As counties in Pennsylvania and other states begin a phased reopening plan, many people are concerned about the continued spread of COVID-19 or another spike in cases. While health officials stress the importance of handwashing and wearing masks, we want to share highlights of an article that can guide you away from situations of high risk.
COVID-19: The Risks – Know Them – Avoid Them
Published on May 6, 2020 by Erin S. Bromage, Ph.D.
Where are people getting sick?
We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.
In order to get infected, you need to get exposed to an infectious dose of the virus; based on infectious dose studies with other coronaviruses, it appears that only small doses may be needed for infection to take hold. Some experts estimate that as few as 1000 SARS-CoV2 infectious viral particles are all that will be needed. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 infectious viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.
How much Virus is released into the environment?
A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors and the transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.
A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds.
A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room). If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.
A Breath: A single breath releases 50 – 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled. Unlike sneezing and coughing which release huge amounts of viral material, the respiratory droplets released from breathing only contain low levels of virus.
Remember the formula: Successful Infection = Exposure to Virus x Time
- If a person coughs or sneezes, the viral particles go everywhere. If you are face-to-face with a person, having a conversation, and that person sneezes or coughs straight at you, it is possible to inhale 1,000 virus particles and become infected. Even if that cough or sneeze was not directed at you, infectious viral particles can fill every corner of a modest sized room. All you have to do is enter that room within a few minutes, take a few breaths and you have potentially received enough virus to establish an infection.
- With general breathing of 20 viral particles per minute into the environment, even if every virus ended up in your lungs (which is very unlikely), you would need 1000 viral particles divided by 20 per minute = 50 minutes.
- Speaking increases the release of respiratory droplets about 10-fold. Assuming every virus is inhaled, it would take 5 minutes of speaking face-to-face to receive the required dose.
- Anyone you spend greater than 10 minutes with in a face-to-face situation is potentially infected. Anyone who shares a space with you (say an office) for an extended period is potentially infected.
- It is critical for people who are symptomatic to stay home. Your sneezes and your coughs expel so much virus that you can infect a whole room of people.
What is the role of asymptomatic people in spreading the virus?
Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.
Infectious people come in all ages, and they all shed different amounts of virus. The amount of virus released from an infected person changes over the course of infection and it is also different from person-to-person. Viral load generally builds up to the point where the person becomes symptomatic. Just prior to symptoms showing, you are releasing the most virus into the environment.
Ignoring the terrible outbreaks in nursing homes, we find that the biggest outbreaks are in prisons, religious ceremonies, and workplaces, such as meat packing facilities and call centers. Any environment that is enclosed, with poor air circulation and high density of people, spells trouble.
As we move back to work, or go to a restaurant, let’s look at what can happen in those environments:
- Restaurants: A single asymptomatic carrier releases low-levels of virus into the air from their breathing. Because of the airflow from vents, approximately 50% of the people at the infected person’s table became sick, 75% of the people on the adjacent downwind table became infected and a few of the people on the upwind table were infected (believed to happen by turbulent airflow). No one out of the main airflow from the air conditioner became infected.
- Call Center: A single infected employee infected 43.5% of the workplace (mostly one side of the room). While the exact number of people infected by respiratory droplets / respiratory exposure versus surface transmission is unknown, it serves to highlight that being in an enclosed space, sharing the same air for a prolonged period increases your chances of exposure and infection.
- Meat Processing Plant: Densely packed workers must communicate to one another amidst the deafening drum of industrial machinery and a cold-room virus-preserving environment.
- Business Networking: Face-to-face business networking
- Choir: A single asymptomatic carrier infected most of the people in attendance after singing inside for 2.5 hours – even though people took steps to minimize transfer (ex. no hugging or handshakes). Singing, to a greater degree than talking, aerosolizes respiratory droplets extraordinarily well. Deep-breathing while singing facilitated those respiratory droplets getting deep into the lungs.
- Indoor sports: A sporting event brings athletes and teammates in close contact in a cool indoor environment, with heavy breathing for an extended period.
- Birthday parties / funerals: An infected person shares a takeout meal served from common dishes and then attends a funeral, hugging family members and others in attendance to express condolences the next day. He also attended a birthday party where he hugged and shared food with other people. The spread of the virus within the household and back out into the community through funerals, birthdays, and church gatherings is believed to be responsible for the broad transmission of COVID-19.
