this time. He said he would visit a gym "only if the gym was able to assure social distancing, require use of face masks/coverings and have procedures in place to keep equipment clean between individual usage."

The reason we asked this question which on the surface may seem a little random is because of the recent lawsuit in which owners of bowling alleys are demanding they be allowed to reopen. This week, Wake County Superior Court Judge James Gale said Gov. Roy Cooper didn't give good enough evidence why bowling alleys should remain closed.

Our health experts disagree.

Moody said he would "probably not" go bowling for some of the same reasons he wouldn't go to a bar or gym.

"Bowling alleys are generally less crowded and the exertion level is lower, but the enclosed space is still an issue," he said.

Permar said she will avoid this type of indoor activity because it promotes a congregation of adults. (She is very hopeful that drive-in movies will make a comeback, though.)

Barzin also dislikes the idea of "a lot of people in one area at the same time."

Bowling is "not something we do on a regular basis and not something we would start doing at this time," he said.

Kippes says if the bowling alley was able to assure social distancing and require the use of face coverings, he would consider it.

Wohl was straight and to the point: "No offense to bowling fans, but this seems like a really low priority during an ongoing pandemic."

Our experts were a little more mixed in their comfort level attending protests, but primarily agreed that it all depends on the circumstances.

Wohl warned against any mass gatherings, including protests, sporting events or political rallies, where masks are eschewed and people are packed closely together. These types of situations "smack of a denial that there is a deadly contagious pathogen circulating in our country," he said.

And when you take those activities indoors, even worse, he said.

But if mask rules and distancing protocols are followed, and it takes place outdoors, Wohl is more comfortable with protests.

"Demonstrations organized to promote distancing and face masks and are held in the open air, are less risky," he said. "And given the importance of such protests at this moment, (they) are acceptable to me."

Kippes said he would attend an outdoor protest or rally if social distancing was maintained and all who attended wore face masks or coverings.

Permar said she is not only comfortable with attending outdoor protests, she has done it.

"I would and have (attend a protest), while wearing a mask and distancing," she said. "I support the important fight against systemic racism which has been amplified by these protests over the last few weeks."

Barzin said he supports protests, and feels that the ones where people are spaced and wearing face coverings are "a little bit safer in terms of something I would consider doing."

"If it was a large mass protest where they weren't requiring those things, even though I would feel like the social issues are the correct ones to participate in, I don't know if I would be out there participating in that just based off the fact that my job requires me to be healthy. I want to provide good care for people, I don't want to put any extra risk on myself or my family or my patients."

Moody was conflicted about protests, but echoed Barzin's concerns about putting his patients at risk.

"Being outdoors is helpful, the crowds are not," he said. "I am very supportive of our right as Americans to protest and view the choice to do so, even at a time of pandemic, as intensely personal."

Moody said he has considered attending protests in Raleigh, but in the end opted not to because he feels an obligation to his patients to be well when he sees them.

"However, I also have an obligation to my patients to advocate for them, and I have a desire to participate as many of my colleagues and friends have," he said. "We all know that 2020 has been a challenging year, and while I have not yet gone to a public protest, I have not ruled it out."

The question of whether or not to send children of any age back to school right now was especially hard for most of our experts. Next week, Cooper is expected to announce the state's plan for reopening schools, but many parents are conflicted.

"There is a terrible tension between the concerns regarding infection at school and the emotional and educational well-being of children and their families," said Wohl, who noted that the American Academy of Pediatrics recommended that students be physically present in school provided "transmission mitigating strategies" are also in place.

"They point out the toll being out of school is taking on children and adolescents, as well as their parents and caregivers," he said. "I do think a balance can be arrived at."

When it comes to college students returning to campus, Wohl says that is "more challenging when the student resides on campus, rather than at home. This requires a lot of discussion for all those impacted by campus reopening, and a close eye on regional trends related to the pandemic."

Permar, our expert in pediatric infectious disease and immunology, has school-age children and says she will send them back to school.

"I support in-person school for all of the benefits that children receive there, including teacher and peer interactions, physical activity and stable meals, that I believe outweighs the risks for children," she said. "The limited disease from SARS-CoV-2 infection in children has been consistent. Moreover, there is growing data that children are less likely to transmit to adults versus the other way around, and masking would further reduce transmission."

Permar says that masking teachers and staff and eliminating unmasked interactions with co-workers (for example, no eating together) should provide them protection. This has proven effective in protecting health care workers, she said.

But she stresses that resources must be committed to schools to make sure they have personal protective equipment for staff, adequate cleaning supplies and the ability to physically distance everyone.

"We should prioritize opening schools over other parts of society, such as restaurants and bars, and promote the development of harm-reduction metrics to monitor virus transmission and child well-being that are specific to school settings instead of applying measures of adult case numbers only to determine if the benefits continue to outweigh the risks of keeping schools open," Permar said.

Kippes agrees, saying he would send his children back to school or college as long as they have plans that "follow recommended guidelines including procedures for social distancing."

Barzin, who has a toddler, recognizes the need for school kids to have social interaction, but isn't sure what's best right now.

"It's a really tough decision as a family," he said. "It's hard because you really want to promote the educational component and the social interaction, but if you're 6 years old and you're doing that in a separated space, how much benefit is actually there for the child versus the instruction that they're getting? It's really tough to know."

Moody is perhaps most cautious.

"This is challenging," he said. "While most data suggests the young are at less risk, it's not zero risk. And large gatherings like school are the perfect way to transmit an illness like COVID-19.

"That being said, there are very good reasons to send children to school and college, including their education and the social interaction they get."

Moody also recognizes that many parents depend on school so that they can go to work, so there are economic impacts, too.

"I don't think this is something that has a single right answer, but I think some degree of caution is needed," he said.

Even with what Moody considers "reasonable" college plans, which have students on campus without breaks and finishing before Thanksgiving, it's hard to prevent the students from interacting with the outside world.

"And once the virus gets into the student population, it may be hard to control," he added.

"As of right now, I'm adopting a wait-and-see attitude, and I think we are probably in for some combination of home schooling, smaller classes, and altered schedules for a while to come."

Go here to read the rest:
Is it safe to send kids to school? Visit gyms? Attend a protest? N.C. experts weigh in. - Winston-Salem Journal

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