Duke experts discuss how to stay safe through the holidays
Duke Health experts discuss how people can stay safe from the coronavirus during the holidays -- Halloween, Thanksgiving and December holidays.
okay. Looks like Zoom has had timeto add everybody. So we will go ahead and get started. Thank you, everyone for joining us. Welcome to the latest Duke media briefing on the Cove in 19 Pandemic and its effects on society. I'm Gregory Philips with Duke Communications, and I'm moderating this event. Halloween is next week. With Thanksgiving, Christmas and other winter holidays close behind. Millions of people have been staying distance for months, which makes the desire to gather for the holidays even stronger this year. But can it be done safely? We have three Duke physicians with us today to discuss how to plan for traveling, gathering and eating for the holidays during the pandemic. I'll introduce our speakers and get the discussion started. Then we'll open it up to question Thanks for those of you who already sent questions. If you're joining us on Zoom, you can submit questions. Why the Q and a window any time. They will also be an opportunity to ask questions in person in a few minutes. Thanks also to everyone. Watching this on YouTube with us today is Cameron Wolf. Here's an infectious disease specialist at Duke Health and an associate professor at the School of Medicine, where he studies infectious diseases on biological and emergency, prepared this hospital systems. Good morning to you, Morning. Also joining us is Emmanuel Walter Jr. He is a professor of pediatrics at the School of Medicine. And he's also chief medical officer of the Duke Human Vaccine Institute, where he directs the Duke Vaccine and Trials Unit. Good morning. Morning, Everyone on we have Viviana Martinez Bianchi. She is a primary care doctor at Duke Family Medicine, where she's also director of health equity and an associate professor in family medicine and community health at the School of Medicine. Dr. Martinez Bianchi will give our answers in English and Spanish today for the benefit of our Spanish speaking audiences. Good morning to you. Good morning. One of the S. Uh, Dr Walter, we'll start with you. The thought of kids going door to door trick or treating feels very different than it did last year. Can that be done safely on there? Any alternatives you can suggest? Yeah. Thanks for the question, Greg. You know, uh, I think this year, obviously a different is than past years. You know, we're in the middle off a pandemic, with the pandemic starting to see Thio reach or starting its second surge here. And I think there are a lot of concerning indicators, you know, with the number of cases going up, hospitalizations and deaths going up here locally and across the country. So I think trick or treat will not be as normal this year and understanding that everybody's kind of fatigue from co vid I just have really concerns about trick or treat, as usual, going door to door like we usually think about in large crowds or large crowds of kids. So I think that's just a perfect a way that potentially spread spread the virus. I think there are a lot of alternate ways that we could look at for celebrating trick or treat Halloween. Uh, you know, that that we can think about people could dio for with their kids they could do pumpkin carving at home. They could potentially even do it in some smaller groups. Socially distanced, making sure that they do things like wearing mask and and sanitizing, um, other things that could be done. You could do like a home scavenger hunt with with candy just kind of keeping it, keeping it small. You might consider doing the home home movie night instead for those that are so compelled that they really want to do a trick or treat. And I could see Cam smiling there, uh, with his kids. My kids are all out of that age range, but I do have grandkids. Um, would I would advise, um, is that you not do it in large groups that you keep it, keep it really small if you really feel compelled. If you're a person that's handing out candy, then you might consider putting the candy at the end of your driveway on a table in little bags. I'll realizing that kids may may grab them all, but that's one thing that you might consider to keep it safe. I think parents should make sure that their Children are wearing masks on DNA, not Halloween masks. I think they need to wear a cloth or surgical mask if they have access to those, Um uh, that they might have and not a Halloween mask over that. Maybe just incorporate that into their costumes and then also they auto carry Santa hand sanitizer with them so that those would be my recommendations to try and try and keep it safe if your trick or treating So, Doctor, thank you very much. And I'm sure we'll come back to that for now. Dr. Wolf, I'd like to move on to you beyond Halloween. What should people keep in mind if they're thinking about traveling for the holidays? How risky is it? And how should people weigh those risks? Yeah, Thanks so much, Greg. I might actually, if you don't mind, just add back under what Chip had said. We sort of think of Halloween. A se young kid event. Um, you know, I have, ah, five and seven year old. They're excited about this, but I think we should also reflect that For many towns, particularly college towns, for example, Halloween is a big A teenager and celebration in your twenties and beyond. So let's not forget that it could be a very common aggregate and type gathered activity for lots of not so young individuals to I think, for those aged people, we also need to be thoughtful about how we sort of think about Halloween. But in answer to your travel question, you know, I think like like like Chip had said, You know that there are some concerning numbers across the country, and I think, as we start thinking about activities like Thanksgiving where travel is going to be, you know, in any given year is is, uh, it's an enormous trouble weekend, I think, statistically the busiest in the United States. I fear that if we don't consider that differently, this year will be getting ourselves into trouble. And so travel, You know, travel is travel is a congregant activity by its very nature. But I think there are ways of sort of mitigating that. The first is, you know, many of us flyover Halloween. I think of Thanksgiving. Sorry of all of the weeks when it's important to consider whether or not I can actually travel by car. Therefore, staying in my family congregate. Um, that that would be a better choice from a safety point of view this year, at least, I think the other thing is to say, if you have to travel and you have to travel in a way that involves public transport, um, be mindful of the groups that are around you where you mask. In fact, I encourage people who are at high risk under those circumstances to actually have it in 95 mask for themselves, not just a cloth mask or a surgical one, although any mask is clearly orders of