Some Useful Tips from the New York Times on Navigating Risk as States Start Opening

The New York Times has an excellent article about how to navigate risk as things begin to reopen: How to Navigate Your Community Reopening? Remember the Four C’s

Because New York Times articles are behind a paywall, and I think this is important information, I have summarized the guidelines below

The Four C’s

Contact

Maintain social distancing. Stay 6 feet away from other people and do not hug or handshake.

Make sure that any places you go also maintain social distancing measures. If you go to a restaurant make sure that patrons are spaced out. For shops and stores,  make sure they limit the number of people inside the shop. Preferably anyplace you go conducts frequent cleaning and disinfection.

Be careful with high touch objects and surfaces. This means tables, light switches, doorknobs, phones, toilets and faucets, any touchscreen, ATMs, and especially gas pump handles. Use disposable gloves, wash hands, or disinfect hands with alcohol gel after touching.

Any 15 minute face-to-face conversation between people who are within 6 feet of each other is considered close contact. Avoid if possible. If talking to someone at a store step back so you maintain the 6-foot social distance. Especially if the other person is not wearing a mask you are at risk even during a normal conversation without coughing or sneezing. Wear a mask to protect yourself and others. One trick to establish a 6 foot distance is to measure your arm, and use that to judge. My arm is about 24 inches when extended, so three of my arms is 6 feet.

Confinement

Avoid indoor settings if it all possible. Keep working from home if possible. Stagnant air inside leads to infected droplets persisting much longer than you expect and there will also be contamination on surfaces.

Crowds

Avoid crowds if it all possible. Large crowds increase your risk of infection even outdoors. 100 people are always going to increase your risk of infection over 30 people. If you are involved in large outdoor protests, be sure to wear a mask, maintain as much social distance as possible, and consider self quarantining or being tested for COVID-19 once you are done protesting.

Choices

For eating there are various options. The CDC has ranked different ways of getting food from low risk to high-risk.

Lowest risk: food service from a drive-through, delivery, take-out and curbside pickup

More risk: drive-through delivery, take-out, and curbside pickup are emphasized. On-site dining is limited to outdoor seating only.

Even more risk: on-site dining with indoor and outdoor seating. Tables at least 6 feet apart.

Highest risk: on-site dining with indoor and outdoor seating with full capacity and tables not spaced 6 feet apart.

Make smart choices about risk. If you are at high risk meaning that you are over 65, have chronic health conditions, have immune compromise, are severely obese, or have chronic lung or kidney disease or heart conditions, then you should take the maximum precautions. (Recent research suggests if you have Type A blood you may also be at risk of more serious disease.)

Even if you personally are at low risk you have to remember that you can infect people you love who are at higher risk. Be altruistic and protect yourself to protect the people you care about.

Be safe out there!

 

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

The Four Safety Dimensions for Covid-19 Prevention–Staying Safe Out There

world with covid-19

There are four simple concepts which will help you stay safe and avoid contracting Covid-19 as you begin to reenter society, and as things begin to open up.

  1. Proximity or closeness to other people outside your own household. A very safe distance is 10 feet, and adequately distance is 6 feet, and anything less than 3 feet of social distance is probably risky.
  2. How long you are in contact with those people. Studies of transmission suggest that a contact time of 30 minutes or more is risky, but in situations of close social distance anything more than five minutes may be risky. (If everyone is wearing a mask, safe contact times may be somewhat longer.)
  3. Whether the environment is confined or open, inside or outside, and if inside how large is the inside environment and is there good air circulation? Outside is almost always better than inside, and inside environments which are larger and have good air circulation are probably less risky than small and sealed environments like elevators. (Or small public restrooms.)
  4. Whether or not everyone is wearing a mask. Studies suggest that the use of masks can reduce transmission by 80 or 90%. That is why doctors and nurses always wear masks when treating sick Covid 19 patients. They also wear eye protection. The use of masks protects you from spreading coronavirus to other people, and also protects you from them spreading coronavirus.

When the more dangerous options among these four factors overlap, you are in peril.

For example, let’s say you decide to get a massage. The massage room is inside, very small, and the massage takes 90 minutes. This is a high-risk situation even if you and the masseuse are both wearing a mask. (And even higher risk if either is not wearing a mask.) You have close social distance, extended exposure, in a small and poorly circulated room, and perhaps the only safety factor is the wearing of masks.

In contrast, you go for a walk in your neighborhood. Other people are out walking but everyone respects at least a 6 foot social distance, and you do not stop to talk with people. Any contact is 6 feet away and lasts only a few seconds. This is a relatively safe situation regardless of the use of masks.

Let’s look at each factor separately.

Indoors versus outdoors

Japanese researchers looked at 110 people who had Covid-19. Only 12.5 percent passed the illness on if their only interactions with people were outdoors. But of those who interacted with people indoors, 75 percent infected other people. Out of the 22 people who met people indoors only six did not infect anyone else. But of the 88 people who met people only outdoors, 77 did not infect anyone. The reason for this appears to be that the tiny droplets that can infect you disperse very rapidly outside. So it appears that outdoor contact is not perfectly safe, but is six times safer than indoor contact.

