An update from our Chief Medical Officer:

It appears that the universal masking across the country is starting to produce the intended results, with overall US case counts declining this week. The majority of cases are now seen in younger adults with less overall severity of illness. But, our deaths continue to mount and sadly now exceed 175,000 Americans. It remains very important for all of our teammates to continue the easiest, cheapest and proven strategies to stay safe and allow our schools and economy to recover and thrive again = masks, physical distancing, hand and cough hygiene.

• Evidence of mask effectiveness is seen in South Carolina, which never imposed a state-wide mask requirement. Cities and towns requiring universal masking developed 50% fewer infections than communities without mask mandates.
• Remember neck gaiters and masks with valves do not effectively prevent droplet transmission and only protect the source. These are not allowed to be worn by patients.
• Wake Forest University health system employs 18,000 and to date there have been 163 employee infections. No transmissions occurred in the outpatient setting. Only 17 infections can be traced to the hospital workplace, and every transmission occurred when proper mask protocol was not followed, with the vast majority infected by co-workers. The remaining 156 cases were acquired in the community.

Japan and Asian countries that have fared much better rely upon a widespread public education campaign that has been very effective. Also time is important; prolonged duration = higher risk.

AVOID the 3 C’s = Closed spaces, Crowded places, Close contact

Scientists have confirmed that ‘super-spreaders’ account for the vast majority of transmissions, with 10% of COVID-19+ people causing 70 – 80% of infections. These occur primarily during super-spreader events and activities, like bars, restaurants, concerts, school, church and funeral services where people are crowded in close contact in confined spaces for prolonged periods and usually with loud talking, singing, crying and hugging without universal mask-wearing at all times.

• Genetic tracing of mutations in COVID-19 strains has confirmed that a single biotech conference in late February in Boston was responsible for 1/3 of all cases sequenced in Massachusetts (>20,000) and 3% of all cases studied in the United States.

Within QualDerm practices we have seen more employee exposures and quarantines in the last 2 weeks than we did in the previous 4 months combined. In nearly every instance, the employee was exposed by an asymptomatic child or young adult in the family. Please be aware that as schools and colleges re-open and younger people interact more there will definitely be more infections. For better or worse, these infections will most likely be asymptomatic which is good for the infected but bad for all their unknowing contacts, especially if older and/or more vulnerable. Every measure that our QDP employees can do to minimize these risks and avoid potential exposures will benefit us all – teammates, family members and patients. Consider masks and physical distancing even with close friends and family who are not specifically living in your home.

To refresh everyone’s memory, when exposed to a COVID-19 + person, you must quarantine for 14 days from the time of exposure. And if that positive patient is a family member in your household, your quarantine time does not begin until the patient is considered safe and no longer transmitting virus, which is 10 days of isolation after testing positive if asymptomatic. So, an employee living closely with an asymptomatic child/family member would need 10 + 14 = 24 days of quarantine before returning to work. In fact, the infected person would be able to return to school/work much sooner than the contact, who must wait longer under quarantine. The following scenarios from CDC demonstrate this reality very clearly.

Other COVID-19 news and headlines:

• A study published in JAMA from India showed that adding face shields to masks was very effective in preventing infection among community health workers. This strategy is available for any employee performing higher risk visits or procedures.
  • Before face shields, 62 workers visited 5880 homes with 31,164 persons. From the 5880 homes visited, 222 persons tested positive for SARS-CoV-2, between May 4 to May 13. Twelve workers (19%) were infected during this period.
    o After face shields, 50 workers (previously uninfected) continued to provide counseling, visiting 18,228 homes. Among the 118,428 persons counseled, 2682 subsequently tested positive for SARS-CoV-2. No worker developed asymptomatic or symptomatic infection.
• CDC ended its travel advisory recommending 14 day quarantines for international travel. CDC recommends all travelers to research and follow the local and state orders and restrictions upon entry and exit when traveling domestically or internationally.
• CDC updated the recommendations for testing of asymptomatic PUI (persons under investigation).
  • If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:
  • You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommends one.
  • A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.
  • You should monitor yourself for symptoms.
  • You should strictly adhere to CDC mitigation protocols, especially if you are interacting with a vulnerable individual.

•  FDA issued an emergency use authorization (EUA) for convalescent plasma, which is the serum from blood containing antibodies from patients previously infected with C-19 that has shown promise as a treatment. Additionally, the potential for manufactured monoclonal antibody treatments remains high.
• FDA also issued EUA for a saliva tests developed by Yale and Rutgers researchers and currently being used by the NBA, PGA and NHL and >65 colleges that could help broaden the testing capacity in the US. The approval is for the lab methodology for testing which shows equivalent accuracy (<1% false negative but slightly lower sensitivity) but is much faster and cheaper. Two specific saliva test kits are now available commercially and more companies can now work on bringing such products to market to augment testing and tracing efforts and to lower costs.
• Hong Kong reports the first known case of re-infection of a 33 yr. old man with a mild case of COVID-19 last March who was infected with a different strain after recent travel to Spain. He is currently showing no symptoms with the re-infection. Scientists believe immunity may last from 3-6 months in most people and annual vaccines will likely be required, similar to flu shots, to contain infections each year.
• QualDerm has finalized our influenza vaccination policy and has ordered vaccines to immunize all QDP employees over the next 2 months.
• A recent JAMA article urged flu vaccination to prevent co-infection with C-19 https://jamanetwork.com/journals/jama/fullarticle/2769836 

Our management team continues to engage with many dermatologists who express interest in partnering with QualDerm. We should all be encouraged by this potential for further growth and differentiation of QDP as the dermatology company of choice. We feel this momentum is driven by our strong reputation for high quality care, patient and staff safety, and operational, financial, IT and management excellence. All team members should be very proud of this development and I thank you all for constantly maintaining and improving our stellar culture, even during trying times like these.

Stay well and best wishes for a safe and enjoyable Labor Day weekend coming up.

Sincerely,

John Albertini, MD