magnitude better than none, Um, like chips said hand washing is still important with hammered the masking message, I think a little bit, but we still need to be respectful of the fact that this virus survives on surfaces much longer than many typical viruses like flu. So hand washing remains important. And there's there's, you know, there's there's activities that we do, that we don't normally think about that in our travel, I think, are high risk. So, for example, when you sit in the waiting room, the waiting wing off the airport, you know that is a is a busy place with lots of people around, and I think people would do themselves well to be very sensitive to the groups of people around them. Perhaps not stop for that extra meal in the in the airport waiting room before they jump on the plane, where they're all sitting down with lots of masks down on. Be thoughtful about those sorts of activities um, I actually encourage folks to take a second mask when they're going to, because, you know, it's it's how often do we get there? And we find that year loop snaps or something and you've got five hours sitting beside someone on the plane. I think you've got lots of opportunities to be really thoughtful this year if in fact you want to travel at all. And that may be actually, the biggest issue is to say, Look, pave. There's been lots of things that are unusual this year. Um, maybe traveling for help for Thanksgiving may in fact be something that people can differ for 12 months. Well, thank you very much on certainly with lots more to follow up on their But Dr Martinez Bianchi, I'd like to move on to you. Of course, the flip side of traveling is the idea of having people gather in your home. Um, how should people approach hosting holiday gatherings this year? Can that be done safely? And if so, how? Well, as a Sui mentioned, it is a different and difficult year, and we have toe. We have to plan it, probably to avoid becoming ill or making others six week over 19. First of all, if you or anyone in your household has symptoms of Kobe 19 or the flu is waiting for cover 19 vital test results or may have been exposed to someone we cover 19 in the last 14 days. Then do not host or participate in any in person gatherings where you could get others infected if they are not the members of your own household. Um, in this case is if you are a person on quarantine or in isolation, then you should celebrate only with those who you may have to quarantine together your family. Members of people who live under your sun roof, your roommate, um and then avoid large, larger gatherings. Tow. Avoid passing this on to others and the total low. Most important to you and the fiestas is an organist are participating unionist personas. You said Wagon and Sogard, DNS. Intimacy Corbett, 19. A grip stance Miranda Law school tell us, celebrate viral but Paris diversity any Oh no, Alvaro's whatever it still looks. Questo Algae income from 19. 0, sweetie, Moscato Sadia sentences Toca assert quarantine Toca as large day in no star conduct condo trust personas and it's a caso communist celebra Laffita solo containing with starting quarantine A. When a person escape even in through in focus. But now they're also safe on state ways together for the holiday. So so the CDC has told us about. You know, they divided about lower risk middle risk and higher and higher risk activities. So a low risk activity for the holidays will be toe. Have a small dinner with only the people who live in your household. The people who live under your same room. Think about preparing traditional family recipes, recipes for family and neighbors especially. You could think about preparing your meals and and maybe delivery to the door to somebody who may be a high risk of severe illness from Cover 19 that needs to isolate. And you could have a virtual dinner and share recipes with friends and family toast stories. Um, on shopping day, you know, box stage shop online rather than in person, so that you're not exposing yourself crowds in in the stores, um, and then watched sports events, parades and movies from home. So I form a Segura's. The onus. Paralysis. 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If you must have other people, make sure if you're indoors Open the windows so their school ventilation is not a crowded on security place If you're gonna go, um, getting going toe a pumpkin patch review which are the Panchen Pumpkin patches that are using hand sanitizer. Report touching pumpkins where people are wearing math. Um where the where in the off the mask is encouraged and enforced. And then look for people who are able to maintain social distance. And you know, our people stayed 6 ft apart, Um, and then attending small outdoor sports events with safety precautions in place. Less activity is a home a Dorado? ESantana Kenya saying. Like relive recon Familiar. Is amigos given in Laconia produced, you know, laugh recommendation. It said the sellers afuera or she's manasota dentro agree NW in Las Puertas is the compact Calabasas, where toes, uh, it elaborate on the statement. Sandra Disinfectant Manos and Carla's Calabasas. Um, E don't say Ali Ente or same pony, Mouzalas mascara, even the last person as well. Um Montini Distance Cement Associate s the Hamas assisted oppa, Kenya's event of the Partido Zonolite delivery and under in Defense associate e wanted toe also make a note off date of the dead, which is also coming up soon for the Latino community. And for those we can think of preparing traditional family recipes playing the music in the home off those people who are diseased, making the creating masks or making an altar for the disease in the home using pillows. But think of things where you're not really involved in the regular crowd that you have. You will have involved during, um, typical times and a parody of Los Muertos Tambien a Music and Jakarta Paramount in a group of pick N O. It's the color mascaras special, a musical, the last person as Puerta's unusual deliberation individuals. Yeah, excellent. Thank you. Uh, Dr Martinez, thanks to all of our Panelists for those comprehensive opening answers, we've certainly got lost to dig into here. I would remind everybody on the cold that you can submit questions by the Q and a window on. I can ask them for you. Or if you prefer, you can raise your hand in zoom so that you ask your question in person. And if you're joining us by cell phone, you can hit star nine Thio Thio Request toe raise your hand so that we can, um, you. But we've had some questions come in already. So we'll kind of work through these. Andi, I'd like to hear from all of the Panelists on this one question we had from The Washington Post asking what research currently informs ideas about the risks of household transmission. For example, the attack rate within a typical household. Um, Dr Wolf, would you like to start off on this one? Sure, you know, there's It's a great question, and there's probably a couple of