GULF HARBOUR MASTER ASSOCIATION
COVID 19 RELATED CLOSURES AND RECOMMENDATIONS
March 23, 2020
1. Real Estate Open Houses are not permitted after March 23, 2020 until further notice.
2. Estate Sales are not permitted after March 23, 2020 until further notice.
3. Community Pools: Pools fall under the purview of the Gulf Harbour communities. Our Communities should consider actions to encourage social distancing, such as limiting the seating availability and disinfection. This CDC web page discusses disinfection preparation: https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Bleach solution can be applied using a garden sprayer. The Master Association suggests that Gulf Harbour Communities consider closing their pools.
4. Pedestrian and Cyclist Safety: With more cyclists and walkers out and about due to gym closures, please dirve with care and obey all stop signs and posted speed limits.
The Gulf Harbour Master Association reminds all of our constituents to adhere to CDC Covid-19 recommendations and guidance as well as guidance from local, state and federal authorities. More information can be found at:
REASSURING Tips from a Pulmonologist at Weill Cornell - New York Presbyterian Hospital - Dr. David Price, M.D., Pulmonary and Critical Care
Notes from this video: https://youtu.be/WxyH1rkuLaw
"My research at Cornell is focused on critically ill patients in the intensive care unit. My area of interest is translational, patient centered studies that improve the management and outcomes of these patients. My job is to decide which patients need ventilators and get ventilators, how long they have to stay on them, and the treatment of these patients."
"You may hear a little inflection in my voice like I'm emotional. It's not because I'm scared. It's actually the opposite. For the first time in a while, I'm actually not scared," Price said via video. "I work at probably the premier hospital in New York City. Our hospital is almost exclusively a COVID-19 hospital, but we're learning and we know a lot. And what I want you guys to know is that every single day we're getting better, we know more. And I am confident that the stuff I can tell you today should make you guys feel like when this comes to your community that you don't have to be scared and that you can protect your family."
. What is C19? What is this disease? Virus in common cold family. But unique b/c human body has never seen this virus before. Probably came from an animal.
. What does this disease look like? What are the symptoms? Fever, cough, sore throat. Then the virus gets into their whole body and it primarily affects the lungs. For about 80% of people you just don't feel good - cough, headache, maybe a little headache. Disease lasts 5 to 7 to 14 days. For mild case, by day 5 better. For people who aren't feeling better, usually start to get short of breath day 3-5 and then better by 7 day mark.
So, how to protect your family?
. Context: How do you get C19? The overarching theme is sustained contact with someone who has this disease, the vast majority of whom will have fever or aches, or someone who is infected and is about to be symptomatic in the next 1-2 days. You get is almost exclusively from your hands to your face - eyes, nose, mouth - i.e., physical contact. Re aerosol transfer, the thought at this point is for aerosol transmission you need long/sustained contact, over 15-30 minutes, w/o any type of mask, small environment. But overwhelming majority of people getting it are getting it by physically touching people who are infectious then touching their own face. This is the thing that makes me smile a little bit, b/c I know I won't get this disease, b/c I know how to protect myself.
So, these steps will prevent 99% of cases. This virus follows the rules. If you do too, you will be fine.
. Step #1. Know that C19 is in your community, no matter where you are.
. Step #2. Always know where hand are and clean them often. This virus is a wimp, it dies immediately on disinfection, any type of disinfectant. We know that if you keep your hands clean you are not going to get this. You are not going to get this by touching something that someone who was infectious touched, e.g. elevator button. It requires physical contact with that person. Yes, clean your hands before and after you touch that button, but that is probably not how you are going to get this. How you get this is you shake the hand of an infectious person then you touch your face.
. Step #3. Don't touch your face. If you don't touch your face, you are not going to get this. So, when you leave your house wear a mask, not b/c the mask itself will prevent infection but b/c it will help you not touch your face. Fine to wear one at home to practice. Start being aware of touching your own face, and don't do it.
