MORGANTOWN — The Department of Health and Human Resources recently invited The Dominion Post to talk with COVID-19 Czar Clay Marsh about the importance of widespread testing.
From that kernel the conversation covered mask wearing and criticisms of the color-coded COVID maps and the ever-evolving response strategy.
Masks
Marsh talked once again about super spreaders: the 5% to 9% of infected people who infect 80% of everybody else, often in the short window before symptoms appear. At least 50% and probably up to 75% of the spread is done by people who don’t know they’re infected.
The infected droplets are spread by talking, yelling, singing, even quiet breathing and masks protect others from the droplets being produced. So the more people with masks the fewer droplets – or aerosols, which stay suspended closer to the face – are generated.
Correctly worn masks, especially three ply, markedly reduce generation of aerosol and droplets, he said. And your county being in the green or yellow shouldn’t be an incentive to not wer a mask: the color doesn’t mean the virus is absent.
For community protection, he said, 60% of the people need to wear masks. At 80%, mask wearing affects the reproductive score – the RT value – approaching the level of a vaccine and above 80% begins to operate like a vaccine.
There’s a theory going around, Marsh said, that masks may even help a wearer develop immunity in the right context by allowing a minute amount of virus to pass through.
In the way that a vaccine provides a tiny amount of the substance you’re seeking to immunize against so the body can learn to fight it off, “you may get just enough virus that can penetrate in order for your system to get used to it and maybe it gives you some immunity toward that virus. That’s at least been speculated”
The Dominion Post asked if one person is the sole mask-wearer in a room full of people, she the person feel safe or worried?
“Worried,” he said. There are only two types of protective masks: the fitted N95 and the papper or capper, which is a personal protective respiratory system with a helmet and independent air supply.
In ordinary social situations, particularly indoors around more people and no ability to distance and with no good airflow, “these become very risky environments.”
The maps
The state’s two COVID-19 maps – the County Alert System and the School Alert System – have been criticized in social media and news media for deviating from the Harvard Global Health Institute’s color-coded map. West Virginia’s maps have five colors instead of four, wider parameters at the bottom end and two metrics instead of just one.
Defending the West Virginia Model, Marsh said the map was created as a public health tool to track spread in counties, not to pen schools. And the cornerstone of trying to control spread is testing a lot of people, not testing the same person over and over to open a school or play football.
So when the began with the Harvard map’s single metric of incidence or infection rate – the number of new cases per day averaged over seven days and adjusted for a per-100,000 population – they found a problem.
The infection rate is the same whether they get 100 positives from 100 tests or 10,000 tests. So people quickly figured out the way to reduce the infection rate was to stop getting tested, and that meant only the sicket people showed up for tests. The Rt rate climbed to the nation’s worst, the death rate climbed, and tests plummeted to half.
“That is not what we wanted.” So they added the second metric, the positivity rate, taking into account CDC and other agency guidance, and the wishes of the national American Federation of Teachers for opening schools (an infection rate below 5%).
This was meant to motivate people to get tested, he said. They expected that with more tests, the positivity rate would drop while the infection rate would initially rise as more infected people were identified. This was desirable because they would find the super spreaders and others walking around not knowing they’re infected.
But as the infected people are moved into quarantine, the infection rate would also start to drop, he said. “And that’s exactly what we’ve seen.” The Rt went from worst to second best – but had bounced up to sixth best on Friday, at .94.
They challenge, he said, is achieving a balance between leaving a generation of students behind and trying to control the spread. Had they simply relied on the Harvand model, he said, they’d be back a square one with everything closed.
Strategy evolution
Again, it’s easy to find in social media and news media criticism of the state’s evolving approach to managing the spread and reopening businesses and schools. People say the changing maps and dual metrics are confusing and seem more motivated by politics than public health.
Marsh offered a quote from author Anais Nin, who once said “We don’t see things as they are; we see things as we are.”
He said, “If you look through a single lens the world looks very clear, black and white, and you can make your calls. If you look through multiple lenses at once, things become a little bit fuzzier.”
Marsh said he isn’t a government person and offered praise of the people he’s working with. “What I’ve been really impressed by is the dedication of so many people who are trying to do the right thing.”
Poltics does enter to some degree. “But I do believe that the governor does care about the state, does care about the health of the people and has prioritized – while trying to keep everybody together – prioritized the health of West Virginians.
He’s never had a conversation with the governor or the advisory group where when all agreed that something was not good for the state’s health that he went ahead with it anyway.
An example of the balance, he said, has been the Monongalia County bars. Keeping them shut is good for pubic health but hurts the businesses. “I think the governor has both of those perspectives in his mind.”
But Marsh said he’ mindful of that part of navigating the system is not trying to change things willy-nilly. And that, for instance, opening schools makes some happy and frightens others. It’s hard to separate personal fears and health form professional duties and purpose.
Some decisions are complicated and they can’t satisfy everyone all the time, he said.
Navigating the comeback, he said, means being open to better ideas and criticism. “If say ‘This is it,’ and it’s obvious that’s not getting it done, to me that just seems kind of dumb.”
Lower the Rt value and incidence rate, testing more, contact tracing, mitigation: “That’s the playbook and what gets you there is what we should do. … If people don’t trust that we’re really trying to do the right thing, and we start to fracture and we don’t stay together, then that’s the worst possible outcome.”
So they have to be cautious and thoughtful about continuing to change the system because it does start to undermine trust and makes people think there are ulterior motives,” he said.
“It’s a very challenging environment for everybody. These are really good people that are working very hard and doing things very honestly and transparently.”
Tweet David Beard@dbeardtdp Email dbeard@dominionpost.com