major studies that would, um, point towards some of that effort. You know, one of the earliest ones, I think, was probably back in June where we started to get publications. I think The Lancet had a had had a good sort of retrospective cohort looking at within Guangzhou, in China, how maney sort of household members became infected after someone had covered within the household. And they would sort of sit. Depending on how you define household members, they would sort of come up with somewhere between 12 toe 17%. But I think the definition of household members there is really crucial because, you know, when we think about, um, the set up of many about different socio, economically derived homes, that could be very different. You know, my what My family set up maybe maybe quite different Thio other members that gave us sort of the first hint of sort of intimate close transmission. I think the other one that sort of stood out for May was actually retrospectively looking back on the very contained transmissions that were occurring on some of the early cruise ships. It's not quite a house, but it's Ah, but it's a containment zone where you really, you know, can examine transmission pretty closely. What was very clear in that in some of those cases, for example, the Diamond Princess in Yokohama had, um you know, the more people that were in the room with you, the higher the transmission rate? Not surprisingly, and I think for folks, um, where there were four per sort of room, almost equivalent to a household. You sort of getting transmission rights then and sort of upwards of 20 or 30%. I think I'd have to look at the exact statistic. Um, it's very proportional to density. I'd be interested in what my colleagues then say in terms of how you would apply the sort of the density thought process to different households. And, you know, also who is the household member, I think becomes really crucial there. So, you know, if it's myself, a wife and two kids within a small confined and clearly we're gonna have lots of contact within that little group. But maybe out sort of extended family may not come very close. That's very different in certain populations. But they would be the 26 studies that I would start with sort of averaging in the teens to twenties. Um, e think my colleagues would probably have their own experiences on this to the thanks, Cam. Yeah, I think Ah, lot of it depends on your as you note your living situation in the density within within your household. You know, um, here, my do pediatric practice and and my experience from you know, if you have an infected, for example, parent, um, and you have a fairly dense living situation with a lot of people in one house that the attack rate in the household is, you know, appears to be much higher. You may have if you have 43 or four Children coming in from that house. You know, often if it's 43 will test positive or, you know, if it's 32 will test positive. So I think it really depends from individual household the household. What? You know what your living situation is. So Viviana may want to comment as well. Dr. Martinez, have you got something you'd like to add? Yeah, I heard the question yesterday, and thank you so much for for asking it because it took me Tito reflection and to looking at what studies have been done. And a zit was mentioned before this radio transmission between eight and 18%. Yet we have, uh, contact tracers who are telling us that sometimes they called the context off a positive case that has been identified, and they hear that the whole family unit is sick with the symptoms off over 19. So I really think, uh, will be wonderful to start looking at studies that are looking at What is the data that contact tracers are collecting? What are the stories that they're hearing in primary care? We often are seeing, Like Dr Walter Simon mentioned earlier that whole family units are sick. We also see that depending on you know, the initial case or who was sick. If it's somebody who's coughing a lot, it has a lot of secretions. Then it's more likely that family members are also gonna be become infected as well. On den the severity, you know, how severe they are. It will depend also on how you know what are there predisposing conditions. Often we had seen reports our families that we have taken care of where maybe the younger person was. A factory worker got sick at a meat packing plant. Went home where? Grandmother um, they're older. Parent takes care of their Children while they're at work. And then the older parents, the one that ended up in the intensive care unit and might have even died well and then the other. The kids also were sick, but the one that ends up being ill is the one going that had diabetes or off other or other pretty predisposing problems. Locate most television. The respectable and transmission is que estamos encontrado. Uh, those looking public A When Reince got the transmission allows personas la familia and cultural the chopper siento because Obama's historians, the lustrous Theodore is the contacto Quentin Kablan portal. A phone on a person s positive total familia is positive. Okay, he said his fault. A general mature, controlled inform Asiana Travis Day. Okay, stand Apprendi Endo lost radar contact with the Departamento de Salud. It can be in Look estamos bien does the latency in primary salute camo medical familiar from a pediatrician? SK Nothing contra most familias and then the jamas por telefono it all a familiar firma. OK, he says. When a person a home and adquirio Najibullah casa la madre a connection calculus Ninjas Gondwana trabajo is like persona que mean agenda therapy. Intensely porky persona que Catania diabetics pre existent. Otra cosa que vemos es Cuando de introduced a familiar when a persona Carmelita toast the Latina Covic, Karma's country secrecy. Honest we go and rest of the la Familia is most common is in fact Well, yes, yes, thank you. If I could add one piece again. Sorry, toe interject. I mean, I think one of the things that we're also trying to figure out and some colleagues here at Duke a looking into is to better understand, um, household and close contact transmissions so well before covered, um, some groups within our genomic core had actually a project up and running where they were trying Thio. Look at suspected viral infection and and see if they could preempt when those infections would be transmitted or when people who might have been exposed would be we're about to become sick. They were able to sort of, um, alter that Suddenly Aske overt emerged to really look at individual people who have been positive, cost a net around there, sort of school or college or family close networks and really try and better understand how how virus transmits between all those different individuals. So we are starting to get some information on viral dynamics, and I think in exactly following along what Chip and Viviana had mentioned, Um, it's it's dependent on who the person