. Step #4. Stay 3-6' away from people.
You do not need a medical mask. If you have one, sure, put it on. But you don't need a big supply of N95's. The general community has 0% need for N95's. In the hospital, I only wear an N95 if I am doing a procedure on a patient who is going to create an aerosol. To protect yourself with a mask, only a regular mask will do.
You don't have to be scared of the outside world. You don't need to be scared of your neighbor. You don't need to be scared of the deliveryman. When you know that the only way you are going to get this is if your hands are dirty and you touch your face, it becomes liberating. The delivery person is not your enemy. The mailman is not your enemy. They are out working and they don't understand this disease. They are heros. This is empowering.
You have to shrink your social circle. Every person you come in contact with has contact with other people. The people who are going to get this are the people who are maintaining large social circles. Find your isolation group and limit everyone's circle to this group.
C19 and home life.
What do you do if you or someone in your home gets this disease?
. Context: throughout the world, China and everywhere else, the vast majority of spread is by home/family transmission. From husband to wife, father to son, daughter to brother. This is scary, but if you understand the rules it's empowering. So, what do you do?
. Anyone symptomatic needs to be isolated, ideally in their own room, so everyone else can avoid sustained contact with the sick person. But it is ok to keep the person in the home. If able, give the sick person their own bathroom. If the person has to come out and interact, they should wash their hands first, and come out with a medical R95 mask on, then clean anything they touched (e.g., plate, cutlery), then go back to isolation. Others family members are going to want to take care of the sick person by getting close - but they should follow the rules above: no sustained physical contact, keep distance, keep hands clean, don't touch your face. But you shouldn't be scared to stay at home with someone who has C19. The vast majority of people are going to have a fever, body aches, feel horrible for 3-5 days, and better by 7. You can then interact when you feel better, when your fever is gone. Current recommendation is if you get sick and then feel better, you can put on a mask and go to work. It's the same with your family. When you feel better, come back out into family life, but wear a mask and wash your hands.
What do I do if I have a mild cold? If you feel like you're getting sick, take precautions as if you have C19 for 1-2 days. Self-isolate. If you feel better, you do not have C19 and can resume routine.
There are exceptions to this: Vulnerable populations in your family. Elderly, immunocompromised, etc. If you have one of these in your home, you and they need to take extra precautions. If someone else in the house gets sick, you need either to find an alternative living situation for the vulnerable, or take the protective steps extremely strictly, to protect the vulnerable, including giving the vulnerable their own protected space. We know that these are the populations that this disease will kill.
When do you go to the hospital? I may be one of the most qualified people in the country to comment on this. Answer: only if you are short of breath. Not if you have a fever. Not if you have body aches. At Cornell right now we are sending a lot of people home to ride it out. We are also finding that people who arrive short of breath stay that way for 5-7 days and then they go home. Of the entire of people who get C19, 10% need to come to the hospital b/c they are short of breath, not more. Of the people who come to the hospital, 1-3% require ICU and ventilator. Of the people who need a vent, the vast majority come off the vent in 7-10 days. So, going to the hospital when you are short of breath is not a death sentence.
Should I get tested if I feel unwell? This is hard question. Depends on availability of testing. If you have flulike symptom, it is likely you have C19. But that won't change the recommendations above. The caveat is that a lot of places are now implementing broad testing, and if you have access - absolutely get the test. B/c when you are feeling better, you can have full interaction with your family. But if your area is short of tests, don't get in the cue. Just take the precautions.
Infants and newborns? We don't think it goes from the mother to the fetus, but rather after-birth on contact. But there is almost no C19 in the population from age 0 to 14. Kids are not getting sick. Kids are not dying. There is a whole debate about whether they are transmitting the disease, but we don't know.
