Answering Your Questions About the Rise in COVID-19 Cases

By , KCBS All News 106.9FM and 740AM

As we continue to navigate these unprecedented times, KCBS Radio is getting the answers to your questions about the coronavirus pandemic.

We took a look at the rising cases across the country and ways we can all limit the spread of disease with Dr. Peter Chin-Hong, infectious disease specialist at UCSF.

Let me start by asking you to give us your broad assessment of where we stand right now, vis-a-vis where, maybe a month ago, you might have thought things would be today.

Totally. A month ago I was looking forward to a haircut, I was looking forward to reopening and may be venturing forth, to maybe trying out some outside dining. But right now I scaled back my expectations. I'm starting to feel nervous and a little bit anxious.

So what happened here?

So there was the Memorial Day effect in California. I think people were tired, you know? We were really good, we were unified for a long time. People were being really good. California was a miracle. California, we looked at the other states and people were looking at us for advice and how we did it. And now, Memorial Day was a nice weekend and people just let loose. They went out, particularly starting in Southern California with the beaches and that's what prompted Governor Newsom to close down some of the Orange County/Huntington Beach areas. And I think it just took off from there.

The challenge for a lot of laypeople is to figure out what the message really is. We're told outdoors is better, but then the beach isn't good. You need exercise, but you can't go on the beach. So what is the best way to sum up what we really want people to hear?

Totally, I think part of the problem is somewhat confusing messaging and the mixed messaging. Part of it is because as we moved on in the epidemic, we understood more about the science, and I think we have a better understanding now. Although I would say that every hour is a new day with COVID-19.

I'd summarize it by the three W's in terms of the ways we can protect ourselves, and forget about the laundry list of 20 things that I think people came out with originally. You boil it down to three things to ward off COVID-19. You wear masks, you wash your hands and you watch your distance. And if you had to choose one thing, I would wear my mask.

That does distill it down, now you've got it down to a phrase like "click it or ticket" or "don't drink and drive" or "don't mess with Texas," right?

I know, exactly.

Why has it been so hard, though, for the health establishment and the political establishment to do that?

Well, I think because within our highest echelons of leadership there was one feeling and then there was the public health officials that were saying something else, so I think nationally we didn't have a very consistent message. And I think in the state we did a lot better. There was a better alignment between science, public health and leadership. And I think in California that's why we probably did much better. And, of course, the Bay Area was the most conservative. I think London Breed was really prescient in closing down or sheltering in place, the first in the country. And then three days later, California followed generally. So I think the alignment between science and leadership sounds like a no brainer, but it hasn't been the case nationally.

Okay, let's get to questions sent in by our listeners to First one: are we able to determine where these new cases are coming from? By that I mean, are they from workplaces or bars or gyms or... ???

Yeah, that's a great question. I think we get some information from contact tracers. Contact tracers are like the gumshoe detectives in this whole business. They get alerted about the positive cases, then they go and investigate. They asked the positive cases, who have you been around in the last week or so?

So I think we've been getting some answers in our area. And I think some of the most compelling outbreaks that we've seen from these contact tracers were around graduation parties and a lot of indoor celebrations that multigenerational families were having behind closed doors. And I think it's a little bit insidious because you know, you're seeing your uncles or your aunts - you don't think of them as high risk - probably for the first time in a long time. And you put 50 people close together having a barbecue, and even though you know these people, nobody is necessarily obviously ill and the nature of this disease is such that you can't tell who has disease or not, because there's a lot of asymptomatic spread. So that was the focus of a lot of transmissions recently in the Sacramento area in particular, Solano, I think.

And then there were work parties as well. And then we got some information from other parts of the country from contact investigators as well. Like in Texas and Mississippi, they were associated with frat parties and pledge parties, so a lot of indoor activities. And certainly the biggest and scariest example of an indoor situation is what's happening in San Quentin now, with over 1,000 prisoners infected.

In fact, that gets to one of the questions we had here. Would it be possible to conduct a stat comparative vaccine trial at San Quentin? Coordinate with Moderna, Pfizer, Roche and other major vaccine research companies to set up a comparative trial among those staff and inmates who volunteer and who are testing negative for the virus and with negative IGG and IGM antibodies?