Commonality of Outbreaks
The reason to highlight these different outbreaks is to show you the commonality of outbreaks of COVID-19. All these infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections.
Indoor spaces, with limited air exchange or recycled air and lots of people, are concerning from a transmission standpoint. Social distancing guidelines don’t hold in indoor spaces where you spend a lot of time. The principle is viral exposure over an extended period of time.
Social distancing rules are really to protect you with brief exposures or outdoor exposures. In these situations, there is not enough time to achieve the infectious viral load when you are standing 6 feet apart or where wind and the infinite outdoor space for viral dilution reduces viral load. The effects of sunlight, heat, and humidity on viral survival, all serve to minimize the risk to everyone when outside.
When assessing the risk of infection (via respiration) at the grocery store or mall, you need to consider the volume of the air space (very large), the number of people (restricted), how long people are spending in the store (workers – all day; customers – an hour). Taken together, for a person shopping: the low density, high air volume of the store, along with the restricted time you spend in the store, means that the opportunity to receive an infectious dose is low. But, for the store worker, the extended time they spend in the store provides a greater opportunity to receive the infectious dose and therefore the job becomes riskier.
As the work closures are loosened, and we start to venture out more, you need to look at your environment, make judgments and assess the risk:
- How many people are here?
- How much airflow is there around me?
- How long will I be in this environment?
- Am I in an open floorplan office? What’s the of volume of people and airflow?
- Does my job require face-to-face talking or yelling?
- Am I sitting in a well-ventilated space with few people? (low risk)
If you are outside, and walk past someone, remember it is “dose and time” needed for infection. You would have to be in their airstream for 5+ minutes for a chance of infection. While joggers may be releasing more virus due to deep breathing, remember the exposure time is also less due to their speed. Please do maintain physical distance, but the risk of infection in these scenarios are low.
While this article focused on respiratory exposure here, please don’t forget surfaces. Those infected respiratory droplets land somewhere. Wash your hands often and stop touching your face!
As we are allowed to move around our communities more freely and be in contact with more people in more places more regularly, the risks to ourselves and our family are significant. Do your part and wear a mask to reduce what you release into the environment. It will help everyone.
To read the full article and see graphs associated with the author’s research, please visit https://www.erinbromage.com/post/the-risks-know-them-avoid-them
When it comes “community,” the care and compassion one finds at St. Anne’s Retirement Community reaches far beyond our doors along Columbia Avenue. Over the past four years, our Catholic-Centered senior living community has been involved in the Brown Bag Lunch program at St. Anne’s Catholic Church.
Located in Downtown Lancaster, St. Anne’s Catholic Church distributes lunches, free of charge, to community members in need. The Brown Bag Lunch program serves approximately 80 to 120 individuals, Monday through Friday, with the help of countless volunteers from organizations throughout Lancaster County.
“The program is utilized by people who are down on their luck. Volunteers don’t ask questions and the recipients are very respectful and thankful for the meal,” says Dan Lytle, who coordinates St. Anne’s Retirement Community’s involvement in the program.
Four times a year, volunteers from St. Anne’s Retirement Community roll up their sleeves to help with the Brown Bag Lunch program on the last Friday of each quarter. Meals are packed in the retirement community’s kitchen by a crew of employees, Residents and Sisters of the Adorers of the Blood of Christ on Thursday for distribution on Friday. When Dan Lytle asks for help with preparing the lunches, the response from the retirement community is so great, he usually has to turn away volunteers.
“I enjoy packing the lunches because so many people here want to help do it. There is love, a lot of love, packed into each of those brown bags. I am always amazed at all the people who want to pitch in,” says Dan of the Residents, Employees and Sisters who volunteer to help with the program.
St. Anne’s Retirement Community takes pride in providing its Residents with compassionate
care, and participation in the Brown Bag Lunch program as an extension of that mission. As for our Employees, Residents and Sisters who assist with preparing and distributing the meals, they too feel special to be a part of it.
The Brown Bag Lunch Program offers an afternoon meal to local residents in need on weekdays at St. Anne’s Catholic Church on Duke Street in Downtown Lancaster from 11:30AM to 1:00PM. For more information about the program, visit http://stannechurch.org and select “Brown Bag Lunch” under the Outreach menu.
Courtesy of Schreiber Pediatric
Alice “Skip” Steudler sat in the middle of a circle of toddlers leading them through musical games.