Duration of contact

There is some interesting data from China and France in terms of likelihood of catching Covid-19 in various different indoor settings. The worst setting was the household where 13 percent of people contracted Covid-19 if someone in their household had it. The next most risky type of environment was public transport, which ranged from 2% to 12% depending on whether or not there was a super spreader event. (Super spreader events are those rare people that seem to be very efficient at spreading the virus.)

Particularly relevant was the finding that 7% of people who came into contact with an infected person in a restaurant dining environment contracted Covid-19. That’s pretty risky to avoid cooking at home! (Note that 85 coronavirus cases were linked on 6/28/20 to a SINGLE restaurant in Michigan, in a single week of operation! The restaurant had poor circulation, poor social distancing rules, and no air filters on ventilation.)

All the other indoor environments had about the same risk, 2%, and this included shared work or study spaces, schools, healthcare settings, and all other settings. The better the ventilation was the less likely transmission.

What about masks?

Masks are particularly helpful in high risk indoor situations, where they block the spread of droplets that can transmit Covid-19. Because the risk of infection is lower outdoors, especially if people are properly socially distancing, they may add very little benefit. But if you are in close contact with other people outdoors, masks may help significantly. This may be why in cities that had large Black Lives Matter demonstrations, there were relatively few outbreaks, as many of the protesters wore masks.

Large Events

Large events are particularly problematic because of super spreader individuals. Research from China and Hong Kong showed that 80% of new infections came from about 20% of people. These are called super spreaders, and we don’t really fully understand why some people are so infectious. But being in a large event such as a sporting event or concert makes it highly likely that there will be one or many super spreader individuals. Avoid these even if they reopen. (As reported on 6/28/20, Swiss authorities had to quarantine 300 people who attended a Zurich nightclub on 6/21/20 because of a super spreader individual.)

High-risk versus low risk situations

Here’s the deal with viral particles. We still don’t really know how many Covid-19 infectious viral particles it takes to get you sick. But some experts estimate that the threshold may be about a thousand particles. A cough releases 3000 droplets and a sneeze releases about 30,000 droplets. These droplets can contain 200 million viral particles, which explains why symptomatic people can spread Covid-19 indoors so easily.

In contrast a single breath releases about 50 to 100 droplets, which fall to the ground quite quickly. Although we don’t know the exact data it’s reasonable to assume that a person breathing may release 30 viral particles per minute. Speaking may change that to 300 per minute. So, this tells you that it would take perhaps 40 minutes of someone breathing near you, or about five minutes of someone speaking with you face-to-face in order to risk infection, assuming it takes 1000 viral particles to contract coronavirus.

This is important because it tells you that if you walk by someone outside or even inside in a grocery store, your risk is low. But let’s say you see a friend of yours in the grocery store, and you spend 15 minutes talking with them. That’s pretty high risk especially if you are face-to-face and not wearing a mask.

Where have most infections occurred?

  • Prisons
  • Long-term care facilities
  • Meatpacking plants
  • Business networking and conferences such as the Biogen conference in Boston in late February
  • With more relevance to most of us, weddings, funerals, birthday parties, family get-togethers,  which make up about 10% of the early super spreading events

Most of us aren’t in prison, we don’t live in a nursing home, we don’t work in a meatpacking plant. But many people have lately been tempted to go to parties which are clearly a high risk situation.

Finally, don’t forget to wash your hands or use alcohol gel. Don’t touch your face which includes your eyes, ears, nose, or mouth. When you get home wash thoroughly, and you may want to even jump in the shower and wash your hair, as some studies in medical settings have found that hair is particularly good at holding viral particles.

Here’s a good way to think about risk. It comes from advice about sexual health. If you have sex with someone, you are being exposed not just to them but to all their prior sexual partners. In a similar way, let’s say you get together with her friend who is not part of your household. You’re not only being exposed to them, but to every person they have had contact with in the last 14 days or so. The clerk in the store who didn’t wear a mask and stepped close to them, the UPS guy who knocked on the door and asked a question from 2 feet away, all the friends that they have had contact with, the people they live with, and all the people that those people have had contact with. As you can see one of the reasons coronavirus spreads so much is that the larger our social networks are the more risk there is.

Finally, be aware that many coronavirus infections are asymptomatic meaning that the people who have coronavirus are neither coughing or sneezing. Some studies suggest that as many as half of the cases are asymptomatic. This means you can’t depend on people knowing that they might be sick. The Center for Disease Control released data on June 26, 2020 that suggests that the real number of coronavirus infections is perhaps 10 times what has been reported. As of today, there are about 2.5 million cases reported in the United States, which means we may have had 25 million cases! That is 7.5% of the US population. This sounds like a lot, but it also means that 92.5% of the United States population is still in danger of contracting the coronavirus.

And that is why I’ve been practicing virtually since early March, and will continue to do so until there is either an effective treatment or a vaccine for the coronavirus. Be safe out there, and ask yourself about each activity if it is worth the risk not only to yourself, but also to all the people you might come into contact with including older parents and grandparents. We are all in this together, and even the young and healthy can transmit coronavirus if they get sick. Yes, we all miss going to restaurants, movie theaters, bars, parties, concerts, and sporting events. But it’s not permanent. I suspect that within the next six months will have much more effective treatments, and within 12 months we will have a vaccine which will let us get back to normal.