I think that would be a great situation from a scientific or epidemiological perspective, but there are a lot of protections from an ethical perspective around doing studies in the prison population. So I think because of these challenges, even though there's a captive audience there with disease, it will be hard to implement versus volunteers in the general population.

I've heard a lot of reports about mutations in the coronavirus and how that might be affecting the spread. Can you ask your guest to address that?

Yeah. So I think there's a lot of talk about mutations, there's this mutation that's being circulated on media. But I think right now my gut feeling is that there hasn't been great evidence for increased human transmission. There's a lot of lab evidence that this protein, this spike on COVID is a little stickier to hit the receptor. And we can use these minor differences in proteins to tell the origin of a virus. For example, this is the Europe virus, this is the Chinese virus, this came from Washington state. But beyond that, there isn't convincing evidence that it's worse or better and most importantly, I think the vaccine is going to be kind of robust because it's a relatively simple virus compared to influenza or even HIV.

San Francisco has a higher population density than the rest of the Bay Area but death rates appear higher outside of San Francisco. Why is that?

That's a great question, and I think it's multi-factorial. I think the proportion of people wearing masks in the San Francisco area, just anecdotally and me walking around, compared to other places that I visited recently like wine country seems to be higher. The population of San Francisco is generally older and the new epidemiology of this particular surge is in the younger population, kind of like the graduation, getting together, beach party kind of population. So I think San Francisco has been a little bit more protected.

Also, it's very enriched with contact tracers because the program started here, so there are a lot more per population. They can go out quickly, identify people who are infected and ask them to quarantine from others. And then finally, I think there's been a lot of initiatives to target vulnerable populations in San Francisco, like in the Bayview and in the Mission so that you not just wait for people to come and ask to be tested, you actually go out and to the community and and test the entire population.

A coworker told me that her sister-in-law is positive for COVID-19. My coworkers sees her family a couple of times a month. The last time she was around them was on June 27th. I don't work in an enclosed office with my co worker, but I've talked with her a few times from a few feet away. Should I be concerned about having my small family over for a Fourth of July barbecue?

So it depends on when she had disease. We know from studies that even though you continue to detect virus, it probably isn't alive anymore after about, I would say, six to seven days. So generally speaking, you're going to be less at risk, particularly if everyone wears masks. And try to maintain social distance, but the most important thing again is wearing masks.

If you're not really sure then definitely have as many people wear masks as possible and the longer you get away from the initial infection, the less risky that person is going to be in general. The biggest bang for the buck is the person who is infected wearing a mask, but the more people that wear a mask the better it is for the group.

And this gets to a question I've heard a lot of variations of from people who want to do some traveling, want to catch up with family, trying to figure out the best way time-wise to figure out if they're clean. In other words, when do I get a test? How do I know how long that test is valid? How safe can I feel before I plan a trip or before I go see Grandpa?

So I would see that if you can get a test and you can quarantine yourself or stay relatively safe in a bubble for about a week, we generally say two weeks of quarantine but that gives a buffer. But if you want a general time from when you can get exposed to when you develop symptoms, that's usually about a week. So you say you get a test, which is a snapshot, and you wait a week later or you feel relatively protected for a week from the rest of society in whatever way. Then I would say that time is relatively safe for you, and I would believe that you would be safe to see Grandma or Grandpa.

You mentioned a bubble, and that's in the minds of a lot of people who are trying to figure out, how do I expand my circle here and how do I verify safety? How do people maintain a safe bubble? Can you create a safe bubble without testing?

Well it's challenging, I think people already did their bubbles early on in the pandemic here in the Bay Area, and it was generally in several settings, like either in the family unit or a couple of families living in the same house on different floors. Or for child care, even essential workers I knew and healthcare workers had no choice but to make their own bubble because nobody was able to take care of the kids. So they had to go into work, so they made friends with a family. And I think if your COVID values were the same and people had generally the same ideas about how to maintain less risky behaviors, that's the original bubble.

I think in terms of expanding the bubble, I will be very cautious. Maybe do it by one or two, try to see people outdoors if you could. Those will be ways to do it in a less risky way. But certainly not having a class reunion, it's probably the ultimate un-bubble, so to speak.