Younger generation goes viral: Officials urge personal responsibility to stop spread

Rehoboth Beach was filled with July Fourth vacationers seeking sand, sun and surf on Saturday. Photo courtesy of Civil Air Patrol

Delaware’s public health and hospital officials are urging heightened prevention of coronavirus transmission following a resurgence of the virus in the state’s beach communities, a spike not totally unexpected and attributed in part to non-compliance and irresponsible behavior.

Concern targets the younger generation, which accounted for a noticeable increase in positive coronavirus cases in the 18 to 34 age demographic.

“Unfortunately, this is escalating as we anticipated throughout the country because of their social behaviors. It is what is. They are young and indestructible in their own mind,” said Dr. Chris Snyder, chief quality officer for Peninsula Regional Medical Center. “Managing these folks and these populations has been somewhat challenging.”

On June 30, Delaware Department of Public Health Director Dr. Karyl Rattay announced testing in the Dewey Beach and Rehoboth Beach ZIP code revealed a significant increase in the percent positive cases, with 102 positive cases of more than 1,000 persons tested. The majority were younger people with mild or no symptoms, which “is common for your adults or kids who are positive for COVID-19,” Dr. Rattay said during the state’s weekly COVID-19 update.

“We just need to educate this population,” said Dr. Rick Hong, Delaware Department of Public Health State Medical Director. “They may not know the specifics of this disease.”

“We’re obviously seeing an uptick of active cases in our coastal beach communities,” said Dr. Bill Chasanov, infectious disease physician/clinical transformation office for Beebe Healthcare. “The Delaware Restaurant Association and the restaurants are obviously very concerned. DEMA, along with Beebe and our other partners with the state have done testing over this past week to try to help our community members out, including those in the restaurant association to really identify if there is an increase within their workforce but also within our community in Lewes, Rehoboth and Dewey …”

Delaware Gov. John Carney responded to the spike, restricting bar seating at establishments in beach area ZIP codes this week.

Additionally, the city of Rehoboth ordered, effective July 1, that facial coverings be worn in all public spaces, including public streets, sidewalks and parks, the Boardwalk, the beach, and all commercial establishments. Face coverings are not required while actively bathing in the ocean. Similar mandates were put in effect in Fenwick Island and Bethany Beach.

“I think the behavior thing is a great word for this. We have to condemn some of this behavior,” said Dr. Snyder. “But that 21 year old who just was positive goes home and sees their 80-year-old grandma, now all of sudden we have a whole different world where nursing homes will have outbreaks and they become the spreader of the bug. They (young persons) may not get sick themselves but they may potentially infect a population that is higher risk. With this population of young people, I think the behavior is both a verb and a noun. My children are in that population and as a parent and as a physician I have spent a large amount of time educating my family. Being on the media side of things over the last three to four months I have also tried to educate everybody else.”

Dr. Chasanov said the younger demographics “tend to be less sick than those who have moved through life a little more. It doesn’t mean that they cannot be extremely sick or even critically ill, but we tend not to see much of that in those demographics as we do with those who are 60 or older. What we do know as the demographic from an age perspective goes up it does increase the risk of more serious complications or more severe illness.”

A key to stemming transmission is changing behavior, Dr. Snyder said.

“As many other viruses are out there, including HIV in the 1980s and 1990s when I first started practice, there is a behavior that we have to establish. And unfortunately, the young population isn’t getting in. l live in Ocean City and see it,” he said. “I think it is really important the parents of these young adults really have to emphasize the fact that they have to somehow maintain them and educate them on the scarcity of protective mechanisms out there. I do relate this to HIV because we had the same problem for two decades before we figured that out. COVID, I think we’ll figure out a lot sooner just because of technology and visibility around the actual virility of this.”

Dr. Hong and and Dr. Chasonov echoed those concerns about the younger demographic and transmission to high-risk populations.

“The group that seems to be composing the majority of these cases are not the ones most likely to get complications,” Dr. Hong said.
“But if they happened to pass it on to someone at high risk or with complications, such as the elderly population, those with certain chronic medical conditions they potentially could harm others. You may be okay, but you may make someone else sick. Take responsibility for your own actions and do what you can to prevent spread.”

Dr. Chasanov said, “If you are obviously in close quarters with a group of people that really haven’t been self-quarantined, if you will, and if you are out at the bars and you are in close contact with people and masks aren’t being worn because people are eating and drinking and things of that nature that is one of those risker behaviors that could increase the risk of transmission.

“That could be from a group of people going out to just a couple people at the bar, and then interaction with the bartender or your server. All those things are high-risk.”

Dr. Snyder applauded Gov. Carney for reeling back reopening measures and limiting the bar seating to help send a message.

“I think there is an alarming lack of judgement being made by folks as far as opening up and having these social interactions. We’re fortunate in Maryland, we haven’t seen an uptick.”

It all boils down to personal responsibility and making the right decision, Dr. Chasanov said.