is, who's positive in the household, what sort of intimacy of the context that they have. Um and then also sort of, you know, it's not just the household, it's it's the household Plus, who travels with you to work. What's the What's the work transport like, what's What's the environment at work? Who comes back into the house? It's It's much more. It's much more complex than just thinking about a statistic within a household. Um, the final thing I would want to adhere to is we're also getting some really good data starting to come out of, um, tertiary care Ansari tertiary education facilities. So understanding transmission within the home when the home is a dormitory. That's a very different sort of transmission capable environment. And I think as we're seeing universities across the country open in different ways and trying to mitigate covert in different ways, we're learning a lot about what could be successful there or or what facilitates easy transmission. Excellent. Thank you. And thank you for adding that we've got lots of questions coming in, so we're gonna get through as many of these as we can. Um, doctor, if I wanted to follow up on something you mentioned earlier about Halloween, not just being for Children, obviously, we know a normal circumstances. You see lots of Halloween parties and grownups, teenagers, college students having these kind of things. But we've also already heard today about the issue of being asymptomatic and still infectious. Eso again, Even if it's restating some about some of the points. What do you think people should bear in mind if they're thinking? Oh, well, I still wanna have a Halloween party. I could do that right? What should people be kind of thinking about? What kind of decisions should they be making when they're adults wanting to celebrate Halloween Dr Walter, take on whoever wants to go first. Okay, I'll start and elect camp since he brought up the adults. And I'm the pediatrician. But, you know, I think the recommendation Aziz Viviana had mentioned, you know, number one if you have co vid, um, or if you've been exposed to someone with Covic, you really should follow recommendations and not be participating in any Halloween or trick or treat type activities. So I would like to emphasize that to begin with, I think you know the risk. Probably the biggest risk is really a bigger risk. Is social gatherings with older teens and young adults for for for Halloween festivities. And you know those air very, very common. And I think if you potentially mix alcohol in with those type of events, you really, um, risk ah, high transmission kind of super spreader type type event, depending upon how big the event is. So, you know, I really would would caution people against a larger gatherings on Halloween or trick or treat and and parties that we think of other things that people dio hay, rides that air with larger groups, etcetera. Um, there really is some very good. If people g o to the Centers for Disease Control website. There's some really very good and specific advice for all the holidays, including Halloween. Thio. Look at eso. I would encourage people to do that. Thank you, Dr Wolf. I'm curious if you could talk a little bit more about this asymptomatic transmission. I know it varies between age groups. And what do we know about whether there are particular age groups in which we're more likely to see asymptomatic transmission? Yeah, it's a It's a good question, Greg. You know, I think generally speaking, the younger Children have have, if not asymptomatic, minimally symptomatic disease. We certainly were certainly very clear on that. I think as it pertains to Halloween, the temptation and pick. This is true in most of our most of our activities that the temptation is to think that Okay, I might have been exposed, but hey, it was 78 10 days ago. I'm feeling fine. Therefore, I can continue hosting the dinner party that I was planning for or the Halloween festival, or Hey, I know all my friends in college buddies air heading out tonight. I feel okay. So I'm probably fine, I'll go out. I think what we do know in that sort of situation is depending on the study and the environment. You're probably looking somewhere between 35 to 55% of otherwise young, healthy adults who can be very capable shares of covert infected themselves, infectious to other people around them, to varying degrees. And you'll be completely I symptomatic. Well, maybe they're symptoms or a sore throat, Scratchy throat. And I think it's pollen or they think it's allergies or they're not sure what it is. Maybe they've been yelling too much, and they're thinking it's there or too many zoom calls in their throats getting saw. Those people can be very capable transmitters, You know, when we've looked on our college campus at the amount of virus that shed by different students, I am consistently shocked at at some of the most prolific shadows of covert, a completely asymptomatic. So if there's a message there, it Z, please don't fool yourself into believing that you're safe. Now I'm getting a scratchy throat by thinking about it. Please don't think for yourself by thinking that you're safe just because your symptoms up there if you know you've had an exposure and someone has traced you and said, Look, I think you need to be on a 14 day quarantine. Please take that seriously. Even if you're feeling well, because there's a reasonable chance that you could be infected. Not not. Excellent. Thank you. And Dr Martinez, if there's anything you've got to add about asymptomatic transmission I'd love to hear that, too. No. Where? CNN Espanol. Look at the doctor Wolf. I'm going to repeat in Spanish with Dr. Wolf was saying I think there is such a tanto riesco the transmission, but personas que son a symptomatic as a little they see luan contact alot Elian Degen. Okay, Issa conducted on a persona Que tiene el videos. Tanika Acela Quarantining los catorce ideas in open Starkey up marketing mission Thomason Levis or porque tengo uh, parking media positive negative test and segundo DEA Nemazee y que esperar low. Scatter serious estamos bien transmission. The person cannot even seen Thomas case transmitting the videos. And Candia is more moist. Grandes yes. A son Lucas. Okay. In Lafayette, tennis broke up a tanto given a terminally infirm Amanda lost members the familiar away La's last person escape diabetes, obesity, uh, factories, areas. So this more more important. Okay. Silla han sido Constancio Contact alos. She's sobbing. Casson can say still expressed us on a persona. Catina Elko Videos In variola grip is the Kevin Lacosse Paris Qatar's ideas commanding lamento necesario para bitter. So your propaganda infection Excellent. Thank you to our Panelists for that, um, Dr Wolf, you talked about travel and some of the ways that maybe we can travel safely if we are traveling. I'm wondering we've had some questions come in about how important is it to consider the current rate of cases in a