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

How to Read Media Coverage of Scientific Research: Sorting Out the Stupid Science from Smart Science

Reading today’s headlines I saw an interesting title, “New Alzheimer’s Gene Identified.”

I was intrigued. Discovering a gene that caused late onset Alzheimer’s would be a major scientific breakthrough, perhaps leading to effective new treatments. So I read the article carefully.

To summarize the findings, a United States research team looked at the entire genome of 2269 people who had late onset Alzheimer’s and 3107 people who did not. They were looking for differences in the genome.

In the people who had late onset Alzheimer’s, 9% had a variation in the gene MTHFD1L, which lives on chromosome 6. Of those who did not have late-onset Alzheimer’s 5% had this variant.

So is this an important finding? The article suggested it was. But I think this is a prime example of bad science reporting. For instance, they went on to say that this particular gene is involved with the metabolism of folate, which influences levels of homocysteine. It’s a known fact that levels of homocysteine can affect heart disease and Alzheimer’s. So is it the gene, or is it the level of homocysteine?

The main reason why I consider this an example of stupid science reporting is that the difference is trivial. Let me give you an example of a better way to report this. The researchers could have instead reported that among people with late-onset Alzheimer’s, 91% of them had no gene changes, and then among people without late onset Alzheimer’s 95% of them had normal genes. But this doesn’t sound very impressive and calls into question whether measurement errors would account for the differences.

So this very expensive genome test yields absolutely no predictive value in terms of who will develop Alzheimer’s and who will not. There is a known genetic variant, called APOE, which lives on chromosome 19. Forty percent of those who develop late-onset Alzheimer’s have this gene, while only 25 to 30% of the general population has it. So even this gene, which has a much stronger association with Alzheimer’s, isn’t a particularly useful clinical test.

The other reason this is an example of stupid science is that basically, this is a negative finding. To scan the entire human genome looking for differences between normal elderly people and elderly people with Alzheimer’s, and discover only a subtle and tiny difference, must’ve been a huge disappointment for the researchers. If I had been the journal editor reviewing this study, I doubt I would’ve published it. Imagine a similar study of an antidepressant, which found that in the antidepressant group, 9% of people got better, and in the placebo group 5% got better. I doubt this would get published.

Interestingly enough, the study hasn’t been published yet, but is being presented as a paper at the April 14 session of the American Academy of Neurology conference in Toronto. This is another clue to reading scientific research. If it hasn’t been published in a peer-reviewed scientific journal, be very skeptical of the research. Good research usually gets published in top journals, and research that is more dubious often is presented at conferences but never published. It’s much easier to get a paper accepted for a conference than in a science journal.

It’s also important when reading media coverage of scientific research to read beyond the headlines, and to look at the actual numbers that are being reported. If they are very small numbers, or very small differences, be very skeptical of whether they mean anything at all.

As quoted in the article, “While lots of genetic variants have been singled out as possible contributors to Alzheimer’s, the findings often can’t be replicated or repeated, leaving researchers unsure if the results are a coincidence or actually important,” said Dr. Ron Petersen, director of the Mayo Alzheimer’s disease research Center in Rochester, Minnesota.

So to summarize, to be a savvy consumer of media coverage of scientific research:

1. Be skeptical of media reports of scientific research that hasn’t been published in top scientific journals. Good research gets published in peer-reviewed journals, which means that other scientists skeptically read the article before it’s published.

2. Read below the headlines and look for actual numbers that are reported, and apply common sense to these numbers. If the differences are very small in absolute numbers, it often means that the research has very little clinical usefulness. Even if the differences are large in terms of percentages, this doesn’t necessarily mean that they are useful findings.

An example would be a finding that drinking a particular type of bourbon increases a very rare type of brain tumor from one in 2,000,00 to three in 2 million. If this was reported in percentage terms the headline would say drinking this bourbon raises the risk of brain tumor by 300%, which would definitely put me and many other people off from drinking bourbon. (By the way, this is a completely fictitious example.) But if you compare the risk to something that people do every day such as driving, and revealed the driving is 1000 times more risky than drinking this type of bourbon, it paints the research in a very different light.

3. Be very skeptical of research that has not been reproduced or replicated by other scientists. There’s a long history in science of findings that cannot be reproduced or replicated by other scientists, and therefore don’t hold up as valid research findings.

4. On the web, be very skeptical of research that’s presented on sites that sell products. Unfortunately a common strategy for selling products, particularly vitamin supplements, is to present pseudoscientific research that supports the use of the supplement. In general, any site that sells a product cannot be relied on for objective information about that product. It’s much better to go to primarily information sites like Web M.D., or the Mayo Clinic site, or one can go directly to the original scientific articles (in some cases), by using PubMed.

So be a smart consumer of science, so that you can tell the difference between smart science and stupid science.

Copyright © 2010 Andrew Gottlieb, Ph.D. /The Psychology Lounge/TPL Productions

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.