Advance with MUSC Health

Reopening after COVID-19

Joseph Gerald (Jerry) Reves, M.D.
May 18, 2020

COVID-19 has come to the world. We first started hearing about it in late December. Denialists pretty much had their way including the World Health Organization and the President of the U.S. After the virus was well on its way to its current pandemic status even the Governor of South Carolina realized something drastic had to be done so he declared an emergency in our State and closed restaurants and businesses on March 16. Fast forward two months, and on May 11 restaurants were opened for inside dining. Many other businesses had already been told they could reopen. If your mind is spinning with all the chaotic directives and mixed messages, you are not alone.

The Facts, Just the Facts

Much is still not known about this novel coronavirus. It is still in the lifespan of our world very, very young – an infant. Hardly anything is known about the virology and epidemiology of COVID-19 compared to those viruses man has dealt with for a long time like chickenpox and influenza. However, some concrete facts have been discovered about COVID-19. It is very transmissible, which means it infects people more easily than say the dreaded Ebola virus or the common flu. The virus is thought to spread almost exclusively by droplets from infected people and then inspiring or getting the droplets in our body by some means. COVID-19 is a more deadly virus than influenza, but not as deadly as Ebola. The victims (meaning people who die from it) of COVID-19 are in the older age group (meaning 60 years old or greater) or have underlying chronic diseases such as hypertension, cardiac disease, and chronic pulmonary disease. The incubation period seems to be between 5 to 14 days, meaning that it may take 5 to 14 days for someone who is infected to manifest symptoms of the disease. South Carolina has not had the number of cases that some places have; for example, South Carolina prevalence has been 1 per 1000 people whereas NY has a prevalence of 20 per 1000 population. Finally, COVID-19 tends to afflict the lower socioeconomic group who work closely together, suffer from poorer health care access, and who rely on mass transit.

Implications of the Facts

This column addresses older folks, hence the title, Healthy Aging. So, dear reader, we are in the high risk group if we contract COVID-19. This is especially so if we have one or more significant chronic diseases. The implication then is we must be careful about our exposure to the disease. We cannot rely on all the well-meaning politicians whose prime concern is the economy and the welfare of the masses below age 60.

We understand the spread is from virus-laden droplets from a cough, sneeze, or exhalation of an infected person. Hence, we have been instructed to wear masks and not to get within six feet of anyone (since we really don’t know who is infected and who is not.) Furthermore, we have learned that we must disinfect with an alcohol disinfectant or wash our hands with soap and water regularly and especially after touching door knobs, handles etc. that infected people could have touched with hands that have the virus droplets on them.

We have also learned the game of social isolation, confined to our homes except for necessary outings for exercise, groceries, doctor visits, and trips to the pharmacy. While some enjoy this break from the throng, most do not and this may be the major factor that beckons us to get back out there and enjoy life – as we used to.

New Cases of COVID-19 in South Carolina 
Figure 1 New Cases of COVID-19 in South Carolina. Note that there is steady fluctuation of new cases between about 100 and 200 cases between March 28 and May 10. This coincides with the Governor's stay at home order. New cases could occur with the reopening of restaurants and businesses in early May. From:

The Best Advice

Because we are all in the high risk category, our reentry into the world needs to be cautious and sensible.  We should avoid large gatherings until there is evidence of a significant and two-week decline in the incidence of new cases in our community. It can be argued that as testing ramps up it will inevitably lead to a prolonged and even an increase in the incidence of new cases. While true this only underscores that the virus is alive and well among us. The figure shows that as this column goes to press, South Carolina spread has been steady for 6 weeks and it is not significantly declining. The concerned among us would see this as reason not to rush out into crowds or even go to faith services (if they are open.) Social distancing and wearing masks are indicated in public until community spread is essentially zero.

The Bottom Line

We are all tired of COVID-19 and the turmoil it has caused world-wide. That does not change the fact that it is still a menace for us older people. Patience is a virtue and this is the time to practice it.

MUSC Health has earned a "High-Performing Hospital" designation in geriatrics from U.S. News & World Report for 2018-2019