COVID-19 first wave not over, says Wellstar Director of Infectious Disease

Dr. Danny Branstetter in white medical jacketDr. Danny Branstetter (photo courtesy of Wellstar Health System)

Dr. Danny Branstetter, the Medical Director of Infectious Disease for Wellstar Health Systems told the Courier Friday that the COVID-19 first wave is not yet over, and that precautions such as face-masks, social distancing and hand-washing are still important to slow the spread of the disease.

Are we out of the “first wave”?

Asked to explain what a “wave” means in a pandemic Branstetter said it was a vernacular term used to describe the rise and fall of the number of cases.

“When you track it out on a graph, it looks like a nice little wave from the ocean,” he said. “It’s just what the trends are in the ongoing infection.”

“So this first cycle of the infection is still ongoing,” said Branstetter.

He said the first wave would be over if transmission of the disease were halted, then held that position for a period of time. When the levels of infection rose again that would be the start of the second wave.

“One of the key features of calling something a pandemic is ongoing community spread and transmission of the disease,” he said. “So we are seeing that in multiple locations throughout the world still, and therefore it’s still called a pandemic.”

“Here in our local area in Cobb County or surrounding areas, we are still in the first wave,” Branstetter said. “It would be the end of the first wave if we were able to reduce or not have detectable ongoing transmission of the virus.”

“But we never reached that point,” he said. “We got lower, but we never went all the way back down to where we couldn’t detect any transmission. So we’re still in the first wave and we’re seeing a rise back again after we flattened it out.”

Age range of new infections

Dr. Branstetter mentioned the widely-reported rise in infections among younger segments of the population.

“Right now the largest group that we’re seeing infection in, in our community, and the largest rise is our 18 to 30 year olds,” he said. “And that’s problematic for our communities for a few reasons.”

“Number one, the younger population are probably more likely to take risk: being in larger groups, spend longer times together, travel further, maybe not wear their face mask as much,” he said.

“Plus they may not have symptoms as much as someone else with a long-standing health problem. So they may inadvertently spread this more easily and they are the most mobile members of our society so they’re out and about more, going from place to place, potentially carrying this.”

How comparable are Cobb’s numbers with other parts of the state?

The Courier asked Dr. Branstetter how Cobb’s numbers compared with the rest of the state.

“I’ve been speaking with Dr. (Janet) Memark (District Health Director of Cobb & Douglas Public Health ) and watching both the state and local numbers,” Branstetter said.

“The interesting thing is that they’re pretty well correlated,” he said. “So Cobb County is also seeing a rise. still seeing the largest numbers within that 18 to 30 year old group.”

“We are still seeing numbers, though, coming in from all age groups, and all different kinds of facilities,” he said. “And I know Dr. Memark is watching skilled nursing facilities and assisted living facilities as well, because we are still seeing a few numbers from those.”

Wearing of masks and other precautions

The Courier asked Branstetter what precautions individuals should be taking at this point.

“So let’s first get some background information about the disease itself,” Branstetter said.

“The disease is transmitted on droplets, pieces of moisture, little tiny particles of moisture, that the virus hitches a ride on to get out into the environment. It leaves our mouth and our nose on these droplets, and lands on surfaces such as doorknobs or our own hands,” Branstetter said.

“And then that makes its way from those places to other people’s hands or other objects. In the rare case, people cough or sneeze, and this droplet will land on somebody else’s mucous membranes,on their eyelids or on their nose,” he said. “But most of the time, this droplet lands on a hand … to a surface … to a hand, then into the nose or mouth.”

“So a mask will do a few things in that whole cycle of infection propagation,” said Branstetter.

“First, when a person wears a mask, that is a barrier to reduce these droplets getting out into the environment,” he said. “So it’ll prevent that initial spread of virus elsewhere.”

“No mask is 100% effective in preventing all droplets that could potentially carry a virus from getting out there. But the goal truly is to reduce the number,” he said.

“The second thing a mask will do is it will actually prevent any droplets, say, someone coughs or sneezes around you, from landing directly on your nose or mouth,” he said “So that’s a direct, but rare case of transmission.”

He said that the final case is that when a mask is in place it prevents you or a person who is infected with the virus from directly touching your face in the nose and mouth area.