Over with the preschool-age kids, Betty Kuhn watched in one corner as a boy sprawled out on the floor with dozens of toy cars. Next to them, Joe Finger and his little buddy Grayson Pavlichko worked on pictures they were painting together. Several kids lined up to talk with Loretta Drolet about their little toy animals.
And out on the playground, Leon Hutton tended to a pile of sticks that served as a make-believe fire.
The unusual thing about these volunteers? They are all at least 79 years old. Skip is the youngster of the group. And the oldest? That’s Loretta, who turned 100 in August.
They come from St. Anne’s Retirement Community in West Hempfield Township, and their visits are coordinated by Hope Long, activity director at St. Anne’s.
All of the St. Anne’s volunteers are parents and grandparents, and they all said they enjoy the visits to Schreiber because they like being around the kids.
Loretta was impressed by how smart the kids are. She recalled one of the children showed her the little animals she had been playing with.
“I said, ‘That’s a doggie.’ And she said, ‘It’s a Dalmatian,'” Loretta said.
Her friends from St. Anne’s are just as impressed with Loretta.
“When I expanded our volunteer base,” Hope said, “I knew Loretta would be perfect. She’s kind and gentle. I knew she would be a good fit.”
“Loretta is my inspiration,” said Leon, who is still basking in the glow of recently being named St. Anne’s King of Hearts for 2017. “I thought if she can do this, I can do it, too.”
Leon admitted he needed a little bit of inspiration in the past year. His wife, Irene, passed away in January of 2016. They had been married 62 years.
“The time at Schreiber has been therapy for me,” he said. “When a person comes out of themselves and gives time, there’s nothing better.”
That’s exactly the kind of reaction Christina Kalyan hoped for when she introduced the program about a year ago. Christina is director of Circle of Friends. She said she thought the kids and the St. Anne’s folks could all benefit from getting together.
“There are a lot of families that don’t have a grandparent figure in their life,” Christina said. “And I wanted to offer (the seniors) a chance to get up and move around and do something that might add a little more meaning to their lives.”
The initial group was made up of a half dozen or so St. Anne’s Residents who have come over once a month (missing occasionally because of weather or schedule). Hope has brought in more Residents for the visits, and she and Christina both said they’d like to add a second visit each month.
“Our Residents love helping others and still have a strong desire to be needed and useful,” Hope said. “Schreiber is the perfect opportunity to allow this to happen. It really is a wonderful partnership and allows everyone the freedom to be who they are with no judgments or expectations from either group. It warms my heart to know that the universal language of love knows no age barrier! We appreciate the opportunity to be a part of the Schreiber family.”
Back in the preschool-age room, Joe and Grayson had finished their paintings, exchanged them and gave each other a hug. These two formed a special bond from Joe’s first visit. Grayson is more than happy to sit on Joe’s lap and just hang out. And Joe’s gruff exterior crumbles away when he talks about his young friend.
“When we see each other and I leave, he makes me cry,” Joe said.
No, this is definitely not your typical volunteer group.
Originally published on February 28, 2017 on schreiberpediatric.org.
The New Year is often a time we reflect on the past year and set expectations for the twelve months ahead of us. Gym memberships, a fresh pair of sneakers, a scenic neighborhood route to walk or run, or a promise to be thankful for the things around you are a great way to focus on a healthier, happier YOU in 2017.
As you look for ways to make positive changes in your life, consider how you can use your time and talent to impact the lives of others.
New Year’s Resolution:
Make Others Smile and Enjoy Doing It
At St. Anne’s Retirement Community, our Residents come from a variety of diverse backgrounds, and chances are, you share something in common with some of them! Whether it’s walking a Resident to daily mass, accompanying a Resident to one of our many campus activities, chatting about current events, sharing an artistic talent or exploring a future profession, St. Anne’s has a variety of volunteer opportunities for people of all ages as well as scout troops and other organized groups. We also need friendly people who love to shop or have retail experience to volunteer in our great Gift Shop!
So, if you enjoy casual conversations with seniors who have experiences they would love to share, consider volunteering at St. Anne’s Retirement Community. As a volunteer, you’ll see firsthand how a little time (and sometimes even a little work) pays off…in friendly smiles and warm handshakes from our Residents.
For more information about volunteer opportunities, call 717-285-5443717-285-5443.