“My general guidance that I give people is as things continue to reopen, as we are in Phase 2 of the state of Delaware reopening, it is important to recognize that as those decisions that are being made, there is an individual decision that everyone has to think about before they decide that it is time to go back out to eat, or the time to go to the beach,” he said “There is not going to be someone there per say policing it … no one is going to stop you from going out to ear right now. Restaurants are open at 60 percent capacity.”

“Let’s say I am someone who had some immune issues, or I am going through chemotherapy for cancer, or some other medical condition that might put me at risk if I contract the virus, that I could become critically ill,” Dr. Chasanov explained. “So, no one is going to police me from not going to those places, but I might need to make that individual decision that, ‘Maybe this still is not the right time.’ We have active cases that are increasing in the state, in our county, Sussex County, and it might not be the best thing for me individually to be going to large group settings yet.”

Personal responsibility, Dr. Hong is critical for greater compliance and ultimately slowing the spread of COVID-19.

“We do want people to have fun, enjoy the summer whether it’s going to be the pool, the beach … people have to realize that safety ultimately should be everyone’s main concern,” he said.

Dr. Chasanov added, “Everyone has to put their individual circumstances and situation at the forefront and make the decision: Is this the right time to go back out into groups, even if they are minimal groups? Is this the time to go to the family barbecue this weekend where there is going to be 50 people? These are the things that are very risky. We do know that there are asymptomatic carriers out there, basically meaning that they are people that are shedding the virus but don’t really have any symptoms or very mild symptoms that they don’t recognize.”

As summer steams deeper into July, officials are hoping families planning get-togethers, parties, celebrations and similar activities take necessary precautions and follow CDC recommended prevention protocol: face coverings, six-foot social distance and hand hygiene.

“As we are reopening the state, we realize that might result in increasing the risk of transmission because there are going to be situations where these infection control measures may not be followed completely,” said Dr. Hong. “We know it’s summertime. It’s time for vacation. We are concerned that people may misinterpret reopening as ‘It’s safe now.’ The virus is still out there. We have seen other states that are going backwards because of the increased number of cases. We’re not there yet. I hope we don’t get there. But it is critical that we get the public’s help and support in continuing to follow these infection control measures.”

“We are very excited about the 4th of July weekend. It is a moment to be very proud of as being Americans, in a country that we want to celebrate appropriately,” Dr. Hong said. “We do encourage people to celebrate but also celebrate safely and understand that these infection control measures are there not just protect you but others around you. We don’t want a happy joyous event to become a solemn sad event if something happens.”

Vacationers pack Rehoboth Beach on the Fourth of July holiday Saturday. Special to the Delaware State News/Chuck Snyder

Party or play?

Common sense, officials say, is the operative word when considering activities, such as playdates, parties, reunions or sports events. Risk increases as the number of people in a group grows.

“Large parties: How do you define a large party?” said Dr. Chasanov. “Well, it depends on the square footage that you are dealing with. If you have 100 people at a pool party in what I consider a regular size backyard that is significantly more risky than if you had two or three people over that were able to physically distance to hang out and spend the day together.”

“If your child is going to play with 20 other children on a playdate you have to understand that that is 20 other kids, and you do increase the risk,” Dr. Chasanov said. “The more people that you put into close contact you increase the risk of becoming in contact with the virus or the infection, and your child getting it and child spreading to you as parent of child’s grandparents. Those are still risker behaviors right now, and they have to be decided upon on an individual basis.”

Dr. Snyder said, “Just be smart. Again, use the same protective mechanisms your healthcare provider would use. You never know when somebody is sick. We want everybody to have those social interactions, but we also want them to heed the warning of, ‘Guys, we’re still dealing with this.”

“We all want to go to parties. We all want to go to bars,” said Dr. Chasanov. “This is the time that you have to think twice about who else you are interacting with.”

Why masks?

Dr. Chasanov offered a word-of mouth-example.

“When I talk, when I sing, I cough, I sneeze, those droplets that propel from my mouth could then land on the other person. If I am infected and those droplets land on the other person or land in their eyes or nose or the mouth, that is really the risk factors of where people get sick from this,” he said. “Maintaining the six feet distance allows for the majority of those droplets not to be kind of transmitted within the radius. So, when I wear a mask … the mask that I wear actually is helping to protect you. It may provide some protection for me, but it is really there to protect you.”

Dr. Snyder agrees. “The mask is more than just a barrier,” he said. “It’s also a reminder not to touch your face. It’s a reminder that the person across from you is being compliant and has that ‘behavior’ down. So, you go in elevator and five people have masks on and one doesn’t. I think that says a lot about that one person as to, ‘Why not.’ At least think about the effect you could have on society and be responsible for your own individual hygiene.”

“The mask thing, a lot of people think it’s more of a political agenda. Frankly, in healthcare we’ve done this for years,” said Dr. Snyder. “This is not really new for us. It’s just a higher volume right now.”

Hand to hand combat

Medical officials peg something seemingly as simple and easy as frequent handwashing or use of hand sanitizer as a huge deterrent in combating the spread of the coronavirus – and other illnesses such as the flu.