destination? If you're traveling to another city, is that something that we should be monitoring? And is it a case where if we're in a city where the rates or maybe higher, we should think twice about traveling and also think twice about inviting people to join us for the holiday? Yeah, it's a really good question, E. I think the first the first sad reality is probably no place in the United States that's free of covert. Let's put that on the table. So I don't think that you should reassure yourself that you're that you could take your mask down if you happen to be going. Teoh. I don't know. In New Hampshire, although rates probably are less than I think the you know it is a true statement to say that it is worth while being aware of what the risk where you're moving to and what that looks like. You know, if I knew Chapel Hill where I'm talking to you from had particularly high transmission rates in the next week, I would be less inclined to host a gathering. No question about So you know, travel is always more complicated because, particularly if you involve airlines, you're invariably involving mixing of people from all sorts of different locations. So it's not as if if I travel from here to Atlanta, that I'm only into mingling with people from Raleigh in Atlanta. So I think the travel is its is its own independent risk. Because of the intensity of the mingling of people who are at both sides of the airport on the plane, you know it is it is worth people considering the size of their gathering, the numbers of people who they wanted to have and where they're hosting it like we talked about is, can it be done inside? Can it be done outside? If possible? Can the windows be opened? All those sorts of activities we just talked about and I think it's a fair point to say, What's the level of covert in your area? Actually, there's a There's a wonderful website that I found very informative to teach patients with that's hosted out of the Georgia Tech. Um uh I Teague, an engineering group that actually allows you to put in county specific details. And it's updated weekly that says, Right, if I if I'm hosting an activity of 10 or 25 or 50 or 100 people, what's the likelihood? Statistically that someone in that group will have covert and it can give you very granular and updated information on on sort of rates of transmission? And what does that mean to even be in a gathering? I found that very informative people could look at that, and I go, you know, Boy, there's a 90% chance that someone in the church today is going to be positive. I might differ and continue on Zoom Church. And so I think there are ways of being aware of the data in the areas where you are in the areas where you're traveling to. That could be very informal. You're absolutely thank you. On if you can share that website with me, I'll have it in case any reporters would like it After briefing Dr Walter, I'd like to come back to this notion of Halloween. We've had some follow up questions. You gave some very helpful suggestions at the beginning of the briefing about things to bear in mind on. We've had some follow ups on that. People would like to know when you think about keeping groups of kids trick or treating small that people are gonna do that. How small is good? How many kids that we're talking about? Should it be no more than two? And I realized these things are nebulous, but any guidance you can give on that people would appreciate, And where you see the biggest risks are in trick or treating. Is it the knocking on the door? Is it the eating of the candy? Should kids should parents be kind of saying no candy? Or what can they do to maybe make candy safer? If that's even possible. Yeah, so I think there there there's a lot wrapped into that one question. It's a It's a really good question. I think. Probably the safest, obviously is is um, doing an activity at home. So maybe having a scavenger home inside your own home with your home group. If if that's not palatable to you or your Children and you really feel so compelled, then then I think and they want to go out, trick or treat. Probably just going it within your family group. Um would be what I would advise and going to a limited number of homes on baby potentially people that you know, Um, very well, just to keep it on a limited, limited basis. I think in terms of candy and Children, I think after they, you know, after they if they're reaching into a bowl to pick out candy, I think that would be an other people have reached in that bowl. That would be the time I might grab the hand sanitizer and and, uh, you know, share it with my Children under supervision. Thio use, um, you know, the safest thing is, if people have maybe grab bags where you where you grab 11 thing at a time, although that's a little bit difficult to control. Um, would I go so far as sanitizing the rappers on my Children's candy when I got home? Good luck with that. I don't know that I would go that far. Um, you might run more risk doing that. So I, you know, and Children are gonna be Children and and and eat their candy before you You get home. So don't I think I would not, um would not be so prescriptive as to say that, but I do think there are things you're keeping the group small, taking hand sanitizer wearing a mask. Uh, you know, avoid long contacts. Don't go into people's houses when your trick or treating Sure on Do you mentioned the mask? We've had another question about that, and I'd like to just reiterate you mentioned this earlier. How? Give me a Halloween mask, you know, is not a covert mask. And could you kind of reiterate that it's it's important to not just assume how. If I'm wearing a witch mask or a skeleton mask, then it's just a good as anything else. It Halloween mask is definitely not protective. So the best thing would be to get Ah, cloth mask that you know would be protective and kind of try to figure a way to incorporate that into the costume this year and and and make it fun. Um, I think that would be and I'm probably not the most creative person at doing that, but but I'm sure there are a lot of creative people out there that configure a good way to do that. So absolutely, Thank you, Dr Martinez Bianchi. When we talked back in the summer, this was the topic, and the question has come up again. How concerned are you that people are delaying and skipping regular medical appointments or avoiding getting the flu shot out of the the fear of going to the doctor's office? Because you know they're concerned about being around other people. How important is it that the people should be keeping the regular appointments and in particular, getting a flu shot right now, getting a flu shot right now is extremely important. We want thio. We we have one viral illness that we can actually help to prevent spread. Um, and we don't want Thio end up crowding hospitals with people with influenza when it's something that we have a vaccine for, right, So we really want to, you know, go and get