How Do You Stay Safe Now That States Are Reopening?
By Ryan Malosh
Editor's note: Now that states are relaxing social distancing restrictions, people desperately want to see friends and family, go to a restaurant and let our kids have playdates. Even grocery shopping sounds fun. But how can you do that and still stay safe? Here, an epidemiologist who is immune-compromised himself walks you through some decision-making.
The Centers for Disease Control and Prevention has finally released new guidelines for businesses, bars and schools that are considering reopening. Although following these guidelines should help, it's frustrating there hasn't been more clear, concise communication about the risk of infection. And without strict guidelines, it will be up to us to minimize our own risk and the risk of everyone around us.
In large part, this is because there is still so much we scientists and physicians don't know about the new coronavirus. The pace of new research on the virus, SARS-CoV-2, and the disease it causes, COVID-19, is truly astonishing. There are also times when the science and the necessity of the moment are in conflict; a prime example is the confusion about using face masks while a worldwide shortage of personal protective equipment exists.
And the pattern of disease is extremely localized. Michigan's outbreak looks different from Iowa's, which looks different from Colorado's. Even within states, outbreaks are very distinct. The outbreak I'm experiencing in southeast Michigan is not like the one my grandparents are experiencing two hours north of here. As a research scientist, I study herd immunity and vaccine effectiveness. As we slowly begin to return to normal life – albeit a new normal – I can tell you there are ways we can minimize our risk.
As a survivor of leukemia and a bone marrow transplant, I am part of a high-risk population, so my risk calculation is likely different from yours. As my state starts to relax restrictions, I will continue to limit my interactions with others as much as I can. Here are things you can consider.
What’s Associated With a High Risk of Transmission?
How SARS-CoV-2 transmits from person to person is still a mystery. It can certainly be transmitted by large respiratory droplets, like those produced when we cough or sneeze. Evidence also suggests that smaller aerosol particles, spread while talking or breathing, can lead to transmission. There is some evidence that people can transmit the virus before they have symptoms, although they will likely have the highest amount of virus close to the start of the illness.
Taking all this together, it's safe to say the riskiest thing you can do is to come into close contact with sick people. That's why the advice about self-isolation if you feel ill is so important.
It's also becoming clear the virus transmits most effectively in indoor settings. There, close contact between infected people and inadequate ventilation are more likely. The infection risk is especially high among household contacts. Efficient transmission in crowded, enclosed spaces also explains the high attack rates in nursing homes, food processing plants, jails and prisons and cruise ships. On the flip side, the risk of transmission does seem to be lower outdoors.
How Do We Minimize Risk?
If the riskiest thing is to be in a crowd while indoors with sick people, then it follows the least risky behavior is to be in small groups, outdoors and to avoid sick people.
I think it will help to describe a simple model of infectious disease. The rate of new infections over a given time period is called the "force of infection," which depends on a few things: the rate at which people contact each other; the probability of infection given contact; and the number of infectious individuals in a population.
This means our ability to prevent new infections depends on two things: reducing the rate at which people contact each other – or reducing the probability of infection given contact.
Reducing the contact rate was the goal of stay-at-home measures. By all accounts, this is still the most effective tool to prevent new infections.
Other nonpharmaceutical interventions, like face masks and hand hygiene, reduce the effective contact, or the chance the virus is transmitted if there is contact. Universal masking may be particularly effective if we can't rely on symptomatic screening for identifying infectious cases.
Or maybe you've heard of the layers of Swiss cheese. Sometimes you have a few interventions (slices of Swiss cheese), but none is perfect (the holes). But stack the slices up, and the holes start to cover up. Layering imperfect interventions can, in a similar way, slow down transmission.
So What Does It All Mean?
I once read a quote about the common cold from Ian Mackay, an Australian virologist: "The only fail-safe means of avoiding a cold is to live in complete isolation from the rest of humanity." The same is probably true for COVID-19.
But that's not realistic. Authorities should borrow ideas from HIV prevention and focus on clear messages for harm reduction. In the absence of stay-at-home orders, all of us will have to decide for ourselves how much risk we are willing to tolerate.
I'm a leukemia survivor, so I will factor that in. You, too, will need to consider your medical history. When I'm not in isolation, I will stack as many layers of Swiss cheese as I can to minimize any risk: staying 6-10 feet away from others, wearing masks, staying outdoors.
I think these are generally common-sense guidelines for anyone.
- If your local authorities allow small gatherings, then getting together with friends who aren't sick or who haven't been in contact with other sick people is safest outdoors.
- Try to stay as far apart from each other as you can.
- Keep a mask and hand sanitizer nearby.
- Don't share food or drinks.
- If anyone feels sick or has had recent contact with someone who feels sick, they should skip the playdate (this goes for adults and kids).