Is there a danger of hospitals exceeding capacity?

The Courier asked Dr. Branstetter if there were any danger of area hospitals exceeding their capacity due to an increase in COVID-19 patients.

He said that in March, when he and Dr. Memark spoke before the Cobb County Board of Commissioners that capacity was a concern, but not at this point.

“There’s not a concern about available beds or ventilators or supplies,” he said. “We are,as well as all of our sister hospital systems throughout the state, watching that very closely.”

“There are surge plans and expansion plans in partnership with public health, state officials, and the National Guard, so we have a lot of room to grow if patient need demands it,” said Branstetter.

Progress made early in the pandemic

Branstetter turned his attention to the progress made early in the pandemic.

“I want to acknowledge the very impressive and wonderful experience that our community had in early interventions doing these measures,” he said. “Flattening that curve in the very beginning is very nice, very beautiful actually to see everyone come together and make such a nice impact so quickly.”

“And just to remind people: this is mask-wearing, it is social distancing, staying home if you’re sick, it is making sure you do your hand hygiene. It is so important to maintain all of these measures,” he said.

What should local businesses do?

Dr, Branstetter went on to talk about the importance of good practices by businesses.

He recommended hand hygiene stations and hand sanitizers.

He said businesses should maintain small groups, and make sure employees have access to personal protective equipment.

Another thing he recommended is that places of business “do symptomatic screening of employees as they come to work, checking temperatures and make sure they’re not having any symptoms that could be COVID-related.”

Companies should support sick leave so that employees take time off if they are sick, and take care of themselves, he said.

“One of the areas that I’ve heard about that are a potential lapse in using face masks and social distancing is common areas and break rooms in places of employment,” he said. “So (businesses should try to) to make sure that those areas are paid extra special attention to and wiped down so we can make sure that employees stay as safe as possible.”

Is another shelter-in-place order likely?

The Courier asked Branstetter his opinion on the likelihood of a shelter-in-place order being issued.

“I hope that we don’t have a shelter-in-place,” he said. “And there are many factors that go into determining that.”

“When we’re thinking about health care, I want people to know that it’s safe to come out and get your healthcare and we’re prepared to take care of patients very safely.”

“I would like for people to understand that this is preventable, we can prevent a shut down or shelter-in-place again, by doing these measures to slow down this infection once again,” said Branstetter.

Other thoughts

The Courier asked Dr. Branstetter if he had any final things he’d like to convey to the public.

He said that if precautions are taken, a second and third wave of pandemic are preventable.

“They’re tired and have COVID fatigue,” he said of the public.

He said two things the scientific and medical communities are diligently working on are a cure and a vaccine.

“We currently don’t have a cure for COVID-19,” he said. “We have some treatments that we’re researching and deploying, that have shown some benefit in some people.”

“But one of the key things that we’re going to need in place for this to really be maintainable in life, to not worry about COVID anymore, is an effective treatment for most people,” he said. “And we currently don’t have that yet.”

“And then the second thing is an effective vaccine,” said Branstetter.

“I’m very encouraged by the early results, the first phases of the trials for a vaccine,” he said. “The phase three trials are going to start in July and August.”

“We have three vaccine candidates that are starting this phase three trial,” he said. “And I’m super excited that they’re making it this far this quickly.”

“We want all those vaccines to be successful because we will need them to protect our society,” he said.

Dr Branstetter then spoke about what the Wellstar system is doing to prepare for the possibility of a surge of cases.

“We’ve partnered with the Department of Public Health, we have worked with the National Guard, we are maintaining a dashboard looking at our case rate, both inpatient and in our community,” he said. “We are balancing the need for procedures within our facility as well as keeping count of our supplies and our personal protective equipment.”

“We have models and staffing models to make sure that if patient demands are there, that we can bring on more staff and shift staffing around for that,” he said.

“But also we have facilities and planning designed for that very need,” he said. “I’m super excited that the new ER here at Kennestone is going to be opening up officially at the end of July or later part of July.”

“It was designed to protect patients so they can continue to receive care,” he said.

He said that the new emergency department and other facilities in the Wellstar system have measures in place to keep incoming patients infected with coronavirus separate from uninfected patients coming in for other reasons.