your vaccine for the flu. Make sure you do it. If you have chronic medical conditions, you want to keep them on check. You want to treat your hypertension. You want to treat your diabetes. You want to make sure your head If you have asthma or other things that you tend tohave exacerbations for in the winter, check with your primary care doctor. Check your with your family doctor, your pediatrician or your internal medicine doctor to make sure that you have your medications. That Europe today, with everything that needs to be taken, care off. We don't want that this way. Already going through a pandemic off a viral illness. We don't want a second panda mia off the problems that went untreated or unchecked. So Sydney Otras conditions Think of Medicamentos Agassi. So LeBron tha era case. Look at the most cancer con respecto I lost ultras. Information is chronic. Ask Alabama Getting Ramos is the document a nurse a al tanto without next problem. Tenemos diabetes, hypertension problemas cardia cause vagina Vera's America's cistern in Houston and asthma. Other conditions. Uh, tambien getting on Susan Alodor. Is it also Medicina Aaliyah Kristen Listo para, uh, Mandan Elk with otras infamous illiterate access a lacuna. The influence at the name of K evitar cash talk and the other influenza Calvero. So General Hospital is tambien put influence that it get momentum. Most cannot think almost capacity hospital area. So, yes. Get your flu shot. Make sure you do it. Uh, Casella control a grip. Excellent. Thank you for that. Still got the questions coming in. That's great. Keeping coming. We'll get to as many of them as we can. Dr. Wolf, I'll come back to you. We've had a question about college students. Obviously, lots of college students are staying on campus and hopefully most of them following guidelines. But are they ready? Recommendations about college students coming home for the holidays. You know, we're seeing some that are planning to stay where they are somewhere they're going home. So what kind of risks present in both those cases? What should people be thinking about when making those decisions? Yeah, actually, the that's something we're thinking about a lot actually. So I think there's there's there's two sort of fundamentals there isn't the first, says Campuses have in fact, intentionally changed their, um, the academic year, if you will, to have it and around Thanksgiving, um, and and part of the part of the reasoning there is is that we recognize travel is a risk. Travel is an added risk. Travel moves your little bubble of people who you hang around with and engages another bubble with the people who you hang around who you weren't hanging around with. Blends risk, and then potentially you bring it back to your college campus. So I think the response to what to that that most colleges have done is to simply say, Hey, we will end our academic year at the end of Thanksgiving from now, and I think we've we've we've sort of approached it, recognizing also that not everyone goes home. You know, if you're a grad student, if you're an international student, traveling home and not coming back for further parts of December may not be possible. So we've started Thio actually go through in a very sort of systematic way and say, Look, you know, if you if you have to travel it all like we said earlier, let's consider a car travel rather than that rather than the airline travel, if you can. If you have to travel, consider it to be a one way travel where you don't need to come back in December and you may be consume or virtual stuff at that point, if you if you prefer, um, or if you know you're going to have to travel somewhere and then have to come back, really try and think about the two weeks leading up to Thanksgiving, for example, that travel period as you will pre quarantine. Think about it as the time when you can do the best thing for yourself to actually minimize the risk that you may inadvertently bring covert to parents. Grand parents, loved ones. Onda. Similarly, tell Teller. So your family. The same thing is to say, Look, you know, the preparation for Thanksgiving begins 10 to 14 days before such a gathering would actually take place in such travel occurs, and I think if folks could be mindful of that, then you know, then we've minimized the chance of someone inadvertently picking up or carrying covert in the high risk situations. Um, you know, for us, we've also taken a guess. They're slightly more aggressive approach on the campus in terms of also, um, testing individuals fork over to make sure they're not minimally or ice symptomatically transmitting upon their return. Onda. We think that's a beneficial way when they then come back into a dormitory, all congregate, living sort of activity or back to class that we further mitigate risk. So do you need to come back at all? Do you need to travel it all? And if so, can you really think in the in the sort of weeks leading up to that how do I How do I minimize the chance of accidentally making someone else? Sure. Thank you very much, Dr Walter. Pediatrics. Question for you. We've had a question come in about wondering about whether Children are tested less frequently because, you know, because it appears that the virus doesn't affect them as severely Or are there any concerns? It seems like people have general concerns that maybe in Children symptoms of being written off as maybe a cold when it could be covered. I mean, how do you kind of approach this kind of assessing Children assed potential carriers of co video? Is it Basically the time to get them tested is exactly the same as adults? Or is it the case that because Children seem to get fever so often and and cold symptoms so often should we treat them any differently? The answer is, is really no in my clinical practice where I'm seeing, you know, Children, uh, on a on a regular basis, what we do in clinic if the parent calls in and reports any symptoms which may suggest co vid. So if they have fever or any respiratory symptoms or or diarrhea, for example, on G I symptoms that may go along with co vid, um, then we usually will set those kids up to get Covad tested first. That would be that's our recommendation. Um, obviously, if the parent wants the child to be seen or if there's an indication to be for the child to be seen in, clinic will do that as well. Uh, the other kids that were regularly testing for covert or those that have X closure. So if if they have a parent who has co vid or a family member sibling that has coded or if they've had an exposure at school or daycare, um, were routinely testing. Those kids usually will wait a period after their exposure. Um, Thio to make sure that that you know when when they would likely be positive. So probably about 5 to 6 days after exposure. Then we'll bring the Children in and and test them so. But we are regularly testing kids. You know, Children. Children can get co vid. Are they Aziz? Doctor Wolf, I mentioned. They tend not