- If you are seeing someone at high risk of severe disease, an older relative or someone with a compromised immune system, take even more precautions and consider whether you can connect with them virtually.
Ryan Malosh is an Assistant Research Scientist at the University of Michigan.
Disclosure statement: Ryan Malosh receives salary support from the Centers for Disease Control and Prevention (CDC) and the National Institute for Allergy and Infectious Disease (NIAID).
Reposted with permission from The Conversation.
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By Melissa Gaskill
Two decades ago scientists and volunteers along the Virginia coast started tossing seagrass seeds into barren seaside lagoons. Disease and an intense hurricane had wiped out the plants in the 1930s, and no nearby meadows could serve as a naturally dispersing source of seeds to bring them back.
Restored seagrass beds in Virginia now provide habitat for hundreds of thousands of scallops. Bob Orth, Virginia Institute of Marine Science / CC BY 2.0<p>The paper is part of a growing trend of evidence suggesting seagrass meadows can be easier to restore than other coastal habitats.</p><p>Successful seagrass-restoration methods include <a href="https://www.sciencedirect.com/science/article/abs/pii/S0304377099000078?via%3Dihub" target="_blank">transplanting shoots</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1061-2971.2004.00314.x" target="_blank" rel="noopener noreferrer">mechanized planting</a> and, more recently, <a href="https://www.nature.com/articles/s41467-020-17438-4" target="_blank" rel="noopener noreferrer">biodegradable mats</a>. Removing threats, proximity to donor seagrass beds, planting techniques, project size and site selection all play roles in a restoration effort's success.</p><p>Human assistance isn't always necessary, though. In areas where some beds remain, seagrass can even recover on its own when stressors are reduced or removed. For example, seagrass began to recover when Tampa Bay improved its water quality by reducing nitrogen loads from runoff by roughly 90%.</p><p>But more and more, seagrass meadows struggle to hang on.</p><p>The marine flowering plants have declined globally since the 1930s and currently disappear at a rate equivalent to a football field every 30 minutes, according to the <a href="https://www.unep.org/resources/report/out-blue-value-seagrasses-environment-and-people" target="_blank" rel="noopener noreferrer">United Nations Environment Programme</a>. And research published in 2018 found the rate of decline is <a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1029/2018GB005941" target="_blank" rel="noopener noreferrer">accelerating</a> in many regions.</p><p>The causes of decline vary and overlap, depending on the region. They include thermal stress from climate change; human activities such as dredging, anchoring and coastal infrastructure; and intentional removal in tourist areas. In addition, increased runoff from land carries sediment that clouds the water, blocking sunlight the plants need for photosynthesis. Runoff can also carry contaminants and nutrients from fertilizer that disrupt habitats and cause algal blooms.</p><p>All that damage comes with a cost.</p>
The Value of Seagrass<p>As with ecosystems like rainforests and <a href="https://therevelator.org/mangroves-climate-change/" target="_blank">mangroves</a>, loss of seagrass increases carbon dioxide emissions. And that spells trouble not just for certain habitats but for the whole planet.</p><p>Although seagrass covers at most 0.2% of the seabed, it <a href="https://www.unenvironment.org/news-and-stories/story/seagrass-secret-weapon-fight-against-global-heating" target="_blank">accounts for 10%</a> of the ocean's capacity to store carbon and soils, and these meadows store carbon dioxide an estimated 30 times faster than most terrestrial forests. Slow decomposition rates in seagrass sediments contribute to their <a href="https://www.researchgate.net/publication/238506081_Assessing_the_capacity_of_seagrass_meadows_for_carbon_burial_Current_limitations_and_future_strategies" target="_blank" rel="noopener noreferrer">high carbon burial rates</a>. In Australia, according to <a href="https://onlinelibrary.wiley.com/doi/10.1111/gcb.15204" target="_blank" rel="noopener noreferrer">research</a> by scientists at Edith Cowan University, loss of seagrass meadows since the 1950s has increased carbon dioxide emissions by an amount equivalent to 5 million cars a year. The United Nations Environment Programme reports that a 29% decline in seagrass in Chesapeake Bay between 1991 and 2006 resulted in an estimated loss of up to 1.8 million tons of carbon.</p>