“Instead of putting alcohol in your mouth let’s put it on your hands,” said Dr. Snyder, whose message to those who wish to socialize is the “consumption of alcohol and drugs unfortunately is precipitating higher social touch. I think it’s really important that they also understand… that you wash your hands really good and wear that mask. The virility of this bug has been clearly identified as being hand to mouth, hand to eye, hand to nose.”

Transmission frequency

Because the coronavirus can survive on surfaces, precautions need to be taken.

“What if someone who had COVID-19 was here and I touch a desk and there are droplets on that desk from that person that I might not be able to see. If I touch the droplets, as long as perform good hand hygiene my risk of infection is very minimal. If it is on my hand and I clean my hand — I’m good. If it is on my hand and I don’t do that, and I touch the areas of my face that is when I could potentially get in trouble,” said Dr. Chasanov.

His recommendation is not wearing gloves, which can spread the virus to objects such as a cell phone to answer a call or text. A person might remove the gloves and then wash their hands, but virus is now on their cell phone.

“That actually becomes a riskier behavior because now they have gloves on and these gloves are touching everything,” said Mr. Chasanov. “It’s tricky. Most of the time I recommend people to not wear gloves and just take hand sanitizer.”

The life span of COVID-19 and viral particles on surfaces is under the microscope.

“There are studies that look to determine on certain surfaces how long the virus or viral particles will live. We do know from preliminary studies that there is a difference,” said Dr. Chasanov. “For example, a copper-coated surface has different viral life than stainless steel or wood, or fabric. We’re still looking to see how that correlates to transmission.”

Dr. Hong said, “It’s not just the viral part but it’s also the environment they are in. If they are in a moist area, they tend to stay around a little bit longer. If its outside versus inside, temperature change things like that, it is really hard to say. I think the message should be that regardless of the environment, that there is a possibility that viral particles could be anywhere, specifically on commonly used surfaces.”

Testing 1-2

Delaware Department of Public Health utilizes several forms of COVID-19 testing – nasal and oral. Results are about the same for both, as well as the instance of false negative results.

“We do our own validation internally in our lab before we release it to public,” said Dr. Hong. “We are very comfortable saying it does not matter which test you get. You’ll get the same accuracy. Inherently, the test itself has some inaccuracies, like every test out there. There is no test out there that is 100 percent perfect.”

Someone who has COVID-19 symptoms – a fever, cough, shortness of breath – and has been exposed to someone with COVID and gets a negative test, whether it is the nasal or saliva based, Dr. Hong questions the validity of that test and may recommend a second test.

“People have to realize that if you are negative, that’s good, but it does not release you from your responsibility to social distance to wear the face coverings and perform hand hygiene,” said Dr. Hong. “We want people to understand that you’re not getting cheated if you get one test over another. All of the tests are comparable in accuracy.”

At Beebe, PCR tests are, either nasal swab or throat swab.

“It looks for active virus in secretion in back of nose or in the back of the throat, respectively. So, this is a false negative rate in the setting that if someone is not actively shedding virus at the time or there is no virus that is able to be detected in the sample then that could give a false negative.

Accuracy of both tests are about equal, Dr. Chasanov said.

Back to ‘normal’?

Dr. Hong and Dr. Snyder believe the world, and closer to home America can someday return to “normal,” but “HIV in 1982, it took us two decades to get comfortable around that. We have much better technology and awareness. If everybody’s behaviors continue to improve over time then yes, there is a way. Is there a vaccine for this? Too soon to tell. We have the smartest people in the world looking at that,” said Dr. Snyder. “But we have a lot to do from a behavior standpoint before that. Yes, I do think that we can go back to normal. But there will always be coronaviruses. “

“The strain of COVID will always be in our world, just like tuberculosis, just like polio, and just like any other virus. Now that we have a better handle over the presentation of it, we can identify, isolate it and support the patients. There is no silver bullet on this one. Viruses are very elusive. They want to survive, too. So, we have to do our best possible prevention because that is definitely worth a pound of cure right now.”

Dr. Hong reiterated personal responsibility in fighting the virus.

“We all play a part in this, and honestly, my opinion is the public is huge in determining what our future is going to be. If these infection control measures are not being followed, we are going to be doing this for quite some time,” he said. “One of the best ways to stop the spread of the disease is to make sure that you contain any infectious particles of body fluid, and don’t spread that out to other people. If we reduce the spread of the disease, then the virus will eventually burn out. The public does have the power to alter the future.”

At present, the presence of a COVID vaccine is a waiting game.

“It really is the last piece to the puzzle,” said Dr. Hong. “ I hope people are open-minded about the vaccine and will consider using the vaccine per CDC recommendations. But that does not mean that we should stop social distancing, using face coverings and washing our hands.”

Dr. Snyder echoed that. “I would hate to see the governors have to shut things down but again there is really no other way other than social distancing to prevent this, because we have no treatment for this. I have 100 family members. I don’t want any of them to go through what I did to people here three, four months ago. It was awful … to see people die unnecessarily.”


Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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