to get as sick as adults with Covidien older adults with co vid, but certainly they can get sick and they some some Children can get quite ill. So and the other thing is, we don't wanna really determine whether they have infection because they can spread it to family members and or particularly grand parents, aunts, uncles who may be older. Sure. Thank you, Dr Walter. Um, just reminds everybody you can submit questions by the Q and a window. If you have them, I'm gonna move on through some or Dr Martinez Bianchi. We've had a question from que pasa asking if you could expand a little bit on your suggestions for celebrating the day of the dead and how that can be done safely and responsibly. All right, Thank you for the question. I'm gonna talk about safe ways for the day of the, um for those in the audience, especially Mexican families, a lot of Latino families will prepare, uh, alter that, um honors the dead. And there's often lots of different activities that go around the date of the debt to make it safe. You want to prepare, you want to do things in avoid the larger gatherings you want toe prepare, for example. Traditional family recipes for family and neighbors Play music in your home that your deceased loved ones enjoyed. If you prepare recipes, don't share, you know, don't have don't host a large dinner, but you could actually get some of the meals to other people who may not be able to cook themselves because they're sick. Um, you could work with your kids to make and decorate masks or making an altar. You can set out pillows and blankets in your home intended for the disease to rest. You can join a virtual get together. Las armas must, uh, ladies Cuban a cough storminess problem area, for ejemplo. Pereira, Rosetta's familiarize tradition Alice, DJ Barley, the Holland Laporta, a personal assistant and firma is the location getting a majority of the formula. And regarding manera can implicate contacto con otras personas. Mm surgical music and longer particulate prudent society. Scary does Jesse does a steady the color mascaras was Colonel Tarbell a lot of photos and la casa limit our group of the La Familia que Viva Junta. You need to stay and not sever celebration. Birtwell and Runyon. There are moderate risk activities, for example, having a small group outdoor open air parade where people are distance more than 6 ft apart. If you you're gonna do a little parade, do it. Make sure that you're maintaining that 6 ft distance visiting and decorating graves of loved ones with household members only and keeping more than 6 ft away from others. So if you're gonna go to the cemetery, do it. But keep that distance, and then if you want to host a small dinner because you mamas, you do it with your local family and friends, do it outdoor and again. You may have this family here and then 6 ft apart. Another table with for another family? No, because the activity Madeira really history at the neuron. This feeling the group of pick a nose like deliberate on the last person assistance temporada formas se p s visit carry the Kerala's to muzzle scary cooperative simplemente innuendo is a species Estancia in Kenyan Montanier's, uh perhaps system asientos city. Most Messina like delivery Podemos Acela and Hardy National Park A entrances. Wanna familia es familia? Separate Delattre for SPS since the distance L a most important secretary and the most important thing is toe toe. Avoid high risk activities during day of the dead so that we way avoid high risk activities to prevent the spread of the virus. You don't want to attend large indoor celebrations with singing or chanting. Okay, it is more important to, you know, assist a grand celebration honest And in the winter, your Sarandos on the CIA's and cantos canto cause is the Soros avoid participated in crowded indoor gatherings or events. Avoid having a large dinner party with people from different households coming from different geographic locations and then avoid using alcohol or drugs which can cloud judgment and increased risky behavior is the inability participant. Runyon's Aventis in Interior Alaska says generally Hunter E to General Grant sent a calm person has a different organ escape preventing different because, you know, geographical. But also the transgender videos the the other communities on the I mature Candida. Yeah. Bit consuming alcohol or drugs. Compelling new blood. Who is your your mental compartment? Oh, really? Focusing because the transmittal mass. But I'm gonna form this father first. Celebra are low. Yes, much as basis Con la familia conductivity Most harmless No teacher. Ah bland nonetheless personas Caritas? Yes. Andalus causes Mass. Linda is pensando in la vida Riviera. Excellent. Thank you very much. Dr. Wolf will come back to you, and I'm certainly interested in everybody's take on this. Um, supplemental funding for public health departments under the Cares Act expires at the end of the year. And and so far, obviously the of not relief packages has seemed to be forthcoming. Could that be right before a potential post holiday surge in cases? And are you concerned that that that you know that lack of funding could exacerbate the situation in the new year? Yes. You know, I mean, let's let's let's get into the mate of that. But But, yes, it is a clear count answer. So I think there's two parts of that. Isn't that number one? What we What we are seeing is an increasing cases. We are seeing, um, projections that they will probably get worse before they get better. And I think that there's a number of activities that we've been talking about in the next couple of months that will potentially act as spreading capable events. So, yes, I'm concerned that numbers will continue to increase whether or not we even get a concurrent, concomitant serious flew in year. So the second thing is you apply that to public health groups that have to be honest, had their budgets stretched incredibly thin over the last 12 months if they were well funded in the first place. And so you know, for us locally, a number of our local health departments, for whom we have a footprint on have had benefits from the cares, acting the way that they applied testing, and that the way that they've been able to internally move, um, human resources to sort of cope with surges when they've occurred. And so I'll be I'll be honest. We're in early stages of discussing with them as to what this would look like, potentially as we move into January and February. Because the other big thing that's going to occur there, that's gonna need enormous public health resource is, is the roll out of a vaccine? And so it's one thing to understand the response from public health and the response from academia to actual clinical disease. It's quite another thing to understand. The resource is required to roll out of vaccine if, in fact, that becomes available during the same sort of light winds. Period is I think we might project. So there's a lot of logistics there