Eelgrass in the river delta at Prince William Sound, Alaska. Alaska ShoreZone Program NOAA / NMFS / AKFSC; Courtesy of Mandy Lindeberg / NOAA / NMFS / AKFSC<p>Seagrasses also protect costal habitats. A healthy meadow slows wave energy, reduces erosion and lowers the risk of flooding. In Morro Bay, California, a 90% decline in the seagrass species known as eelgrass caused extensive erosion, according to a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272771420303528?via%3Dihub" target="_blank" rel="noopener noreferrer">paper</a> from researchers at California Polytechnic State University.</p><p>"Right away, we noticed big patterns in sediment loss or erosion," said lead author Ryan Walter. "Many studies have shown this on individual eelgrass beds, but very few studies looked at it on a systemwide scale."</p><p>In the tropics, seagrass's natural protection can reduce the need for expensive and often-environmentally unfriendly <a href="https://www.nioz.nl/en/news/zeegras-spaart-stranden-en-geld" target="_blank" rel="noopener noreferrer">beach nourishments</a> regularly conducted in tourism areas.</p><p>Seagrass ecosystems improve water quality and clarity, filtering particles out of the water column and preventing resuspension of sediment. This role could be even more important in the future. By producing oxygen through photosynthesis, meadows could help offset decreased oxygen levels caused by warmer water temperatures (oxygen is less soluble in warm than in cold water).</p><p>The meadows also provide vital habitat for a wide variety of marine life, including fish, sea turtles, birds, marine mammals such as manatees, invertebrates and algae. They provide nursery habitat for <a href="https://wedocs.unep.org/bitstream/handle/20.500.11822/32636/seagrass.pdf?sequence=1&isAllowed=y" target="_blank" rel="noopener noreferrer">roughly 20%</a> of the world's largest fisheries — an <a href="https://www.floridamuseum.ufl.edu/science/seagrass-meadows-harbor-wildlife-for-centuries/" target="_blank" rel="noopener noreferrer">estimated 70%</a> of fish habitats in Florida alone.</p><p>Conversely, their disappearance can contribute to die-offs of marine life. The loss of more than 20 square miles of seagrass in Florida's Biscayne Bay may have helped set the stage for a widespread <a href="https://www.wlrn.org/2020-08-14/the-seagrass-died-that-may-have-triggered-a-widespread-fish-kill-in-biscayne-bay" target="_blank">fish kill</a> in summer 2020. Lack of grasses to produce oxygen left the basin more vulnerable when temperatures rose and oxygen levels dropped as a result, says Florida International University professor Piero Gardinali.</p>
Damaged Systems, a Changing Climate<p>Governments and conservationists around the world have already put a lot of effort into coastal restoration efforts. And that's helped some seagrass populations.</p><p>Where stressors remain, though, restoration grows more complicated. <a href="https://www.rug.nl/research/portal/en/publications/the-future-of-seagrass-ecosystem-services-in-a-changing-world(3a8c56db-7bed-4c9e-ac7f-c72453e2a102).html" target="_blank">Research</a> published this September found that only 37% of seagrass restorations have survived. Newly restored meadows remain vulnerable to the original stressors that depleted them, as well as to storms — and <a href="https://www.ecowatch.com/tag/climate-crisis">climate change</a>.</p>
Seagrass in Dry Tortugas National Park, Florida. Alicia Wellman / Florida Fish and Wildlife / CC BY-NC-ND 2.0<p>In Chesapeake Bay a cold-water species of seagrass is currently hitting its heat limit, especially in summer, according to Alexander Challen Hyman of University of Florida's School of Natural Resources and Environment. As waters continue to warm due to climate change, the species likely will disappear there.</p><p>Climate-driven sea-level rise complicates the problem as well. Seagrasses thrive at specific depths — too shallow and they dry out or are eaten, too deep and there isn't enough light for photosynthesis.</p>
But There’s Good News, Too<p>Luckily, left to its own devices, a seagrass meadow can flourish for hundreds of years, according to a <a href="https://royalsocietypublishing.org/doi/10.1098/rspb.2019.1861" target="_blank" rel="noopener noreferrer">paper</a> published last year by Hyman and other researchers from the University of Florida. The researchers arrived at their conclusion by looking at shells of living mollusks and fossil shells to estimate the ages of meadows in Florida's Big Bend region on the Gulf Coast.</p><p>That area has extensive, relatively pristine seagrass meadows. "Our motivation was to understand the past history of these systems, and shells store a lot of history," said co-author Michal Kowalewski.</p><p>A high degree of similarity between living and dead shells indicates a stable area, while a mismatch suggests an area shifted from seagrass to barren sand. The researchers found that long-term accumulations of shells resembled living ones, suggesting that the seagrass habitats have been stable over time.</p><p>That stability allows biodiversity to thrive, creating conditions where specialist species can survive and flourish, according to Hyman.</p><p>Discovering the long-term stability of seagrass meadows has implications for choosing restoration sites, Kowalewski notes.</p><p>"There must be reasons they thrive in one place, while a mile away they don't and fossil data says they probably never did," he said. "If we remove a seagrass patch, we cannot hope to plant it somewhere else. It's not just the seagrass that is special. The location at which it's found is special, too."</p><p>A better approach is conserving these habitats in the first place, but we're not doing enough of that right now. The UN reports that marine protected areas safeguard just 26% of recorded seagrass meadows, compared with 40% of coral reefs and 43% of mangroves.</p>
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