July 9, 2020

An update from our Chief Medical Officer:

I hope everyone had a safe and relaxing July 4th holiday weekend. COVID-19 has now surpassed the 4-month mark for QualDerm and I know that we all appreciated the break, however short. For those with upcoming summer vacation plans, please ensure you follow all health and safety protocols to remain well and able to resume work upon your return. Remember that any close contact with a confirmed COVID-19 case or any household positive will require a 14 day quarantine following the exposure before returning to work, even if you remain asymptomatic. Health care personnel can return earlier if no symptoms and with 2 negative tests >24 hours apart, but these results generally take 3-6 days due to high lab volumes and tests won’t even be given less than 6 days after the exposure. Plus obviously, we don’t want any team member becoming infected and sick.  Given the rising prevalence in younger people who often remain asymptomatic, you will not likely know until days later that you’re at risk and need to stay out of work. Your practices and patients need you, especially during our recovery phase, so please continue to be extra mindful of how to reduce your personal risk. The following graphs can help guide your activities.

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Japan, which has effectively contained COVID-19, has widely enacted measures to “avoid the three C’s”: closed spaces, crowded places and close-contact settings, especially those involving loud talking. These settings all pose a major risk of infection and all businesses nationwide are managing these exposures.

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My daughter who graduated college and is applying to medical school has been hired as a North Carolina Contact Tracer, leading the county’s bilingual team. She provided these slides.

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The leadership team remains optimistic about our company’s current recovery and very proud of and grateful for your dedication to our safety and quality mission. Keep it going! Nearly all our furloughed team members are now back and eager to contribute to an even more efficient and productive workflow. Please continue to provide suggestions for improvement to our “Bright Ideas” campaign!

I would like to highlight some recent COVID-19 headlines and the news stories most relevant and informative from my CMO perspective.

  • 3 new symptoms of C-19 infection identified by CDC and will be added to our screening
    • Congestion/runny nose
    • Nausea
    • Diarrhea

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  • >50% of C-19 + patients do not report any known contact with another positive patient

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    • Silent transmission by asymptomatic and pre-symptomatic people is a major source of infection
    • Therefore, isolation alone of symptomatic patients cannot control the spread
    • Rapid testing and Contact tracing are also critical steps, but remain challenging
    • MASKS and PHYSICAL DISTANCING are vital; assume everyone is positive!
  • Airborne transmission risk may be greater than previously known – an open letter to WHO by 239 scientists from 32 countries published this week suggests that Coronavirus transmission by fine aerosol mist may account for some airborne infections, although much of the lab research was not performed in a clinical setting. The predominant theory remains that most transmission occurs via larger droplets from coughing/sneezing in close proximity (1-2 meters). WHO scientists acknowledged the possibility stating, “Evidence of airborne transmission in crowded, closed, poorly ventilated settings . . . cannot be ruled out” and will continue to research and study the issue before updating any guidance. What does this mean for us?
    • Masks, physical distancing and frequent disinfection remain paramount
    • N95s remain appropriate for any aerosol generating procedures (AGPs), including aesthetic and surgical procedures in the perioral/perinasal area
      • Guidelines were recently published in Facial Plastic Surgery and Aesthetic Medicine by a multi-specialty group led by dermatologist Dr Jeffrey Dover that outline safety recommendations for aesthetic procedures in the COVID-19 setting. QualDerm measures were essentially consistent and these detailed guidelines have been incorporated into our OSHA Exposure Control Plan.
    • These simple safety measures protect us from the very frequent (50%) silent transmission by asymptomatic and pre-symptomatic persons
    • Consider the higher risk of indoor social interactions and larger confined gatherings
    • Health care personnel continue to demonstrate extremely low infection rates due to appropriate use of PPE, screening and triage, and safety protocols
      • Wake Forest data for >200 HCP with direct COVID-19 contact who used proper PPE = zero infections
  • While record setting daily case counts dominate the headlines, fewer areas are truly seeing a rising percentage of positive test results, a better indicator of a local spike.
    • Surging case counts, but falling death rates
    • Dr Fauci explained the likely explanations in an address to the AMA this week:
      • Increased testing is identifying more cases in young people (18 – 35 year olds engaging in riskier behaviors) with better outcomes and less deaths
      • We are protecting our vulnerable populations much better nationwide (elderly and those with underlying conditions), esp. in nursing homes
      • There could be a delay in deaths due to lag time between case diagnosis, hospitalization and death; Dr Fauci cautioned that the ratio could change so continue to reduce risks and take all safety measures seriously!

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  • Good news regarding COVID-19 testing and treatment
    • Newly approved COVID-19 test promises results in 15 minutes for about $20
      • FDA provided emergency authorization for Becton Dickenson to mass produce a point-of-care rapid test with a goal of 2M tests per week by fall
    • Drugmaker Regeneron says it could have potential coronavirus treatment ready by end of summer; US government will provide the drug at no charge
      • The Administration has signed a $450M contract with the company to make and supply the cocktail — which consists of two human antibodies binding “non-competitively to the receptor binding domain of the virus’ spike protein” hindering its ability “to escape treatment.”
    • Vaccine candidate shows promise in clinical trial
      • Pfizer’s vaccine candidate generated neutralizing antibodies that prevent the coronavirus from functioning, and the levels of those neutralizing antibodies were 1.8 to 2.8 times higher than the levels found in recovered COVID-19 patients; further human testing is ongoing to determine that these antibodies truly prevent infection
      • Operation Warp Speed has provided US government contracts to several companies to fast-track vaccine production, including $1.4B to Novavax this week, and previously to AstraZeneca and Moderna Therapeutics.
  • Clinical Updates and Resources
    • American Dental Association released guidance to reduce viral loads in oral mucosa by rinsing the mouth for 30 seconds with 1.5% hydrogen peroxide solution prior to dental procedures; this recommendation would also apply to surgical and cosmetic procedures in the perioral area.
      • Dilute standard 3% H2O2 solution with drinking water in 1:1 ratio
    • Microwave, glass container, grocery store produce bag and rubber band can effectively steam sterilize N95 masks without loss of fit integrity in 3 minutes
      • Simple, rapid process with cheap readily available supplies can enhance PPE supplies and reduce costs
    • CDC offers comprehensive clinical guidance with a 24-hour call center hotline
      • 800-CDC-INFO (800-232-4636)

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Please stay safe, healthy and upbeat. Continue to support each other as the dog days of summer roll in and we recognize that this COVID-19 pandemic will continue to alter our state of normalcy for many more months. Remember we can all still enjoy our lives, care for our patients, and contribute to a vibrant economy by remaining smart, vigilant and cautious in our behaviors. WEAR A MASK! It’s not political, it’s just common sense, good science, and every citizen’s duty. (A mask alone reduces one’s risk of contracting the infection by 85% if coming in close contact with C-19+ person, and if the infected person also wears a mask, the risk is <5%)

And for those with continued anxiety and concern over the unknown, the Wake Forest COVID Task Force leader Dr Chris Ohl recently delivered this message which I’ll paraphrase. ‘Consider that this pandemic is like running a marathon…except that you don’t know how many miles are left. So I’m telling you the end of the race is July 4th, 2021, by the time we truly conquer it through safe behaviors, testing, tracing, treatments, vaccines and herd immunity. If we get there faster, then wonderful, but at least this will set our expectations and allow us to continue moving forward with resilience and optimism.’ I’m personally optimistic we’ll hit the finish line even sooner.



John Albertini, MD