that I've got to come through. And, you know, the last thing I would wish for is for is for good public health to be battered around by financial restrictions because we can't get our we can't get our individuals to agree on what would be a reasonable strategy for financing. So yes is the answer. I am marked. Thank you very much, Dr Walter. Go ahead. Yeah, I would add on toe what Cam said and really just say yes. I have big concerns, you know, click. Really? I think you know, this pandemic has shown ah, lot of the issues with a public health system that's been underfunded for for years. And then, you know, I think Thio not extend, you know, extra funding toe try and help with this pandemic situation is would be a big mistake. So especially as camp suggest. As you know, we're dealing with a surge in cases in and also trying to roll out a vaccine at the same time, which is really going to take quite a bit of public health infrastructure. So thank you. And I'm gonna come back to that right before we wrap up. We're getting towards the last five minutes. But, Dr Walter, I'd like to stay with you for a second because we've had a question about families. Think about gathering for Thanksgiving, Christmas and other holidays. How hopeful are covert tests, you know, Is it worth somebody? If they could get access to a test getting tested beforehand and using that as a guide as to whether it's safe to be around other people. How much the trust can we put in that as we plan? Yeah, you know, It might be a somewhat helpful in some situations, but I don't think we can be fooled by, uh, totally by testing, because if somebody may have been exposed and may not yet totally have developed infections. So if you test them too early, you may miss the test positivity. So I think it could be reassuring, but potentially falsely reassuring, so I wouldn't I wouldn't put all my stock and testing. So we've had great examples of that, Greg. That contrasts beautifully. According to what Chip just said, the first is good, effective use of testing when combined with really rigid mitigation within athletics. There's been a lot of groups have done that very successfully. And yet the contrast is daily testing, which failed to control really significant outbreak that happened over the last month up in D. C. At the White House. You can't do testing by itself and expect that this will get you out of a problem. Sure. Thank you very much for that. Dr Martinez, Would you like thio add anything to that? Yes. You can't. You have to do the prevention and mitigation. We have measures. We know that we're in a mask doing good hand washing and keeping distance really helps us to avoid the transmission. So you can't just do testing alone will not do this. We need to do the these measures to prevent passing it alone. It is just extremely important to remember that the most important element that we have right now is to wear a mask. If it wasn't for the mask, everybody at our house system will be set right. We are. We're wearing masks to prevent us house care workers getting sick. And it's working. So just do it because it really will prevent getting sick and passing it along. Greg, It may actually be worth doubling up on that and sharing with folks a NAR tickle that was put out by infection prevention here in the hospital that showed really the time point that we instigated mask wearing amongst all of our health care workers who, presumably more than anyone else, were exposed to covert on a regular basis and now employees right of infection completely plateau. At that point, with that single intervention, it was really quite a profound difference, and I'd be happy to share that article of folks wanted. It was really meaningful it. Please, Dr. Wolf, if you'll share that with May, then we will. We'll send it out along with the link to the video to all the reporters that joined today. So that will. That will be in there. We're about to wrap up here. Dr. Walter, I'd like to come back to you. You are obviously chief medical officer of the Human Vaccine Institute on I think a lot of people are wondering. It's like, Okay, we need to make prices this year. We need to lock down on the holidays. Won't feel the same. What are the chances that maybe by next year, with the current vaccine timelines that we have and with lots of fingers crossed that the holidays might seem more like normal? Or should we be prepared that large gatherings that we see it, the holidays, There's gonna be a new normal for the foreseeable future, maybe for several years. That's a really good question. And one I don't I don't have the crystal ball for, but I think you know, we are hopeful. There are many candidate vaccines that air in the pipeline that are being tested in large scale trials right now. We're doing some of that work here. Here it, Duke. I think we should hopefully have some preliminary results from those studies coming out later this year, maybe a soon as sometime next month, Late next month. That will start to see some some results from. Obviously, it's a really complicated situation because there many vaccines, uh, out there, Not all of them will come to market or come to be available. Excuse me. I shouldn't say market, but come to be available at the same time. Uh, there will be limited amounts to start off with. So there are allocation plans, uh, to thio distribute vaccine that are being developed by the CDC in the state state health departments. Um, and s o. I think we will see a gradual rollout of vaccines. Uh, next year, probably by I would. I'm hopeful that by mid next year, um, that that will have a pretty a broader dissemination of vaccine in the population and that maybe, you know, once we get through this second surge of of of infection and we have a vaccine by mid next year that's fairly widely distributed that that things may normalize a little bit more and be a lot better towards the end of next year. Does that mean we'll be back to normal? I don't know that I can can guarantee that at this point. I mean way, maybe somewhat in this situation next year, but I think we'll be sitting a lot better late next year than we are currently. Well, thank you very much for that. And I think a shred of hope is as good a place as any to leave it. We've reached an hour, so I think we'll leave it there. Thank you, everyone for joining us. Thank you to our Panelists Viviana Martinez, Bianchi, Chip, Walter and Kanwal for sharing your perspectives. Next week's briefing returns to the subject of the U. S. Election, by which time Election day itself will be less than a week away. If you'd like to be on the list of future briefings, please email news at duke dot e d u to let us know. In the meantime today, I think we've learned that Bloom hoarseness is a thing that you should listen to your doctor and overall, please wear a mask. So stay well on. Be sure to vote. Thank you very much and have a great day. Thank you. Thanks to thanks for you. Thank you so much.