Protecting front line providers? The vast vast majority of transmission is droplet - a sick person to either a surface where it's quickly taken up by someone else or to another person's hand, and then that person's hand to their face. The only time we in the hospital wear N95 mask is when we are doing something to a patient that makes them spit a lot. The vast majority of time, 80%, when nurses are in the room with a C19 patient, they are wearing a surgical mask only. In HK and Singapore, when front line providers wear a surgical mask in general and N95 when and aerosolizing procedure, 0% transmission to healthcare providers. None. The healthcare providers getting sick, and they are getting very sick, are one clear population: healthcare providers on the front line who have extensive contact and are not protecting themselves. E.g. GP who took a nasal swab 3 weeks ago in the office in NYC and was unaware the patient was C19 and didn't take precautions; the ER doctor who 3 weeks ago in NYC didn't know the level of protection required. At Cornell, where we have been doing this for 3 weeks, we can interact with C19 patients and if we follow the rules, we are not getting sick.
Is it safe to go outside? Yes. Just follow the rules.
What about bandanas? Sure. Because it will prevent you from touching your face.
Road trips? Fine, as long as no one in the car has C19.
Disinfect packages, groceries, etc? In NYC where it is rampant, out of an abundance of caution, yes have it left at the door, use gloves to accept deliveries, but don't worry about what's inside the package. Just don't high five the deliveryman. Don't pick up the plastic bag and have a huge long interaction with that bag. Everything you touch, clean your hands. But I don't believe you need to wipe things down. I live in rooms with C19 patients for 12 hrs day and so I have a clear procedure for disinfecting myself. But that is not you.
Should I go to the doctor? Use telemedicine. We have an army of doctors at home waiting to take your call. Do not go to the doctor; do not go to the hospital.
What's the incubation period? Depends on exposure, probably. ER doctor who is exposed to a lot of disease it's probably a couple of days. For milder exposure, could be upwards of 14 days. So casual contact and you don't feel sick at 14 days, you probably won't get this disease.
Who is at risk? EVERYONE OLDER THAN AGE 14. It hits the entire spectrum of ages older than 14. We see a ton of 35 year olds. Some day we understand why but today we don't. If you are older than 14, take care. The younger you are, the less likely you land on a vent. But we have young people on vents and older people who come through fine. We don't know why.
What drugs can I use to remedy myself? Use Tylenol, it cuts fever. We are no longer using ibuprofen - causes inflammation. What we see is people get progressively short of breath, and if it keeps going they end up on a vent. They typically settle out after 1 day. And then after c 7 days we can typically get them off the vent. Dealing with these patients as a doctor is incredible simple - it's the same procedure for all patients, though it is very scary for the patients.
Homemade mask? Sure, and give your stash of N95 masks to the hospital. They need them. You don't.
What can we expect to happen? Social distancing will last for months, and up to a year. The first thing you do is flatten the curve and bring cases down so hospitals don't get overwhelmed. Then people will get relaxed and there will be a second small spike. Then it will get under control as people's behavior changes. As soon as you learn the rules, it's empowering. New normal for 6-9 months.
What about symptomatic spread? Cruise ship data, people shed the disease 1-2 days before fever. So if you get sick, notify the people you had contact with in the prior 1-2 days. If they feel ok after 2-4 days they will probably be fine. But I don't think there are huge asymptomatic spreaders giving this to everyone.
Immunity after infection? Yes, people are absolutely becoming immune. The stories you are hearing are people who didn't fully resolve the disease. We know that 1-2 days after you have the disease until about 14 days into the disease, you are spreading it to the environment. 81K people in China got the disease, 76K recovered and now have antibodies that protect them. Natural course: C19 will enter world circulation, spreading around the world, getting milder and 5 years from now you'll get this exact virus and it will feel like a cold. But the first time through the population it will be far more impactful.
For care providers: screen patients and hand hygiene. That'll do it. If you are doing close in care in NYC at the center of the epidemic, use a mask.
Pregnant women? We are not seeing any difference - pregnancy does not seem to impact your odds. We do see a male predominance. But for most people who get it you're going to feel awful and then you are going to feel better.
Tony Oroszlany, '87
980 Park Avenue - New York, New York